Transkript

1 TOTAL KNEE SYSTEM T TOTAL DÝZ SÝSTEMÝ TOTAL KNEE SYSTEM TOTAL DÝZ SÝSTEMÝ The key in orthopaedic sciences SURGICAL TECHNIQUE CERRAHÝ TEKNÝK IMPLANTS & INSTRUMENTS ÝMPLANTLAR VE EL ALETLERÝ

2 CONTENTS ÝÇÝNDEKÝLER T Total Knee System Introduction Giriþ Tibial Stage Tibial Safha Use of Intra-Medullary Cutting Guide Intra Medular Kesi Gaydýnýn Kullanýmý Setting the Tibial Slope 9 Tibial Eðimin Ayarlanmasý Setting the Level of the Cut 1 Kesimin Seviyesinin Belirlenmesi Use of the Extra-medullary Alignment Guide 1 Extra Medular Kesi Gaydýnýn Kullanýmý Positioning of the Guide 1 Gaydýn Pozisyonlanmasý Setting the Tibial Slope 1 Tibial Slope un Ayarlanmasý Setting the Rotation 1 Rotasyonun Belirlenmesi Setting the Level of the Cut 1 Kesim Seviyesinin Belirlenmesi Realisation of the Tibial Cut Tibial Kesimin Gerçekleþtirilmesi Choosing the Tibial Component Tibial Komponentin Belirlenmesi Assembly of the Standard and PS Mobile Test Inserts 17 Standart ve PS Mobile Insertlerin Yerleþtirilmesi Femoral Stage 1 Femoral Safha Prepare the Sizing Guide 1 Ölçüm Gaydýnýn Hazýrlanmasý

3 Positioning of the Guide 1 Gaydýn Konumlandýrýlmasý Placing the Guide 19 Gaydýn Yerleþtirilmesi Fixing the Guide Gaydýn Sabitlenmesi Patella Stage Patellar Safha Patella Resurfacing Technique Patellanýn Yeniden Yüzeylendirilmesi Tekniði Inset Patella Technique Inset Patella Tekniði Inserting the Test Femoral Component Test Femoral Komponentin Yerleþtirilmesi Tibial Baseplate 5 Tibial Baseplate Instruments&Trays 6 El Aletleri&Tavalar

4 Introduction Giriþ Material Malzeme T Total Knee System T Total Knee System is designed and developed for use in cemented and cementless application of Total Knee arthroplasty. Total Diz artroplastisinde sementli ve sementsiz kullaným için dizayn edilmiþ ve geliþtirilmiþtir. The unique femoral cutting guide combines various functionalities in one component. This enables the surgeon to shape the femur fast and accurate with only one guide positioning and fixing. Benzersiz femur kesi kýlavuzu ile birden çok iþlevi tek bir yapýda toplamaktadýr. Bu sayede cerrah; kýlavuzu bir kez konumlandýrma ile gerekli 5 kesiyi hýzlý ve hatasýz yaparak femuru uygun yapýya getirebilmektedir. T Total Knee system offers mobile and fixed insert options. This enables the surgeon to make the appropriate choice for the case. T Total diz sistemi, hem mobil hem de sabit insertli (Bað kesen/koruyan) opsiyonlarýný sunmaktadýr. Bu sayede Cerrah vakanýn gerektirdiði en doðru seçeneði tercih edebilmektedir T Total Knee System manufactured from: -CoCrMo alloy according to ISO 5- for Femoral Components -Tibial Components; -CoCrMo alloy according to ISO 5- for Mobile System -TiAlV alloy according to ISO 5- for Fix System -PE-UHMW (Ultra High Molecular Weight Polyethylene crosslinked according to ISO 5-1/ for Patella and inserts. : -Femoral komponentler ISO 5- standartýna uygun CoCrMo alaþýmýndan -Tibial komponentler; -Mobile yapý için kullanýlan komponent ISO 5- standartýna uygun CoCrMo alaþýmýndan -Fix yapý için kullanýlan komponent ISO 5- standartýna uygun TiAlV alaþýmýndan -Patella ve insertler ISO 5-1/ standartýna uygun Ultra Yüksek Moleküler Aðýrlýklý Polietilen (PE-UHMW) çapraz baðlý malzemeden imal edilmiþtir.

