surgical technique *smith&nephew tc-plus™ …...• failure after surface replacement (e.g....

Surgical Technique Extramedullary Procedure *smith&nephew

TC-PLUS™ REVISIONRevision Knee System

Sawblade Thickness: 1.00 mm

Complex Primary Knee System

TC-PLUS™ Revision EM Procedure

Table of Contents

Introduction ............................................................................................. 2General Warnings and Comments .......................................................... 3Concept/Product Description ................................................................. 4Indications/Contraindications ................................................................. 8Case Study ............................................................................................ 10Preoperative Planning ........................................................................... 12Surgical Technique ................................................................................ 15

Femoral Preparation ..........................................................................19Tibial Preparation ............................................................................. 29Optional Tibial Anchorage Preparation with Offset ........................... 36Posterior-Stabilized Option ............................................................... 41Patellar Preparation .......................................................................... 44

Assembling the Implants-Components ............................................. 46Implanting the Components ............................................................. 51

Postoperative Treatment ........................................................................ 54Sterilization ............................................................................................ 55Implants ................................................................................................ 57Instruments ........................................................................................... 66

Nota Bene

The technique description herein is made available to the healthcare professional to illustrate the author’s suggested treatment for the procedure. In the final analysis, the preferred treatment is that which addresses the needs of the patient.

The following technique is for informational and educational purposes only. It is not intended to serve as medical advice. It is the responsibility of treating physicians to determine and utilize the appropriate products and techniques according to their own clinical judgment for each of their patients. For more information on the TC-PLUS Revision, including its indications for use, contraindications, and product safety information, please refer to the product's label and the Instructions for Use packaged with the product.

Prior to performing this technique, please consult the Instructions for Use documentation provided with each device for additional health and safety information, including indications, contraindications, warnings and precautions.

Product Overview ( Combination Tables ) ............................................. 88

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Introduction

The TC-PLUS™ Revision knee prosthesis, with the posterior-stabilized version, has been developed to extend the indication range of the primary TC-PLUS knee system.

The TC-PLUS Revision knee system use the same joint design (femur/insert) and resections as the TC-PLUS Primary knee system. Just additional stem connection and blocks fixation have been added.

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General Warnings and Comments

WarningsThey are written in orange. They must be followed as they relate to critical functions or this information should be noted as it contains valuable advice which helps the user to clinically apply the system..

TrainingOnly adequately trained operators should use the TC-PLUS™ Revision knee system. This Surgical Technique must be fully read and understood as part of the training. If any part of this documentation is not clear, please contact your Smith & Nephew representative.

ImplantsTC-PLUS Revision knee system components are only designed for use with the indicated Smith & Nephew implants and instruments. Implants and instruments must be used in accordance with the instructions in all other relevant Surgical Techniques.

ResponsibilityIt is the responsibility of the user of the TC-PLUS Revision knee system to review all relevant information concerning the product before use. All the information provided in the Instructions for Use and in the Surgical Technique are to help the user in preparing for use of the product. The user must check all recommendations concerning the product in the Instructions for Use and in the Surgical Technique and is responsible for all clinical decisions taken.

Cleaning and SterilizationAll instruments must be sterilized before use. Detailed information on cleaning and sterilization of instruments is contained in the separate cleaning and sterilization instructions No. 03389.

Additional WarningsWarnings and comments cited in other Surgical Techniques relating to TC-PLUS knee systems must also be followed.

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The femoral components are manufactured from CoCrMo alloy and are asymmetrical. They are identical to the primary TC-PLUS femoral components in terms of design, kinematics properties and bone resections.

The femoral patellar groove is deeply hollowed-out and present a 6° oblique patella tracking. The revision femoral component has a 6° valgus connection that allows the use of different stems.

To compensate femoral bone defects, distal and/or posterior femoral blocks can be fixed to the femoral component.

The femoral components, both the standard and the posterior-stabilised version, are available in sizes 2, 4, 6, 8 and 10.

Femoral Components

Concept / Product Description

The TC-PLUS™ Revision knee system is the revision version of the primary tricompartmental TC-PLUS knee system. In addition, the TC-PLUS PS Revision Knee System is the „posterior-stabilized“ option of the TC-PLUS Revision and the corresponding revision version of the primary TC-PLUS PS knee system.

As the TC-PLUS Revision implants offer the same resections as the tricompatimentalTC-PLUS Primary knee prosthesis, this permits if necessary an easy intraoperative switchover from the resurfacing to the condylar revision knee.

The femoral and tibial components of the TC-PLUS Revision correspond, apart from the connection for the stems and the blocks, to those of the TC-PLUS Primary knee system. The tibia inserts are identical; therefore the femoral and tibial components of both knee systems are fully cross compatible. The range includes femoral and tibial components fitted with stem couplings; the corresponding Ti6Al4V stems for non-cemented application and in CoCrMo stems for cemented application. CoCrMo blocks are available to compensate femoral and tibial bone defects.

All stems of the TC-PLUS Revision can be combined with the femoral and tibial components of the TC-PLUS Revision. The same applies for the femoral components of the TC-PLUS PS Revision.

The implants are available in five sizes (corresponding to TC-PLUS sizes 2, 4, 6, 8 and 10). Each size can be combined with the next size up or down (see product overview from page 88).

Product Description

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Patellar Component

The tibial inserts present a snapping fixation and is additionally secured by a screw.

The tibial inserts are identical to those used in the primary TC-PLUS knee portfolio, they are manufactured from UHMW-polyethylene and are available in six different heights of 9mm, 11mm, 13mm, 15mm, 17mm and 19mm for the ultracongruent tibia inserts and in seven different heights of 9mm, 11mm, 13mm, 15mm, 17mm and 19mm (optionally 21mm for the posterior-stabilised tibia inserts. The target is, independent to the degree of tibial bone substance loss, to be able to restore the joint line.

The minimum effective PE thickness in the load zone is 6mm.

Please see the available sizes in the implant table (on page 57 ff).

The all-poly (UHMW-polyethylene) patellar component has a symmetrical biconcave surface for better tracking and are available in thickness 10mm (8mm optional).

The patellar component are identical to those in theTC-PLUS™ portfolio.

Tibial Inserts

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Tibial Component

The femoral and tibial blocks are manufactured from CoCrMo alloy.

In order to compensate different femoral and/or tibial bone defects, there are distal femoral blocks available in heights of 5mm, 10mm and 15mm, posterior femoral blocks in heights of 5mm and 10mm and proximal tibial blocks in heights of 5mm, 10mm and 15mm.

The same femoral blocks are used for both standard and posterior-stabilised femoral components. The same tibial blocks, except height of 15mm, are used for the medial- as for the lateral-condyle of the tibial component.

The blocks have to be assembled to the femoral and tibial components with screws and can then be cemented.

The symmetrical tibial component is manufactured from CoCrMo alloy.

In order to minimize polyethylene wear inside the tibial component, the base plate is polished on the inside and the insert is completely enclosed along its entire circumference.

The revision tibial component has a 3° slope connection that allows the use of different stems.

To compensate tibial bone defects, proximal tibial blocks can be fixed on the tibial component.

The tibial component is available in sizes 2, 4, 6, 8 and 10.

Femoral and Tibial Blocks

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Cemented Stem

Non-Cemented Stem

The femoral and tibial components can also be stabilised intramedullary anchored in the bone by using non-cemented cylindrical stems, made of forged Ti6Al4V alloy. These stems are not suitable for primary anchorage; therefore they are not designed for press-fit or osseo-integration.

A wide range of stems enables an optimal adaptation to different indications. They are available in various diameters (Ø 10, Ø 12, Ø 14, Ø 16, Ø 18 and Ø 20mm) and lengths (40mm, 80mm, 110mm and 150mm) in order to ensure optimum anchorage, even with a variety of femoral or tibial geometries.

For the femoral components, aside from the straight stems, 2° valgus stems (for covering additional valgus of 4° or 8°) are available in various diameters (Ø 10, Ø 12,Ø 14, Ø 16, Ø 18 and Ø 20mm) and lengths (80mm, 110mmand 150mm).

For the tibial components, aside from the straight stems, offset stems with 3.75mm offset (placed 360° on the tibia) are available in various diameters (Ø 10, Ø 12, Ø 14, Ø 16, Ø 18 and Ø 20mm) and lengths (80mm, 110mm and150mm).

Please see the available sizes in the implant table ( on page 57 ff ).

2° 3.75 mm

The femoral and tibial components can be intramedullary anchored in the bone by cemented conical stems, made of forged CoCrMo alloy.

Available in lengths; 80mm, 110mm and 150mm.

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Indications

The principal preoperative planning factor is the correct diagnosis. It has to be determined whether the bone and stability situation allow the implantation of an uncoupled prosthesis.

The main indications for implantation of TC-PLUS™ Revision are :

• Degenerative or posttraumatic arthrosis

• Rheumatoid arthritis

• Avascular necrosis of the femoral condyles

• Joint destruction with restricted function and requirement for additional stabilizationwith longer stems andreconstruction of bone defects

• Marked contractures and axial deformity less than 20 - 25°

• Failure after surface replacement (e.g. infection, loosening) - Revision of a primaryprostheses

• Trauma - induced femoral or tibial fractures

Important

Due to the design, it is possible to switch with relatively little effort, even intra-operatively, from the TC-PLUS knee system (or TC-PLUS PS) to the TC-PLUS Revision knee system (or TC-PLUS PS Revision), since the resections and prosthesis sizes are identical

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• Acute or chronic, local or systemic infections (or in the case of a correspondinganamnesis)

• Severe muscle, nerve or vascular diseases that endangers the affected extremity

• Laking bone substance or inadequate bone quality that endangers a stable seatingof the prothesis

• Distinct collateral ligament instability

• Pronounced genu recurvatum

• Axial misalignment over 25°

• All concomitant diseases that may endanger the function of the implant. Theseinclude in particularextreme insufficiency of the knee extensor mechanism, whichcan lead to excessive joint distortion; orsevere adiposity which can lead to a dorsalimpingement, which leads to instability of the components. Inthese cases it may beadvisable to use a constrained rotating or a tumor prosthesis

• Patient hypersensitivities or allergies to the materials used

• Strenuous physical activity (e.g. competitive sport, hard physical work)

Contraindications

Contraindications are :

ImportantSee also instructions in package insert for knee prostheses ( IFU ) Lit. No. 12.24

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Preoperative situation

Case Study

Patient with varus displaced or implanted tibia, with a medial instability that must be revised because of pain and swelling.

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Postoperative Result

Immediately postoperative; functional and pain-free reconstruction with TC-PLUS™ Revision knee.

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Preoperative Planning

A full-leg X-ray with the patient in the standing position is recommended for preoperative planning purposes. If this is not possible, an X-ray of the thigh, including the femoral head, should be taken. The X-ray images of the knee joint at three levels should be available for planning the surgery. A tangential patellar exposure, a frontal and a sagittal to the leg axis exposure must be taken.

For preoperative planning there are X-ray templates available: with scale of 1.15:1 Lit. No. 1354 / 1355 and with scale of 1:1 Lit. No. 1511 / 1512 (see page 87). The lateral view of the condyles is decisive. If these are no longer completely intact, it is possible to switch to the condylar width. In cases of doubt, the smaller implant should be selected to prevent the prosthesis components from protruding. In normal cases, the size determination and the correct positioning of the prosthesis are controlled intraoperatively with relevant instruments and planning may also be possible on the unrestored opposite side leg.

Important

The femoral and tibial component sizes can all be combined with the next size up or down (see product overview on page 88 ff).

Large deviations of the femoral neck angle as well as severe deformities of femur and tibia (e.g. posttraumatic axial deformities) must be taken into consideration during surgical planning.

In cases of deformities away from the knee joint that adversely influence the mechanical axis, additional corrective osteotomies may be indicated.

