Zimmer Biomet OSS Compress Surgical Technique Manual Download Page 1

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OSS

™

Orthopedic Salvage System

Compress

Device

Surgical Technique

Summary of Contents for OSS Compress

Page 1: ...OSS Orthopedic Salvage System Compress Device Surgical Technique ...

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Page 3: ...ialing 40 Realignment of Spindle 42 Pin Drilling and Insertion 42 Final Construct Assembly 45 Without Locking Cap and Screw 45 Optional Locking Cap and Screw Assembly 46 Screw Placement Guide 48 Utilizing Reduced Resection for a Segmental Distal Femur Replacement 48 Utilizing Taper Adapter for a Distal Femoral Replacement 49 Utilizing Diaphyseal Segment and Taper Adapter for a Distal Femoral Repla...

Page 4: ...9 5 8 5 15 5 1 29 7 7 9 5 1 28 5 8 5 7 7 5 1 28 7 15 5 1 27 5 8 5 13 5 1 27 7 7 7 5 1 26 5 8 5 5 7 5 1 26 7 13 5 1 25 5 8 5 11 5 1 25 7 5 7 5 1 24 5 8 5 5 5 5 1 24 7 11 5 1 23 5 8 5 9 5 1 23 7 5 5 5 1 22 5 8 5 4 4 5 1 22 7 9 5 1 21 5 8 5 7 5 1 21 7 4 4 5 1 20 5 8 5 3 3 5 1 20 7 7 5 1 19 5 8 5 5 5 1 19 7 3 3 5 1 18 5 8 5 4 5 1 18 7 5 5 1 17 5 8 5 3 5 1 17 7 4 5 1 16 7 3 5 1 14 5 8 5 5 1 13 7 5 1 11...

Page 5: ...acement particularly advantageous for bone loss and the standard Compress Device requiring 80 mm of medullary placement Figure 2 The following surgical technique will focus on the standard 80 mm anchor plug spindle offering Note Please reference the IFU for indications and contraindications relating to the Compress Device and OSS implants Note While the 9 and 13 hole anchor plugs exist this techni...

Page 6: ...on it is recommended that the no face adapter provisional be attached to segmental provisionals in order to ascertain some semblance of the construct length Figures 4 and 5 This is suggested at the onset of the surgery because once the holes for the transverse pins are drilled and the anchor plug is secure within the canal no additional bone may be resected without dramatically altering the origin...

Page 7: ...h the modular planers the triple reamers are preset to the desired reaming depth and prepare for both the anchor plug and centering sleeve diameters Figure 7 This allows the femoral osteotomy site to be perpendicular to the longitudinal axis of the femoral shaft Note The triple reamer tips protrude past the medullary placement to a depth of 65 mm on the short reamers and 100 mm on the standard rea...

Page 8: ...Technique Canal Preparation cont Sequentially ream with gentle force against the femoral osteotomy site until full circumferential cortical contact at the osteotomy site and centering sleeve location is achieved Figure 8 Figure 8 ...

Page 9: ...ique Centering Sleeve B Diameter Anchor Plug A Diameter Canal Preparation cont The A diameter of the final triple reamer will determine the anchor plug size and the B diameter will determine the centering sleeve size Figure 9 Figure 9 ...

Page 10: ...r to the Triple Reamer Tablefortheappropriateanchorplugandcentering sleeve diameters Figure 10 Triple Reamer Table Size Diameters Use Anchor Plug Diameter Use Centering Sleeve Diameter A mm B mm 10 12 10 12 10 11 13 11 13 10 13 12 14 12 14 12 14 13 15 13 15 12 15 14 16 14 16 14 16 15 17 15 17 14 17 16 18 16 18 16 18 17 19 17 19 16 19 18 20 18 20 18 20 19 21 19 21 18 21 20 22 20 22 20 22 21 23 21 2...

Page 11: ...provisional when the final reamer at the resection level is 12 mm It is also used with centering sleeve provisionals when the final reamer measures 14 mm through 28 mm Thesecondanchorplugholder Figure11B isusedonly when the final reamer at the resection level measures 13 mm This 13 mm anchor plug holder is used without a centering sleeve provisional Slide the anchor plug holder through the cross b...

Page 12: ...p onto the anchor plug holder Be sure to align the exposed metal nub inside the provisional with the female keyway located on the holder When the provisional meets the cross bar lock into place with a clockwise turning motion Figures 13 and 14 Confirm that the centering sleeve provisional fits snugly within the canal at the osteotomy site Figure 13 Figure 14 ...

