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Smith & Nephew TC-PLUS Revision, Surgical Technique, Page: 4 / 98

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Smith & Nephew TC-PLUS Revision Surgical Technique Download Page 4

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Introduction

T

he 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.

Summary of Contents for TC-PLUS Revision

Page 1: ...Surgical Technique Intramedullary Procedure smith nephew TC PLUS REVISION Revision Knee System Sawblade Thickness 1 00 mm Complex Primary Knee System...

Page 2: ......

Page 3: ...inal analysis the preferred treatment is that which addresses the needs of the patient Disclaimer The following technique is for informational and educational purposes only It is not intended to serve...

Page 4: ...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 Prima...

Page 5: ...nce with the instructions in all other relevant Surgical Techniques Responsibility It is the responsibility of the user of the TC PLUS Revision knee system to review all relevant information concernin...

Page 6: ...stem As the TC PLUS Revision implants offer the same resections as the tricompatimental TC PLUS Primary knee prosthesis this permits if necessary an easy intraoperative switchover from the resurfacing...

Page 7: ...ry TC PLUS knee portfolio they are manufactured from UHMW polyethylene and are available in six different heights of 9 mm 11 mm 13 mm 15 mm 17 mm and 19 mm for the ultracongruent tibia inserts and in...

Page 8: ...ed 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 co...

Page 9: ...ndrical stems made of forged Ti6Al4V alloy These stems are not suitable for primary anchorage therefore they are not designed for osseo integration For matching the different patients anatomy a wide s...

Page 10: ...on with restricted function and requirement for additional stabilization with longer stems andreconstruction of bone defects Marked contractures and axial deformity less than 20 25 Failure after surfa...

Page 11: ...diseases that may endanger the function of the implant These include in particularextreme insufficiency of the knee extensor mechanism which can lead to excessive joint distortion orsevere adiposity w...

Page 12: ...10 Preoperative situation Case Study Patient with varus displaced or implanted tibia with a medial instability that must be revised because of pain and swelling...

Page 13: ...11 Postoperative Result Immediately postoperative functional and pain free reconstruction with TC PLUS Revision knee...

Page 14: ...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 determinat...

Page 15: ...rawn 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 t...

Page 16: ...14...

Page 17: ...e 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 t...

Page 18: ...erior condyles if present 4 Tibial resection and optional augment resection 5 Patellar resection optional Overview of the resections sequences for primary application Important For the standard instru...

Page 19: ...tting out of the box if the PS version is required Remove residual posterior condyles if present Overview of the resection sequences for revision application Important For the standard instrument set...

Page 20: ...t Nr 42000089 75006487 Speed Pins 3 2 65mm 6x PAC Art Nr SYS251354 75009338 Speed Pins 3 2 80mm 6x PAC Art Nr SYS251355 75009339 Speed Pins 3 2 110mm 6x PAC Art Nr SYS251356 75009340 AO Adapter for Sp...

Page 21: ...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...

Page 22: ...n to prevent the development of a relative extension position risk of notching or flexion position projecting patella Preparing the femoral anchorage Reamers are used carefully and in progressive stag...

Page 23: ...ped drill until the engraved marking Femur respectively Femur PS corresponding to the joint line The chosen trial stem is attached to the extension for trial stem 8 mm and with the modular handle care...

Page 24: ...ation the mark L for left knee or R for right knee is visible on the arrow T Important Make sure that the femoral bushing is inserted in the correct L or R position Adjustment and correction occurs wi...

Page 25: ...y and distally in 2 mm increments 4 mm The side handles can be removed from the femoral suspension device and attached on the femoral tibial revision cutting block Distal femoral resection The femoral...

Page 26: ...tation can be adjusted visually in relation to the epicondylar axis with the aid of two bone pins 75 mm long which are inserted laterally into the A P femoral cutting block revision The groove stone i...

Page 27: ...e checked Important In the case of over resection or under resection a correction can be made by loosening the groove stone and moving the A P femoral cutting block revision In this case the cleared p...

Page 28: ...ch side is the operation the mark LEFT for left knee or RIGHT for right knee is visible on the arrow ANTERIOR T Important When using distal and or posterior femoral augmentation blocks the correspondi...