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Planning the surgery using the radiograph

The following procedure is recommended for the anterior-posterior whole leg imaging process:

A Anatomical femoral axisB Anatomical tibial axisC Mechanical leg axisD Mechanical femoral axisE Tibial resection depth (mm)a Valgus angle

Post-opPre-op

1. The femoral axis A (anatomical axis) is drawn onto the radiograph.

2. A line is drawn from the femoral head to the center of the knee (mechanical axis D) on the radiograph.

3. The angle measured between the anatomical and the mechanical axis = angle a determines the valgus angle.

4. The tibial axis B is drawn in and the tibial resection plane E is determined to avoid exces sive resection, especially if defects are present.

5. The component sizes and resection depths are determined preoperatively using the X-Ray templates (see page 87) in AP and the lat eral planes.

6. The mechanical leg axis C should merge with lines D and B after correction.

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Positioning of the patient for the surgery

Surgical Technique

In case of an implant revision, where components must be removed at the beginning of the surgery, Smith & Nephew with the RENOVATION Knee set, offers the surgeons a knee specific implant extraction system that contents different instrument options to facilitate the removal of different femur and tibia components (loose first and then extract).

The instrument set consists of a basic set (no. SAP 75210243 / 0944290) and sterile packaged, single-use chisel-blades and saw-blades (see surgical technique Lit. No. 04044 (2025)).

Surgery is performed whilst the patient is supine. It is recommended that the blood supply be partially blocked with the use of a tourniquet. But this is not absolutely necessary. The leg must be covered, so as to allow movement and secured to the operating table in such a way that the knee joint is brought into a stable 90° flexion position. Most of the surgical steps are performed in this position.

Surgical procedure

The skin incision can be a midline incision or a parapatellar incision. If there are scars from skin incisions made during previous surgery, it is advisable to use them for access in order to reduce the risk of cutaneous blood flow disorders. Medical arthrotomy is recommended, or an approach adapted to the pathological situation.

After the usual preparation (meniscus resection, removal of osteophytes and synovectomy if necessary), the cruciate ligaments are sectioned close to the bone.

Implant component removal

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It is important that the flexion and extension gaps are identical.

1. Distal femoral resection and optional distalaugment resection

3. Chamfer and trochlea resections and cuttingout of the box if the PS version is required

Remove residual posterior condyles ifpresent

4. Tibial resection and optional augmentresection

5. Patellar resection ( optional )

Overview of the resection sequences for primary application

ImportantFor this instrument set, use 1.00mm saw blades for all bone resections!See Lit. No. 01218 for corresponding connection.

2. A/P femoral resections and optional posterioraugment resection

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The bone resections are refreshed after extraction of the primary implants.

1. Distal femoral resection and optional distalaugment resection

2. A/P femoral resections and optional posterioraugment resection

3. Chamfer and trochlea resections and cuttingout of the box if the PS version is required

Remove residual posterior condyles ifpresent

Overview of the resection sequences for revision application

ImportantFor this instrument set, use 1.00mm saw blades for all bone resections!See Lit. No. 01218 for corresponding connection.

4. Tibial resection and optional augmentresection

5. Patellar resection ( optional )

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Use of Speed-pins

We also offer speed-pins as an alternative for fixing the instrument to the bone.

The speed-pins are available in different lengths and types:

Speed-Pins with Rim Ø 3.2 / 30mm – 6x PAC (Art. Nr. 42000089/75006487)

Speed-Pins Ø 3.2 / 65mm

– 6x PAC (Art. Nr. SYS251354/75009338)Speed-Pins Ø 3.2 / 80mm

– 6x PAC (Art. Nr. SYS251355/75009339)Speed-Pins Ø 3.2 / 110mm

– 6x PAC (Art. Nr. SYS251356/75009340)

AO Adapter for Speed-Pins (Art. Nr.: SYS251316/75009310)

The speed-pins are delivered non-sterile and for multiple use. The limitation use of the speed pin is defined as the standard pin, until the functionality is no longer ensured.

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Femoral Preparation

Access: Please refer to the relevant surgical textbooks for the initial access to the knee.

ImportantIn addition to the bone resections, it is important to correct any ligament imbalance by appropriate soft-tissue procedures. If necessary, a general release should be performed on the side of the contracture.

The leg is flexed and any osteophytes on the femur and tibia should be removed. This will provides good exposure of the knee joint, which facilitates size determination.

Femoral size determination

The adjustable IM femoral drill guide is set to the planned size of the femoral components (size marking «2», «4», «6», «8» or «10») and inserted under the quadriceps into the centre of the femur. The distal stop should be on the medial condyle. Make sure that the guide is flat on the anterior femoral cortical bone in the direction of the femoral axis.

Open the femoral IM canal with the Ø 8mm IM drill.

ImportantTo ensure an optimal position of the femoral drill guide on the condyles, gently tap the M/L area, not the drill guide section of the instrument.

By using the femoral sizer («2», «4», «6», «8» or «10») the size is determined, sagittaly according to the inside/ outside contours as well as ventrally according to the anterior/posterior resections and the medial/lateral contours.

Important

The line in the sagittal view of the femoral sizer shows the position of the femoral IM canal, i.e. the position of the stem.

During measurement note the marks corresponding to medial and lateral «LEFT» and « medial».

Femoral opening

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Align the device with regard to rotation. Note that the removable handles are parallel to the epicondylar axis.

The femoral/tibial cutting block is screwed to the femoral suspension device and positioned over the trial stem extension (Ø 8mm). The handles can be attached.

The Ø 8mm IM rod is carefully inserted using the modular handle to approximately the isthmus of the femoral IM canal. It is important to work carefully to prevent excess pressure in the IM canal.

The modular handle is now removed.

Important

With too short IM guidance, the alignment may be incorrect (varus/valgus and/or extension/flexion) and pay attention to the femoral recurvatum.

Locating the distal femoral cutting block

Select the femoral bushing, «4°», «6°» and «8°» bushings are available, in accordance with the angle � measured in the preoperative planning. The femoral bushing is inserted into the femoral suspension device, so that depending on which side is the operation, the mark «L» for left knee or «R» for right knee is visible on the arrow «q».

Important

Make sure that the femoral bushing is inserted in the correct («L» or «R») position. Adjustment and correction occurs with removing, rotating by 180° and re-inserting the femoral bushing.

The femoral/tibial cutting block is screwed to the femoral suspension device and positioned over the trial stem extension (Ø 8mm). The handles can be attached.

Important

In revision cases, the 7mm distal revision spacer for femoral condyle is attached to the femoral suspension device (black plastic component in picture). This substitutes the missing distal bone substance. The resulting resection remains still 2mm.

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Controlling the alignment

Before performing the distal femur resection, check that the revision femoral/tibial cutting block (select the valgus angle «4°», «6°» or «8°») is perpendicular to the mechanical leg axis. By attaching the handle with the axial alignment rod on the femoral/tibial cutting block, the mechanical axis can be controlled by reference to the hip head centre.

Important

If the valgus angle is not correct, the femoral/tibial cutting blockcan be adjusted by changing the femoral bushing.

After preliminary drilling with the Ø 3.2mm drill, the femoral/ tibial cutting block is fixed with two bone pins (75mm long) through the holes marked «0». This position resects 9mm from the distal femur, which corresponds to the distal thickness of the femoral prosthesis without femoral blocks.

Important

For preventing any conflict with the trial stem, the most lateral «0» pin hole of the femoral/tibial cutting block is preferred.

The bone pin on the femoral suspension device is removed with pin extractor. After loosening the fixation screw the IM rod (Ø 8mm) is removed using the modular handle.

The suspension device is now removed.

Important

The resection depth can be adjusted proximally and distally in 2mm increments (± 4mm).

The side handles can be removed from the femoral suspension device and attached on the femoral/tibial cutting block.

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Distal femoral resection

The femoral/tibial cutting block is slid onto the bone. The distal femoral resection is then performed using a 1mm saw blade through the «0» saw slot (closed slot with facet).

Important

For locking the femoral/tibial cutting block, an additional pin can be inserted into the oblique holes market with «AUX». After resection, the pin can be removed.

When using distal femoral blocks the resection is performed through the open saw slots. Corresponding femoral blocks in 5mm, 10mm and 15mm are available.

Important

If there is an extension deficit, it is recommended to move the distal resection 2 - 4mm proximally to adjust the extension gap. For hyper-mobile patients, a 2mm smaller distal femoral resection is recommended.

The distal resection is the reference for the following steps and has to be checked for accuracy.

The femoral/tibial cutting block is now removed.

Important

The side handles can be removed from the femoral/tibial cutting block and attached on the femoral A/P femoral cutting block revision.

Locating the A/P femoral cutting block

With the resection stylus, the anterior and posterior resection plane and height are checked.

Important

In the case of over-resection or under-resection a correction can be made by removing the bone pins, following by introducing again the IM rod and attaching the A/P femoral cutting block (with the femoral stylus and the groove stone).

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The groove stone and the femoral stylus are assembled on the A/P femoral cutting block. The IM rod Ø 8mm is inserted through the A/P femoral cutting block into the femoral IM canal.

Important

When using distal femoral blocks the corresponding blocks must be fixed on the A/P femoral cutting block. Respect the thickness («5mm», «10mm» or «15mm») and size («2, 4» or «6, 8, 10»).

Setting the femoral rotation and the resection depth

The rotation can be adjusted visually in relation to the epicondylar axis with the aid of two bone pins (75mm long) which are inserted laterally into the A/P femoral cutting block.

By loosening the groove stone, the A/P femoral cutting block can be moved with referencing the femoral stylus to the correct level of the anterior cortical bone.

After preliminary drilling with the Ø 3.2mm drill, the A/P femoral cutting block is fixed with two bone pins (38mm with head) through the lateral 45° oblique holes.

The IM rod Ø 8mm, the femoral stylus and the groove stone can be removed.

Controlling the resections

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A/P and chamfer resections

The anterior femoral resection is made through the closed saw slot with the 1mm saw blade (anterior slot with facet).

The femoral chamfer resections are made through the corresponding slots (slots with facet).

The A/P femoral cutting block is removed.

The posterior femoral resection is made through the two open posterior saw slots (slots with facet).

When using posterior femoral blocks, the resection is made through the open 5mm and 10mm saw slots.

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Positioning the femoral reamer guide

The chosen femoral reamer guide of the previously defined femoral size is positioned on the prepared bone and aligned.

Important

When using distal and/or posterior femoral blocks the corresponding blocks must be fixed to the femoral reamer guide. Note the corresponding thickness (5mm», «10mm» or «15mm»).

It is to respect to use only the available plastic impactor for hitting the femoral reamer guide. Do not hit with metal instruments.

The posterior M/L dimension of the femoral reamer guide corresponds to the M/L implant dimension. The external contour of the femoral reamer guide corresponds to the anterior lateral femoral flange contour, the anterior laser markings to the anterior medial femoral flange contour.

Important

If not sufficient A/P support is available, the femoral reamer guide can also be aligned intramedullary with the femoral valgus adapter («4°», «6°» or «8°») and Ø 8mm alignment bushing over the IM rod (Ø 8mm).

After preliminary drilling, the femoral reamer guide is fixed with bone pins (75mm long or 38mm with head) through the anterior and lateral oblique holes.

Important

Be aware that the anterior bone pins must be inserted before the distal bone pins.

If a PS femoral component is required, the surgical technique for the posterior-stabilized version is performed (see instructions from page 41).

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Preparing the femoral anchorage

According to the predetermined valgus angle, the corresponding femoral valgus adapter («4°», «6°» or «8°») is inserted on the femoral reamer guide.

The femoral valgus adapter is inserted into the femoral reamer guide, so that depending on which side is the operation, the mark «LEFT» for left knee or «RIGHT» for right knee is visible on the arrow «ANTERIOR ».

An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in axial alignment and depth (the end of the reamer alignment guide corresponds to the tip of the reamer).

The reamer bushing with the smallest diameter («Ø10») is inserted into the femoral valgus adapter.

Important

Reamer bushings and reamers in diameter «Ø10», «Ø12», «Ø14», «Ø16», «Ø18» and «Ø20» are available.