5 FEMORAL COMPONENT Standard Standart Cemented Sementli Posterior Stabilizer Posterior Kýsýtlatyýcýlý Cemented Sementli Ref. Number Ref. Numarasý Co.Cr-alloy Co.Cr-alaþým Size Ebat Style Tip Ref. Number Ref. Numarasý Co.Cr-alloy Co.Cr-alaþým Size Ebat Style Tip Right/Sað Right/Sað Right/Sað Right/Sað Right/Sað Right/Sað Right/Sað Right/Sað Right/Sað Right/Sað Right/Sað Right/Sað Left/Sol Left/Sol Left/Sol Left/Sol Left/Sol Left/Sol Left/Sol Left/Sol Left/Sol Left/Sol Left/Sol Left/Sol TIBIAL COMPONENT Standard/Standart Cemented/Sementli Ref. Number Ref. Numarasý Ti alloy Ti alaþým Size Ebat Mobile Bearing Cemented/Sementli Ref. Number Ref. Numarasý Co.Cr alloy Co.Cr alaþým Size Ebat 1 5

6 TIBIAL INSERT FIXED T Total Knee System Standard/Standart Ref. Number Ref. Numarasý Size Ebat Thickness Kalýnlýk Ref. Number Ref. Numarasý Posterior Stabilizer Posterior Kýsýtlayýcýlý Size Ebat Thickness Kalýnlýk

7 TIBIAL INSERT MOBILE BEARING Standard/Standart Ref. Number Ref. Numarasý Size Ebat Standard Thickness Kalýnlýk PATELLA Ref. Number Ref. Numarasý Posterior Stabilizer Posterior Kýsýtlayýcýlý Size Ebat Re-Surfacing Thickness Kalýnlýk Ref. Number Ref. Numarasý Size Ebat Ref. Number Ref. Numarasý Size Ebat 1 6

8 TIBIAL STEM T Total Knee System Ref. Number Ref. Numarasý Co.Cr alloy Co.Cr alaþým Size Ebat 5 5 7

9 TIBIAL STAGE TIBIAL SAFHA USE OF INTRA-MEDULLARY CUTTING GUIDE ÝNTRA MEDULAR KESÝ GAYDININ KULLANIMI Drill a hole using the Drill 1 mm (Ref: ) bit from attached to tibia of anterior cruciate ligaments. 1 mm çapýndaki drill (Ref: ) ile anterior Cruciate Ligamentin yapýþtýðý yerden delik açýn. Additional Info/Ek Bilgi After drilling the tibia, it is possible to make use of the bit already assembled on the power tool drill to drill the femoral hole. Tibiayý delerken kullanmýþ olduðunuz drill i femuru delerken de kullanmanýz mümkündür. Introduce the intramedullary rod (Ref:165) and the tibial support (Ref:16511) as deep as possible into the tibia. Lower the support the reach contact with the prespinal surface. Tibial destek (Ref:16511) ile intramedülar rodu (Ref:165), tibianýn içine mümkün olduðunca derin bir þekilde yerleþtirin. Sonrasýnda tibial desteði prespinal yüzeyle temas edecek þekilde çakýn. Fasten the tibial resection guide on the tibial guide s peak point with using the fixation screw. Tibial kesi gaydýný tibial gaydýn üzerine, en üst noktada olacak þekilde fiksasyon vidasý ile sabitleyin. Insert the telescopic rod into the tube of tibial guide. Teleskopik rodu tibial gaydýn tüpü içine takýn. Insert the tibial guide with the into the tibial support and firmly tighten the.5 screw with the Screwdriver (Ref: 16165) to fix the tibial support. Tibial gaydý tibial desteðe takýn ve yandaki vidayý.5 mm tornavidayla (Ref: 16165) sabitleyin.

10 Set the tibial slope at degree by turning the frontal screw on the tibial guide. Tibial gaydýn üzerindeki ön yüzdeki vidayý çevirerek tibial slopu dereceye ayarlayýn. Attention/Dikkat Ensure that the screw located on to the tibial resection guide (Ref: ) is directly facing the centre of the tibial plate (the junction of the internal third and two external thirds of the tibial tuberosity) Tibial kesi gaydýnýn (Ref: ) üzerindeki vidanýn direkt olarak tibial plate in merkezine doðru baktýðýna emin olun (Tibial tuberositinin internal 1/ ü ve eksternal / ünün kesiþme noktasý.) SETTING THE TIBIAL SLOPE TÝBÝAL EÐÝMÝN AYARLANMASI Adjust the posterior slope between and 1 degrees on the scale of the tibial guide (Ref: ) by turning the frontal thumbwhell switch of the guide anticlockwise. Gaydýn ön tarafýndaki mekanizmayý saat yönünün tersine döndürerek tibia gayd (Ref: ) üzerindeki skalasýndan posterior slopu ile 1 derece arasýnda ayarlayýn. Attention/Dikkat The tibial slope must be set before setting the height of cut. Kesimin yüksekliðini belirlemeden önce tibial slopu belirleyiniz. An excessive slope could damage the tibial insertion of the posterior cruciate ligament. Fazla verilen bir slop posterior baðýn tibial insersiyonuna zarar verebilir. Extract the telescopic rod of the guide and ensure that the lower extremity end of the rod is clearly matching the centre of the ankle. Gaydýn teleskopik rodunu uzatýn ve rodun alt ucunun ayak bileði ekleminin merkezine denk düþtüðüne emin olun. 9