Page 29: ...the femoral resections and anchorage 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 th...

Page 30: ...t 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 The f...

Page 31: ...lary use and are described with the corresponding surgical technique The 40 mm stem length is only available for extramedullary application When using cemented stems the 12 mm reamer is used to drill...

Page 32: ...onding to the tibial resection with the smallest 9 mm tibial insert The engraved marking Tibia correspond to the joint line Important The laser markings 5 10 15 and 20 correspond to the augmentation b...

Page 33: ...ibial stylus is positioned on the tibial plateau The tibial stylus can be used for both primary resections 11 mm marking and for revisions resections 1 mm marking Important In primary revision procedu...

Page 34: ...inserted into the oblique holes market with AUX After resection the pin can be removed The ligaments must be protected during all resections When using tibial blocks the resection is conducted throug...

Page 35: ...knesses 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 releas...

Page 36: ...bial sizer trial assembled with the tibial slope adapter 3 and the alignment bushing 8 are intramedullary placed over the extension for trial stem 8 mm and applied onto the proximal bone resection The...

Page 37: ...is used to check the scope of movement the patella guide and the tension of the soft tissue apparatus The corresponding manipulation tibial insert which had previously been defined with the joint gap...

Page 38: ...erted with the hammer Important When using tibia blocks appropriate manipulation tibia blocks 5 mm 10 mm and 15 mm are available They are fixed laterally on the manipulation tibial component tibial si...

Page 39: ...onding blocks on the tibial sizer Note the corresponding thickness 5 mm 10 mm or 15 mm and side Rlat Lmed or Llat Rmed The 15mm tibial blocks are anatomically bent M L and posterior Therefore the unde...

Page 40: ...of the surgery Insert the 2 plastic centering rings into the transfer guide 3 75 mm for improved centering of the instrument Important The 2 plastic centering rings must be inserted with the inclinati...

Page 41: ...is inserted with the hammer Important When using tibia blocks appropriate manipulation tibia blocks 5 mm 10 mm and 15 mm are available They are fixed laterally on the manipulation tibial component tib...

Page 42: ...and or posterior tibia blocks appropriate manipulation femoral blocks 5 mm 10 mm and 15 mm are available They are fixed laterally on the manipulation femoral component The corresponding manipulation t...

Page 43: ...ich 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 ba...

Page 44: ...lly and in progressive stages starting with 10 with use of the corresponding bushing to ream to the required stem diameter and depth Important The depth indicator is on the reamer observe the laser ma...

Page 45: ...l trials PS revision and tibial insert trials PS are available See page 42 for the next step The largest reamer bushing 20 is inserted into the femoral valgus adapter 4 6 or 8 The 20 mm drill is then...

Page 46: ...resected and replaced by a 10 mm thick patellar implant if an 8 mm thick patellar implant is planned resect just 8 mm accordingly An alternative option is the inlay technique in which the implant is p...

Page 47: ...ed anchoraging technique mill briefly onlay technique or countersink by 3 mm to 5 mm inlay technique Milling down to the stop results in a depth of 5 mm Important Patellar implants with a height of 10...

Page 48: ...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 Important A stem connection with 3 posterior slo...

Page 49: ...not under tension Otherwise the wrench must be returned The offset stem page 65 is inserted into the taper on the assembling block and set to the offset position with the aid of the transfer guide pr...

Page 50: ...ly excepted tibial blocks size 15 mm 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 t...

Page 51: ...ction is undamaged clean and dry before mounting 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 wi...

Page 52: ...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 dist...

Page 53: ...ording 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 k...

Page 54: ...be removed in extension Insertion of the tibial insert The ultracongruent tibial insert or PS tibial insert is slid onto the tibial component and positioned bent at 90 If necessary use the tibial ins...

Page 55: ...pressed in with the patella gripper with lock and press in aid in position The excess cement is carefully removed The gripper is left until the cement has fully hardened After manual placement of the...

Page 56: ...ion 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 move...

Page 57: ...st 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 co...

Page 58: ...58...

