PPS P I N P O S I T I O N I N G S Y S T E M GMK EFFICIENCY VERSION. Hip Knee Spine Navigation

Transcription

1 PPS P I N P O S I T I O N I N G S Y S T E M D ESIGNED FOR YOU BY YOU GMK EFFICIENCY VERSION Surgical Surgical Technique Hip Knee Spine Navigation

2 MyKnee Surgical Technique Hip Knee Spine Navigation I N T R O D U C T I O N This document describes the Surgical Technique to implant the GMK Total Knee System using the MyKnee PPS blocks. MyKnee PPS blocks are patient-specific pin positioners. They are created utilizing MRI images of the patient s knee and pre-operative 3D planning. Resections are performed through the standard cutting blocks which are positioned using the holes of the MyKnee PPS blocks, according to the surgeon s pre-operative planning. This technique applies only to surgical procedures that are to be carried out with GMK Efficiency Single Use Instruments. GMK Efficiency can be used in association with all MyKnee PPS tibial blocks, but a special version of the MyKnee PPS femoral blocks must be used. The compatibility with GMK Efficiency is indicated on the label of these blocks.. 2

3 C A U T I O N Use GMK Efficiency EXCLUSIVELY in association with the dedicated MyKnee PPS femoral blocks. The compatibility with GMK Efficiency is indicated on the label of these blocks. Always check that the description on the label states Femur Pin Positioner Efficiency prior to use. GMK For the complete list of MyKnee PPS femoral blocks that are compatible with Efficiency, please refer to the 'MyKnee PPS femoral blocks Efficiency' section ( 15). MyKnee PPS femoral blocks that are not listed are NOT COMPATIBLE with GMK Efficiency Single Use Instruments. S Y M B O L S Throughout the surgical technique you will find the following symbol: The MSS box descriptions refer to instruments that have been specifically designed for Muscle Sparing approaches. SS 3

4 MyKnee Surgical Technique Hip Knee Spine Navigation I N D E X 1 INDICATIONS CONTRAINDICATIONS PRE-OPERATIVE PL ANNING SURGICAL APPROACH DISTAL FEMORAL RESECTION MyKnee Femoral PPS Block Positioning Preparing the Distal Cutting Block Fixation Holes Preparing the 4in1 Cutting Block Fixation Holes Performing the Distal Resection TIBIAL RESECTION MyKnee Tibial PPS Block Positioning Preparing the Tibial Cutting Block Fixation Holes Performing the Tibial Resection EXTENSION GAP CONTROL ANTERIOR CUT, POSTERIOR CUT AND CHAMFERS Anterior Reference Femoral Peg Reference FEMORAL FINISHING

5 10 TIBIAL FINISHING PATELLA TRIALS SELECTION OF THE PROSTHETIC COMPONENTS SIZE MATCHING FINAL IMPLANTS MYKNEE PPS FEMORAL BLOCKS EFFICIENCY MYKNEE PPS TIBIAL BLOCKS

6 MyKnee Surgical Technique Hip Knee Spine Navigation 1 INDICATIONS MyKnee Pin Positioners are intended to be used as anatomical pin positioners specifically designed for a single patient to assist in the positioning of total knee replacement components intra-operatively and in guiding the marking of bone before cutting. MyKnee Pin Positioners are intended for use with GMK Total Knee System when the clinical evaluation complies with its cleared indications for use. 2 CONTRAINDICATIONS Contraindications for using MyKnee instrumentation are the same as the situations when a total knee replacement is contraindicated. It is the surgeon s responsibility to verify that the patient is not allergic to the material of which the MyKnee PPS blocks are made (Polyamide PA12). 3 PREOPERATIVE PL ANNING The pre-operative planning is managed through the website in cooperation between the surgeon and Medacta International. Please contact Medacta International to gain access to the website. The goal of the pre-operative planning is to assess the surgical parameters regarding femoral and tibial implantation in order to manufacture dedicated patient specific single use pin positioners. Parameters are planned by the surgeon and include: Femoral implant size Tibial implant size Femoral resections - Posterior cut height, on both condyles (medial and lateral) - Distal cut height, on both condyles (medial and lateral) Femoral angles - Varus/valgus - Flexion/extension Femoral rotation - Internal/external rotation vs posterior condylar axis or vs epicondylar axis Tibial resection - Proximal cut height related to both plateaus (medial and lateral) Tibial angles - Varus/valgus - Posterior slope. MRI imaging is used to create 3D bone models which replicate the patient s natural anatomy. This bone model is used to create the anatomic PPS blocks, which are specific to the patient s knee morphology, without using any alignment jigs for positioning. NOTICE Please refer to the official MRI protocol available on the website myknee.medacta.com. Scans taken with different protocols may lead to unusable images. Before using MyKnee s procedures, every radiology center must be registered. Please contact Medacta International to register your Radiological Center. 6