11 SETTING THE LEVEL OF THE CUT KESÝMÝN SEVÝYESÝNÝN BELÝRLENMESÝ Place the tibial stylus (Ref: ) on the tibial resection guide on the side where tibial resection is expected to be greatest. Place the tibial stylus mm if measurement is performed medially or place it mm if measurement is performed laterally. Tibial stylusu (Ref: ) tibial kesi gaydýnýn üzerine, tibial kesimin yapýlacaðý yönden yerleþtirin. Tibial ölçüm medialden yapýlacaksa stylus a lateralden yapýlacaksa mm ye konumlandýrýlýr. Ensure a sufficient cut of the controlateral compartment with the assistance of the Blade Runner (Ref: ). ýf necessary use the micrometer adjustment screw to adjust the level of the cut. Blade Runner (Ref: ) yardýmýyla contro-lateral kompartýmanýn yeterli bir seviyede kesileceðine emin olun. Gerektiði hallerde mikrometrik ayarlama vidasýnýn yardýmýyla yapýlacak kesimin seviyesini ayarlayýn. Drill the two inferior holes located on each side of the fixation screw of the tibial resection guide and inroduce two pins, diameter. mm (Ref: ). Tibial kesi gaydýnýn fiksasyon vidasýnýn her iki tarafýnda bulunan alltaki iki deliði. mm drill ile delin ve çapý. mm lik iki çiviyi buraya çakýn. Release the tibial resection guide fixation screw. Tibial kesi gaydýnýn fiksasyon vidasýný gevþetin. 1

12 Withdraw the intramedullary rod and remove the tibial guide and tibial support together. Ýntramedüller rodu çekerek çýkartýn, tibial gaydý ve tibia desteði birlikte çýkartýn. Place the tibial resection guide in contact with the tibia, sliding it on the two pins. Tibial kesi gaydýný tibiayla temas edecek þekilde, iki çivinin üzerinden kaydýrmak suretiyle yaklaþtýrýn. After drilling the tibial cutting guide s other fixing hole with the.mm drill, fix the tibial cutting guide with. mm nail (Ref: ). Tibial kesi gaydý üzerindeki diðer sabitleme deliðini. mm drill ile deldikten sonra. mm lik çivinin (Ref: ) yardýmýyla sabitleyin. 11

13 USE OF THE EXTRA-MEDULLARY ALIGNMENT GUIDE EXTRA MEDULAR KESÝ GAYDININ KULLANIMI Assembly of the upper part Gaydýn üst kýsmýnýn kurulumu Fasten the tibial resection guide on the tibial guide s peak point with using the fixation screw. Tibial kesi gaydýný tibial gaydýn üzerine, en üst noktada olacak þekilde fiksasyon vidasý ile sabitleyin. Insert the tibial guide with the into the tibial support and firmly tighten the.5 screw with the screwdriver to fix the tibial support. Tibial gaydý tibial desteðe takýn ve yandaki vidayý.5 mm tornavidayla sabitleyin. Set the tibial slope at degree by turning the frontal screw on the tibial guide. Tibial gaydýn üzerindeki ön yüzdeki vidayý çevirerek tibial slopu dereceye ayarlayýn. Assembling of the lower part Gaydýn alt kýsmýnýn kurulumu Tibial guide attachment (Ref:16511), tibial guide-malleolar pincer (Ref:16511) and tibial guidemalleolar pincer attachment (Ref:16511) are mounted reference mm. Tibial gayd uzatma parçasý (Ref:16511), tibial gayd malleolar pincer (Ref:16511) ve tibial gayd malleolar pincer baðlantý parçasý (Ref:16511) mm referans alýnarak monte edilir. POSITIONING OF THE GUIDE GAYDIN POZÝSYONLANMASI Position the lower part of the guide taking care that the malleolar pincer is exactly facing the centre of the ankle joint. Gaydýn alt kýsmýný malleolar pincer tam olarak eklem baðýnýn merkezine bakacak þekilde pozisyonlandýrýn. 1