Page 13: ...d on the final reamer diameter A in the Canal Preparation step into the anchor plug holder Be sure the male tab of the holder fits into the female tab of the anchor plug head Figure 15 Tighten into position with a clockwise motion of the anchor plug holder knob Figure 16 Figure 15 Figure 16 ...

Page 14: ... appropriate drill guide to match the selected anchor plug Figure 17 Place the cross bar through the drill guide Figure 18 Figure 17 Figure 18 The small drill guide is used with the 10 mm 12 mm anchor plugs The large drill guide is used with 14 mm 24 mm anchor plugs ...

Page 15: ... are packaged with each anchor plug Align the drill guide with the anchor plug by placing one of the short drill bits through the far upper right hole of both the anchor plug and the drill guide Figure 19 Figure 19 Figure 20 Place the other short drill bit through the far upper left hole of both the anchor plug and drill guide Figure 20 ...

Page 16: ...chor plug and drill guide Figure 21 Once the drill bits are in place minimize the lateral distance between the drill guide and the anchor plug to optimize targeting once the anchor plug is inserted into the bone Figure 22 Alternate tightening of both adjustment knobs located on top with a clockwise motion until snug Figure 23 Figure 22 Figure 23 ...

Page 17: ... femoral osteotomy site and that the centering sleeve provisional is snug within the canal Figure 25 Placement of the anchor plug within the medullary canal is non directional location is typically dictated by the best exposure and ease of access to the drill guide Anchor Plug cont When the knobs are tight all three drill bits should slide freely through the alignment holes Figure 24 Note If the d...

Page 18: ...r run a short drill bit through hole 1 of the drill guide until contacting the bone At full power drill through both cortices Figure 26 Leave the short drill bit in place Figure 26 Figure 27 Repeat this procedure with the second short drill bit through hole 5 leaving the short drill bit in place Figure 27 ...

Page 19: ... three placement holes Remove the long drill bit when finished Figure 28 Transverse Pins Transverse Pin Measurement The hook depth gauge is used to measure the bi cortical distance for determining the transverse pin length Figure 29 Start by loosening knobs 1 and 2 and collapsing the sleeves together Figure 28 Figure 29 ...

Page 20: ...18 Compress Device Surgical Technique Transverse Pins cont Tighten knob 2 Figure 30 Push the hook through a pre drilled hole and engage the outer aspect of the far cortex Figure 31 Figure 30 Figure 31 ...

Page 21: ...ue Figure 32 Figure 33 Transverse Pins cont Collapse the sleeves against the drill guide and tighten knob 1 Figure 32 Release the hook from the far cortex and position the tip firmly against the outer aspect of the near cortex Figure 33 ...

Page 22: ...nt Loosen knob 2 slide the sleeve against the drill guide and tighten knob 2 Figure 34 Figure 34 Figure 35 Transverse Pin Selection Remove the hook depth gauge from the drill guide and read the bi cortical distance that appears on the sliding scale Figure 35 ...

Page 23: ...ins cont Basedonthedepthmeasurementshownonthesliding scale add an additional 4 mm to the measurement and select the transverse pin length that will provide the necessary 2 mm overhang on each side of the cortex Figure 36 20 mm 24 mm 28 mm 32 mm 36 mm 40 mm 44 mm 48 mm 52 mm 56 mm 60 mm 64 mm 68 mm 72 mm 76 mm Figure 36 Figure 37 ...

Page 24: ...ure 38A and the adjustment knob Figure 38B Note Ensure the adjustment knob is loose by turning in a counterclockwise motion this will ensure that the handle will accept the pin inserter Place the threaded end of the pin inserter into the pin inserter handle and tighten with a clockwise turn Figure 39 A B Figure 38 Figure 39 ...

Page 25: ...al Technique Transverse Pins cont Tighten the adjustment knob with a clockwise turn until the pin inserter is secure Figure 40 Figure 40 Transverse Pin Insertion Place a transverse pin onto the pin inserter Figure 41 Figure 41 ...

Page 26: ...three available holes in the drill guide Figure 42 Figure 42 Figure 43 Gently tap the impaction head until the pin is properly seated The pin is properly seated when the tabs on the pin inserter come into contact with the cortex Figure 43 and a 2 mm overhang is visible on both the inner outer cortex ...

Page 27: ...25 Compress Device Surgical Technique Figure 44 Figure 45 Transverse Pins cont Pull to remove the pin inserter Figure 44 and proceed with seating the next two transverse pins Figure 45 ...