Page 59: ...6 22468 8 75005147 22470 10 Tibial components SAP No Art No Size 75005136 22302 2 75005137 22304 4 75005138 22306 6 75005139 22308 8 75005140 22310 10 Patella components SAP No Art No Height 75004784...

Page 60: ...75006073 25430 4 19 mm 75006075 25436 6 9 mm 75006076 25437 6 11 mm 75006077 25438 6 13 mm 75006061 25402 6 15 mm 75006079 25441 6 17 mm 75006078 25440 6 19 mm 75006080 25446 8 9 mm 75006081 25447 8...

Page 61: ...104 22241 10 10 mm 75005105 22242 10 15 mm Femoral blocks distal medial left SAP No Art No Size 75005106 22249 2 5 mm 75005107 22250 2 10 mm 75005108 22251 2 15 mm 75005109 22252 4 5 mm 75005110 22253...

Page 62: ...22280 8 10 mm 75005133 22281 8 15 mm 75005134 22282 10 5 mm 75005135 22283 10 10 mm 75005136 22284 10 15 mm Femoral blocks posterior SAP No Art No Size Height 75005081 22212 2 5 mm 75005082 22213 2 10...

Page 63: ...22534 4 15 mm R lat L med 75005166 22535 4 15 mm L lat R med 75005157 22516 6 5 mm 75005158 22517 6 10 mm 75005167 22536 6 15 mm R lat L med 75005168 22537 6 15 mm L lat R med 75005159 22518 8 5 mm 7...

Page 64: ...m 80 mm 75007332 61103 16 mm 80 mm 75007333 61104 10 mm 110 mm 75007334 61105 12 mm 110 mm 75007335 61106 14 mm 110 mm 75007336 61107 16 mm 110 mm 75007337 61108 18 mm 110 mm 75007345 61116 12 mm 150...

Page 65: ...58 61132 20 mm 150 mm Non cemented stems 3 75 offset Ti6Al4V for tibial component only SAP No Art No Size Height 75007360 61140 10 mm 80 mm 75007361 61141 12 mm 80 mm 75007362 61142 14 mm 80 mm 750073...

Page 66: ...7 22614 2 17 mm 75005178 22615 2 19 mm 75005181 22620 4 9 mm 75005182 22621 4 11 mm 75005183 22622 4 13 mm 75005184 22623 4 15 mm 75005185 22624 4 17 mm 75005186 22625 4 19 mm 75005189 22630 6 9 mm 75...

Page 67: ...1 mm 75005203 22646 8 21 mm 75005211 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 Description 75005142 2239...

Page 68: ...07137 600175 Tibial Sizer Handle 1 75005659 251065 3 2 mm 1 75007140 600179 75 mm 6 75007141 600180 100 mm 2 75007138 600177 25 mm 75007139 600178 38 mm 75018329 Drill Bone Pin Bone Pin Bone Pin with...

Page 69: ...Set SAP No 75200233 Art No 0944031 SAP No Art No Description 75005672 251096 Drill AO 3 2 mm 1 75005673 251097 IM Drill with Starter Tip AO 8 mm 1 75007109 600128 Drill with Stop AO 20 mm 1 75005412...

Page 70: ...16 150 mm 1 75007128 600159 18 150 mm 1 75007129 600160 20 150 mm 1 75007194 600292 Extension for Trial Stem 8 mm 1 600112 75007098 253301 Reamer Trial Stem Handle 1 75004829 22000032 Stepped Drill 10...

Page 71: ...ented Trial Stems on request Case Set SAP No 75200281 Art No 0944094 SAP No Art No Description 75007111 600130 80 mm 1 75007110 600129 110 mm 1 75007112 600131 150 mm 1 Trial Stem Trial Stem Trial Ste...

Page 72: ...75007251 600443 6 1 75007252 600444 8 1 75007253 600445 10 1 75007195 600293 4 1 75007196 600294 6 1 75007197 600295 8 1 75007218 600371 2 1 75007219 600372 4 1 75007220 600373 6 1 75007221 600374 8 1...

Page 73: ...73...

Page 74: ...4 8 1 75007232 600395 10 1 75007153 600200 0 1 75007155 600202 2 1 75007158 600206 5 mm 6 75007159 600209 10 mm 6 75007171 600247 15 mm 4 75007173 600249 15 mm 2 75007169 600238 1 Femoral Trial Adapte...