14 Insert the tibial guide into the extramedular guide. Let the upper and lower part of the extramedular guide free to slide into each other. Tibial gaydý, ekstramedular gaydýn içine yerleþtirin. Tibial aparatýn yukarý ve aþaðý bölümlerini birbirinin içine doðru serbestçe kayacak bir þekilde býrakýn. Slightly hammer the first spike at the centre of the tibia, leavng free the second one. Approach the resection guide at a distance of approximately 5 mm from the tibila epiphysis by sliding the upper part of the tibial guide on the tibial support. Tibial destek kolundaki çiviyi tibial platoya çakýn, ikincisini boþta býrakýn. Kesi gaydýna, tibial epipihysisten yaklaþýk 5 mm lik bir uzaklýktan tibial gaydýn üst kýsmýný tibial desteðe kaydýrarak yaklaþýn. SETTING THE TIBIAL SLOPE TÝBÝAL SLOP UN AYARLANMASI Additional info/ek bilgi Tibial slope will be set according to patient s anatomy by moving the lower part of the extramedular guide. Tibial slop, hastanýn anatomisine baðlý olarak, ekstramedular gaydýn alt kýsmýnýn hareket ettirilmesi sonucunda belirlenir. Attention/Dikkat The tibial slope must be set up before setting the level of cut. Kesimin seviyesi belirlenmeden önce tibial slop belirlenmelidir. Until the definitive correct position of the resection guide has not been defined the upper and lower part of the tibial ancillary should remain free to slide into each other. Kesi gaydýnýn nihai pozisyonlandýrýlmasý belirlenene dek tibial aparatýn yukarý ve aþaðý bölümleri birbirine doðru rahatça kayabilecek þekilde serbest býrakýlmalýdýr. An excessive slope choice could damage the tibial insertion of the posterior cruciate ligament. Haddinden fazla bir slop seçimi posterior cruciate ligamentin tibial insersiyonuna zarar verebilir. 1

15 SETTING THE ROTATION ROTASYONUN BELÝRLENMESÝ The control of the rotation of the resection guide can be done taking the fixation screw as reference for the center of the guide. the screw should face the center of the tibia.also check that the lower part is correctly centred on the mid point of the ankle joint. The long pin can now be hammered and fixed in the tibial surface. Kesi gaydýnýn rotasyonunun kontrolü gaydýn ortasýndaki fiksasyon vidasý referans alýnarak yapýlýr. Vida tibianýn merkezi yönüne bakmalýdýr. Bunlara ilaveten aþaðý kýsmýn ayak bileði ekleminin merkezine doðru ortalanarak konumlandýrýldýðý da kontrol edilmelidir. Bu noktadan sonra uzun çivi tibianýn yüzeyine çakýlarak sabitlenebilir. SETTING THE LEVEL OF THE CUT KESÝM SEVÝYESÝNÝN BELÝRLENMESÝ Place the tibial stylus (Ref: ) on the tibial resection guide on the side where tibial resection is expected to be greatest. Place the tibial stylus mm if measurement is performed medially or place it mm if measurement is performed laterally. Tibial stylusu (Ref: ) tibial kesi gaydýnýn üzerine, tibial kesimin yapýlacaðý yönden yerleþtirin. Tibial ölçüm medialden yapýlacaksa stylus a lateralden yapýlacaksa mm ye konumlandýrýlýr. Ensure a sufficient cut of the controlateral compartment with the assistance of the Blade Runner. ýf necessary use the micrometer adjustment screw to adjust the level of the cut. Blade Runner yardýmýyla contro-lateral kompartýmanýn yeterli bir seviyede kesileceðine emin olun. Gerektiði hallerde mikrometrik ayarlama vidasýnýn yardýmýyla yapýlacak kesimin seviyesini ayarlayýn. Drill the two inferior holes located on each side of the fixation screw of the tibial resection guide and inroduce two pins, diameter. mm (Ref: ). Tibial kesi gaydýnýn fiksasyon vidasýnýn her iki tarafýnda bulunan alltaki iki deliði. mm drill ile delin ve çapý. mm lik iki çiviyi (Ref: )buraya çakýn. 1

16 Release the tibial resection guide s fixation screw. Tibial kesi gaydýnýn fiksasyon vidasýný gevþetin. T Total Knee System Withdraw the extramedullary guide and remove the tibial guide and tibial support together. Ekstramedular gaydý çýkartýn, tibial gaydý ve tibia desteði birlikte çýkartýn. Attention/Dikkat While tibial guide and extramedullary guide is being removed ensure that tibial resection guide is not moving. Tibial gaydýn ve ekstramedular gaydýn sökülmesi sýrasýnda tibial kesi gaydýnýn yerinden oynamamasýna dikkat edilmelidir. Place the tibial resection guide in contact with the tibia, sliding it on the two pins. Tibial kesi gaydýný tibiayla temas edecek þekilde, iki çivinin üzerinden kaydýrmak suretiyle yaklaþtýrýn. After drilling the tibial cutting guide s other fixing hole with the.mm drill, fix the tibial cutting guide with. mm nail (Ref: ). Tibial kesi gaydý üzerindeki diðer sabitleme deliðini. mm drill ile deldikten sonra. mm lik çivinin (Ref: ) yardýmýyla sabitleyin. REALISATION OF TIBIAL CUT TÝBÝAL KESÝMÝN GERÇEKLEÞTÝRÝLMESÝ Perform the tibial cut using the saw blade. Býçak aracýlýðýyla kesimi gerçekleþtirin. Attention/Dikkat Saw Blade to be used for cutting must be 1. mm thickness. To use a thinner blade makes imporer cutting. Kesim esnasýnda kullanýlan býçaðýn kalýnlýðý 1. mm olmalýdýr. Kesim için daha ince bir býçak kullanýlmasý kesimde hataya sebep olacaktýr. CHOOSING THE TIBIAL COMPONENT TÝBÝAL KOMPONENTÝN BELÝRLENMESÝ Choose the size of tibial component using the trial baseplates. Deneme baseplatelerini kullanarak tibial komponentin uygun boyunu seçin.

