TOTAL KNEE ARTHROPLASTY SYSTEM

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1 SURGICAL TECHNIQUE TOTAL KNEE ARTHROPLASTY SYSTEM 90-SRK B.0 0

2 Contents 1. Implant Sizing 2. Surgical Technique a. Incision and Exposure b. Distal Femoral Resection c. Tibial Resection d. Femoral Sizing e. Femoral Chamfer Cutting f. Trialing g. Femoral Preparation h. Tibial Preparation i. Patellar Resection and Preparation j. Final Component Implantation k. Closure l. Appendix I: A/P Adjustment of Femoral Chamfer Cutting m. Appendix II: PS Femoral Preparation n. Appendix III: Tibial Tray Extraction 3. Instrument Set 4. Reorder List 5. Instructions for Use 1

3 1. Implant Sizing CR/CS Femoral Components Patellas Size AP Length ML Width Height PS Femoral Components Size Major Minor Diameter Diameter Thickness Oval Oval Oval Oval Round Round Round Round Poly Inserts Size AP Length ML Width Height Tibial Trays Size ML Width AP Length Thickness Height Size ML Width AP Length Stem Height *NOTE - Poly Inserts defined by both a size profile and a thickness. Poly Inserts offered in CR, UCCS, PS, and MPCS families. The MPCS is offered in right and left options. 2

4 2. Surgical Technique a) Incision and Exposure The Responsive Orthopedics Total Knee Arthroplasty Instruments are designed for a standard, medial parapatellar surgical approach. Incision and exposure should be performed according to the surgeon s preference. b) Distal Femoral Resection Remove intercondylar osteophytes. With the knee in flexion, use the Femoral Drill to access the femoral intramedullary canal slightly medial of the center of the intercondylar notch and 1cm above the origin of the PCL. Attach the T-Handle to the IM Rod. Collar of T-Handle should line up with groove on the IM Rod when fully attached. Slide on the Distal Femoral Angle Guide. Insert the IM Rod into the intramedullary canal and adjust the Distal Femoral Angle Guide so that it rests on the condyles. 3

5 Adjust the varus/valgus resection angle by squeezing the trigger and rotating the pointer until it indicates the desired angle from 0 to 9. Move the pointer towards the R for right knees, and the L for left knees. To lock the varus/valgus angle, push the locking tab on the side down towards the trigger. To unlock, push it up towards the pointer. Slide the bone-facing side of the Distal Femoral Angle Guide towards the femur until it touches. Optionally, use the lower or upper set of pin holes and a threaded headed pin to hold in place. Attach a Distal Femoral Cutting Guide to the Distal Femoral Resection Guide. Choose either 0 or 3 of distal femoral flexion as appropriate. Drop the Distal Femoral Resection Guide onto the Distal Femoral Angle Guide by lining up the two posts on top of the Distal Femoral Angle Guide with the two holes through the Distal Femoral Resection Guide. 4

6 Rotate the knob on the Distal Femoral Resection Guide to set the resection depth. Read the depth by aligning the tick marks on the knob with the thick line centered on the top of the Distal Femoral Resection Guide. The femoral implants are all 9mm thick distally. Once resection depth has been set, pin the Distal Femoral Cutting Guide in place. Use non-headed pins through the 0, +2 or -2 holes to allow for adjustments in resection depth, or use headed threaded pins in the off-axis holes to lock the Distal Femoral Cutting Guide in place (shown). Remove the IM Rod, Distal Femoral Angle Guide and Distal Femoral Resection Guide by pulling back on the lock on the Distal Femoral Resection Guide while sliding all three instruments away from the femur in the same direction as the IM Rod. Resect the femoral condyles by cutting through one of the two slots. Use the 0 slot to resect at the same depth as read on the knob. Use the +4 slot to resect an additional 4mm of bone. 2mm adjustments can be made by using the +2 or -2 pin holes. *NOTE The Distal Femoral Resection Guide is designed to be used with a saw blade that is 1.27 mm thick. 5

7 c) Tibial Resection Assemble the Tibial Alignment Guide. Slide the Ankle Clamp into the dovetail on the Tibial Alignment Guide and lock by rotating the far knob. Attach a Tibial Cutting Block to the Tibial Alignment Guide by aligning the two pegs on the Tibial Alignment Guide to the two large holes in the Tibial Cutting Block and pushing them together until the Tibial Cutting Block snaps in place. Use either the Tibial Cutting Block, Right or Symmetric for a right knee and either the Tibial Cutting Block, Left or Symmetric for a left knee. Attach the Tibial Resection Stylus to the cutting block by sliding the post into the hole on the top of the Tibial Cutting Block until it snaps into place. Select the corresponding stylus for either 10mm of resection from the more prominent side or 2mm of resection from the more deficient side. *NOTE - the minimum combined thickness of the Poly Insert and Tibial Tray is 10mm. 6

8 Place the knee in flexion and place the Ankle Clamp around the malleoli. Adjust the varus/valgus angle by sliding the Tibial Alignment Guide relative to the Ankle Clamp. The up-rod of the Tibial Alignment Guide should fall approximately 6mm medial of center at the ankle, centered on the distal tibial anterior crest. For reference, the tick marks are spaced at 5mm. Tighten the far knob to lock. Adjust the posterior slope by sliding the uprod away from the Ankle Clamp. The Poly Inserts have a built-in 3 of posterior slope. To maintain that slope, slide two fingers between the uprod and the patient s leg and set the uprod parallel to the tibia. The tick marks represent 1 of posterior slope when the uprod is in the middle of its motion range. Tighten the angled knob to lock the angle. Uprod Lock Posterior Slope Lock Varus/Valgus Lock 7