7 The surgeon will receive a MyKnee Surgical Planning Report (ref.no. M 08.59). This report indicates the surgical parameters, according to their default profile, previously set on the MyKnee website. An example of this report is located on the following page. It is the surgeon s responsibility to validate the preliminary planning or set different parameters according to their own assessment. Both validation and changes to the planning must be communicated via the MyKnee website (see picture on the next page). After the planning has been validated by the surgeon, MyKnee PPS blocks are manufactured and delivered to the associated representative. MyKnee PPS blocks can be supplied sterile or non-sterile (see pictures below). Where supplied non-sterile, it is the healthcare institution s responsibility to clean and sterilize them before use. Please read the Note for sterilization included at the end of this surgical technique. The surgical technique requires the use of a few reusable metal instruments. Please refer to the dedicated GMK Efficiency surgical technique for the list of reusable metal instruments required to complete the surgical procedure. It is recommended that a full conventional metallic instrument set be available and ready for the operation as a back up to a MyKnee PPS GMK Efficiency case. The compatibility between GMK Efficiency and metal instruments is described in the dedicated GMK Efficiency surgical technique. In the surgical technique described hereafter, the resections are performed in the following order: Distal femoral resection Tibial resection A/P femoral resections and chamfers* NOTICE * The surgeon can change the resection order according to his/her preferences**. ** Distal femoral resection must be performed before the A/P Femoral resections and chamfers. Federal law (USA) restricts this device to sale by or on the order of physician. Some specific instruments are fixed to the bone by means of dedicated pins. Before using the pins, ensure that they are intact and fully functional. BENT OR DEFECTIVE PINS CANNOT BE USED AND MUST BE REPLACED BY NEW ONES. When extracting pins it is important to avoid any bending as this results in axial alignment between the pin and the dedicated extractor. It is strongly recommended not to impact or hammer on any instruments unless otherwise specified in the surgical technique. For detailed instructions contact your local Medacta sales representative. 7

8 8 MyKnee Surgical Technique Hip Knee Spine Navigation

9 4 SURGICAL APPROACH The most commonly used surgical approach is the medial parapatellar approach. Other approaches may be used depending on the surgeon s practice. S Do not remove any osteophytes from the tibia or femur. This will ensure the boney references, utilized by the MyKnee PPS blocks, are not altered. 5 DISTAL FEMORAL RESECTION 5.1 MyKnee Femoral PPS Block Positioning Each MyKnee femoral PPS block shows the following information: 1- patient ID 2- MyKnee femoral PPS block reference and lot number. 1 2 A lateral parapatellar approach may be indicated for some patients. Different MyKnee tibial PPS blocks are available depending whether a medial or lateral surgical approach is used. The femoral block will suit both medial and lateral approaches. The surgeon must indicate in the surgery planning which kind of surgical approach will be used. Before starting the surgery, please check the accuracy of the data that is specific to the patient. An example of the patient ID is shown below: N_SUR_XTK_SN_DDMMYYYY N= first letter of patient s given name SUR = first three letters of patient s family name XTK = side operated, left (LTK) or right (RTK) SN= first letters of the surgeon s given and family name DDMMYYYY= patient s birth date (DD=day, MM=month, YYYY=year). DO NOT use the PPS block if it does not clearly indicate the patient identification string. Should this occur, please contact Medacta staff immediately. DO NOT use MyKnee PPS blocks on a patient for whom the pre-operative planning has not been carried out. A MyKnee PPS block used on a different patient will lead to unpredictable total knee replacement outcomes. DO NOT remove any osteophytes from or around the trochlear groove before positioning the femoral PPS block on the bone. 9