Reamers are used carefully and in progressive stages (starting with «Ø10») with use of the corresponding bushing, to ream to the required stem diameter and depth.

Important

The depth marking is on the reamer: observe the laser markings («40», «80», «110» und «150») when using this technique. The recessed notch markings are for the IM application and are described in the corresponding surgical technique.

When using cemented stems, the Ø 12mm reamer is used to drill to the desired depth. Cemented stems are available in 80mm, 110mm and 150mm lengths.

The 40mm length stem is only available as non-cemented stem.

Controlling the stem position

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Preparing the femoral stem connection

The largest reamer bushing «20» is inserted into the femoral valgus adapter («4°», «6°» or «8°»). The Ø 20mm drill is then drilled to the stop to prepare the recess for the stem connection.

Preparing the trochlear recess

The femoral trial adapter is placed and screwed to the femoral trial (corresponding to the preset valgus angle) and the trial stem (corresponding to the diameter and depth of the last reamer).

The femoral trial is inserted with the impactor.

Important

When using distal and/or posterior femoral blocks, the corresponding femoral block trials («5mm», «10mm» or «15mm») are available. They are fixed sliding laterally on the femoral trials.

The valgus femoral adapter and the Ø 20mm reamer bushing are replaced with the trochlear chisel guide.

The trochlear recess is prepared with the trochlear chisel.

ImportantThe label «ANTERIOR» on the trochlear chisel guide must be visible on the arrow «ANTERIOR q».

The trochlear chisel guide is removed.

Controlling the femoral resections and anchorage

28

Removing the dorsal condyle residue

Important

This must be checked in all cases!

After having completed the femoral resections, use the curved osteotome to remove all osteophytes as well as protruding posterior condyles. At this point, a posterior contracture can also be released. This will improve flexion and prevent possible damage to the polyethylene insert by these bony projections.

This is especially important for the posterior-stabilized version.

Important

The femoral trial is used as reference for resection of the bone with the curved osteotome.

It is recommended to leave the femoral trial component assembled with stem and eventually femoral blocks to be used as reference, respectively as comparison component when assembling the definitive implant.

The femoral trial can be removed with using the slap hammer.

If necessary, the femoral trial can be left in place for protecting the femoral condyle during tibial preparation.

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Tibial opening

Open the tibial IM canal with the Ø 8mm drill or directly with the Ø 8/14mm stepped drill.

Position the hole centrally M/L and one third from anterior.

Locating the tibial cutting block

The IM Ø 8mm guide rod is carefully inserted with the modular handle to approximately the isthmus of the tibial marrow channel and removed again. It is important to work carefully to prevent overpressure in the tibial marrow channel.

The Ø 8mm IM rod is again carefully inserted into the femoral IM canal. The modular handle is now removed.

Important

With too short IM guidance, the alignment may be incorrect (varus/valgus and/or extension/flexion) and pay attention to the femoral recurvatum.

Tibial Preparation

The leg is flexed and any remaining osteophytes and the intercondylar eminence are removed.

The two tibial resection guide IM components are coupled together by jointing arrow «ò» to arrow «ñ» and pressing the button.

The femoral/tibial cutting block is attached to the tibial resection guide IM with the top small grub screw and slid completely onto the IM Ø 8mm guide rod.

Important

Ensure the lock lever is set to «OPEN» to slide in place the tibial resection guide IM. The lock lever is then reversed to fix the tibial resection guide IM in place.

The femoral/tibial cutting block is first lifted upwards by pressing the button so the tibial stylus can be attached.

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Setting the resection height

The alignment is checked again with the axial alignment rod. The rod tip must point to the centre of the ankle joint.

The tibial stylus can now be removed.

The resection height is checked with the resection stylus. The femoral/tibial cutting block can be adjusted using the large grub screw ± 6mm.

Important

The top small grub screw is used for assembling the femoral/tibial cutting block only.

After preliminary drilling with the Ø 3.2mm drill, the femoral/tibial cutting block is fixed with two bone pins (75mm or 100mm long) through the holes marked «0».

Handles can be attached.

The tibial stylus is positioned on the tibial plateau. The tibial stylus can be used for both primary resections («11mm» marking) and for revisions resections («1mm» marking).

Important

In primary procedures, the «11mm» tibial stylus is positioned on the lowest point of the less damaged condyle.

In revision procedures where no tibial blocks are required, the «1mm» tibial stylus is positioned on the lowest area of the tibial plateau.

In revision procedures where tibial blocks are required, the «1mm» tibial stylus is positioned on the lowest point of the less damaged condyle.

Controlling the alignment and the tibial resection

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The tibial resection is performed using a 1mm saw blade through the «0» saw slot (closed slot with facet).

Important

For locking stable the femoral/tibial cutting block, an additional pin can be inserted into the oblique holes market with «AUX». After resections the pin can be removed.

The ligaments must be protected during all resections.

When using tibial blocks the resection is conducted through the open saw slots. Tibial blocks are available in 5mm, 10mm and 15mm heights.

As guidance for the vertical tibial block cut, two bone pins (length 75mm or 100mm) are inserted into the two proximal holes level with closed saw slot (0 cut). The vertical cut is performed between the two pins to the depth of the tibial block.

Important

If the femoral/tibial cutting block is distally or proximally relocated (purpose of thicker or thinner bone resection), this is moved to the right (± 2mm) or parallel (± 4mm). Should the relocation be moved to the right, the vertical cut should be performed external to the right pin rather than between the pins.

The femoral/tibial cutting block is now removed.

The lock lever is set to «OPEN» and the tibial resection guide IM is removed from the femoral/tibial cutting block by unscrewing the top small grub screw.

The IM rod is also removed using the modular handle.

The femoral/tibial cutting block is slid onto the bone.

Tibial resection

32

Controlling the joint gaps

The ligament tension in flexion and extension is checked with spacers. The tibial spacers («9», «11», «13», «15», «17», «19» and optional «21» for the TC-PLUS™ PS Revision only) represent the full tibial height (tibial component and tibial insert). The metal femoral condyle spacer, which represents the height of the femoral component, is attached to the tibial spacer.

Important

When using femoral/tibial blocks the corresponding spacer blocks must be fixed to the spacer. Note the corresponding thickness («5mm», «10mm» or «15mm»). These can be fixed either on the tibial side or on the femoral side.

The flexion and extension gaps are checked by inserting the spacer in the joint gap. If necessary further release or resection are performed.

Important

If distal and posterior femoral blocks of different thicknesses are used, using the femoral trial component is recommended rather than the femoral condyle spacer.

The mechanical axis can be checked by inserting the axial alignment rod in the handle.

To release the spacer blocks, a long pin can be inserted in the hole and used as a lever.

The two bone pins in the tibia are then removed.

Tibial size determination

The tibial sizer trial and the handle are assembled and applied onto the proximal bone resection. The tibial sizer trial should completely cover the cortex without projecting beyond the tibia. In case of doubt a lateral projection is preferred, because a medial projection may cause irritation of the pes anserinus. If the projection is not acceptable, a smaller size should be used (pay attention to the combination!). The correct tibial size is then determined.

Important

By use of tibial blocks, the corresponding blocks are to be attached to the tibial sizer. Note the corresponding heights («5mm», «10mm» or «15mm») and side «Rlat/Lmed» or «Llat/Rmed»). The 15mm tibial blocks are anatomically tapered M/L and posterior. Therefore, the under contour is always a size smaller than the upper contour.

If an offset stem is required, see instructions page 36.

33

Setting the tibial rotation

The tibial rotation can be conducted anatomical static (orientation to the tibial cortical bone and the axial alignment rod) or anatomically dynamic (orientation to the femoral rotation).

In the anatomically static type the tibial sizer is already fixed in the correct position with bone pins (with head).

In the anatomically dynamic type the tibial sizer can be left free or fixed medially with only one bone pin (with head).

Important

The tibial sizer can also be aligned intramedullary, with a tibia slope adapter «3°» and the alignment bushing «8», on the IM Ø 8mm guide rod. It is important for the tibial sizer not to project.

Now the flexion and extension gap are controlled.

This manipulation is used to check the joint stability, the range of motion, the patella tracking and position and the soft-tissue stability.

In the anatomically dynamic type the definitive position of the tibial sizer is determined by manipulation of the knee joint in extension and in flexion and definitively fixed with bone pins through the ventral holes.

Important

It is important for the tibial sizer not to project.

When the position of the tibial sizer has been set, the position can be marked ventrally on the tibia bone.

The corresponding tibial insert trial, which had previously been defined with the joint gapspacer, is placed on the tibial sizer.

The femoral trial adapter is placed and screwed to the femoral trial (corresponding to the preset valgus angle) and the trial stem (corresponding to the diameter and depth of the last reamer).

The femoral trial is hammered in using the corresponding impactor.

Preparing the tibial anchorage

After removal of the femoral trial and the tibial insert trial, the tibia slope adapter «3°» is attached to the tibial sizer and fixed with the retaining screw.

To improve the stability, the tibial sizer is additionally fixed with two or four bone pins with heads (25mm or 38mm).

The reamer bushing with the smallest diameter («10») is inserted into the tibia slope adapter «3°».

Important

Reamers are available in diameter «Ø 10», «Ø 12», «Ø 14», «Ø 16», «Ø 18» and «Ø 20».

The reamer is used cautiously and in stages (starting with «Ø 10») with the assistance of the corresponding reamer bushing to drill to the adequate diameter and depth.

Important

The depth marking is on the reamer: observe the laser-etched marks («40», «80», «110» and «150») when using this technique. The milled marks are for intramedullary use and are described with the corresponding surgical technique.

When using cemented stems the Ø 12mm reamer is used to drill to the desired depth and the corresponding non-cemented trial stem is used. Cemented stems are available in lengths of 80mm, 110mm and 150mm.

The 40mm length stem is only available as non-cemented stem.

An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in its axial alignment and depth (the end of the reamer alignment guide corresponds to the tip of the reamer).

34

Preparing the tibial IM canal

The Ø 20mm drill is used to drill down to the stop to prepare the IM canal for the stem connection with the largest reamer bushing «20», which is assembled with the tibia slope adapter «3°».

The test reposition is used to check the scope of movement, the patella guide and the tension of the soft-tissue apparatus.

The tibial trial consists of the previously used tibial sizer, which is tensioned between the tibial stem holder and the tibial anchorage connection, and the trial stem (corresponding to the diameter and depth of the last reamer), which is screwed in place.

The tibial trial is hammered in using the corresponding impactor.

Important

When using tibia blocks, appropriate tibiaL blocks trials («5mm», «10mm» and «15mm») are available. They are fixed laterally on the tibial trial (tibial sizer).

See page 40 for the following steps (femur).

35

The tibia rasp guide is positioned on the tibial sizer and fixed with the retaining screw.

The proximal tibia marrow space is definitively prepared with the tibia rasp. The tibia rasp is tapped in till the stop.

ImportantThe small tibia rasp guide and tibia rasp are used for tibia sizes 2 and 4 («2, 4»), and the large for tibia sizes 6 to 10 («6, 8, 10»).

Then the tibia rasp guide and the tibial sizer are removed.

Trial reduction ( tibial component )

Positioning the tibial sizer for offset stems

Offset Stem Option

Preparing the tibial anchorage for offset stems

36

Use the reamer «Ø 10» to drill carefully to the required depth.

Important

Reamers are available in diameter «Ø 10», «Ø 12», «Ø 14», «Ø 16», «Ø 18» and «Ø 20». The depth marking is on the reamer: observe the milled markings and the depths marked «IM» when using this technique («IM80», «IM110» and «IM150»). The laser-etched marks are for extramedullary use and are described with the corresponding surgical technique.

The 40mm length is only available as non-cemented stem.

When using cemented stems the Ø 12mm reamer is used to drill to the desired depth and the corresponding non-cemented trial stem is used. Cemented stems are available in lengths of 80mm, 110mm and 150mm. The length 40mm is only available as a non-cemented stem.