9 Place the Tibial Cutting Block against the tibia with the Tibial Resection Stylus in the center of the chosen side of the tibia. Secure the Tibial Cutting Block to the bone with non-headed pins through the 0, +2 or -2 holes to adjust resection depth, or use the lower off-axis pin hole with threaded headed pins to lock the Tibial Cutting Block in place. Remove the Tibial Alignment Guide by pressing the button near the Tibial Cutting Block and pulling the Ankle Clamp off of the patient. Remove the Tibial Resection Stylus by squeezing the button on the post and pulling upwards. Resect the tibia by cutting through the slot to maintain the resection depth of the the Tibial Resection Stylus, or on the top face of the Tibial Cutting Block to resect 4mm less. 2mm depth adjustments can be made using the +2 or -2mm holes. *NOTE: The Tibial Cutting Block is designed to be used with a saw blade that is 1.27 mm thick 8

10 d) Femoral Sizing Rotate the locking tab on the Femoral Sizer clockwise to unlock; (shown) pull the stylus and feet apart to open the Femoral Sizer to its maximum height. Slide the feet under the condyles and push the main body of the Sizer so that it sits flush against the resected distal femur. Slide the stylus so that the pointers match the size predicted from templates. Rotate the stylus so that it is touching the anterior cortex just superior to the trochlea. The stylus tip indicates the location of the anterior tip of a Femoral Component of the indicated size. With the stylus touching the femur, read the size from the windows on the distal face of the Femoral Sizer. Tick marks indicate sizes. To lock the Femoral Sizer in place, rotate the locking tab counterclockwise to the position shown. 9

11 Use the Cutting Block Drill to drill two holes into the distal femur through the holes on the Femoral Sizer. Use the holes marked 3R for right knees, and 3L for left knees. This will place the chamfer cuts in 3 degrees of external rotation off the posterior condyles. *NOTE: the holes are centered between the anterior cortex and the posterior condyles, so if a different size Femoral Component is chosen during chamfer cutting or after trialing, the AP position of the holes does not need to be adjusted. 10

12 e) Femoral Chamfer Cutting Choose the same size 4-in-1 Cutting Block as indicated by the Femoral Sizer, and align the spikes with the holes drilled. If necessary, use a mallet on the 4-in-1 Cutting Block so that it is flush to the resected distal femur. The width of the anterior and posterior sections of the Block is equal to the width of the corresponding Femoral Component. Implant Width The Angel Wing can be inserted into the slots to visualize the cuts. The longer side represents the position of the anterior flange of a size 4 Femoral Component. *NOTE: For A/P adjustment of the 4-in- 1 Cutting Block, see Appendix I. Use two threaded headed pins with the two off-axis holes in the 4-in-1 Cutting Block to lock it in place. Make the four resection cuts through the slots in the 4-in-1 Cutting Block. Once complete, remove the two pins and the 4-in-1 Cutting Block. *NOTE: For PS notch resection, see Appendix II. *NOTE: The 4-in-1 Cutting Block is designed to be used with a saw blade that is 1.27 mm thick. 11

13 f) Trialing Choose the appropriate Femoral Component Trial that matches the size of the 4-in-1 Cutting Block and either left or right. Position the Femoral Component Trial onto the resected femur by hand or with the Femoral Inserter/Extractor. Squeeze the blue pad to engage the locking arms of the Femoral Inserter/Extractor with the Femoral Component Trial, and then tighten the lock knob to secure the Trial. Lock Knob Use the Femoral Condyle Impactor and/or the Femoral Notch Impactor to impact the trial until it sits flush with the resection cuts. 12

14 Size the tibia by choosing one of the Tibial Tray Trials and attaching the Tibial Tray Trial Holder. Push the central post into the rectangular hole on the anterior side of the Tibial Tray Trial, and press together until the Tibial Tray Trial snaps in place. Rotate the blue knob of the Tibial Tray Trial Holder clockwise to lock the Tibial Tray Trial in place. Place the Tibial Tray Trial onto the resected tibia to check the size. Position the Tibial Tray Trial so that it maximizes coverage without overhang. If there is too little coverage or too much overhang, switch up or down a size. *NOTE: The IM Rod can be inserted through the hourglass hole in the Tibial Tray Trial Holder to check the angle of the tibial resection cut. 13

15 Poly Trial Selection: Always choose a Poly Trial that is the same size as the Femoral Component. The color of the Poly Trial must match the colored insert on the Femoral Component Trial. The Poly Insert does not need to be the same size as the Tibial Tray, and the locking feature allows for upsizing and downsizing. onto the anterior lip to lock the Poly Trial in place. Keel Punch Guide - Floating: Insert the Keel Punch Guide - Floating into the Tibial Tray Trial. Slide the chosen Poly Trial onto the Tibial Tray Trial posterior-edge down until the posterior locking tabs engage. Push down on the anterior lip to lock the Poly Trial in place. Slide the Tibial Tray Trial/Poly Trial assembly onto the resected tibia. Flexing the knee can help the Poly Trial slide past the Femoral Component Trial. Keel Punch Guide - Spiked: Position the Tibial Tray Trial on the resected tibia to maximize coverage. Pulling the lower leg anterior may help access the tibia. Align the spikes on the Keel Punch Guide - Spiked with the Tibial Tray Trial, and mallet on the Keel Punch Guide - Spiked until it is fully seated on the Tibial Tray Trial. Insert the Poly Trial by sliding the posterior edge along the Tibial Tray Trial and then pressing down 14