10 MyKnee Surgical Technique Hip Knee Spine Navigation Before use, visibly inspect the MyKnee PPS block to ensure it is intact and in good working order. A 3D bone model of the patient s femoral bone will be supplied with the MyKnee femoral PPS block. Matching the PPS block with the 3D bone model allows for an additional check of the PPS block s integrity before use. The 3D bone model can be supplied sterile or non-sterile. Where supplied nonsterile, it must be sterilized by the healthcare institution. Please read the Note for sterilisation included at the end of this surgical technique. The 3D femoral bone model allows for an accurate simulation of the position of the MyKnee femoral PPS block. A secondary verification can be completed by using the angel wing to verify the resection level and compare this resection to the planned femoral resection level marked on the bone model. The block must be in contact with the trochlea, the anterior part of the condyles and the distal part of the condyles. To ensure maximum stability, verify that contact areas between the MyKnee femoral PPS block and the femur are flush. If bone models are available ensure that contact areas between the MyKnee PPS block and the bone are in the same position as the areas marked on the bone model. The block is positioned manually on the distal femur. Due to the anatomical shape of the block, only one orientation is possible. Correct placement corresponds to maximum stability of the block. MRI-based MyKnee femoral PPS block contact area Before positioning the MyKnee femoral PPS block, remove the soft tissues from the femur without damaging the osteophytes. Inaccurate positioning may lead to cut parameters that do not match the planning. Once the MyKnee femoral PPS block has been properly positioned on the femur, the cut parameters are automatically set for the knee that is undergoing surgery according to the pre- operative planning (see par.3). 10

11 TIP The telescopic alignment rod can be used to check the proper positioning of the MyKnee femoral PPS block on the bone. Secure the block in position, and connect the rod to the guide using the green holes in the figure below. A visual check on the distal and anterior cut levels can be carried out using the angel wing as per the yellow slots in the figure below. If bone models are available, verify the cut height with the planned resection level that is marked on the bone model. To avoid malalignment, do not alter the MyKnee femoral PPS block position whilst drilling the pin holes. Pin the MyKnee femoral PPS guide by inserting two 3.2 mm diameter pins into the drilled holes. 5.3 Preparing the 4in1 Cutting Block Fixation Holes Before removing the MyKnee femoral PPS block, use the dedicated drills to prepare the holes for the 4in1 cutting block fixation. Two alternative options are available: Anterior reference parallel pins Femoral pegs Alignment rod holes Angel wing slots Check the varus/valgus alignment with the telescopic alignment rod only after final positioning of the MyKnee femoral PPS block. Do not use the telescopic rod to position the MyKnee PPS block. 5.2 Preparing the Distal Cutting Block Fixation Holes Once the position of the femoral PPS block is deemed satisfactory, prepare the holes for GMK Efficiency distal cutting block by drilling the dedicated parallel pin holes as shown in the picture below. To avoid malalignment, do not alter the MyKnee femoral PPS block position whilst drilling the pin or peg holes. Distal cutting block pin holes 11

12 MyKnee Surgical Technique Hip Knee Spine Navigation 5.4 Performing the Distal Resection Remove the MyKnee femoral PPS block by sliding it up and off the two pins previously placed. If the block is difficult to remove, remove one or both pins, slide the block off and reinsert the pin(s). Slide the GMK Efficiency distal cutting block onto the pins through the holes marked with a line. The picture on the right shows the correspondence between the MyKnee femoral PPS block row of pins and the distal cutting block pin holes. Before cutting, visually double check the cut height using the standard angel wing through the sawblade slot and the varus/valgus alignment with the telescopic alignment rod (as per the green holes in the figure on the right). Fix the distal cutting block and perform the distal resection following the procedure described in the dedicated GMK Efficiency surgical technique. After the resection, thoroughly rinse the joint before positioning both the trial and final implants. If a distal recut is necessary, follow the same procedure described in the dedicated GMK Efficiency surgical technique. Otherwise, remove the guide and the pins. Standard slotted distal cutting block (Ref ) Parallel positioning holes Alignment rod holes/ sawblade guide holes 12 1

