KneeTec PFJ. Surgical Technique

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1 KneeTec PFJ KneeTec PFJ Surgical Technique

2 CONTENTS INDICATIONS p.3 CONTRAINDICATIONS p.4 INSTRUCTION FOR USE p.5 Anterior Resection p.6 Sizing and Positioning p.11 Femoral Preparation p.14 Distal and Chamfer Preparation p.16 Adjustment of the preparation p.17 Trials p.19 Patellar Preparation p.20 Cementing Technique p.22 IMPLANTS p.23 INSTRUMENTATION p.24 TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 2

3 INDICATIONS INDICATIONS The replacement of the patellofemoral joint w ith the KNEETEC PFJ device is indicated in the case of symptoms and serious signs affecting daily activities involving the joint: Serious degenerative arthritis, of the patellofemoral joint, Failure of conservative procedures (realignment, arthroscopy, transfer of the tibial tuberosity) w ith the persistence of joint pain or dysfunction, Patellofemoral dislocation (dysplastic or other origin), Post-traumatic arthritis (patellar fracture). The KNEETEC PFJ patellofemoral prosthesis is intended for cemented use only.. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 3

4 CONTRAINDICATIONS CONTRAINDICATIONS Patella Baja. Patella Alta. Algodystrophy.- Local pain syndrome. Arthrofibrosis. Poor axis alignment. Flexion deformation. Flexion limitation (clearance < 90 ). Early onset of chondral disease (pain syndrome of the anterior knee). Arthritis of the femorotibial joint. Systemic infection, fever and/or local inflammation. Poor bone stock or poor skin coverage around the knee joint that w ould make the procedure unjustifiable. Elevation of sedimentation rate unexplained by other disease, elevation of WBC count. Distant foci of infection from genitourinary, pulmonary, skin and other sites, dental focus infection w hich may cause hematogenous spread to the implant site. Bone immaturity. Inadequate neuromuscular status. Neuromuscular or psychiatric disorders w hich might jeopardize fixation and postoperative care. Know n allergy to one of the materials. Patient pregnancy. Recommendations The extensor system must be verified and if necessary corrected. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 4

5 INSTRUCTION FOR USE Drill Bit Dia. 3.5 mm for pegs, Reamers Dia. 9 mm Dia. 6 mm & Pin driver Drills and Reamers have a quick attachment mechanism either of t he Stryker- Zimmer-Hall type to connect to the Stryker-Zimmer-Hall tip, or of the type to connect to a Jacob mandrel through the trepan part that is at the end of the drill bit. Before use, check that Drill and Reamer are not bent since t hat may excessively stress the Drill, Reamer, motor or drill guide. During its first insertion be sure to be in the central axis of the hole before drilling to avoid any tw isting of the Drill or Reamer w hich could cause bending or even breakage of the instrument. Saw blades: The saw blades that have been included have various types of at tachment w hich correspond to different type of drills on the market. It is important that the correct attachment type be used for proper functioning of the saw blade. Before use, be sure to check that the saw blade is not bent since that may excessively stress the saw blade, motor or slot. During its insertion be sure to be in the central axis of the slots before cutting to avoid any tw isting of the saw blade w hich could cause bending or even breakage of the saw blade. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 5

6 Approach is function of surgical habits. After incision, identify and draw the trochlear line. Coupe antérieure ANTERIOR RESECTION The Anterior Cutting Guide has a slot w hich can be adjustable: 1/ Unscrew the screw w ith the screw driver. 2/ Adjust the assembly in order to have the peg at the same. level than the Support. 3/ Screw the screw. 4/ Assemble the Stylus on the Anterior cutting Guide. 5/ Adjust the level of the resection at 0. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 6

7 Put the Anterior Stylus on the anterior cortex. The Anterior Cutting Guide must be in contact w ith both distal condyles. 1/ Drill the Intra-Medullary canal w ith the Drill Bit Dia.3.5mm. 2/ Insert the IM Nail. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 7

8 1/ Assemble the EM Alignment Guide. 2/ Adjust the Neutral Femoral External Rotation. 3/ Mark the neutral position 0. 4/ If necessary, adjust the external rotation by rotating the EM Guide. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 8

9 The central hole allow s to check the definitive resection: Use the Drill Bit Dia.3.5mm. Insert the Drill (engine off) into the hole. Start drilling once the Drill is in contact w ith the cartilage. The exit of the Drill Bit corresponds to the exit of the Saw blade 1/ Drill the more appropriate hole w ith the Drill Bit Dia. 3.5mm in order to avoid any damage of the cartilage. 2/ Insert a Smooth Pins Dia. 3.5mm L.50mm. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 9