16 Trial the knee by extending the knee carefully while checking the stability and alignment. If the knee has instability, switch to a thicker Poly Trial. If the knee cannot reach full extension, switch to a thinner Poly Trial. The knee should maintain stability in flexion while reaching full extension. Use the Poly Trial Removal Tool to pry out the Poly Trial through the anterior removal feature. If using the Keel Punch Guide - Floating, mark the position of the Tray Trial by marking the bone at the lines on the Tray Trial. Remove the Poly Trial (and the Tray Trial if using the Keel Punch Guide - Floating). 15

17 g) Femoral Preparation Drill the lug holes through the Femoral Component Trial using the Femoral Lug Drill. Remove the Femoral Component Trial using the Femoral Inserter/Extractor by clamping onto the notches at the medial and lateral sides of the trial. Squeeze the blue pad to engage the Inserter/Extractor, tighten the lock knob to secure the trial, and hit the mallet surface to pull off the Femoral Component Trial. While squeezing the blue pad, loosen the lock knob, then release the blue pad to release the Femoral Component Trial. 16

18 h) Tibial Preparation If using the Keel Punch Guide - Floating, place the Tibial Tray Trial back onto the tibia using the markings on the Trial for orientation. Insert two threaded headed pins through the holes in the Keel Punch Guide to lock the Tray Trial in place. Select the appropriate Keel Punch (1-2 for Tibial Tray sizes 1 & 2, 3-6 for Tibial Tray sizes 3, 4, 5 & 6) and align the tip of the Keel Punch with the cruciform cutout in the Keel Punch Guide. Use a mallet to drive the Keel Punch into the bone until the top surfaces of the Keel Punch cruciform sit flush to the Keel Punch Guide. Use a mallet to hit upwards on the Keel Punch for removal. Remove the pins. Remove the Tibial Tray Trial using the Tibial Tray Trial Holder. If necessary, pry the Keel Punch Guide - Spiked out of the Tibial Tray Trial utilizing the two slots medial and lateral of the center of the Keel Punch Guide - Spiked. 17

19 i) Patellar Resection and Preparation Measure the patellar thickness with the Patella Caliper. Rotate the black cap to lock or unlock the Patella Caliper. Clamp the Patella Resection Guide onto the everted patella. Place the desired depth guide so that it is touching the most prominent point on the patella. The numbers on the tabs represent resection depth in millimeters. Refer to the Implant Sizing section for thickness of the components. Squeeze the handles together and then tighten the speed lock to secure the Patella Resection Guide in place. Cut across the top surface of the Patella Resection Guide to resect the patella. Unscrew the speed lock to unlock the Patella Resection Guide. Snap the appropriate Patella Drill Guide onto the Patella Clamp Handle. Use the Patella Drill Guide Oval for Patella, Oval Components, and the Patella Drill Guide Round for Patella, Round Components. 18

20 Position the Patella Drill Guide onto the resected patella so that the handle extends straight in the medial/lateral plane from the medial edge of the patella. Use the markings on the Patella Drill Guide to choose the appropriate size Patella Component and check bone coverage. When satisfied, squeeze the bottom handle to clamp the Patella Drill Guide in place. Use the Patella Lug Drill to drill the three lug holes in the patella. Release ratchet bar to unlock the Patella Clamp Handle. Use the Patella Puck to confirm bone coverage and protect the resected patella during trialing. Align lugs with the lug holes from resection. Lugs are identical across all patella implants so upsizing / downsizing are permitted. 19

21 j) Final Component Implantation Tibial Tray: Apply bone cement to the surface of the resected tibia and/or the bonefacing surface of the Tibial Tray. Press the Tibial Tray into place by hand. Use the Tibial Tray Impactor with a mallet for final seating of the Tibial Tray. Remove any excess bone cement. If removal of the Tibial Tray is necessary, use the Tibial Tray Extractor to pry the Tibial Tray away from the Tibia. 20

22 Femoral Component: Apply bone cement to the surface of the resected femur and/or the bonefacing surfaces of the Femoral Component. Attach the Femoral Component to the Femoral Inserter/Extractor in the same manner as the Femoral Component Trials. Place the Femoral Component onto the femur, lining up the lugs with the lug holes. Lightly tap the back of the Femoral Inserter/Extractor if necessary. Impact the Femoral Component with the Femoral Condyle Impactor and/or the Femoral Notch Impactor for final seating. Remove any excess bone cement. Should removal of the Femoral Component be required, attach the Femoral Inserter/Extractor and mallet on the underside of the handle. 21

23 Poly Insert: Slide the posterior edge of the Poly Insert along the Tibial Tray. Push as far posterior as possible, applying force to the anterior surface of the Poly Insert. Use the Poly Impactor to seat the Poly Insert, aligning the tip of the Poly Impactor with the patellar relief on the Poly Insert and holding at a 45 degree angle. Strike the Poly Impactor with a mallet to snap the Poly Insert in place. When fully implanted, the bottom surface of the Poly Insert should sit flush to the polished top surface of the Tibial Tray. Should removal of the Poly Insert be required, use the Poly Removal Tool by lining up the two tines with the two reliefs on the inferior edge of the Poly Insert. Use a mallet to drive the Poly Removal Tool posteriorly, wedging the Poly Insert up off the Tibial Tray. 22