After measuring the size of the tibia, the tibial sizer with pre-assembled tibia eccentric connection (3.75mm) is positioned on the IM Ø 8mm guide rod.

The tibial sizer is positioned with the transfer guide so it does not project. It should in good contact on the cortical bone all round.

Important

When using tibial blocks place the corresponding blocks on the tibial sizer.

Note the corresponding thickness («5mm», «10mm» or «15mm») and side («Rlat/Lmed» or «Llat/Rmed»). The 15mm tibial blocks are anatomically tapered M/L and posterior. Therefore, the under contour is always smaller a size than the upper contour.

If the decision is made that an offset stem is not required, see page 35 for the following steps.

Preparing the tibial anchorage

Controlling the stem position

An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in its axial alignment and depth (the end of the reamer alignment guide corresponds to the tip of the reamer).

Preparing the tibial stem connection

The trial stem and the extension (Ø 8mm) is carefully inserted with the modular handle to approximately the isthmus of the tibial marrow channel to the height of the proximal bone surface (till about the line; marked with «MIN.») and the modular handle is now uncoupled. It is important to work carefully to prevent overpressure in the tibial marrow channel.

Important

By using too short intramedullary guide, it may happen that the alignment results incorrect (varus/valgus, extension/ flexion).

The hole is drilled for the opening of the stem connection with the stepped drill Ø 10/20mm to the engraved marking (corresponds to the resection plane).

Important

The «+5», «+10», «+15» and «+20» marks are used to indicated the planned resection depth.

Positioning the tibial sizer for offset stems

When the rotation has been adjusted, the tibial sizer is fixed with the inclined bone pin holes.

Important

The vertical bone pins must be inserted before preparation of the stem connection.

37

Fixing the stem transfer guide

After insertion of the vertical bone pins with head, the transfer guide can be placed in the tibial component.

The transfer guide takes the offset position by clamping the lever and acts as a guide for assembly of the tibial trial and later for assembly of the implants.

Hold the transfer guide when tensioning the lever.

Insert the 2 black plastic centering rings into the transfer guide (3.75mm) for improved centering of the instrument.

Important

The 2 black plastic centering rings must be inserted with the inclination downwards (see arrows).

Now the transfer guide must be removed and the trial stem can be pulled out.

Important

Never open the lever of the stem transfer guide till the end of the surgery.

Preparing the tibial stem connection and IM canal

After insertion of the tibia slope adapter «3°» and the largest reamer bushing «20», the preparation of the stem connection of the tibial component can be conducted.

Final preparation of the tibial anchorage using the standard drill Ø 20mm and the tibia rasp (stem connection and ribs are prepared).

Important

The stepped drill Ø 10/20mm cannot be used because of the eccentricity.

Removal of the guide and instruments.

Preparing the transfer guide

38

Preparing the tibial trial

The corresponding tibial sizer with the matching tibial anchorage connection and «OFFSET» stem adapter are assembled together to become the tibial trial.

Important

Assembly is carried out on the instrument table.

The transfer guide (3.75mm) is positioned based on the fins.

The selected trial stem is fixed to the tibial trial eccentric adapter (3.75mm).

Important

The position is set by the projections.

Finally the trial stem is fixed by a screw on the tibial trial in the specified offset position.

The tibial trial is hammered in using the corresponding impactor.

Important

When using tibial blocks, corresponding tibial block trials («5mm», «10mm» and «15mm») are available. They are fixed sliding laterally on the tibial trial (tibial sizer).

See page 40 for the following steps (femur).

Trial reduction ( tibial component )

39

Trial reduction ( femoral component )

The femoral trial adapter 0° or ±2°, is screwed to the femoral trial (corresponding to the preset valgus angle) and the trial stem (corresponding to the diameter and depth of the last reamer).

Important

There is a danger that the same trial stem will be needed on the femur and on the tibia. In this case a shorter trial stem of the same diameter is assembled on the femoral trial or a trial stem of the same length and smaller diameter or no trial stem at all is used.

The femoral trial is hammered in using the corresponding impactor.

Important

When using distal and/or posterior tibia blocks, corresponding femoral block trials («5mm», «10mm» and «15mm») are available. They are fixed laterally on the femoral trial.

The corresponding tibial insert trial is positioned.

The implant seat, the kinematics of the joint and the patella function are checked.

The final decision in favor of a patella replacement is made at this point (see instructions from page 44 ).

40

If the definitive implants are specified, the components are prepared for assembly (see instructions from page 46).

The trials are removed with the slap hammer, starting with the femur.

Important

However, we recommend leaving the trials with stem and any blocks assembled as a reference. They are used as a check and as a comparison to the definitive implant.

After the A/P and facet resections the chisel guide is positioned on the femoral reamer guide and fixed in place with a retaining screw.

The proximal limit of the box is accurately defined first with the femoral box chisel.

41

Posterior-Stabilized Option

In the case of complete insufficiency of the posterior cruciate ligament or if it is cut during surgery, e.g. with bending contractures greater than 30°, dorsal instability in bending position is possible.

A posterior-stabilized model (PS) for cemented application is available as compensation. It includes a revision femoral component which includes a box in the intercondylar region designed to accept a PS tibial insert with a higher pin. The movement of the femoral box on the tibial pin in bending results in the physiological roll-back and prevents displacement of the femoral-tibial contact point in the ventral direction (to the tibia).

SURGICAL TECHNIQUE FOR PS KNEE REPLACEMENT

The PS case is also used for the posterior-stabilized type (PS). Preparation of the demur for receiving the box requires a box saw guide with the femoral box chisel and the drill with the PS stop.

Important

To prevent unwanted fractures in the femoral condyle during preparation of the tibia (by Hohman support), the femoral box and the femoral anchorage can also be prepared at the end after preparation of the tibia.

Preparing the femoral box

The box is prepared medially and laterally with the oscillating saw.

Important

The medial and lateral saw cuts are aligned at an inclination to make it easy to place the IM-guided femoral component (valgus) in the correct position.

According to the predetermined valgus angle, the corresponding femoral valgus adapter («4°», «6°» or «8°») is inserted on the femoral reamer guide.

The femoral valgus adapter is inserted into the femoral reamer guide, so that depending on which side is the operation, the mark «LEFT» for left knee or «RIGHT» for right knee is visible on the arrow «ANTERIOR ».

The reamer bushing with the smallest diameter («Ø10») is inserted into the femoral valgus adapter.

Important

Reamer bushings and reamers in diameter «Ø10», «Ø12», «Ø14», «Ø16», «Ø18» and «Ø20» are available.

Reamers are used carefully and in progressive stages (starting with «Ø10») with use of the corresponding bushing, to ream to the required stem diameter and depth.

Important

The depth marking is on the reamer: observe the laser markings when using this technique. The recessed notch markings are for the IM application and are described in the corresponding surgical technique.

When using cemented stems, the Ø 12mm reamer is used to drill to the desired depth. Cemented stems are available in 80mm, 110mm and 150mm lengths.

42

An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in axial alignment and depth (the end of the reamer alignment guide corresponds to the tip of the reamer).

Preparing the femoral stem connection

For reduction, femoral trials PS revision and tibial insert trials PS are available.

See page 40 for the next step.

The largest reamer bushing «20» is inserted into the femoral valgus adapter («4°», «6°» or «8°»). The Ø 20mm drill is then drilled to the stop to prepare the recess for the stem connection.

ImportantBecause the femoral stem connection for the PS femoral component is deeper, the specific Ø 20mm drill with PS stop must be used.

Proceed with tibia preparation from page 29.

Trial reduction

43

44

Positioning the patella clamp and patella resection

Determine patellar size using the patellar sizer. Supplied sizes are Ø 26, Ø 29, Ø 32 and Ø 35mm. Note that the patellar component is implanted with a slight medial offset, thus matching the position of the natural patellar ridge. Small implant sizes are recommended for small patella to enable this offset to be reproduced.

The patellar instruments permit the use of the « onlay » technique in which 10mm of the bone are resected and replaced by a 10mm thick patellar implant (if an 8mm thick patellar implant is planned, resect just 8mm accordingly).

An alternative option is the « inlay » technique, in which the implant is partially countersunk (3mm to 5mm). Here, the patella is only resected approx. 7mm to 5mm below the ridge. The thickness of the residual bony patella should not be less than 12mm. See also the « Milling » section on page 45.

After placing the patellar cutting guide on the patellar clamp with the ratchet, grasp the patella with the clamp. The patellar thickness can be read from the mm scale on the handle.

Adjust the patella osteotomy insert (mm scale) to the height to be resected and resect the patella with the oscillating saw (mm saw blade with unset teeth, see page 87).

Important

When resecting, ensure that the saw blade does not migrate, e.g. due to sclerotic bone sectors.

Patellar size determination

Patellar Preparation

The leg is extended. Soft tissue on the posterior surface of the patella is exposed preserving the ligaments.

If there is no patella replacement, we suggest that the patella is always denervedand osteophytes are removed.

45

Milling

Using patellar drill guide and the patellar drill with stop, prepare the anchoring holes for the pegs.

Trial reduction

Patellar trials are available for trial reduction.

Assemble the patellar bushing onto the patellar clamp with the ratchet.

Select the patellar reamer to match the corresponding patella size. Depending on the selected anchoraging technique, mill briefly (« onlay » technique) or countersink by 3mm to 5mm (« inlay » technique). Milling down to the stop results in a depth of 5mm.

Important

Patellar implants with a height of 10mm are recommended as standard. Implants with a height of 8mm are available as an alternative for thin patella.

Drill anchoring holes

46

Assembling the tibial component

The prepared automatic hammer with adapter is placed on the stem. The stem is securely attached to the tibial component by three times impacting on the stem.

ImportantA stem connection with 3° "posterior slope" is integrated on the tibial component as standard.

The tibial component (page 57) is positioned in the specified position on the assembling block.

The stem (page 62 and 63) is inserted into the taper.

Important

Pay attention that the tapered connection is undamaged, clean and dry before assembling and by using non-cemented stems that a pocket is anterior, not a rib.

If an offset stem is planned, see assembling instructions from page 47.

Fixing the stem ( cemented/non-cemented ) to the tibial component

Assembling the Implants - Components

The assembling block is essential for safe and gentle assembling of the implants.

Important

When assembling the implant components, always start with the stem first. Then the tibial blocks can be fixed. Otherwise the tibial block screw may come loose during impacting.

Be aware; if any screw or PE pin is missing from the respective component or for any reason is not sterile, a set of replacement screws and PE pins (page 65) is available.

47

Assembling by using offset stems

With the stem screw is the stem additionally secured.

ImportantThe stem screwdriver is intentionally slim designed and

has to be used carefully.

The offset stem (page 63) is inserted into the taper on the assembling block and set to the offset position with the aid of the transfer guide (pre-assembled with the centering rings and straight surface on the elbow on the stem must be flush with the straight internal surface of the transfer guide).

Important

Pay attention that the tapered connection is undamaged, clean and dry before assembling.

The prepared automatic hammer with adapter is placed on the stem. The stem is securely attached to the tibial component by three times impacting on the stem.

Then the transfer guide is removed.

Securing the stem

The stem screw has to be tight with the provided screwdriver with torque. The required torque is reached when the line reaches the Stem/Block position (4.5 Nm).

Important

The screwdriver with torque is maintenance-free. However, make sure that the marking is at Position «0» when it is not under tension. Otherwise the wrench must be returned.

48

Assembling the tibial blocks

There are tibial blocks with a thickness of 5mm, 10mm and 15mm available for the tibial component (page 61).

To enable tibial block assembly the required PE pegs must first be removed.

Important

The tibial blocks can be inserted either medially or laterally (excepted tibial blocks size 15mm).

The tibial blocks are also fixed mechanically with the pre-assembled screws with the screwdriver with torque. The required torque is reached when the line reaches the« Stem/Block » position (4.5 Nm).

Important

The screws are screwed into the tibial block through the tibial component and must always be countersunk.