10 The anterior resection can be adjusted + /-2mm. Insert the Resection Check in the slot in order to check the level of the resection. If necessary: 1/ Unscrew the screw on the Cutting Guide w ith the screw driver. 2/ Adjust the thickness of the resection by screw ing the superior w heel until the chosen value. 3/ Screw the screw on the Cutting Guide w ith the screw driver. The anterior Resection can be performed TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 10

11 2. POSITIONING AND SIZING The instrumentation is designed to help the surgeon to position the implant in order to have a smooth contact betw een the trochlear component and the native condyles Use of the positioning frame according to the side (Left or Right). Adjust the position of the screw s according to the size of the femur: Screw s on the bottom for Small Knees Screw s on the top for Large knees 1/ Position the Positioning Frame on the anterior resection. 2/ Position the Frame in order to be aligned w ith the distal limit of the resection (Flush Line). Accurate alignment can be done w ith the Distal Stabilization Screw s. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 11

12 The Trochlear Orienting Frame could help to visualize the Flush Line for small knees. 2/ Adjust the medio-lateral position taking account the center of the intercondylar notch and the cover of the resection. Check and validate the Flush Line. 4/ Sizing: The sizing can be done according to the top of the frame but all the femoral preparation is the same w hatever the size, so the sizing can be modified during or at the end of the surgery. Size 4 Size 3 Size 2 Size 1 TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 12

13 The tip gives the orientation of the trochlear line, for information only. CAUTION In case of alignment w ith the natural trochlear groove, the implant can be mal-aligned w ith the Flush line, it could be necessary to find a compromise betw een the flush line and the trochlear orientation. Once the position is chosen, the positioning Frame can be secured w ith 3 Self Tapered Screw s L.25mm; these screw s are screw ed w ith the Pin Driver. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 13

14 3. FEMORAL PREPARATION Assemble the Distal Reaming Guide on the Box Reaming Frame (Right or Left), Locking system on the open position. Once inserted, lock the system. OPEN LOCKED Assemble the assembly on the Trochlear Frame. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 14

15 Start Reaming all the holes w ith the reamer Dia. 9mm. 1/ Unlock the Box Reaming Guide. 2/ Turn the Guide upside dow n. 3/ Lock the Guide. Start Reaming again. All the holes have to be done. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 15

16 4. DISTAL AND CHAMFER PREPARATION 1/ Assemble the Distal Reaming Guide on the Positioning Frame. 2/ Ream the chamfer w ith the Reamer Dia. 6mm. 3/ Ream the Distal Part w ith the Reamer Dia. 6mm. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 16

17 5. ADJUSTMENT OF THE PREPARATION Remove all the assembly. The Rasp allow s you to remove all the residual bone after reaming. 1/ Screw the 4 Drilling Guides for Pegs onto the Femoral Drill Guide (size 1 and 3 are available and allow s you to check the positioning, but all definitive sizes fit the preparation). TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 17

18 2/ Check the size and the position of the Guide on the anterior resection and on the preparation: - No overhang of the implant. - Respect of the flush line. If necessary use the rasp to adjust the positioning of this Guide, until you are flush w ith the distal condyles and until the guide is stable. Pegs preparation: 1/ Drill the central proximal holes first w ith the Drill Bit for pegs. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 18

19 2/ Stabilize the Femoral Drill guide w ith the Stabilization peg. 3/ Drill the central hole. 4/ Stabilize the guide w ith another Stabilization peg. 5/ Drill the 2 other holes. 6. TRIALS Use trochlear trials. It allow s you to check the position of the trochlear component. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 19

20 7. PATELLAR PREPARATION For patellar preparation use the HLS KneeTec Box YKAG95. Exposure of the patella. Measure the thickness of the patella. Determine resection level: -Restoration of the initial thickness of the patella minus 1 or 2 mm. Patellar components are 7mm for XS and S; and 8.5mm for M and L. -Resection that leaves a remnant of 12 mm thickness. Resection plane: resection should be performed parallel to the anterior cortex and should provide an equal residual thickness (to achieve this, more bone is generally removed medially than laterally). TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 20

21 The impaction clamp or the patella drill guide can be used to perform the slots associated w ith the patellar drill bit. The various sizes of patellar rings could help to center the slots. Assemble the ring on the clamp or guide. Perform the 3 holes, one laterally, and 2 medially. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 21

22 8. CEMENTING TECHNIQUE Cement the Trochlear implant. Use the Femoral Impactor to impact the definitive trochlear implant.. Position the patella into the previously drilled holes. Tighten and maintain the patella in position w ith the Patellar Impaction Clamp. TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 22