24 Patella: Apply bone cement to the resected patellar surface and/or the Patella Component. Align the lugs to the three lug holes drilled in the patella. If using a Patella, Oval Component, the major axis should be oriented in the medial/lateral direction. Snap the Cement Clamp onto the Patella Clamp Handle. Position the plastic Cement Clamp on the Patella Component and squeeze to lock the handle in place. Remove all excess bone cement. Leave the Cement Clamp compressed until the bone cement has set. k) Closure Prior to closing, confirm proper implant placement and knee kinematics. Closure should be performed according to the surgeon s preference. 23

25 l) Appendix I: A/P Adjustment of Femoral Chamfer Cutting If the position of the 4-in-1 Cutting Block based on the holes drilled through the Femoral Sizer needs to be adjusted, remove the 4-in-1 Cutting Block from the femur and align the spikes on the 4-in-1 AP Adjustment Guide with the drilled holes. *NOTE: If new holes to drill would fall too far medral or lateral, rotate the 4-in-1 Adjustment Guide 180. Push the spikes into the drilled holes, using a mallet if necessary. Use the Cutting Block Drill to drill through the upper holes to move chamfer cuts 2mm anterior or through the lower holes to move the chamfer cuts 2mm posterior. Use cutouts on the top and bottom of the 4-in-1 AP Adjustment Guide to remove from the bone. Insert the spikes on the 4-in-1 Cutting Block into the newly drilled holes and continue with chamfer cutting. 24

26 m) Appendix II: PS Femoral Preparation Position the Notch Cutting Guide of the same size as the 4-in-1 Cutting Block on the resected femur. The anterior curves of the Notch Cutting Guide are identical to the anterior flange of the matching PS Femoral Component (either Right or Left), and the overall width of the Notch Cutting Guide is identical to the ML width of the matching PS Femoral Component. Lock the Notch Cutting Guide in place with pins through the holes. Cut the PS box with the saw anterior to the femur, cutting along the three cutting surfaces. 25

27 n) Appendix III: Tibial Tray Extraction Ensure the locking arm of the Tibial Tray Extractor is released. Position the posterior tabs of the Tibial Tray Extractor under the posterior locking feature on the Tibial Tray. Squeeze the locking arm until it clicks to lock onto the Tibial Tray. Mallet upwards on the strikeplate to dislodge and remove the Tibial Tray. Press the black button above the lock arm to release the Tibial Tray. Lock Release 26

28 3. Instrument Set Femoral Drill (9.5mm) IM Rod Distal Femoral Angle Guide Distal Femoral Resection Guide Distal Femoral Cutting Block (0, 3 ) Femoral Sizer 27

29 Cutting Block Pre- Drill 4-in-1 Cutting Block (sizes 1, 2, 3, 4, 5, 6) 4-in-1 AP Adjustment Guide Notch Cutting Guide (sizes 1, 2, 3, 4, 5, 6) Angel Wing Femoral Lug Drill 28

30 Femoral Inserter/ Extractor Femoral Condyle Impactor Femoral Notch Impactor Tibial Alignment Guide 29

31 Tibial Resection Stylus (2mm, 10mm) Tibial Cutting Block (symmetric, left, right) Tibial Tray Trial Holder Keel Punch Guide (floating, spiked) Keel Punch (1-2, 3-6) 30

32 Tibial Tray Impactor Tibial Tray Extractor Poly Impactor Poly Removal Tool Poly Trial Removal Tool 31

33 CR/CS Femoral Trial (sizes 1, 2, 3, 4, 5, 6; left/right) PS Femoral Trial (sizes 1, 2, 3, 4, 5, 6; left/right) Tibial Tray Trial (sizes 1, 2, 3, 4, 5, 6) Poly Trial (CR, UCCS, PS, MPCS; sizes 1, 2, 3, 4, 5, 6; thicknesses 10, 12, 14, 16, 18, 20; left/right for MPCS only) 32

34 Patella Resection Guide Patella Lug Drill Patella Modular Handle Patella Drill Guide (round, oval) Cement Clamp 33

35 Patella Caliper Patella Pucks (Oval 32, 35, 38, 41: Round 29, 31, 33, 36) Pins (threaded, threaded headed) Pin Power Adapter T-Handle 34

36 4. Reorder List Name CR/CS Femoral Component CR/CS Femoral Component, Size 1, Left CR/CS Femoral Component, Size 1, Right CR/CS Femoral Component, Size 2, Left CR/CS Femoral Component, Size 2, Right CR/CS Femoral Component, Size 3, Left CR/CS Femoral Component, Size 3, Right CR/CS Femoral Component, Size 4, Left CR/CS Femoral Component, Size 4, Right CR/CS Femoral Component, Size 5, Left CR/CS Femoral Component, Size 5, Right CR/CS Femoral Component, Size 6, Left CR/CS Femoral Component, Size 6, Right PS Femoral Component PS Femoral Component, Size 1, Left PS Femoral Component, Size 1, Right PS Femoral Component, Size 2, Left PS Femoral Component, Size 2, Right PS Femoral Component, Size 3, Left PS Femoral Component, Size 3, Right PS Femoral Component, Size 4, Left PS Femoral Component, Size 4, Right PS Femoral Component, Size 5, Left PS Femoral Component, Size 5, Right PS Femoral Component, Size 6, Left PS Femoral Component, Size 6, Right Tibial Tray, Size 1 Tibial Tray, Size 2 Tibial Tray, Size 3 Tibial Tray, Size 4 Tibial Tray, Size 5 Tibial Tray, Size 6 Tibial Tray Reorder Code 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