Assembling the femoral component

The femoral component (page 57, or page 64 for PS) is placed in the specified position on the assembling block.

49

Fixing the stem ( cemented/non-cemented ) to the femoral component

When using a 2° valgus stem (page 63) the markings on the femoral stem connection and stem («4°» or «8°») must match.

The stem (page 62 and 63) is inserted into the taper.

ImportantPay attention that the tapered connection is undamaged, clean and dry before assembling and by using non-cemented stems that a pocket is anterior, not a rib.

If a valgus stem is planned, see instructions below.

The prepared automatic hammer with adapter is placed on the stem. The stem is securely attached to the femoral component by three times impacting on the stem.

ImportantWhen using the straight stem the valgus angle is Assembling by using valgus stemso the stem connection.

Assembling by using valgus stems

50

Securing the stem

Femoral blocks 5mm, 10mm and 15mm thick (15mm distal only) are available for the femoral components (page 59 and 60).

Important

When using blocks note that the femoral implants must be clean and dry. Note the corresponding size combinations.

The femoral blocks are also fixed mechanically with the pre-assembled retaining screws with the screwdriver with torque. The required torque is reached when the line reaches the Stem/Block position (4.5 Nm).

Important

The posterior femoral blocks are the same for medial and lateral use.

In the case of distal femoral blocks make sure that the correct blocks are selected for the desired position, because there are three different blocks matching the contours.

When using distal and posterior blocks, it is recommended to screw tightly the posterior block first and then the distal block. This is particularly advisable by use of a 15mm distal block.

The stem is additionally secured with the stem retaining screw. The retaining screw must be tightened with the screwdriver with torque. The required torque is reached when the line reaches the Stem/Block position (4.5 Nm).

Important

The stem retaining screw for retaining the stem is packaged with the femoral component.

Assembling the femoral blocks

Implanting the Components

Mix the bone cement according to the respective manufacturer's instructions. Clean, wash and dry the bone bed sufficiently. Modern cementing techniques using a vacuum mixer and jet lavage are recommended.

The TC-PLUS™ Revision knee is used with cement, with the exception of non-cemented stems. First cement the tibial component and then the femoral component.

Important

With sclerotic bone it is recommended to drill several holes using an Ø 3.2mm drill. This improves anchorage between the bone cement and the bone.

Ti6Al4V stems: The backs of the condyles and the box walls of the femoral component are coated with cement. The back of the tibial component is coated with cement (back of plateau and box). The Ti6Al4V stems are not cemented.

Important

When implanting Ti6Al4V stems, pay attention that the rotations alignments of the femoral and tibial components correspond already when the stems are inserted to the definitive implant positions. This prevents unnecessary rib notches occurring in the IM canal.

CoCr stems: The medullary plugs are accordingly placed deeper. It is recommended to fill up the medullary cavities using a cement gun.

51

Implanting the tibial and femoral components

In 90° flexed position, the tibial component is hammered in using the corresponding impactor. Excess cement is carefully removed. While the cement is setting, the implant components must be under continuous pressure.

The tibial insert of the corresponding size must not be placed until the cement has fully hardened. Ultracongruent tibial inserts (page 58) and PS inserts(page 64 and 65) are available.

Important

Make sure that cement is placed between the fin connection and stem connection when using tibial blocks.

The femoral component is hammered using the impactor. Here too continuous pressure must be maintained and excess cement removed.

Important

Make sure that the posterior femoral condyles do not come into contact with the tibial component when impacting the femoral component. We recommend covering the tibial component with a compress.

52

Last controlling

Prior to definitive assembly of the tibial insert it is possible to use the tibial insert trial for a final trial reduction.

Before the cement has set, the excess cement must be removed in extension.

Insertion of the tibial insert

In 90° flexed position, the ultracongruent tibial insert (or PS tibial insert) is slided manually onto the tibial component. If necessary, use the tibial insert impactor with the handle.

Important

Note the correct anatomical alignment. It is important to make sure that no soft tissue is coming between the tibial insert and the tibial component.

53

If patellar replacement is indicated, the patellar component (page 57) of the TC-PLUS™/RT-PLUS™ knee systems is used since the geometry of the patellar groove matches this implant.

Assemble the patellar inserter on the patellar clamp with the ratchet. Coat the back of the patellar component with cement and fill the three peg holes of the patella with cement. Insert the patellar component by hand with the leg extended and press in, using the patellar clamp with the ratchet fitted with the patellar inserter. Remove excess cement. Leave the clamp in place until the cement has completely set.

After manual placement of the PE retaining screw into the tibial insert, the PE retaining screw is tightened with the screwdriver with torque. The required torque is reached when the line reaches the PE position (2.5 Nm).

Important

The screwdriver with torque is maintenance-free. However, make sure that the marking is at Position «0» when it is not under tension. Otherwise the screwdriver with torque must be returned.

Implanting the cemented patellar component

54

Wound closure

The wound must again be rinsed out thoroughly after implantation. Close the wound in layers, inserting two intra-articular and one subcutaneous Redon drain.

Rehabilitation

The operated leg is immobilized in a splint and the knee joint is cooled. Isometric contraction exercises should be performed on the first postoperative day. Thrombosis prophylaxis is required until full load can be borne.

On the second postoperative day, after removing the drains, assisted movement exercises and the use of a motorized splint (CPM) are started. The operated leg can be generally bear a load early on.

Mobilization of the patient is initially occurs with a walking frame or crutches, which can be limited as steadiness of gait improves.

Postoperative Treatment

55

Sterilization

Implants

All the implants described in this Surgical Technique are sterile when they are delivered by the manufacturer. Implants must never be re-sterilized.

Instruments

Instruments are not sterile when they are delivered. Before use they must be cleaned by the usual methods in accordance with internal hospital regulations and sterilized in an autoclave in accordance with the legal regulations and guidelines applicable in the relevant country. (For detailed information please refer to leaflet document no. 03389).

The applicable settings should be verified by the user in accordance with the instructions for use issued by the autoclave manufacturer.Instrument manufacturers and dealers accept no responsibility for sterilization of products by the customer.

57

Implants

TC-PLUS™ Revision implants for cemented application

Femoral components left

SAP No. Art. No.Size75005148 22482 275005149 22484 475005150 22486 675005151 22488 875005152 22490 10

Femoral components right

SAP No. Size75005143 22462 275005144 22464 475005145 22466 675005146 22468 875005147 22470 10

Tibial components

SAP No. Art. No. Size75005136 22302 275005137 22304 475005138 22306 675005139 22308 875005140 22310 10

Patella components

SAP No. Art. No. Thickness75004784* 21182* Ø 26 mm 8 mm75004787 21192 Ø 26 mm 10 mm75004785* 21183* Ø 29 mm 8 mm75004788 21193 Ø 29 mm 10 mm75004786* 21184* Ø 32 mm 8 mm75004789 21194 Ø 32 mm 10 mm75004790 21195 Ø 35 mm 10 mm

* Special sizes ( on request )

The patellar components are the same as those of the TC-PLUS™ knee system

Size

Art. No.

58

Tibial inserts ultracongruent

SAP No. Art. No. Size Thickness75006065 25416 2 9mm75006066 25417 2 11mm75006067 25418 2 13mm75006059 25400 2 15mm75006069 25421 2 17mm75006068 25420 2 19mm

75006070 25426 4 9mm75006071 25427 4 11mm75006072 25428 4 13mm75006060 25401 4 15mm75006074 25431 4 17mm75006073 25430 4 19mm

75006075 25436 6 9mm75006076 25437 6 11mm75006077 25438 6 13mm75006061 25402 6 15mm75006079 25441 6 17mm75006078 25440 6 19mm

75006080 25446 8 9mm75006081 25447 8 11mm75006082 25448 8 13mm75006062 25403 8 15mm75006084 25451 8 17mm75006083 25450 8 19mm

75006085 25456 10 9mm75006086 25457 10 11mm75006087 25458 10 13mm75006063 25404 10 15mm75006089 25461 10 17mm75006088 25460 10 19mm

The tibial inserts are the same as those of the TC-PLUS™ knee system

59

Femoral blocks distal / lateral

SAP No. Art. No. Size Thickness75005091 22228 2 5mm75005092 22229 2 10mm75005093 22230 2 15mm

75005094 22231 4 5mm75005095 22232 4 10mm75005096 22233 4 15mm

75005097 22234 6 5mm75005098 22235 6 10mm75005099 22236 6 15mm

75005100 22237 8 5mm75005101 22238 8 10mm75005102 22239 8 15mm

75005103 22240 10 5mm75005104 22241 10 10mm75005105 22242 10 15mm

Femoral blocks distal / medial left

SAP No. Art. No. Size75005106 22249 2 5mm75005107 22250 2 10mm75005108 22251 2 15mm

75005109 22252 4 5mm75005110 22253 4 10mm75005111 22254 4 15mm

75005112 22255 6 5mm75005113 22256 6 10mm75005114 22257 6 15mm

75005115 22258 8 5mm75005116 22259 8 10mm75005117 22260 8 15mm

75005118 22261 10 5mm75005119 22262 10 10mm75005120 22263 10 15mm

The femoral blocks are the same for the TC-PLUS™ Revision knee system and for the TC-PLUS PS Revision knee system

Thickness

60

Femoral blocks distal / medial right

SAP No. Art. No. Size Thickness75005121 22270 2 5mm75005123 22271 2 10mm75005124 22272 2 15mm

75005125 22273 4 5mm75005126 22274 4 10mm75005127 22275 4 15mm

75005128 22276 6 5mm75005129 22277 6 10mm75005130 22278 6 15mm

75005131 22279 8 5mm75005132 22280 8 10mm75005133 22281 8 15mm

75005134 22282 10 5mm75005135 22283 10 10mm75005136 22284 10 15mm

Femoral blocks posterior

SAP No. Art. No. Size Thickness75005081 22212 2 5mm75005082 22213 2 10mm

75005083 22214 4 5mm75005084 22215 4 10mm

75005085 22216 6 5mm75005086 22217 6 10mm

75005087 22218 8 5mm75005088 22219 8 10mm

75005089 22220 10 5mm75005090 22221 10 10mm

The femoral blocks are the same for the TC-PLUS™ Revision knee system and for the TC-PLUS PS Revision knee system

61

Tibial blocks

SAP No. Art. No. Size Thickness75005153 22512 2 5mm75005154 22513 2 10mm75005163 22532 2 15mm R-lat/L-med75005164 22533 2 15mm L-lat/R-med

75005155 22514 4 5mm75005156 22515 4 10mm75005165 22534 4 15mm R-lat/L-med75005166 22535 4 15mm L-lat/R-med



75005161 22520 10 75005162 22521 10 10mm

75005171 22540 10 15mm R-lat/L-med75005172 22541 10 15mm L-lat/R-med

5mm

62

Cemented Stems ( conical ) [CoCrMo]

SAP No. Art. No. Length75007325 61000 80mm75007327 61002 110mm75007326 61001 150 mm

Non-cemented stems – straight [Ti6Al4V]

SAP No. Art. No. Size Length

75007329 61100 Ø 10mm 80mm75007330 61101 Ø 12mm 80mm75007331 61102 Ø 14mm 80mm75007332 61103 Ø 16mm 80mm

75007333 61104 Ø 10mm 110mm75007334 61105 Ø 12mm 110mm75007335 61106 Ø 14mm 110mm75007336 61107 Ø 16mm 110mm75007337 61108 Ø 18mm 110mm


Cemented and non-cemented stems are identical for femoral and tibial components of the TC-PLUS™ Revision or TC-PLUS PS Revision knee systems

ImportantThe 40mm stems are foreseen for the EM procedure. For the IM procedure, these stems are too short for giving a good and stable anchorage in the IM canal (reference for the cutting blocks).