Page 75: ...75...

Page 76: ...44 8 15 mm 1 75006007 253285 10 5 mm 1 75006013 253295 10 10 mm 1 75005992 253245 10 15 mm 1 Tibial Sizer Trial Tibial Sizer Trial Tibial Sizer Trial Tibial Sizer Trial Tibial Sizer Trial Case Lid Tib...

Page 77: ...8 600297 6 10 1 75007199 600198 1 75007152 22000031 3 75 mm 1 75004828 22000035 2 4 1 75004832 22000036 6 10 1 75004833 22000033 1 Tibial Rasp Tibial Rasp Guide Tibial Rasp Guide Tibial Rasp Tibial An...

Page 78: ...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 Tibi...

Page 79: ...79...

Page 80: ...89 Impactor Large 1 75007202 600300 75005998 253271 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 750...

Page 81: ...81...

Page 82: ...No Description 75006037 253365 Tibial Spacer 21 mm 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 7...

Page 83: ...83...

Page 84: ...21 mm Tibial Insert Trials PS on request SAP No Art No Description 75005936 253146 2 21 mm 1 75005944 253156 4 21 mm 1 75005953 253166 6 21 mm 1 75005962 253176 8 21 mm 1 75005971 253186 10 21 mm 1 Ca...

Page 85: ...85...

Page 86: ...request 26 8 mm 1 75005704 251210 29 8 mm 1 75005705 251211 32 8 mm 1 Optional Reamer Drill with AO Connection on request 75004871 22000038 Patellar Drill with Stop AO 5 5 mm 1 75004989 22000280 Pate...

Page 87: ...87...

Page 88: ...88...

Page 89: ...medullar Procedure 15801 en 1402 X ray templates TC PLUS Revision 1 15 1 1354 A1 A2 A3 B X ray templates TC PLUS PS Revision 1 15 1 1355 A1 A2 A3 B X ray templates TC PLUS Revision 1 1 1511 A1 A2 A3 B...

Page 90: ...228 5 mm Dist Lat 22231 5 mm Dist Lat 22234 5 mm Dist Lat 22237 5 mm Dist Lat 22240 5 mm 22229 10 mm 22232 10 mm 22235 10 mm 22238 10 mm 22241 10 mm Dist Lat 22230 15 mm 22233 15 mm 22236 15 mm 22239...

Page 91: ...15 mm 22540 15 mm R Lat L Med R Lat L Med R Lat L Med d e M L t a L R d e M L t a L R 22534 15 mm 22532 15 mm 22537 15 mm 22539 15 mm 22541 15 mm L Lat R Med L Lat R Med L Lat R Med L Lat R Med 22535...

Page 92: ...50 mm 61114 40 mm 61101 80 mm 61105 110 mm 61116 150 mm 61115 40 mm 61102 80 mm 61106 110 mm 61109 150 mm 61103 80 mm 61107 110 mm 61110 150 mm 61108 110 mm 61111 150 mm 61112 150 mm 61113 40 mm 61100...

Page 93: ...nted Stems 61121 80 mm 61125 110 mm 61133 150 mm 61122 80 mm 61126 110 mm 61129 150 mm 61123 80 mm 61127 110 mm 61130 150 mm 61128 110 mm 61131 150 mm 61132 150 mm 61120 80 mm 61124 110 mm 20 18 16 14...

Page 94: ...150 mm 61143 80 mm 61147 110 mm 61150 150 mm 61148 110 mm 61151 150 mm 61152 150 mm 61140 80 mm 61144 110 mm 12 14 16 18 20 10 94 61121 80 mm 61125 110 mm 61133 150 mm 61122 80 mm 61126 110 mm 61129...

Page 95: ...95 Note...

Page 96: ...96 Note...

Page 97: ...97 Note...

Page 98: ...r Smith Nephew Orthopaedics AG Oberneuhofstrasse 10d 6340 Baar Switzerland Trademark of Smith Nephew 15801 en V1 1402 10 18 0123 For further information please contact our local sales office www smith...

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