37 Poly Insert CR, Size 1, 10mm Poly Insert CR, Size 1, 12mm Poly Insert CR, Size 1, 14mm Poly Insert CR, Size 1, 16mm Poly Insert CR, Size 1, 18mm Poly Insert CR, Size 1, 20mm Poly Insert CR, Size 2, 10mm Poly Insert CR, Size 2, 12mm Poly Insert CR, Size 2, 14mm Poly Insert CR, Size 2, 16mm Poly Insert CR, Size 2, 18mm Poly Insert CR, Size 2, 20mm Poly Insert CR, Size 3, 10mm Poly Insert CR, Size 3, 12mm Poly Insert CR, Size 3, 14mm Poly Insert CR, Size 3, 16mm Poly Insert CR, Size 3, 18mm Poly Insert CR, Size 3, 20mm Poly Insert CR, Size 4, 10mm Poly Insert CR, Size 4, 12mm Poly Insert CR, Size 4, 14mm Poly Insert CR, Size 4, 16mm Poly Insert CR, Size 4, 18mm Poly Insert CR, Size 4, 20mm Poly Insert CR, Size 5, 10mm Poly Insert CR, Size 5, 12mm Poly Insert CR, Size 5, 14mm Poly Insert CR, Size 5, 16mm Poly Insert CR, Size 5, 18mm Poly Insert CR, Size 5, 20mm Poly Insert CR, Size 6, 10mm Poly Insert CR, Size 6, 12mm Poly Insert CR, Size 6, 14mm Poly Insert CR, Size 6, 16mm Poly Insert CR, Size 6, 18mm Poly Insert CR, Size 6, 20mm Poly Insert CR 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

38 Poly Insert UCCS, Size 1, 10mm Poly Insert UCCS, Size 1, 12mm Poly Insert UCCS, Size 1, 14mm Poly Insert UCCS, Size 1, 16mm Poly Insert UCCS, Size 1, 18mm Poly Insert UCCS, Size 1, 20mm Poly Insert UCCS, Size 2, 10mm Poly Insert UCCS, Size 2, 12mm Poly Insert UCCS, Size 2, 14mm Poly Insert UCCS, Size 2, 16mm Poly Insert UCCS, Size 2, 18mm Poly Insert UCCS, Size 2, 20mm Poly Insert UCCS, Size 3, 10mm Poly Insert UCCS, Size 3, 12mm Poly Insert UCCS, Size 3, 14mm Poly Insert UCCS, Size 3, 16mm Poly Insert UCCS, Size 3, 18mm Poly Insert UCCS, Size 3, 20mm Poly Insert UCCS, Size 4, 10mm Poly Insert UCCS, Size 4, 12mm Poly Insert UCCS, Size 4, 14mm Poly Insert UCCS, Size 4, 16mm Poly Insert UCCS, Size 4, 18mm Poly Insert UCCS, Size 4, 20mm Poly Insert UCCS, Size 5, 10mm Poly Insert UCCS, Size 5, 12mm Poly Insert UCCS, Size 5, 14mm Poly Insert UCCS, Size 5, 16mm Poly Insert UCCS, Size 5, 18mm Poly Insert UCCS, Size 5, 20mm Poly Insert UCCS, Size 6, 10mm Poly Insert UCCS, Size 6, 12mm Poly Insert UCCS, Size 6, 14mm Poly Insert UCCS, Size 6, 16mm Poly Insert UCCS, Size 6, 18mm Poly Insert UCCS, Size 6, 20mm Poly Insert UCCS 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

39 Poly Insert PS, Size 1, 10mm Poly Insert PS, Size 1, 12mm Poly Insert PS, Size 1, 14mm Poly Insert PS, Size 1, 16mm Poly Insert PS, Size 1, 18mm Poly Insert PS, Size 1, 20mm Poly Insert PS, Size 2, 10mm Poly Insert PS, Size 2, 12mm Poly Insert PS, Size 2, 14mm Poly Insert PS, Size 2, 16mm Poly Insert PS, Size 2, 18mm Poly Insert PS, Size 2, 20mm Poly Insert PS, Size 3, 10mm Poly Insert PS, Size 3, 12mm Poly Insert PS, Size 3, 14mm Poly Insert PS, Size 3, 16mm Poly Insert PS, Size 3, 18mm Poly Insert PS, Size 3, 20mm Poly Insert PS, Size 4, 10mm Poly Insert PS, Size 4, 12mm Poly Insert PS, Size 4, 14mm Poly Insert PS, Size 4, 16mm Poly Insert PS, Size 4, 18mm Poly Insert PS, Size 4, 20mm Poly Insert PS, Size 5, 10mm Poly Insert PS, Size 5, 12mm Poly Insert PS, Size 5, 14mm Poly Insert PS, Size 5, 16mm Poly Insert PS, Size 5, 18mm Poly Insert PS, Size 5, 20mm Poly Insert PS, Size 6, 10mm Poly Insert PS, Size 6, 12mm Poly Insert PS, Size 6, 14mm Poly Insert PS, Size 6, 16mm Poly Insert PS, Size 6, 18mm Poly Insert PS, Size 6, 20mm Poly Insert PS 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

