Sports Med
Joint
Spine
Surgical Technique
CALIPERED KINEMATIC ALIGNMENT
Page 1: ...Sports Med Joint Spine Surgical Technique CALIPERED KINEMATIC ALIGNMENT...
Page 2: ...ng 12 5 TIBIAL RESECTION 13 5 1 Mark the A P axis on the tibia 13 5 2 Assembling the Extramedullary Guide 13 5 3 Setting the tibial varus valgus with the extramedullary guide 14 5 4 Setting the tibial...
Page 3: ...0 13 2 Proximal tibial resection 30 14 ANNEX 2 MIS GUIDE COMPATIBILITY 31 14 1 Distal femoral resection 31 14 2 Proximal tibial resection 32 15 ANNEX 3 4IN1 CUTTING BLOCK COMPATIBILITY 32 15 1 Posteri...
Page 4: ...ot identifiable alternative tools like patient matched technology are required to kinematically align the femoral and or tibial components provided enough information on the patient s native anatomy i...
Page 5: ...nance of any malalignment and conceal the true bone size Resect the anterior cruciate ligament If you are using a GMK Sphere CS insert resect also the posterior cruciate ligament which also aids expos...
Page 6: ...could lead to patellar instability Orienting the drill hole parallel to the anterior surface of the distal femoral shaft minimizes flexion of the femoral component 90 5 10 mm 4 Insert the rod 8 10 cm...
Page 7: ...figure below and one pin in the oblique hole marked in blue in the figure below and then remove everything except the distal cutting block by releasing the lever Reference Line Standard distal slotted...
Page 8: ...nd internal external rotation of the femoral component by placing the 0 posterior referencing guide in contact with the posterior femoral condyles Use the 4in1 cutting block to perform the anterior po...
Page 9: ...g the anterior stylus 14 4 2 4IN1 CUTTING BLOCK POSITIONING Option 1 Posterior Pegs Once the size has been established drill through the dedicated peg holes indicated in blue on the picture below on t...
Page 10: ...1 and 2 mm washers 17 To apply the washer slide it over the posterior peg of the 4in1 block until it contacts the flat surface of the back of the 4in1 block Secure the washer by inserting the short fi...
Page 11: ...ock by inserting two headed pins into the two lateral oblique fixation holes Remove the positioning pins OPTION If no correction washers were used cancellous bone screws can be used alternatively or t...
Page 12: ...washer was used place an angel wing between the 4in1 block and the bone on the over resected condyle Perform the remaining femoral resections as follows Anterior cut Posterior chamfer Anterior chamfe...
Page 13: ...of the almost elliptically shaped boundary of the articular surface black dots Mark also the anterior posterior axis that passes through the center of the tibia and parallel to the A P axis of the la...
Page 14: ...he tibia insert a pin into the central slot to fix the rotation Inserting this pin will still allow adjustment of the tibial slope and varus valgus Central Slot 25 CAUTION The cutting block does not h...
Page 15: ...allows for any corrections or recuts that might be necessary to re establish soft tissue balance 5 6 STABILIZATION OF THE TIBIAL CUTTING BLOCK Check the cut height and posterior slope using the angel...
Page 16: ...m When one tibial condyle is thinner than the other by 1 mm or more expect tightness in that compartment and or slackness in the other when assessing varus valgus laxity with the knee in full extensio...
Page 17: ...oral component while the independent cut reference spacer simulates the thickness of the tibial component plus the minimum 10 mm insert Assemble the independent cut reference spacer with the femoral s...
Page 18: ...fore cutting 37 If a correction is needed to restore a tight rectangular gap follow the steps below TIGHT MEDIAL LOOSE LATERAL IN EXTENSION TIGHT LATERAL LOOSE IN MEDIAL EXTENSION Remove medial osteop...
Page 19: ...soft tissues and examin the interfacebetweenthefemoralcomponentandinsert Manually apply a varus valgus stress Confirm the laxity is negligible and increase insert thickness if needed Flex the knee 15...
Page 20: ...t raising the femoral joint line by 2 mm violates the kinematic alignment goal of restoring the native tibial femoral articular surfaces FLEXION EXTENSION Tight Ok Loose Tight 1 2 3 OK 4 5 6 GMK SPHER...
Page 21: ...ML of a size 4 tibial implant and must be used with a size 3 insert CAUTION If a size 4 tibial implant is going to be implanted with a femur of a smaller size 3 3 2 2 1 1 a bridge tibial tray t4 i3 mu...
Page 22: ...g position does not change between the two sizes Please note that peg position does not change between size 1 and 1 2 and 2 and so on 46 Fixation holes Position the trochlear milling guide on the dist...
Page 23: ...d holes B Use the built in pins to stabilize the femoral trochlearcutting guide C D For enhanced stability insert two additional pins into the anterior holes of the guide E F B F E D C 50 Perform the...
Page 24: ...n of the tibial trial in order to centre the spherical medial femoral compartment on the spherical medial tibial plateau In order to help identify the correct position of the tibial baseplate two line...