17 To strengthen the fit of the tibial trial baseplate and avoid translation movements during the preparation of the keel, put in place two.7 pins (Ref: 16651) in the holes of the trial tibial baseplate located posteriorly. Then barrel is mounted on the trial baseplate and drilling process is performed with 1 mm drill. Tibia deneme baseplate inin tam olarak yerine oturmasýný saðlamak ve keel yuvalarýnýn hazýrlanmasý sýrasýnda ortaya çýkacak translasyon hareketini önlemek için deneme tibial baseplate ine posterior olarak konumlandýrýlmýþ iki deliðe.7 mm lik iki adet pini (Ref: 16651) yerleþtirin. Daha sonra deneme baseplate i üzerine Barrel monte edilerek 1 mm lik Drill ile delme iþlemi gerçekleþtirilir. Attention/Dikkat If tbial stem is not used, perform drilling up to first line on the drill. If tibial stem is used, perform drilling up to second line Delme iþlemi tibial stem kullanýlmadýðý durumlarda drill üzerindeki ilk çizgiye kadar, tibial stem kullanýlacaðý durumlarda ikinci çizgiye kadar yapýlmalýdýr. After drilling, assemble the Slide Hammer Attachment (Ref: 1651), the Puncher (Ref: )and the Slide Hammer (Ref: 1651) together thus create the frame of the keel. Delme iþlemi yapýldýktan sonra Hareketli Çakýcý-Çýkarýcý Ucu (Ref: 1651), Puncher (Ref: ) ve Hareketli Çakýcý-Çýkarýcý (Ref: 1651) birbirine monte edilerek keel in dýþ hatlarýný oluþturun. When adding an tibial stem after using the puncher itself, the test tibial stem of the chosen length must be screwed to the end of the puncher and the whole unit introduced through the trial baseplate to prepare the path for the tibial stem. Puncher ý kullanýldýktan sonra ilaveten bir tibial stemin eklenmesi gerektiði hallerde seçilen boyun testi puncher a vidalanmalý ve tüm aparat tial steme gerekli yolu açmak için deneme baseplate inin içine yerleþtirilmelidir. 16

18 Place a appropriate size trial insert and mount the test tibial component handle to the baseplate Uygun test inserti yerleþtirin ve Test Tibial Komponent Tutucuyu baseplate e monte edin. Assess tibial correction of the knee in extension. Control the orthogonal aspect of the tibial cut by introducing the centromedullary rod in one of the holes at the extremity of the trial baseplate handle. Ekstensiyon halindeki dize gereken tibial düzeltme iþlemini yapýn. Deneme baseplate inin tutacacaðýný ucunda bulunan deliklerden birine merkezi-medüller rodu yerleþtirmek suretiyle tibial kesimin orthogonal görünümünü elde edebilirsiniz. Additional info/ek bilgi In order to pre-select the size of tibial insert, the resected part of the tibia may be superimposed on the trial baseplate. Tibial insert ün boyunu önceden belirleyebilmek için tibianýn kesilmiþ bölümünü deneme baseplate iyle üstüste koyun. ASSEMBLY OF THE STANDARD AND PS MOBILE TEST INSERTS STANDART ve PS MOBIL BEARING TEST INSERTLERÝN YERLEÞTÝRÝLMESÝ 17