40 Poly Insert MPCS Poly Insert MPCS, Size 1R, 10mm Poly Insert MPCS, Size 1R, 12mm Poly Insert MPCS, Size 1R, 14mm Poly Insert MPCS, Size 1R, 16mm Poly Insert MPCS, Size 1R, 18mm Poly Insert MPCS, Size 1R, 20mm Poly Insert MPCS, Size 1L, 10mm Poly Insert MPCS, Size 1L, 12mm Poly Insert MPCS, Size 1L, 14mm Poly Insert MPCS, Size 1L, 16mm Poly Insert MPCS, Size 1L, 18mm Poly Insert MPCS, Size 1L, 20mm Poly Insert MPCS, Size 2R, 10mm Poly Insert MPCS, Size 2R, 12mm Poly Insert MPCS, Size 2R, 14mm Poly Insert MPCS, Size 2R, 16mm Poly Insert MPCS, Size 2R, 18mm Poly Insert MPCS, Size 2R, 20mm Poly Insert MPCS, Size 2L, 10mm Poly Insert MPCS, Size 2L, 12mm Poly Insert MPCS, Size 2L, 14mm Poly Insert MPCS, Size 2L, 16mm Poly Insert MPCS, Size 2L, 18mm Poly Insert MPCS, Size 2L, 20mm Poly Insert MPCS, Size 3R, 10mm Poly Insert MPCS, Size 3R, 12mm Poly Insert MPCS, Size 3R, 14mm Poly Insert MPCS, Size 3R, 16mm Poly Insert MPCS, Size 3R, 18mm Poly Insert MPCS, Size 3R, 20mm Poly Insert MPCS, Size 3L, 10mm Poly Insert MPCS, Size 3L, 12mm Poly Insert MPCS, Size 3L, 14mm Poly Insert MPCS, Size 3L, 16mm Poly Insert MPCS, Size 3L, 18mm Poly Insert MPCS, Size 3L, 20mm Poly Insert MPCS, Size 4R, 10mm Poly Insert MPCS, Size 4R, 12mm Poly Insert MPCS, Size 4R, 14mm Poly Insert MPCS, Size 4R, 16mm Poly Insert MPCS, Size 4R, 18mm Poly Insert MPCS, Size 4R, 20mm Poly Insert MPCS, Size 4L, 10mm Poly Insert MPCS, Size 4L, 12mm 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

41 Poly Insert MPCS, Size 4L, 14mm Poly Insert MPCS, Size 4L, 16mm Poly Insert MPCS, Size 4L, 18mm Poly Insert MPCS, Size 4L, 20mm Poly Insert MPCS, Size 5R, 10mm Poly Insert MPCS, Size 5R, 12mm Poly Insert MPCS, Size 5R, 14mm Poly Insert MPCS, Size 5R, 16mm Poly Insert MPCS, Size 5R, 18mm Poly Insert MPCS, Size 5R, 20mm Poly Insert MPCS, Size 5L, 10mm Poly Insert MPCS, Size 5L, 12mm Poly Insert MPCS, Size 5L, 14mm Poly Insert MPCS, Size 5L, 16mm Poly Insert MPCS, Size 5L, 18mm Poly Insert MPCS, Size 5L, 20mm Poly Insert MPCS, Size 6R, 10mm Poly Insert MPCS, Size 6R, 12mm Poly Insert MPCS, Size 6R, 14mm Poly Insert MPCS, Size 6R, 16mm Poly Insert MPCS, Size 6R, 18mm Poly Insert MPCS, Size 6R, 20mm Poly Insert MPCS, Size 6L, 10mm Poly Insert MPCS, Size 6L, 12mm Poly Insert MPCS, Size 6L, 14mm Poly Insert MPCS, Size 6L, 16mm Poly Insert MPCS, Size 6L, 18mm Poly Insert MPCS, Size 6L, 20mm Patella, Oval 32 Patella, Oval 35 Patella, Oval 38 Patella, Oval 41 Patella, Round 29 Patella, Round 31 Patella, Round 33 Patella, Round 36 Patella 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

42 Instruments Femoral Drill 90-SRK IM Rod 90-SRK Distal Femoral Resection Guide 90-SRK Distal Femoral Angle Guide 90-SRK Distal Femoral Cutting Block, 0 deg 90-SRK Distal Femoral Cutting Block, 3 deg 90-SRK Femoral Sizer 90-SRK Cutting Block Drill 90-SRK in 1 Cutting Block, Size 1 90-SRK in 1 Cutting Block, Size 2 90-SRK in 1 Cutting Block, Size 3 90-SRK in 1 Cutting Block, Size 4 90-SRK in 1 Cutting Block, Size 5 90-SRK in 1 Cutting Block, Size 6 90-SRK in 1 AP Adjustment Guide 90-SRK Notch Cutting Guide, Size 1 90-SRK Notch Cutting Guide, Size 2 90-SRK Notch Cutting Guide, Size 3 90-SRK Notch Cutting Guide, Size 4 90-SRK Notch Cutting Guide, Size 5 90-SRK Notch Cutting Guide, Size 6 90-SRK Angel Wing 90-SRK Femoral Lug Drill 90-SRK Femoral Inserter/Extractor 90-SRK Femoral Condyle Impactor 90-SRK Femoral Notch Impactor 90-SRK Tibial Alignment Guide 90-SRK Tibial Ankle Clamp 90-SRK Tibial Resection Stylus - 2mm 90-SRK Tibial Resection Stylus - 10mm 90-SRK Tibial Cutting Block, Symmetric 90-SRK Tibial Cutting Block, Left 90-SRK Tibial Cutting Block, Right 90-SRK Tibial Tray Trial Holder 90-SRK Keel Punch Guide - Floating 90-SRK Keel Punch Guide - Spiked 90-SRK Keel Punch SRK Keel Punch SRK Tibial Tray Impactor 90-SRK Tibial Tray Extractor 90-SRK Poly Impactor 90-SRK Poly Removal Tool 90-SRK Poly Trial Removal Tool 90-SRK