23 IMPLANTS IMPLANTS FEMORAL COMPONENT GDI401 Femoral Component Size 1 Right GDI402 Femoral Component Size 2 Right GDI403 Femoral Component Size 3 Right GDI404 Femoral Component Size 4 Right GDI411 Femoral Component Size 1 Left GDI412 Femoral Component Size 2 Left GDI413 Femoral Component Size 3 Left GDI414 Femoral Component Size 4 Left PATELLA GDI119 Patellar Component XXS KneeTec PFJ GDI120 Patellar Component XS HLS KneeTec GDI121 Patellar Component S HLS KneeTec GDI122 Patellar Component M HLS KneeTec GDI123 Patellar Component L HLS KneeTec TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 23

24 INSTRUMENTATION YKAG98 Femoral Preparation Box Ref. Désignation Qté N Inferior Tray MDU730 Rasp 1 1 MWB012 Hexagonal screwdriver 3,5 mm 1 2 MDI376 Pin extractor 1 3 MDI390 EM Alignment Guide 1 4 MDI387 Anterior Stylus 1 5 MDI424 Femoral Impactor 1 6 MDU557 Oscillat saw blade 1,2mm Aesculap 1 7 MDU558 Oscillat saw blade 1,2mm Hall-Linvatec 1 7 MDU559 Oscillat saw blade 1,2mm AO 1 7 MDU560 Oscillat saw blade 1,2mm Stryker B 1 7 MDI394 Trochlear Orienting Frame 1 8 MDI399 Box Reaming Guide 1 9 MDI421 Reamer Dia. 9mm 1 10 MDI420 Reamer Dia. 6mm 1 11 MDI422 Drill Bit for Pegs 1 12 MDI386 IM Nail 1 13 MDI425 Drilling Guide for Pegs 4 13 MDI427 Trial Patellar XXS 1 13 MDI491 Stabilization Peg 2 13 MDI339 Smooth Pin Dia. 3,5mm L. 50 mm KEA060 Pin Driver Quick Connect 1 13 MVV665 Self Tapered Screw L. 25mm 4 13 MDI490 Drill Bit Dia. 3.5 mm 2 13 MDI423 Resection Check 1 13 TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 24

25 INSTRUMENTATION Ref Name Qty # Superior Tray Left MDI392 Positioning Frame Left 1 1 MDI393 Distal Stabilization Screw 2 2 MDI493 Anterior Cutting Guide Left 1 3 MDI396 Distal Reaming Guide Left 1 4 MDI398 Box Reaming Frame Left 1 5 MDI411 Femoral Trial S1 Left 1 6 MDI412 Femoral Trial S2 Left 1 6 MDI413 Femoral Trial S3 Left 1 6 MDI481 Femoral Drill Guide S1 Left 1 7 MDI483 Femoral Drill Guide S3 Left 1 7 Superior Tray Right MDI391 Positioning Frame Right 1 8 MDI393 Distal Stabilization Screw 2 9 MDI492 Anterior Cutting Guide Right 1 10 MDI395 Distal Reaming Guide Right 1 11 MDI397 Box Reaming Frame Right 1 12 MDI401 Femoral Trial S1 Right 1 13 MDI402 Femoral Trial S2 Right 1 13 MDI403 Femoral Trial S3 Right 1 13 MDI471 Femoral Drill Guide S1 Right 1 14 MDI473 Femoral Drill Guide S3 Right 1 14 TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 25

26 INSTRUMENTATION YKAG95 Patellar Preparation Box Ref. Name Qty # MDI133 Patellar Impaction Clamp 1 1 MDI132 Patellar Resection Clamp 1 2 MDI380 Patellar Drill Guide 1 3 MDI381 Patellar Ring Extra Small 1 4 MDI382 Patellar Ring Small 1 5 MDI383 Patellar Ring Medium 1 6 MDI384 Patellar Ring Large 1 7 MDI128 Patellar Drill Bit Dia. 7mm 1 8 MDI120 Trial Patellar Extra Small 1 9 MDI121 Trial Patellar Small 1 10 MDI122 Trial Patellar Medium 1 11 MDI123 Trial Patellar Large 1 12 TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 26

27 US HEADQUARTERS INTERNATIONAL HEADQUARTERS Tornier, Inc. Tornier SAS Nesbitt Avenue South 161 rue Lavoisier Bloomington, MN Montbonnot Saint Martin USA France Tel Tel (0) w w.tornier.com TORNIER Temporary Surgical Technique KneeTec PFJ - UGPT112 27

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