19 FEMORAL STAGE FEMORAL SAFHA PREPARE THE SIZING GUIDE ÖLÇÜM GAYDININ HAZIRLANMASI Fix the handle (Ref: 161) on the femoral anterior sizing guide (Ref: 16). Tutma kolu (Ref: 161) Femoral anterior ölçüm gaydýna (Ref: 16) takýlýr. Introduce the Intramedular rod through the orientation hole and set the femoral valgus (right or left side) with pulling the orientation pin (established from the pre-operative planning). Place the posterior wedge (Ref: 1651) on medial. Intramedülar rodu oryantasyon deliði yardýmýyla yerleþtirin ve ameliyat öncesi planlamada belirlenmiþ olan açý derecesinde oryantasyon mandalýný çekin, femoral valgusu ayarlayýn ve býrakýn. dýþ rotasyon kamasýný (Ref: 1651) mediale konumlandýrýn. Fix the anterior sizing stylus to the femoral anterior sizing guide (left or right bone laterally) Anterior ölçüm stylusunu femoral anterior ölçüm gaydýna takýn. (sað veya sol kemiðin lateraline) POSITIONING OF THE GUIDE GAYDIN KONUMLANDIRILMASI Flex the knee to 9 degree. Drill, using the gauged 1 mm diameter drill in the axis of the femur, immediately up front the femoral insertion of the Posterior Cruciate Ligament. Ameliyat edilecek dizi 9 derecelik bir açýya getirin. 1 mm çapýndaki drill i kullanarak femur eksenini hemen posterior Cruciate Ligament in önündeki femur insersiyonundan delmeye baþlayýn. 1

20 PLACING THE GUIDE GAYDIN YERLEÞTÝRÝLMESÝ T Total Knee System Fix the femoral anterior sizing guide to the femur with using intramedular rod. Measure the bone size with stylus on the anterior side. Measuring of femoral anterior sizing guide and measuring of scale on stylus must be matched. Verify the measuring with using femoral anterir sizing guide control attachment. Then make sure there is a contact between guide and posterior and distal edge of the condyles. Femoral anterior ölçüm gaydý intramedular rod ile femur a takýlýr. Anteriordan stylus ile ölçüm yapýlýr. Femoral anterior ölçüm gaydý üzerinde okunan ölçü ile Stylus üzerindeki skalada bulunan ölçü birbiri ile eþleþmelidir. Kontrol sacý yardýmýyla ölçüm gaydýnýn yan kýsmýnda bulunan referans kanallarýndan ölçüm doðrulamasý yapýlýr. Son aþama olarak gaydýn, kondilin posterior ve distaline temas ettiðinden emin olunuz. Hammer two Ø. mm nails (Ref: ) into femur through the reference holes on the femoral anterior sizing guide and remove the intramedular rod and femoral anterior sizing guide. Femoral anterior ölçüm gaydý üzerindeki referans deliklerinden femura adet Ø (Ref: ) çivi çakýlýr ve ölçüm gaydý ve intramedular rod çýkarýlýr. 19

21 FIXING THE GUIDE GAYDIN SABÝTLENMESÝ Fix the femoral anterior sizing guide and determined size cutting guide onto the nails. Then mount the Femoral Cutting Guide Attachment (Ref: 16511) on the assembly. Fix the Femoral Cutting Guide Attachment on the peak point of the cortex with the two.7 mm pins. Femoral anterior ölçüm gaydý ile belirlenen ölçüdeki kesi gaydý referans çivilerinin üzerinden takýlýr, sonra Femoral Kesi Gaydý Sabitleme Kolu (Ref: 16511) takýlýr. Sabitleme kolu korteksin en tepe noktasýna adet.7 mm lik çivi ile sabitlenir. Check for the last time that posterior and distal contact with the condyles is ensured. Son birkez, kondiller ile posterior ve distal temasýn gerçekleþtiðini kontrol edip temastan emin olun. Fix the guide laterally and medially with Ø. mm nails in four places (During the fixing process cutting block must be immobile). Femoral kesi bloðu lateralden ve medialden Ø. mm çiviler ile yerden sabitlenir. (Bu iþlem sýrasýnda kesi bloðu kesinlikle hareket etmemelidir.) Femoral cuts in the following order: Kesi sýralamasý þu þekilde olmalýdýr: 1- Anterior - Posterior - Anterior Chamfer - Posterior Chamfer 5- Distal ( mm) 1 Attention/Dikkat After anterior and posterior cuts performed referans nails are removed and cutting is continued. Anterior ve Posterior kesiler yapýldýktan sonra referans çivileri sökülerek diðer kesilere devam edilir.

22 Check that all cuts correctly performed. The implant will be ready for application. Distal kesim tamamlandýðýnda femur implant uygulamaya hazýr olur. 5 Remove the nails. Çivileri sökün. Remove the cutting block. Kesi bloðunu çýkartýn. Additional info/ek bilgi Saw Blade to be used for cutting must be 1. mm thickness. To use a thinner blade makes imporer cutting Kesim esnasýnda kullanýlan býçaðýn kalýnlýðý 1. mm olmalýdýr. Kesim için daha ince bir býçak kullanýlmasý kesimde hataya sebep olacaktýr. FEMUR 1