43 CR/CS Femoral Component Trial Size 1, Right CR/CS Femoral Component Trial Size 2, Right CR/CS Femoral Component Trial Size 3, Right CR/CS Femoral Component Trial Size 4, Right CR/CS Femoral Component Trial Size 5, Right CR/CS Femoral Component Trial Size 6, Right CR/CS Femoral Component Trial Size 1, Left CR/CS Femoral Component Trial Size 2, Left CR/CS Femoral Component Trial Size 3, Left CR/CS Femoral Component Trial Size 4, Left CR/CS Femoral Component Trial Size 5, Left CR/CS Femoral Component Trial Size 6, Left PS Femoral Component Trial Size 1, Left PS Femoral Component Trial Size 2, Left PS Femoral Component Trial Size 3, Left PS Femoral Component Trial Size 4, Left PS Femoral Component Trial Size 5, Left PS Femoral Component Trial Size 6, Left PS Femoral Component Trial Size 1, Right PS Femoral Component Trial Size 2, Right PS Femoral Component Trial Size 3, Right PS Femoral Component Trial Size 4, Right PS Femoral Component Trial Size 5, Right PS Femoral Component Trial Size 6, Right Tibial Trial Size 1 Tibial Trial Size 2 Tibial Trial Size 3 Tibial Trial Size 4 Tibial Trial Size 5 Tibial Trial Size 6 Poly Trial - CR 1x10 Poly Trial - CR 1x12 Poly Trial - CR 1x14 Poly Trial - CR 1x16 Poly Trial - CR 1x18 Poly Trial - CR 1x20 Poly Trial - CR 2x10 Poly Trial - CR 2x12 Poly Trial - CR 2x14 Poly Trial - CR 2x16 Poly Trial - CR 2x18 Poly Trial - CR 2x20 Poly Trial - CR 3x10 Poly Trial - CR 3x12 Poly Trial - CR 3x14 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

44 Poly Trial - CR 3x16 Poly Trial - CR 3x18 Poly Trial - CR 3x20 Poly Trial - CR 4x10 Poly Trial - CR 4x12 Poly Trial - CR 4x14 Poly Trial - CR 4x16 Poly Trial - CR 4x18 Poly Trial - CR 4x20 Poly Trial - CR 5x10 Poly Trial - CR 5x12 Poly Trial - CR 5x14 Poly Trial - CR 5x16 Poly Trial - CR 5x18 Poly Trial - CR 5x20 Poly Trial - CR 6x10 Poly Trial - CR 6x12 Poly Trial - CR 6x14 Poly Trial - CR 6x16 Poly Trial - CR 6x18 Poly Trial - CR 6x20 Poly Trial - UCCS 1x10 Poly Trial - UCCS 1x12 Poly Trial - UCCS 1x14 Poly Trial - UCCS 1x16 Poly Trial - UCCS 1x18 Poly Trial - UCCS 1x20 Poly Trial - UCCS 2x10 Poly Trial - UCCS 2x12 Poly Trial - UCCS 2x14 Poly Trial - UCCS 2x16 Poly Trial - UCCS 2x18 Poly Trial - UCCS 2x20 Poly Trial - UCCS 3x10 Poly Trial - UCCS 3x12 Poly Trial - UCCS 3x14 Poly Trial - UCCS 3x16 Poly Trial - UCCS 3x18 Poly Trial - UCCS 3x20 Poly Trial - UCCS 4x10 Poly Trial - UCCS 4x12 Poly Trial - UCCS 4x14 Poly Trial - UCCS 4x16 Poly Trial - UCCS 4x18 Poly Trial - UCCS 4x20 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

45 Poly Trial - UCCS 5x10 Poly Trial - UCCS 5x12 Poly Trial - UCCS 5x14 Poly Trial - UCCS 5x16 Poly Trial - UCCS 5x18 Poly Trial - UCCS 5x20 Poly Trial - UCCS 6x10 Poly Trial - UCCS 6x12 Poly Trial - UCCS 6x14 Poly Trial - UCCS 6x16 Poly Trial - UCCS 6x18 Poly Trial - UCCS 6x20 Poly Trial - PS 1x10 Poly Trial - PS 1x12 Poly Trial - PS 1x14 Poly Trial - PS 1x16 Poly Trial - PS 1x18 Poly Trial - PS 1x20 Poly Trial - PS 2x10 Poly Trial - PS 2x12 Poly Trial - PS 2x14 Poly Trial - PS 2x16 Poly Trial - PS 2x18 Poly Trial - PS 2x20 Poly Trial - PS 3x10 Poly Trial - PS 3x12 Poly Trial - PS 3x14 Poly Trial - PS 3x16 Poly Trial - PS 3x18 Poly Trial - PS 3x20 Poly Trial - PS 4x10 Poly Trial - PS 4x12 Poly Trial - PS 4x14 Poly Trial - PS 4x16 Poly Trial - PS 4x18 Poly Trial - PS 4x20 Poly Trial - PS 5x10 Poly Trial - PS 5x12 Poly Trial - PS 5x14 Poly Trial - PS 5x16 Poly Trial - PS 5x18 Poly Trial - PS 5x20 Poly Trial - PS 6x10 Poly Trial - PS 6x12 Poly Trial - PS 6x14 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