75007342 61113 Ø 10mm 40mm75007343 61114 Ø 12mm 40mm75007344 61115 Ø 14mm 40mm

63

Non-cemented stems – 2° valgus [Ti6Al4V] ( for femoral component only )

Art. No. Size Length75007346 61120 Ø 10mm 80mm75007347 61121 Ø 12mm 80mm75007348 61122 Ø 14mm 80mm75007349 61123 Ø 16mm 80mm



Non-cemented stems – 3.75° offset [Ti6Al4V] ( for tibial component only )

SAP No. Art. No. Size Length75007360 61140 75007361 61141 75007362 61142 75007363 61143

75007364 61144 75007365 61145 75007366 61146 75007367 61147 75007368 61148

75007373 61153 75007369 61149 75007370 61150 75007371 61151 75007372 61152

Non-cemented stems with 2° valgus are identical for the femoral component of the TC-PLUS™ Revision and TC-PLUS PS Revision knee systems

2°

3.75 mm

SAP No.

Ø 10mm 80mmØ 12mm 80mmØ 14mm 80mmØ 16mm 80mm

Ø 10mm 110mmØ 12mm 110mmØ 14mm 110mmØ 16mm 110mmØ 18mm 110mm

Ø 12mm 150mmØ 14mm 150mmØ 16mm 150mmØ 18mm 150mmØ 20mm 150mm

64

Posterior-Stabilised Version

TC-PLUS™ PS Revision implants for cemented application

Femoral components left

SAP No. Art. No. Size75007315 60102 275007316 60104 475007317 60106 675007318 60108 875007319 60110 10

Femoral components right

SAP No. Art. No. Size75007320 60122 275007321 60124 475007322 60126 675007323 60128 875007324 60130 10

Tibial inserts PS

SAP No. Art. No. Size Thickness75005173 22610 2 75005174 22611 2 75005175 22612 2 75005176 22613 2 75005177 22614 2 75005178 22615 2

9mm 11mm 13mm 15mm 17mm 19mm

75005181 22620 4 9 mm75005182 22621 4 11 mm75005183 22622 4 13 mm75005184 22623 4 15 mm75005185 22624 4 17 mm75005186 22625 4 19 mm

75005189 22630 6 9 mm75005190 22631 6 11 mm75005191 22632 6 13 mm75005192 22633 6 15 mm75005193 22634 6 17 mm75005194 22635 6 19 mm

SAP No. Art. No. Size Thickness75005197 22640 8 75005198 22641 8 75005199 22642 8

9mm 11mm 13mm

75005200 22643 8 15mm75005201 22644 8 17mm75005202 22645 8 19mm

75005205 22650 10 9mm75005206 22651 10 11mm75005207 22652 10 13mm75005208 22653 10 15mm75005209 22654 10 17mm75005210 22655 10 19mm

The tibial inserts are the same as those of the TC-PLUS™ knee system

65

Tibial inserts PS ( on request )

SAP No. Art. No. Size Thickness75005179 22616 2 75005187 22626 4 21 mm75005195 22636 6 21 mm75005203 22646 8 21 mm75005211 22656 10 21 mm

The tibial inserts are the same as those of the TC-PLUS™ knee system.

Set of spare screws and PE pins

Art. Nr.SAP No. Quantity Description75005142 22390 1 Set of Spare Screws and PE Pins:

2x Tibial PE Pins1x Tibial Block Screw1x Femoral Stem Screw1x Tibial Stem Screw

This set is intended as safety backup.

21 mm

66

Instrument Set: SAP No. 75200232 Art. No. 0944030

Case Set: SAP No. 75200215 Art. No. 0944012

Art. No.SAP No. Description Size Quantity75006024 253309 Case Basic Instrument, Empty – 175007661 990019 Case Lid – 1

� 75007192 600290 Alignment Bushing Ø 8mm 1� 75007099 600115 1 75007100 600116 1 75007101 600117 1 75007102 600118 1 75007103 600119 1 75007104 600120

Reamer BushingReamer BushingReamer BushingReamer BushingReamer BushingReamer Bushing

Ø 10mmØ 12mmØ 14mmØ 16mmØ 18mmØ 20mm 1

� 75007108 600125 Drill with Stop Ø 20mm 1� 75005663 251073 IM Drill with Starter Tip Ø 8mm 1� 75005902 252746 Resection Stylus 1mm 1� 75005857 252068 Quick Lock Handle – 4� 75007137 600175 Tibial Sizer Handle – 1 75005659 251065 1 75007140 600179 6 75007141 600180 2 75007138 600177 75007139 600178 75018329

DrillBone PinBone Pin Bone Pin with Head Bone Pin with Head Allen Wrench

Ø 3.2mm 75m m

100m m 25mm 38mm

SW 3.5 1 75007233 600398 Femoral / Tibial Cutting Block (1 mm) – 1� 75007160 600214 Femoral Condyle Spacer 7mm 1� 75006032 253360 9mm 1 75006033 253361 11mm 1 75006034 253362 13mm 1 75006035 253363 15mm 1 75006030 253359 17mm 1 75006036 253364

Tibial SpacerTibial SpacerTibial SpacerTibial SpacerTibial SpacerTibial Spacer 19mm 1

75007163 600223 5mm 4 75007164 600224 10mm 4 75007172 600248

Spacer Attachment Spacer AttachmentSpacer Attachment 15mm 4

� 75005420 240391 Pin Extractor� 75007135 600172 Axial Alignment Rod ( I / II ) – 1

Instruments

TC-PLUS™ Revision Instrument Set (1mm)

Basic Instruments

44

– 1

75018329

67

Optional Drill with AO Connection ( on request ) Set: SAP No. 75200233 Art. No. 0944031

SAP No. Art. No. Description 75005672 251096 Drill (AO) Ø 3.2mm 1� 75005673 251097 IM Drill with Starter Tip (AO) Ø 8mm 1� 75007109 600128 Drill with Stop (AO) Ø 20mm 1 75005412 240374 Stepped Drill (AO) Ø 8/14mm 1

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68

Trial Stems & Reamers Case Set: SAP No. 75200216 Art. No. 0944013

SAP No. Art. No. Description 75006017 253302 Trial Stems Case, Empty – 1

75007661 990019 – 1� 75007113 600132 1

75007114 600133 175007115 600134

Ø 10 / 40mmØ 12 / 40mmØ 14 / 40mm 1

� 75007116 600135 1 75007117 600136 1 75007118 600137 1 75007119 600138

Ø 10 / 80mmØ 12 / 80mmØ 14 / 80mmØ 16 / 80mm 1

� 75007120 600145 175007121 600146 175007122 600147 175007123 600148 175007124 600149

Ø 10 / 110mmØ 12 / 110mmØ 14 / 110mmØ 16 / 110mmØ 18 / 110mm 1

� 75007125 600150 1 75007126 600157 1 75007127 600158 1 75007128 600159 1 75007129 600160

Ø 12 / 150mmØ 14 / 150mmØ 16 / 150mmØ 18 / 150mmØ 20 / 150mm 1

� 75007194 600292 Extension for Trial Stem Ø 8mm 1600112 � 75007098

253301

Reamer + Trial Stem Handle – 1

� 75004829 22000032 Stepped Drill Ø 10 / 20mm 1 75005300 240003 Stepped Drill Ø 8 / 14mm 1 75007168 600232 IM Rod Ø 8mm 1� 75007235 600401 Reamer 1 75007236 600402 Reamer 1 75007237 600403 Reamer 1 75007238 600404 Reamer 1 75007239 600405 Reamer 1 75007240 600406 Reamer

Ø 10mmØ 12mmØ 14mmØ 16mmØ 18mmØ 20mm 1

� 75005419 240387 Reamer Alignment Guide EM – 1

Case LidTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial Stem

Tray Reamers, Empty75006016 – 1

Size Quantity

ImportantThe 40mm trial stems are foreseen for the EM procedure. For the IM procedure, these trial stems are too short for giving a good and stable anchorage in the IM canal (reference for the cutting blocks).

69

Optional Cemented Trial Stems ( on request ) Case Set: SAP No. 75200281 Art. No. 0944094

SAP No. Art. No. Description 75007111 600130 80mm 1

75007110 600129 110mm 175007112 600131 150mm 1

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Size Quantity

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Femoral Instruments Case Set: SAP No. 75200217 Art. No. 0944014

SAP No. Art. No. Description 75006015 253300 Case Femoral Trials, Empty – 1

75007661 990019 Case Lid – 1� 75006001 253275 Femoral Drill Guide IM, Adjustable – 1� 75007144 600183 Femoral Distal Spacer Revision 7mm 1� 75007145 600184 6° 1

75007146 600185 4° 175007147 600186 8° 1

� 75007148 600187 Femoral Suspension Device Revision – 1� 75007234 600399 – 1� 75007175 600257 Groove Stone for Femoral Cutting Block – 1� 75007213 600351 2 1 75007214 600352 4 1 75007215 600353 6 1 75007216 600354 8 1 75007217 600355 10 1 75007241 600407 2

75007242 600408 2–4 / 5mm 6–10 / 5mm 2

75007243 600409 2 75007244 600410

2–4 / 10mm 6–10 / 10mm 2

� 75007245 600411 2 75007246 600412

2–4 / 15mm 6–10 / 15mm 2

� 75007249 600441 2 175007250 600442 4 175007251 600443 6 175007252 600444 8 175007253 600445 10 1

75007195 600293 4° 1 75007196 600294 6° 1 75007197 600295 8° 1� 75007218 600371 2 1

75007219 600372 4 175007220 600373 6 175007221 600374 8 175007222 600375 10 1

� 75007130 600161 – 1� 75007200 600298 – 1

Femoral BushingFemoral BushingFemoral Bushing

Femoral Stylus

Femoral Cutting Block SpacerFemoral Cutting Block SpacerFemoral Cutting Block SpacerFemoral Cutting Block Spacer

Femoral Cutting Block SpacerFemoral Cutting Block Spacer

Femoral SizerFemoral SizerFemoral SizerFemoral SizerFemoral SizerFemoral Valgus AdapterFemoral Valgus AdapterFemoral Valgus AdapterFemoral Reamer GuideFemoral Reamer GuideFemoral Reamer GuideFemoral Reamer GuideFemoral Reamer Guide

Trochlear ChiselTrochlear Chisel Guide

Femoral Cutting Block (1 mm)Femoral Cutting Block (1 mm)Femoral Cutting Block (1 mm)Femoral Cutting Block (1 mm)Femoral Cutting Block (1 mm)

Size Quantity

71

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Femoral Trials Case Set: SAP No. 75200218 Art. No. 0944015

SAP No. Art. No. Description 75006018 253303 Femoral Trial Case, Empty – 1

75007661 990019 Case Lid – 1� 75007223 600381 2 1

75007224 600382 4 175007225 600383 6 175007226 600384 8 175007227 600385 10 1

� 75007228 600391 2 175007229 600392 4 175007230 600393 6 175007231 600394 8 175007232 600395 10 1

� 75007153 600200 0° 1� 75007155 600202 ± 2° 1� 75007158 600206 5mm 6

75007159 600209 10mm 675007171 600247 15mm 475007173 600249 15mm 2

� 75007169 600238 – 1

Femoral Trial AdapterFemoral Trial AdapterFemoral Block TrialFemoral Block TrialFemoral Block TrialFemoral Block Trial

Femoral Trial RightFemoral Trial RightFemoral Trial RightFemoral Trial RightFemoral Trial Right

Femoral Trial LeftFemoral Trial LeftFemoral Trial LeftFemoral Trial LeftFemoral Trial Left

Curved Osteotome

Size Quantity

73

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Tibial Instruments Case Set: SAP No. 75200219 Art. No. 0944016

SAP No. Art. No. Description 75006019 253304 Case Tibial Instruments, empty – 1

75007661 990019 – 1� 75006025 253311 2 1

75006026 253312 4 175006027 253313 6 175006028 253314 8 175006029 253315 10 1

� 75005920 253111 2 / 5mm 175005925 253121 2 / 10mm 175005983 253221 2 / 15mm 175005921 253112 4 / 5mm 175005926 253122 4 / 10mm 175005984 253222 4 / 15mm 175005922 253113 6 / 5mm 175005927 253123 6 / 10mm 175005985 253223 6 / 15mm 175005923 253114 8 / 5mm 175005928 253124 8 / 10mm 175005986 253224 8 / 15mm 175005924 253115 10 / 5mm 175005929 253125 10 / 10mm 175005987 253225 10 / 15mm 1