23 PATELLA STAGE PATELLAR SAFHA PATELLA RESURFACING TECHNIQUE PATELLANIN YENÝDEN YÜZEYLENDÝRÝLMESÝ TEKNÝÐÝ Lock the patella resection guide into the universal patella clamp. After carefully releasing the periphery of the patella, position the resection guides at the appropriate resection level, with the assistance pf the patellar stylus and firmly lock. Patella kesi gaydýný patella kýskacýna kenetleyin. Dikkatli bir þekilde patellanýn periferisini serbest býraktýktan sonra patellar stylusun yardýmýyla kesi gaydlarýný uygun kesim seviyesinde konumlandýrýn ve kýskacý, saðlamca kilitleyin. Perform the patellar cut through the slots of the resection guides. Kesim gaydýnýn oluklarý içinde patellar kesimi gerçekleþtirin. Open the patellear clamp, remove the two resection guides and position the spike jaw and drilling template. Patella kýskacýný açýn, iki kesi gaydýný da yerinden çýkartýn ve spike jaw ve delici þablonu konumlandýrýn. Apply the drilling template on the resected surface of the patella and drill three holes with the 5 mm diameter drill guide. Delici þablonu patellanýn kesilmiþ olan yüzeyine uygulayýn ve 5mm çaplý delici gayd yardýmýyla üç adet delik açýn. Remove the drill guide, select the correct size of trial patella and put in place. Four sizes are available (,1,,). Kesici gaydý yerinden çýkartýn, deneme patellalarýnýn arasýndan doðru boyu seçin ve yerine oturtun. (dört deðiþik ölçüsü mevcuttur :,1,,)

24 INSET PATELLA TECHNIQUE ÝNSET PATELLA TEKNÝÐÝ Select the size of patella using the different barrels (Ref: ). Farklý ölçülerdeki barelleri (Ref: ) kullanarak patellanýn ebatýný belirleyin. T Total Knee System Lock the corresponding guide of the selected diameter on the patellar clamp equipped with its spike jaws. Sivri uçlarý olan patella kýskacýný uygun çaptaki gayda kenetleyin. Ensure that the reaming depth ring is correctly adjusted. ýntroduce the reamer of corresponding diameter into the guide and ream until contact is made between the ring of the reamer and the upper part of the guide. If the reamer depth is inadequate, it is possible to increase this by raising the reamer ring. Oyucu derinlik halkasýnýn doðru bir þekilde ayarlandýðýna emin olun. Uygun çaptaki oyucuyu gayda yerleþtirin ve oyucu ile gaydýn üst kýsmý temas edene dek uygulayýn. Eðer delinecek derinlik yetersiz ise oyucu halkasý kaldýrýlarak derinlik arttýrabilir. Place the trial patella, holding it with the two jaws expressly designed to this purpose mounted on the clamp. Deneme patellasýný kýskacýn üzerine bu amaçla yerleþtirilmiþ olan jaw lardan tutarak yerleþtirin.

25 Attention/Dikkat The reaming power tool must be operated once the reamer has been completely introduced into the guide. In order to reduce any risk of fracturing the patella, reaming must be performed with caution at low speed, keeping the patellar clamp closed. Oyucu motor, oyucu ancak gaydýn içine tamamen yerleþtirildikten sonra çalýþtýrýlmalýdýr. Patellanýn kýrýlma riskini ortadan kaldýrmak için oyma iþlemi dikkatlice en düþük güçte; patella kýskacý kapalý haldeyken yapýlmalýdýr. INSERTÝNG THE TEST FEMORAL COMPONENT TEST FEMORAL KOMPONENTÝN YERLEÞTÝRÝLMESÝ Position the described test femoral component to the femoral component impactor (Ref: 1651). Hammer the test femoral component to the femur wit using slide hammer. Belirlenen test femoral komponenti Femoral Komponent Çakýcýya (Ref: 1651) yerleþtirin. Hareketli çakýcý-çýkarýcýyý kullanarak test femoral komponenti femur a çakýn. Drill the peg holes on trial femoral component with Ø7 mm (Ref: )drill. Test femoral komponent üzerindeki deliklerden Ø7 mm (Ref: ) drill ile peg deliklerini açýn.

26 Check correct alignment of the lower limb, introducing the intramedular rod into the test tibial component handle. Ýntramedular rodu test tibial komponent tutucu içerisinden geçirerek aks açýlarýný kontrol edin. TIBIAL BASEPLATE May be position 5 or 5 mm extension. If has been considered necessary, the baseplate should be screwed. 5 ve 5mm uzatma takýlabilir. Gerekli durumlarda tibial base plate vida ile sabitlenebilir. 5

27 Instruments & Trays/El Aletleri & Tavalar Tibia instrument tray 1 Tibia el aletleri tava 1 Tibia instrument tray Tibia el aletleri tava Tibia instrument tray Tibia el aletleri tava Femur instrument tray 1 Femur el aletleri tava 1 Femur instrument tray Femur el aletleri tava 6