13 6 TIBIAL RESECTION 6.1 MyKnee Tibial PPS Block Positioning Each MyKnee tibial PPS block shows the following information: 1-patient ID 2-MyKnee tibial PPS block reference and lot number. 2 Before starting the surgery, please check the accuracy of the data that is specific to the patient. An example of the patient ID is shown below: N_SUR_XTK_SN_DDMMYYYY 1 DO NOT remove any osteophytes from the tibial bone. Before use, visibly ensure that the MyKnee tibial PPS block is intact and in good working order. A 3D bone model of the patient s tibia will be supplied with the MyKnee tibial PPS block. Matching the PPS block with the 3D bone model allows for an additional check of the PPS block integrity before use. The 3D bone model can be supplied sterile or non-sterile. Where supplied non-sterile, it must be sterilized by the healthcare institution. Please read the Note for sterilization included at the end of this surgical technique. The 3D tibial bone model allows for an accurate simulation of the correct position of the MyKnee tibial PPS block. A secondary verification can be accomplished using the angel wing to verify the resection level, as the planned tibial resection level is marked on the bone model. The block is positioned manually on tibial plateaus. N= first letter of patient s given name SUR = first three letters of patient s family name XTK = side operated, left (LTK) or right (RTK) SN= first letters of surgeon s given and family name DDMMYYYY= patient s birth date (DD=day, MM=month, YYYY=year). DO NOT use the PPS block if it does not clearly indicate the patient identification string. Should this occur, please contact Medacta immediately. DO NOT use the MyKnee tibial PPS block on a patient for whom the pre-operative planning has not been carried out. A MyKnee tibial PPS block used on a different patient will lead to unpredictable total knee replacement outcomes. Due to the anatomical shape of the block, only one orientation is possible. Correct placement corresponds to maximum stability of the block. To ensure maximum stability, verify that the points of contact between the MyKnee tibial PPS block and the tibial bone are flush. Use the bone models to ensure that the contact points between the MyKnee tibial PPS block and bone are in the same position as the areas marked on the bone model. 13

14 MyKnee Surgical Technique Hip Knee Spine Navigation Medial approach MRI-based MyKnee tibial PPS blocks contact area Lateral approach MRI-based MyKnee tibial PPS blocks contact area Before positioning the MyKnee tibial PPS block remove the soft tissues from the tibia without damaging the osteophytes. Inaccurate positioning may lead to cut parameters that do not match the planning. Once the MyKnee tibial PPS guide has been properly positioned on the tibia, the cut parameters are automatically set for the knee that is undergoing surgery according to the pre- operative planning (see par.3). Alignment rod holes Angel wing slots Check the tibial varus/valgus with the telescopic alignment rod only after proper positioning the MyKnee tibial PPS block. Do not use the telescopic rod to position the MyKnee block. TIP The telescopic alignment rod can be used to check the proper positioning of the MyKnee tibial PPS block on the bone. Secure the block in position, and connect the rod to the guide using the green holes in the figure to the right. A visual check on the proximal tibial cut level can be carried out using the angel wing as per the yellow slots in the figure below. If bone model is available, verify the cut height with the planned resection level that is marked on the bone model. 14 1