� 75006003 253281 2 / 5mm 175006009 253291 2 / 10mm 175005988 253241 2 / 15mm 175006004 253282 4 / 5mm 175006010 253292 4 / 10mm 175005989 253242 4 / 15mm 175006005 253283 6 / 5mm 175006011 253293 6 / 10mm 175005990 253243 6 / 15mm 175006006 253284 8 / 5mm 175006012 253294 8 / 10mm 175005991 253244 8 / 15mm 175006007 253285 10 / 5mm 175006013 253295 10 / 10mm 175005992 253245 10 / 15mm 1

Tibial Sizer / TrialTibial Sizer / TrialTibial Sizer / TrialTibial Sizer / TrialTibial Sizer / Trial

Case Lid

Tibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-Med

Size Quantity

75

Tibial Instruments ( next )

SAP No. Art. No. Description � 75007247 600413 2–4 1� 75007248 600414 6–10 1� 75007132 600165 2–4 1� 75007133 600166 6–10 1 75023718 22000514 Holder Tibial Resection Guide IM – 1 75023727

600173 Tibial Stylus 1mm / 11mm 1� 75010947600167 Tibial Slope Adapter 3° 1� 75007134600296 2–4 1 75007198600297 6–10 1� 75007199600198 – 1� 7500715222000031 3.75mm 1� 75004828 22000035 2–4 1� 75004832 22000036 6–10 1� 75004833 22000033 – 1

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Tibial Rasp Tibial Rasp Guide Tibial Rasp Guide

Tibial Rasp

Tibial Anchoring ExtensionTibial Anchoring Extension Tibial Stem Retainer Tibial trial Eccentric Adapter Tibial Anchoring Extension, Offset Tibial Anchoring Extension, Offset Tibial Stem Retainer, Offset

22000523 Support Tibial Resection Guide IM

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1± 6mm


Size Quantity

76

Tibial Insert Trials CS Case Set: SAP No. 75200220 Art. No. 0944017

SAP No. Art. No. Description 75006020 253305 Case Tibial Insert Trials CS, empty – 1

75007661 990019 Case Lid – 1� 75005600 250400 2 / 9mm 1

75005601 250401 2 / 11mm 175005602 250402 2 / 13mm 175005603 250403 2 / 15mm 175005630 250431 2 / 17mm 175005604 250404 2 / 19mm 1

� 75005605 250405 4 / 9mm 175005606 250406 4 / 11mm 175005607 250407 4 / 13mm 175005608 250408 4 / 15mm 175005631 250432 4 / 17mm 175005609 250409 4 / 19mm 1

� 75005610 250410 6 / 9mm 175005611 250411 6 / 11mm 175005612 250412 6 / 13mm 175005613 250413 6 / 15mm 175005632 250433 6 / 17mm 175005614 250414 6 / 19mm 1

� 75005615 250415 8 / 9mm 175005616 250416 8 / 11mm 175005617 250417 8 / 13mm 175005618 250418 8 / 15mm 175005633 250434 8 / 17mm 175005619 250419 8 / 19mm 1

� 75005620 250420 10 / 9mm 175005621 250421 10 / 11mm 175005622 250422 10 / 13mm 175005623 250423 10 / 15mm 175005624 250435 10 / 17mm 175005625 250424 10 / 19mm 1

Size Quantity

Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)

Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)

Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)

77

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Assembly Instruments

SAP No. Art. No. Description Size Quantity75006021 253306 Case Assembly Instruments, empty

75007661 990019 � 75007142 600181 Slap Hammer � 75007143 600182 Adapter for Slap Hammer Flat 1� 75007149 600188 Adapter for Slap Hammer M6 1� 75006000 253273 Impactor Tibial Insert – 1� 75007190 600288 Impactor Small 1� 75007191 600289 Impactor Large 1� 75007202 600300 75102308 75102308 75005999 253272 Adapter for Tibial Stem Screw SW 7 1� 75007188 600279 Adapter w. Spherical Hexagonal Head SW 3.5 2� 75007170 600239 75007166 600228 � 75007201 600299 Adapter for Automatic Hammer � 75004827 22000030 Tibia Eccentric Connection (I/II/III) 3.75mm 1� 75004831 22000034 Transfer Guide (I/II) 3.75mm 1� 75004834 22000037


Case Lid

Screwdriver with TorqueModular Handle

Assembling BlockAutomatic Hammer

Centering Ring (I/II)

– 1

– 1– 1– 1

– 1

– 1– 1– 1

– 2

79

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SAP No. Art. No. Description 75006023 253308 Case Femoral Instrument PS, empty – 1

75007661 990019 Case Lid – 1� 75005777 251529 Femoral Box Chisel – 1� 75005994 253267 2–10 1� 75005995 253268 Drill with Stop, Femur PS Ø 20mm 1� 75007150 600189 Adapter for Slap Hammer Hook 1� 75007203 600312 2 1

75007204 600314 4 175007205 600316 6 175007206 600318 8 175007207 600320 10 1

� 75007208 600332 2 175007209 600334 4 175007210 600336 6 175007211 600338 8 175007212 600340 10 1

Optional 21 mm Tibial Insert PS (on request)

Art. No.SAP No. Description � 75006037 253365 Tibial Spacer 21mm 1

Optional Drill with AO Connection (on request)

Art. No. Description � 75005996 253269 Drill with Stop, Femur PS (AO) 1

Size Quantity

Instrument Set: SAP No. 75200277 Art. No. 0944090


Posterior-Stabilised Version

TC-PLUS™ PS Revision Instrument Set

Femoral Instruments PS

Chisel Guide for Box Chisel ( 1 mm )

Femoral Trial PS LeftFemoral Trial PS LeftFemoral Trial PS LeftFemoral Trial PS LeftFemoral Trial PS LeftFemoral Trial PS RightFemoral Trial PS RightFemoral Trial PS RightFemoral Trial PS RightFemoral Trial PS Right

Size Quantity

Size QuantitySAP No.Ø 20mm

Set: SAP No. 75200280 Art. No. 0944093

Set: SAP No. 75200233 Art. No. 0944031

81

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Tibial Insert Trials PS

Art. No.SAP No. Description Quantity75006022 253307 Case Tibial Insert Trials PS, empty – 1

75007661 990019 Case Lid – 1� 75005930 253140 2 / 9mm 1

75005931 253141 2 / 11mm 175005932 253142 2 / 13mm 175005933 253143 2 / 15mm 175005934 253144 2 / 17mm 175005935 253145 2 / 19mm 1

� 75005938 253150 4 / 9mm 175005939 253151 4 / 11mm 175005940 253152 4 / 13mm 175005941 253153 4 / 15mm 175005942 253154 4 / 17mm 175005943 253155 4 / 19mm 1

� 75005947 253160 6 / 9mm 175005948 253161 6 / 11mm 175005949 253162 6 / 13mm 175005950 253163 6 / 15mm 175005951 253164 6 / 17mm 175005952 253165 6 / 19mm 1

� 75005956 253170 8 / 9mm 175005957 253171 8 / 11mm 175005958 253172 8 / 13mm 175005959 253173 8 / 15mm 175005960 253174 8 / 17mm 175005961 253175 8 / 19mm 1

� 75005965 253180 10 / 9mm 1 75005966 253181 10 / 11mm 1 75005967 253182 10 / 13mm 1 75005968 253183 10 / 15mm 1 75005969 253184 10 / 17mm 1 75005970 253185 10 / 19mm 1

Optional 21 mm Tibial Insert Trials PS (on request)

SAP No. Art. No. Description � 75005936 253146 2 / 21mm 1

75005944 253156 4 / 21mm 175005953 253166 6 / 21mm 175005962 253176 8 / 21mm 175005971 253186 10 / 21mm 1

Case Set: SAP No. 75200279Art. No. 0944092

Size Quantity

Tibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PS

Size

Set: SAP No. 75200280Art. No. 0944093

Tibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PS

83

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Patellar Instruments

SAP No. Art. No. Description 75018088 22000451 Case Patellar Instrument, Empty – 1

75007661 990019 Case Lid – 1� 75005702 251204 – 1� 75005881 252203 – 1� 75005723 251292 1

75005724 251293 175005725 251294 175005726 251295

Ø 26 / 10mmØ 29 / 10mmØ 32 / 10mmØ 35 / 10mm 1

� 75005717 251278 Patellar Drill with Stop Ø 5.5mm 1� 75005718 251280 – 1� 75005716 251277 – 1� 75005707 251230 1 75005708 251231 1 75005709 251232 1 75005710 251233

Ø 26mmØ 29mmØ 32mmØ 35mm 1

75005711 251240 1 75005712 251241 1 75005713 251242 1 75005714 251243


75005706 251216 1 75005707 251283 1 75005708 251284 1 75005709 251285

Patellar Mill with StopPatellar Mill with StopPatellar Mill with StopPatellar Mill with Stop


� 75005034 22000327 – 1

84

Optional Patellar Trials 8mm (on request)

175005704 251210 175005705 251211

Ø 26 / 8mmØ 29 / 8mmØ 32 / 8mm 1

Optional Reamer/Drill with AO Connection (on request)

� 75004871 22000038 Patellar Drill with Stop (AO) Ø 5.5mm 1 75004989 22000280 Patellar Mill with Stop (AO)

Patellar Mill with Stop (AO)Patellar Mill with Stop (AO)Patellar Mill with Stop (AO)

175004990 22000281 175004991 22000282 175004992 22000283


Size Quantity

Size Quantity

Quantity


Size

Patellar ClampPatellar Clamp Cutting Guide ( 1mm )

Patellar SizerPatellar inserterPatellar Clamp BushingPatellar Clamp BushingPatellar Clamp BushingPatellar Clamp Bushing

Patellar TrialPatellar TrialPatellar TrialPatellar Trial

Patellar Drill GuidePatellar Drill GuidePatellar Drill GuidePatellar Drill Guide

Bone thickness Sizer

Patellar TrialPatellar TrialPatellar Trial

Set: SAP No. 75200212Art. No. 0944008

Set: SAP No. 75200251Art. No. 0944049

SAP No. Art. No. Description

SAP No. Art. No. Description

� 75005703 251209

Patella

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Documents

ImportantThe following documents are available for support

Product accompanying documents

Name Lit. No.