Page 25: ...baseplate in order to finish the keel preparation Remove the trial handle 59 9 4 TIBIAL STEM EXTENSION For additional tibial baseplate stability if required a stem extension can be added to the tibial...
Page 26: ...65 mm stem option ream to the 65 mm mark 62 Remove the 11 mm reduction bush and insert the 15 5 mm reduction bush in the reamer guide assembled on the trial baseplate and finish the keel preparation...
Page 27: ...at least 13 mm of bone remains after resection Perform the patellar resection through the slots of the resection guides OPTION The patella size can be assessed using dedicated templates Open the patel...
Page 28: ...preparations and selected the definitive components these are opened in an aseptic manner and implanted with bone cement It is generally easier to implant the tibial component first 12 1 TIBIAL IMPLAN...
Page 29: ...w and attach it to the femoral component using the two lateral slots Lock together by turning the handle firmly The bone cement must be prepared according to the cement manufacturer s instructions Onc...
Page 30: ...tting guide 02 07 10 0127 Metal unslotted MIS distal cutting guide 2 618 67 Compatible holes The unslotted cutting guide is compatible only with the unslotted distal cut positioner ref 02 07 10 0185 1...
Page 31: ...below Metal slotted distal cutting guide 02 07 10 4574 Metal slotted MIS distal cutting guide 02 12 10 0489 Metal unslotted MIS distal cutting guide 2 618 Metal unslotted MIS recut guide 2 642 69 Com...
Page 32: ...4542 4543 Reference line Metal slotted MIS tibial cutting guide 02 07 10 0290 0291 Reference line 71 Tibial cutting block holes right knee Parallel positioning holes Oblique fixation holes Tibial styl...
Page 33: ...r plates are in contact with the medial and lateral posterior condyles The position of the posterior referencing guide rarely requires correction because it is uncommon for the posterior femoral condy...
Page 34: ...r and posterior resection level using the angel wing Whether a femoral upsizing downsizing or a 4in1 block repositioning is required see the paragraph below 15 3 FEMORAL UPSIZING DOWNSIZING The differ...
Page 35: ...ctor extractor ref 02 02 10 0174 can be used Assemble the femoral impactor to the slider hammer grab the lateral grooves of the plate and pull it out 82 Position the 4in1 cutting block on the distal r...
Page 36: ...ing block as shown in the picture below and pull it out 83 Downsizing after femoral resections If despite soft tissue release the flexion gap is still tight a femoral downsizing may be needed Using th...
Page 37: ...4L 4 02 12 0004R 02 12 0024L 4 02 12 0024R 02 12 0005L 5 02 12 0005R 02 12 0025L 5 02 12 0025R 02 12 0006L 6 02 12 0006R 02 12 0026L 6 02 12 0026R 02 12 0007L 7 02 12 0007R GMK FIXED TIBIAL TRAY CEMEN...
Page 38: ...12 02 12 0512FR 02 12 0513FL 13 02 12 0513FR 02 12 0514FL 14 02 12 0514FR 02 12 0517FL 17 02 12 0517FR 02 12 0520FL 20 02 12 0520FR GMK SPHERE FLEX TIBIAL INSERT SIZE2 REF LEFT THICKNESS mm REF RIGHT...
Page 39: ...0513CRL 13 02 12 0513CRR 02 12 0514CRL 14 02 12 0514CRR GMK SPHERE CR TIBIAL INSERT SIZE2 REF LEFT THICKNESS mm REF RIGHT 02 12 0210CRL 10 02 12 0210CRR 02 12 0211CRL 11 02 12 0211CRR 02 12 0212CRL 1...
Page 40: ...al Cut Reference Block Unworn Worn 1 4 02 12 10 0724 Distal Cut Reference Block Worn Worn 1 5 02 12 10 0725 2 Valgus correction cutting guide 1 6 02 12 10 0726 2 Varus correction cutting guide 1 7 02...
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Page 42: ...GMK Sphere Calipered Kinematic Alignment Surgical Technique 42 18 COMPATIBILITY CHART GMK Patella GMK Sphere Flex CR Insert GMK Sphere Femur GMK Tibia Tibia...
Page 43: ...Size 1 Size 1 Size 1 Size 1 Size 2 Size 3 Size 4 Size 5 Size 6 Size 2 Size 2 Size 2 Size 2 Size 3 Size 3 Size 3 Size 3 Size t3 i4 Size 4 Size 4 Size 4 Size t4 i3 Size 4 Size 5 Size 5 Size 5 Size 5 Si...
Page 44: ...GMK Sphere Calipered Kinematic Alignment Surgical Technique 44 NOTES...
Page 45: ...45...
Page 46: ...GMK Sphere Calipered Kinematic Alignment Surgical Technique 46...
Page 47: ...d sterilized in an autoclave respecting the US regulations directives where applicable and following the manufactures instructions for use of the autoclave For detailed instructions please refer to th...
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