15 6.2 Preparing the Tibial Cutting Block Fixation Holes Once the position of the MyKnee tibial PPS guide is deemed satisfactory, prepare the holes for the GMK Efficiency tibial cutting block by drilling the dedicated pin holes as shown in the picture below. 6.3 Performing the Tibial Resection Pin the MyKnee tibial PPS guide by inserting two 3.2 mm diameter pins into the drilled holes. To remove the MyKnee tibia PPS block, slide the block over the two pins previously placed. If it is difficult to remove the MyKnee tibia PPS block, remove one or both pins. Then slide the guide up and off and reinsert the pin(s). Position the corresponding GMK Efficiency tibia cutting block on the pins in the holes marked with a line. The picture below shows the correspondence between the MyKnee tibial PPS block pin holes and the tibial cutting block pin holes. Before cutting, visually double check the cut height and the posterior slope using the standard angel wing through the dedicated slot on the guide. Also check the varus/valgus alignment with the telescopic alignment rod (as per the green holes in the picture below). Fix the tibia cutting block and perform the tibial resection following the procedure described in the dedicated GMK Efficiency surgical technique. After the resection, thoroughly rinse the joint before positioning both the trial and final implants. Standard tibial cutting guide pin holes MIS tibial cutting guide pin holes Tibial slope pin hole TIP The slope hole direction corresponds to the sagittal plane. Marking the position of this hole on the bone can be useful to detect the center of the tibial plateau. Should a tibial recut be necessary, follow the procedure described in the dedicated GMK Efficiency surgical technique. Otherwise remove the guide and the pins. Whilst drilling the pin holes, do not alter the position of the MyKnee tibial PPS block as this could cause the guide to misalign. 15

16 MyKnee Surgical Technique Hip Knee Spine Navigation Standard tibial cutting block (Ref ) MIS tibial cutting block left side (Ref ) MIS tibial cutting block left side (Ref ) Parallel positioning holes MIS guide Alignment rod holes Parallel positioning holes Standard guide Parallel positioning hole MIS guide Alignment rod holes 16 1

17 7 EXTENSION GAP CONTROL Follow the procedure described in the dedicated GMK Efficiency surgical technique. 8 ANTERIOR CUT, POSTERIOR CUT AND CHAMFERS To perform the anterior, posterior and chamfer resections the GMK Efficiency 4in1 cutting block of the planned femoral size is required. The 4in1 cutting block can be fixed to the femur by the following methods: Further stabilization can be obtained using oblique fixation holes or cancellous bone screw holes, as indicated in the figure below. Anterior reference Femoral peg reference 8.1 Anterior Reference After the MyKnee femoral PPS block has been removed from the femur and the distal resection has been performed (see 5.4), position the anterior referenced parallel pins into the corresponding holes using the dedicated pin impactor. Slide the predetermined 4in1 cutting block onto the femur along the corresponding zero reference line indicated on the 4in1 cutting block. 4in1 cutting block holes Parallel positioning (Anterior Referencing) Oblique fixation holes Cancellous bone screw holes Once the 4in1 cutting block has been properly fixed to the femur, visually double check the cut height using the standard angel wing before cutting. Check the correct femoral external rotation of the 4in1 cutting blocks using the rotation guide (horseshoe). To perform the cuts, follow the procedure described in the dedicated GMK Efficiency surgical technique. TIP Parallel positioning holes (Anterior Referencing) The anterior reference method allows for correction of the 4in1 cutting block position. To correct the position move the block onto a different row of parallel pin holes as indicated in the picture below. 17

18 MyKnee Surgical Technique Hip Knee Spine Navigation 8.2 Femoral Peg Reference After the femoral PPS block has been removed from the femur and the distal resection has been performed (see 5.4), assemble the pegs to the 4in1 cutting block of the correct size and position the guide flush to the distal resection respecting the corresponding pre-drilled holes. 4in1 cutting block Parallel +2/-2mm repositioning holes (Anterior Referencing) Femoral peg holes The posterior reference method DOES NOT allow the 4in1 cutting block position to be corrected. Once the 4in1 cutting block has been properly fixed to the femur, visually double check the cut height using the standard angel wing before cutting. Check the correct femoral external rotation of the 4in1 cutting blocks, using the rotation guide (horseshoe). To perform the cuts, follow the procedure described in the dedicated GMK Efficiency surgical technique. 18 1