Surgical technique Extramedullar Procedure 15802-en (1356)Surgical technique Intramedullar Procedure 15801-en (1402)

X-ray templates "TC-PLUS™ Revision" (1.15:1) 1354-A1-A2-A3-BX-ray templates "TC-PLUS PS Revision" (1.15:1) 1355-A1-A2-A3-BX-ray templates "TC-PLUS Revision" (1:1) 1511-A1-A2-A3-BX-ray templates "TC-PLUS PS Revision" (1:1) 1512-A1-A2-A3-BProduct overview "TC-PLUS Revision" 1358Product overview "TC-PLUS PS Revision" 1497

01218Sawblade Portfolio

Product information 15873-en (1357)

88

Prod

uct o

verv

iew

( co

mbi

natio

n ta

ble

)

TC-P

LUS™

Rev

isio

n

Fem

oral

blo

cks

dist

al /

pos

terio

r

Tibi

al in

sert

sUl

trac

ongr

uent

Fem

oral

com

pone

nts

right

/ le

ft

Tibi

al c

ompo

nent

s

2544

6 /

9 m

m25

447

/ 11

mm

2544

8 /

13 m

m25

403

/ 15

mm

2545

1 /

17 m

m

2543

6 /

9 m

m25

437

/ 11

mm

2543

8 /

13 m

m25

402

/ 15

mm

2544

1 /

17 m

m

2542

6 /

9 m

m25

427

/ 11

mm

2542

8 / 1

3 m

m25

401 /

15 m

m25

431 /

17 m

m

2545

6 /

9 m

m

2545

7 /

11 m

m

2545

8 /

13 m

m

2540

4 /

15 m

m

2546

1 /

17 m

m

2541

6 /

9 m

m25

417

/ 11

mm

2541

8 /

13 m

m25

400

/ 15

mm

2542

1 / 17

mm

Pate

llar c

ompo

nent

s

2118

4* /

8 m

m21

194

/ 10

mm

Ø29

Ø32

Ø35

Ø26

2118

3* /

8 m

m21

193

/ 10

mm

2119

5/ 1

0 m

m21

182*

/ 8

mm

2119

2 /

10 m

m

* Sp

ecia

l siz

es

Post

erio

r22

212

/ 5

mm

2221

3 /

10 m

m22

214

/ 5

mm

2221

5 /

10 m

m

Post

erio

r22

216

/ 5

mm

2221

7 /

10 m

m

Post

erio

r22

218

/ 5

mm

2221

9 /

10 m

m

Post

erio

r22

220

/ 5

mm

22

221 /

10 m

m

Post

erio

r

2230

8 60322

4032222

310

2230

2

2246

822

466

2246

422

490

2247

022

488

2248

622

484

2246

222

482

Size

6Si

ze 2

Size

8Si

ze 4

Size

10

2222

8 /

5 m

mD

ist /

Lat

:22

231 /

5

mm

Dis

t / L

at:

2223

4 /

5 m

mD

ist /

Lat

: 22

237

/ 5

mm

Dis

t / L

at:

2224

0 /

5 m

m

2222

9 /

10 m

m22

232

/ 10

mm

2223

5 /

10 m

m22

238

/ 10

mm

2224

1 /

10 m

m

Dis

t / L

at:

2223

0 /

15 m

m22

233

/ 15

mm

2223

6 /

15 m

m22

239

/ 15

mm

2224

2 /

15 m

m

2224

9 /

5 m

m22

250/

10 m

m

Dis

t / M

ed L

:22

252

/ 5

mm

2225

3 /

10 m

mD

ist /

Med

L:

2225

5 /

5 m

m22

256

/ 10

mm

Dis

t / M

ed L

: 22

258

/ 5

mm

2225

9 /

10 m

mD

ist /

Med

L:

2226

1 /

5 m

m

2226

2 /

10 m

m

Dis

t / M

ed L

:

2225

1 / 15

mm

2225

4 /

15 m

m22

257

/ 15

mm

2226

0 /

15 m

m22

263

/ 15

mm

2227

0 /

5 m

m22

271

/ 10

mm

Dis

t / M

ed R

:22

273

/ 5

mm

2227

4 /

10 m

mD

ist /

Med

R:

2227

6 /

5 m

m22

277

/ 10

mm

Dis

t / M

ed R

: 22

279

/ 5

mm

2228

0 /

10 m

mD

ist /

Med

R:

2228

2 /

5 m

m

2228

3 /

10 m

m

Dis

t / M

ed R

:

2227

2 /

15 m

m22

275

/ 15

mm

2227

8 / 1

5 m

m22

281

/ 15

mm

2228

4 /

15 m

m

Tibi

al b

lock

s22

516

/ 5

mm

2251

7 /

10 m

m22

518

/ 5

mm

2251

9 /

10 m

m22

520

/ 5

mm

22

521 /

10 m

m

2251

4 /

5 m

m22

515

/ 10

mm

2251

2 /

5 m

m22

513

/ 10

mm

2253

6 / 1

5 m

m22

538

/ 15

mm

2254

0 / 1

5 m

m

R-La

t / L

-Med

:R-

Lat /

L-M

ed:

R-La

t / L

-Med

: :de

M-L / taL-R

:deM-L / taL-

R22

534

/ 15

mm

2253

2 /

15 m

m22

537

/ 15

mm

2253

9 /

15 m

m22

541 /

15 m

m

L-La

t / R

-Med

:L-

Lat /

R-M

ed:

L-La

t / R

-Med

: :de

M-R / taL-L

:deM-

R / taL-L22

535

/ 15

mm

2253

3 /

15 m

m

2545

0 / 1

9 m

m25

440

/ 19

mm

2543

0 / 1

9 m

m25

460

/ 19

mm

25

420

/ 19

mm

Tibi

al in

sert

s PS

Fem

oral

com

pone

nts

PS ri

ght /

left

Tibi

al c

ompo

nent

s

2264

0 /

9 m

m22

641

/ 1

1 mm

2264

2 /

13 m

m22

643

/ 15

mm

2264

4 /

17 m

m22

645

/ 19

mm

2264

6* /

21 m

m

2263

0 /

9 m

m22

631

/ 1

1 mm

2263

2 /

13 m

m22

633

/ 15

mm

2263

4 /

17 m

m22

635

/ 19

mm

2263

6* /

21 m

m

2262

0 /

9 m

m22

621

/ 1

1 mm

2262

2 /

13 m

m22

623

/ 15

mm

2262

4 /

17 m

m22

625

/ 19

mm

2262

6* /

21 m

m

2265

0 /

9 m

m

2265

1 /

11 m

m

2265

2 /

13 m

m

2265

3 /

15 m

m

2265

4 /

17 m

m

2265

5 /

19 m

m

2265

6* /

21 m

m

2261

0 /

9 m

m22

611

/ 1

1 mm

2261

2 /

13 m

m22

613

/ 15

mm

2261

4 /

17 m

m22

615

/ 19

mm

2261

6* /

21 m

m

2118

4* /

8 m

m21

194

/ 10

mm

2118

3* /

8 m

m21

195

/ 10

mm

2118

2* /

8 m

m21

193

/ 10

mm

2119

2 /

10 m

m

Ø29

Ø32

Ø35

Ø26

* Sp

ecia

l siz

es

8210662106

42106 01106

0310680106

6010640106

6012

260

102

Size

6Si

ze 2

Size

8Si

ze 4

Size

10

Tibi

al b

lock

s22

516

/ 5

mm

2251

7 /

10 m

m22

518

/ 5

mm

2251

9 /

10 m

m22

520

/ 5

mm

22

521 /

10 m

m

2251

4 /

5 m

m22

515

/ 10

mm

2251

2 /

5 m

m22

513

/ 10

mm

2253

6 / 1

5 m

m22

538

/ 15

mm

2254

0 / 1

5 m

m

R-La

t / L

-Med

:R-

Lat /

L-M

ed:

R-La

t / L

-Med

: :de

M-L / taL-R

:deM-L / taL-

R22

534

/ 15

mm

2253

2 /

15 m

m22

537

/ 15

mm

2253

9 / 1

5 m

m22

541 /

15 m

m

L-La

t / R

-Med

:L-

Lat /

R-M

ed:

L-La

t / R

-Med

: L-

Lat /

R-M

ed:

2253

5 /

15 m

m22

533

/ 15

mm

Post

erio

r22

212

/ 5

mm

2221

3 /

10 m

m22

214

/ 5

mm

2221

5 /

10 m

m

Post

erio

r22

216

/ 5

mm

2221

7 /

10 m

m

Post

erio

r22

218

/ 5

mm

2221

9 /

10 m

m

Post

erio

r22

220

/ 5

mm

22

221 /

10 m

m

Post

erio

r

2222

8 /

5 m

mD

ist /

Lat

:22

231 /

5

mm

Dis

t / L

at:

2223

4 /

5 m

mD

ist /

Lat

: 22

237

/ 5

mm

Dis

t / L

at:

2224

0 /

5 m

m

2222

9 /

10 m

m22

232

/ 10

mm

2223

5 /

10 m

m22

238

/ 10

mm

2224

1 /

10 m

m

Dis

t / L

at:

2223

0 /

15 m

m22

233

/ 15

mm

2223

6 /

15 m

m22

239

/ 15

mm

2224

2 /

15 m

m

2224

9 /

5 m

m22

250/

10 m

m

Dis

t / M

ed L

:22

252

/ 5

mm

2225

3 /

10 m

mD

ist /

Med

L:

2225

5 /

5 m

m22

256

/ 10

mm

Dis

t / M

ed L

: 22

258

/ 5

mm

2225

9 /

10 m

mD

ist /

Med

L:

2226

1 /

5 m

m

2226

2 /

10 m

m

Dis

t / M

ed L

:

2225

1 / 15

mm

2225

4 /

15 m

m22

257

/ 15

mm

2226

0 /

15 m

m22

263

/ 15

mm

2227

0 /

5 m

m22

271 /

10 m

mD

ist /

Med

R:

2227

3 /

5 m

m22

274

/ 10

mm

Dis

t / M

ed R

:22

276

/ 5

mm

2227

7 /

10 m

mD

ist /

Med

R:

2227

9 /

5 m

m22

280

/ 10

mm

Dis

t / M

ed R

:22

282

/ 5

mm

22

283

/ 10

mm

D

ist /

Med

R:

2227

2 / 1

5 m

m22

275

/ 15

mm

2227

8 /

15 m

m22

281

/ 15

mm

2228

4 /

15 m

m

89

TC-P

LUS™

PS

Revi

sion

Fem

oral

blo

cks

dist

al /

pos

terio

r

Pate

llar c

ompo

nent

s

2230

8 22

306

2230

422

310

2230

2

90

Non

-cem

ente

d St

ems

Cem

ente

d St

ems

6100

0 /

80

mm

61

002

/ 11

0 m

m

6100

1 / 15

0 m

m

6111

4 /

40

mm

61

101 /

80

mm

61

105

/ 11

0 m

m

6111

6 /

150

mm

6111

5 /

40

mm

61

102

/ 8

0 m

m

6110

6 /

110

mm

61

109

/ 150

mm

6110

3 /

80

mm

61

107

/ 11

0 m

m

6111

0 /

150

mm

61

108

/ 11

0 m

m

6111

1 / 1

50 m

m

6111

2 /

150

mm

6111

3 /

40

mm

61

100

/ 8

0 m

m

6110

4 /

110

mm

Ø12

Ø10

Ø14

Ø16

Ø18

Ø20

80

mm

150

mm

40

mm

110

mm

80

mm

150

mm

110

mm

Stra

ight

Ste

ms

( for

fem

oral

and

tibi

al c

ompo

nent

s )

91

6112

1 /

80 m

m

6112

5 /

110

mm

61

133

/ 15

0 m

m

6112

2 /

80

mm

61

126

/ 11

0 m

m

6112

9 /

150

mm

6112

3 /

80

mm

61

127

/ 11

0 m

m

6113

0 /

150

mm

6112

8 /

110

mm

61

131 /

150

mm

6113

2 /

150

mm

6112

0 /

80

mm

61

124

/ 11

0 m

m

Ø20

Ø18

Ø16

Ø14

Ø12

Ø10

80

mm

150

mm

110

mm

2° V

algu

s St

ems

( for

fem

oral

com

pone

nts

)

Non

-cem

ente

d St

ems

Ø12

Ø14

Ø16

Ø18

Ø20

Ø10

92

80

mm

150

mm

110

mm

3,75

mm

Offs

et S

tem

s ( f

or ti

bial

com

pone

nts

)

Non

-cem

ente

d St

ems

6115

2 /

150

mm

6114

1 /

80 m

m

6114

5 /

110

mm

61

153

/ 15

0 m

m

6114

2 /

80

mm

61

146

/ 11

0 m

m

6114

9 /

150

mm

6112

3 /

80

mm

61

127

/ 11

0 m

m

6115

0 /

150

mm

6114

8 /

110

mm

61

151 /

150

mm

6114

0 /

80

mm

61

144

/ 11

0 m

m

93

Note

ManufacturerSmith & Nephew Orthopaedics AGOberneuhofstrasse 10d6340 BaarSwitzerland

™ Trademark of Smith & Nephew 15802-en V1 (1356) 12/180 1 2 3

For further information please contactour local sales office.www.smith-nephew.com