46 Poly Trial - PS 6x16 Poly Trial - PS 6x18 Poly Trial - PS 6x20 Poly Trial - MPCS 1x10 R Poly Trial - MPCS 1x12 R Poly Trial - MPCS 1x14 R Poly Trial - MPCS 1x16 R Poly Trial - MPCS 1x18 R Poly Trial - MPCS 1x20 R Poly Trial - MPCS 2x10 R Poly Trial - MPCS 2x12 R Poly Trial - MPCS 2x14 R Poly Trial - MPCS 2x16 R Poly Trial - MPCS 2x18 R Poly Trial - MPCS 2x20 R Poly Trial - MPCS 3x10 R Poly Trial - MPCS 3x12 R Poly Trial - MPCS 3x14 R Poly Trial - MPCS 3x16 R Poly Trial - MPCS 3x18 R Poly Trial - MPCS 3x20 R Poly Trial - MPCS 4x10 R Poly Trial - MPCS 4x12 R Poly Trial - MPCS 4x14 R Poly Trial - MPCS 4x16 R Poly Trial - MPCS 4x18 R Poly Trial - MPCS 4x20 R Poly Trial - MPCS 5x10 R Poly Trial - MPCS 5x12 R Poly Trial - MPCS 5x14 R Poly Trial - MPCS 5x16 R Poly Trial - MPCS 5x18 R Poly Trial - MPCS 5x20 R Poly Trial - MPCS 6x10 R Poly Trial - MPCS 6x12 R Poly Trial - MPCS 6x14 R Poly Trial - MPCS 6x16 R Poly Trial - MPCS 6x18 R Poly Trial - MPCS 6x20 R Poly Trial - MPCS 1x10 L Poly Trial - MPCS 1x12 L Poly Trial - MPCS 1x14 L Poly Trial - MPCS 1x16 L Poly Trial - MPCS 1x18 L Poly Trial - MPCS 1x20 L 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

47 Poly Trial - MPCS 2x10 L 90-SRK Poly Trial - MPCS 2x12 L 90-SRK Poly Trial - MPCS 2x14 L 90-SRK Poly Trial - MPCS 2x16 L 90-SRK Poly Trial - MPCS 2x18 L 90-SRK Poly Trial - MPCS 2x20 L 90-SRK Poly Trial - MPCS 3x10 L 90-SRK Poly Trial - MPCS 3x12 L 90-SRK Poly Trial - MPCS 3x14 L 90-SRK Poly Trial - MPCS 3x16 L 90-SRK Poly Trial - MPCS 3x18 L 90-SRK Poly Trial - MPCS 3x20 L 90-SRK Poly Trial - MPCS 4x10 L 90-SRK Poly Trial - MPCS 4x12 L 90-SRK Poly Trial - MPCS 4x14 L 90-SRK Poly Trial - MPCS 4x16 L 90-SRK Poly Trial - MPCS 4x18 L 90-SRK Poly Trial - MPCS 4x20 L 90-SRK Poly Trial - MPCS 5x10 L 90-SRK Poly Trial - MPCS 5x12 L 90-SRK Poly Trial - MPCS 5x14 L 90-SRK Poly Trial - MPCS 5x16 L 90-SRK Poly Trial - MPCS 5x18 L 90-SRK Poly Trial - MPCS 5x20 L 90-SRK Poly Trial - MPCS 6x10 L 90-SRK Poly Trial - MPCS 6x12 L 90-SRK Poly Trial - MPCS 6x14 L 90-SRK Poly Trial - MPCS 6x16 L 90-SRK Poly Trial - MPCS 6x18 L 90-SRK Poly Trial - MPCS 6x20 L 90-SRK Patella Puck Oval SRK Patella Puck Oval SRK Patella Puck Oval SRK Patella Puck Oval SRK Patella Puck Round SRK Patella Puck Round SRK Patella Puck Round SRK Patella Puck Round SRK Threaded Pin 1290 Headed Pin 1297 Pin Power Adapter 1206 T-Handle w/quick connect 90-SRK Patella Resection Guide 90-SRK Patella Lug Drill 90-SRK Patella Clamp Handle 90-SRK

48 Patella Drill Guide - Round 90-SRK Patella Drill Guide - Oval 90-SRK Cement Clamp 90-SRK Patella Caliper

49 Femoral Prep Case Tibial Prep Case Patellar Prep Case Femoral Trial Case CR/CS Femoral Trial Case PS Poly Trial Case CR Poly Trial Case UCCS Poly Trial Case PS Poly Trial Case MPCS Right Poly Trial Case MPCS Left Trays 90-SRK SRK SRK SRK SRK SRK SRK SRK SRK SRK

50 49 5. Instructions For Use

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