28 Pens Çivi Tutucu Pense Screw Driver Tornavida /,5 Drill Adaptor Drill Tutucu Adaptör Drill Bit Drill / Ø, Drill Bit Drill / Ø5 Drill Bit Drill / Ø7 Drill Bit Drill / Ø1 Nail Çivi / Ø,7X Nail Çivi / Ø,X55 Nail Çivi / Ø,X7 Nail Çivi / Ø,X7 Impactor Bar Çakýcý Pimi 1675 Universal Femoral Component Impactor Üniversal Femoral Komponent Çakýcý Femoral Anterior Sizing Guide Femoral Anterior Çivi Ölçüm Gaydý 7

29 161 Femoral Anterior Sizing Guide Handle Femoral Anterior Ölçüm Kaydý Tutma Kolu 16 Femoral Anterior Sizing Guide Control Attachment Femoral Anterior Ölçüm Kaydý Kontrol Sacý Intramedular Rod for Tibia Intramedular Rod / Tibia Posterior stabilisation Shaft Peg for Test Tibial Insert Test Tibia Ýnsert Posterior Stabilizasyon Parçasý Test Tibial Component Test Tibial Komponent 1 5 Test Tibial Component Handle Test Tibial Komponent Tutucu Barrel Barrel Tibial Support Tibial Destek Parçasý Tibial Guide Tibial Gayd Tibial Guide Attachment Tibial Gayd - Uzatma Parçasý Tibial Guide - Malleoler Pincer Tibial Gayd - Malleoler Pincer Tibial Guide - Malleoler Pincer Attachment Tibial Gayd - Maleoler Pincer Baðlantý Parçasý Telescope Teleskop

30 Tibial Stylus Tibial Stylus Blade Runner Blade Runner Tibial Component Impactor Tibial Komponent Çakýcý Test Tibial Stem Test Tbial Stem 5 5 Notching Intsrument Yuva Açýcý Distal Wedge Distal Wedge Anterior Chamfer Wedge Anterior Chamfer Wedge Femoral Cutting Guide Attachment Femoral Kesi Gaydý Sabitleme Kolu Posterior Wedge Posterior Kama / Slide Hammer Hareketli Çakýcý - Çýkarýcý Slide Hammer Attachment Hareketli Çakýcý - Çýkarýcý Ucu Puncher Puncher Femoral Component Impactor Femoral Komponent Çakýcý 9

31 Patellar Clamp Patella Tutucu Spike Jaw Patella Sivri Uçlu Çene Patella Recection Guide Patella Kesi Gaydý Right / Sað Left / Sol Pressurizing Jaws Patella Bastýrýcý Çene Dirilling Template Patella Delik Þablonu Barrel Barrel 1 Patella Reamer Patella Oyucu 1 Patella Stylus Patella Stylus Calliper Gauge Kumpas Test Tibial Insert / Test Tibia Insert / Test Tibial Insert / 1 Test Tibia Insert / 1

32 Test Tibial Insert / Test Tibia Insert / Test Tibial Insert / Test Tibia Insert / Test Tibial Insert / Test Tibia Insert / Test Tibial Insert / 5 Test Tibia Insert / 5 Posterior stabilisation Shaft for Test Femoral Component T Test Femoral Komponent Posterior Stabilizasyon Þaftý Test Femoral Component TTest Femoral Komponent Right / Sað Right / Sað 1 Right / Sað Right / Sað Right / Sað Right / Sað 5 Left / Sol Left / Sol 1 Left / Sol Left / Sol Left / Sol Left / Sol 5 Test Patella Component Test Patella Komponent 1 1

33 Test Re-Surfacing Patella Component Test Re-Surfacing Patella Komponent 1 Femoral Cutting Guide Femoral Kesi Gaydý Resection Guide 9 Tibial Kesi Gaydý Mobile Bearing Test Tibial Insert / MB Test Tibia Insert / Mobile Bearing Test Tibial Insert / MB Test Tibia Insert / Mobile Bearing Test Tibial Insert / MB Test Tibia Insert / Mobile Bearing Punch Handle MB Test Tibial Komponent Çakýcý - Çýkarýcý Ucu Mobile Bearing Test Tibial Component MB Test Tibial Komponent 1 5

34 Revision / Printed in TURKEY - 9/11 - TIPSAN Design The products being manufactured by TIPSAN A.S. has been certified from SZUTEST (Strojírensk Zkušební Ústav) for EC certificate (CE 1) according to Annex II. and II. of Council Directive 9//EEC concerning medical devices Kemalpasa Cd. 7/1 Sk. No: Pinarbasi - IZMIR - TURKEY Tel: Fax: marketing@tipsan.com.tr