Page 28: ...he short drill bits and seat the fourth transverse pin Figure 46 Figure 46 Figure 47 Remove the final short drill bit and seat the fifth and final transverse pin Figure 47 Note The transverse pins come packaged with one additional pin that is not required for implantation The anchor plug only accepts a total of five pins ...

Page 29: ...27 Compress Device Surgical Technique Figure 49 Transverse Pins cont Loosen the anchor plug holder knob Figure 48 and remove the drill guide assembly Figure 49 Figure 48 ...

Page 30: ... be used later on in the technique Spindle Diameter Selection Measure the maximum diameter of the resected bone with a ruler Figure 51A or the spindle sizer Figure 51B Note The ruler may be used to measure for all four spindle sizes 30 mm 38 mm 44 mm and 37 x 49 mm elliptical The spindle sizer measures for the 38 mm spindle small and the 44 mm spindle large Figure 50 Figure 51 ...

Page 31: ...indle would be selected The implant collar of the spindle should overhang the bone Figure 53 Figure 52 Figure 53 A B C D Figure 54 Select a spindle based upon the prepared diameter of the osteotomy site 30 mm Spindle Anatomies up to 26 mm in diameter Figure 54A 38 mm Spindle Anatomies up to 34 mm in diameter Figure 54B 44 mm Spindle Anatomies up to 40 mm in diameter Figure 54C 49 mm x 37 mm Ellipt...

Page 32: ...e of the spindle sizer place the gauge onto the thinnest portion of the cortical wall to determine the appropriate force level 400 lb 600 lb 800 lb Figure 56 Compress Device Force Table for Standard Compress Cortical Thickness mm Force Level lb 0 0 2 4 Not Indicated 2 5 3 9 400 4 0 5 4 600 5 5 and above 800 Cortical thickness less than 2 5 mm is a contraindication for this system Note Cortical thi...

Page 33: ...y Select the appropriate face reamer blade based on the spindle diameter that was chosen in the previous step Figure 57 The small face reamer blade addresses the 30 mm and 38 mm spindles Figure 58A The large face reamer blade is used for the 44 mm and elliptical 49 mm x 37 mm spindles Figure 58B ...

Page 34: ... provisionals when the final triple reamer diameter measures 14 mm through 24 mm Important The 13 mm reamer pilot Figure 59B is used only when the final triple reamer diameter at the resection level measures 13 mm The reamer pilot is used without a centering sleeve provisional Place the face reamer blade over the two retaining tabs located on the reamer body and secure with a clockwise turning mot...

Page 35: ... the osteotomy site Figure 62 Important Start power and run at full speed prior to the face reamer contacting the bone Ream to the mechanical stop Spindle cont Slide the centering sleeve provisional that was previously used on the anchor plug holder and lock it into place with a clockwise turning motion Figure 61 Figure 62 Figure 61 ...

Page 36: ...nd is now ready to accept the face adapter provisional if required Figure 63 If trialing is desired insert the reamer pilot into the end of the face adapter provisional Figure 64 Place the reamer pilot over the exposed traction bar and assemble the necessary provisionals Once trialing is complete remove provisionals ...

Page 37: ...designed into the standard implant The centering sleeve implants are added to increase this diameter as needed Place the centering sleeve implant onto the spindle Figure 65 Impact the centering sleeve with the sleeve impactor Figure 66 Note The centering sleeve implant should be sized accordingly to fit snug within the canal Figure 66 ...

Page 38: ...e completely seated within the prepared canal at the bone implant interface The spindle should be aligned anteriorly so that the rotation alignment mark and one of the female spindle slots lines up with the vertical rotational alignment mark made earlier Figure 67 Figure 67 Position the anti torque wrench into two of the female spindle slots and tighten the locking knob Figures 68 and 69 Figure 68...

Page 39: ...37 Compress Device Surgical Technique Spindle Implantation Place the nut into the nut driver and insert onto the exposedanchorplugtractionbarinthespindle Figure 70 and 71 Figure 70 Figure 71 ...

Page 40: ...s felt this is the initial contact of the nut with the washers of the spindle Continue to slowly turn the nut driver in a clockwise direction until the compression cap can be manually released or until an additional one half turn 180 degrees is achieved then stop turning The compression cap should release by hand in a counter clockwise motion Figures 72 and 73 Figure 72 Figure 73 ...

Page 41: ...remove the nut driver and place the spanner wrench Figure 74 into the surface holes of the compression cap and twist off in a counterclockwise direction Figure 75 Important After the compression cap is removed from the spindle DO NOT DISCARD Place the compression cap in reserve on the back table until the surgery is completed Figure 74 Figure 75 ...