19 9 FEMORAL FINISHING Follow the procedure described in the dedicated GMK Efficiency surgical technique. 10 TIBIAL FINISHING Follow the procedure described in the dedicated GMK Efficiency surgical technique. 11 PATELLA Follow the procedure described in the dedicated GMK Efficiency surgical technique. 12 TRIALS Follow the procedure described in the dedicated GMK Efficiency surgical technique. 13 SELECTION OF THE PROSTHETIC COMPONENTS - SIZE MATCHING Follow the procedure described in the dedicated surgical technique of the Medacta knee implant. 14 FINAL IMPLANTS Follow the procedure described in the dedicated surgical technique of the Medacta knee implant. 19

20 MyKnee Surgical Technique Hip Knee Spine Navigation 15 MYKNEE PPS FEMORAL BLOCKS EFFICIENCY The following table summarises the MyKnee Efficiency PPS block reference codes, depending on the knee undergoing surgery (Right or Left). The references are divided into non-sterile and sterile versions. Description NON-STERILE Reference N. STERILE Reference N. MyKnee Efficiency STD Femur PPS - MRI - Left - Size S MyKnee Efficiency STD Femur PPS - MRI - Left - Size S MyKnee Efficiency STD Femur PPS - MRI - Left - Size S MyKnee Efficiency STD Femur PPS - MRI - Left - Size S MyKnee Efficiency STD Femur PPS - MRI - Left - Size S MyKnee Efficiency STD Femur PPS - MRI - Left - Size S MyKnee Efficiency STD Femur PPS - MRI - Left - Size S MyKnee Efficiency STD Femur PPS - MRI - Left - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Left - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Left - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Left - Size M SM FEMUR MRI MEDIAL/LATERAL APPROACH MyKnee Efficiency STD Femur PPS - MRI - Left - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Left - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Right - Size S MyKnee Efficiency STD Femur PPS - MRI - Right - Size S MyKnee Efficiency STD Femur PPS - MRI - Right - Size S MyKnee Efficiency STD Femur PPS - MRI - Right - Size S MyKnee Efficiency STD Femur PPS - MRI - Right - Size S MyKnee Efficiency STD Femur PPS - MRI - Right - Size S MyKnee Efficiency STD Femur PPS - MRI - Right - Size S MyKnee Efficiency STD Femur PPS - MRI - Right - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Right - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Right - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Right - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Right - Size M SM MyKnee Efficiency STD Femur PPS - MRI - Right - Size M SM 20 2

21 16 MYKNEE PPS TIBIAL BLOCKS The following table summarises the MyKnee PPS tibial block reference codes, depending on the surgical approach (medial or lateral) and the knee undergoing surgery (Right or Left). The references are divided into non-sterile and sterile versions. Description NON-STERILE Reference N. STERILE Reference N. TIBIA MRI MEDIAL APPROACH TIBIA MRI LATERAL APPROACH MyKnee Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee Tibial Pin Positioner Block - MRI Right Lateral - Size S 21

22 MyKnee Surgical Technique Hip Knee Spine Navigation Description NON-STERILE Reference N. STERILE Reference N. MyKnee MIS Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Medial - Size S TIBIA MRI MEDIAL APPROACH TIBIA MRI LATERAL APPROACH MyKnee MIS Tibial Pin Positioner Block - MRI Left Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Medial - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Left Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Lateral - Size S MyKnee MIS Tibial Pin Positioner Block - MRI Right Lateral - Size S 22 2

23 Part numbers subject to change. N O T E F O R S T E R I L I S A T I O N Note for sterilization: in case the instrumentation is not sterile upon delivery, it must be cleaned before use and sterilized in an autoclave respecting the US regulations, directives where applicable and following the instructions for use of the autoclave manufacturer. For detailed instructions please refer to the document Recommendations for cleaning decontamination and sterilization of Medacta International reusable orthopedic devices available at Medacta, GMK and MyKnee are registered trademarks of Medacta International SA, Castel San Pietro, Switzerland. 23

24 MyKnee Surgical Technique Hip Knee Spine Navigation Medacta International SA Strada Regina Castel San Pietro Switzerland Phone Fax info@medacta.ch D I S T R I B U T E D Medacta USA, Inc West Carroll Avenue - Chicago Illinois Phone Fax info@medacta.us.com BY MyKnee PPS Efficiency Surgical Technique ref: 99.MY26E.12PPSUS rev. 00 Last update: November