Page 42: ...Femoral Trialing When trialing for the Compress 7 cm 8 5 cm or 10 cm reduced resection implants proximal or distal Figure 78 it is necessary to place the Compress 5 cm taper adapter provisional with the threaded connection 32 481075 over the exposed spindle taper Figure 79 Place the Compress reduced resection provisional over the no face adapter provisional until the magnets inside the blue provis...

Page 43: ...41 Compress Device Surgical Technique Figure 79 Figure 80 ...

Page 44: ...e nut Change the rotation of the spindle Figure83 andre startthelockingprocess beginning with Figure 71 Pin Drilling and Insertion The Pin Placement Table specifies which array of holes may be used based on the centering sleeve that was previously selected Figure 84 Pin Placement Table Spindle Size Inner Array Middle Array Outer Array 30 mm 13 14 mm Sleeve 38 mm 13 mm Sleeve 13 18 mm Sleeve 13 22 ...

Page 45: ...selected holes of the spindle collar until fully seated Figure 85 Insert the specially designed drill into each respective drill guide Start at full power prior to contact and drill until the guides prevent further advancement Drill to the mechanical stop Figures 86 and 87 Figure 84 Figure 85 Figure 86 Figure 87 ...

Page 46: ...ion and thread the screw until it is fully seated Figure 89 Repeat for remaining pin locations Note It is recommended whenever possible that a minimum of 3 pins are placed in the spindle collar Spindle Implantation cont Remove the first drill guide leaving the others in place Figure 88 Figure 89 Figure 88 ...

Page 47: ...the anti rotation pins are in place impact the femoral construct taper adapter diaphyseal segment and distal femoral construct together on the back table Once the femoral construct is assembled impact over the spindle taper Figure 90 Refer to the Screw Placement Guide for proper placement beginning on page 48 ...

Page 48: ...to mechanically secure the taper adapter or reduced resection femoral components to the spindle With the spindle in place unscrew the locking screw fromthelockingcapandsetthescrewaside Figure91 Thread the locking cap into the spindle taper using the nut driver to firmly seat the locking cap Figures 92 and 93 Figure 91 Figure 92 Figure 93 ...

Page 49: ...le taper and secure the construct with the locking cap screw Figure 94 Figure 95 After the locking cap and screw have been assembled impact each implant component one at a time and secure with the corresponding screw Figure 95 Refer to the Screw Placement Guide for proper placement beginning on page 48 Figure 94 ...

Page 50: ... Resection Segmental Distal Femur 7 cm OSS Small Head Small Thread Locking Screw optional Compress Spindle 1 cm Compress Locking Cap optional 8 cm Replacement Length is Illustrated Screw Placement Guide Utilizing Reduced Resection Segmental Distal Femur Replacement ...

Page 51: ...Adapter 5 cm Compress Spindle 1 cm 13 cm Replacement Length is Illustrated 7 cm 5 cm 1 cm OSS Large Head Large Thread Locking Screw Screw Placement Guide Utilizing Taper Adapter for a Distal Femoral Replacement Compress Locking Cap optional OSS Small Head Small Thread Locking Screw optional ...

Page 52: ...tal Distal Femur 7 cm Compress Spindle 1 cm 18 cm Replacement Length is Illustrated 7 cm 5 cm 1 cm OSS Diaphyseal Segment 5 cm 5 cm OSS Large Head Large Thread Locking Screw Screw Placement Guide Utilizing Diaphyseal Segment and Taper Adapter for a Distal Femoral Replacement Compress Locking Cap optional OSS Small Head Small Thread Locking Screw optional ...

Page 53: ...pindle 1 cm Compress Anchor Plug Compress Reduced Resection Proximal Femur 7 cm 8 cm Replacement Length is Illustrated 7 cm 1 cm Screw Placement Guide Utilizing Reduced Resection Proximal Femur for a Proximal Femoral Replacement OSS Small Head Small Thread Locking Screw optional ...

Page 54: ...mpress Spindle 1 cm Compress Anchor Plug OSS Finn Style Proximal Femur 7 cm OSS Large Head Large Thread Locking Screw 13 cm Replacement Length is Illustrated 7 cm 1 cm 5 cm Screw Placement Guide Utilizing Taper Adapter for a Proximal Femoral Replacement OSS Small Head Small Thread Locking Screw optional ...

Page 55: ...aphyseal Stacking Adapter OSS Compress Taper Adapter 5 cm Compress Locking Cap optional Compress Spindle 1 cm Compress Anchor Plug OSS Finn Style Proximal Femur 7 cm Screw Placement Guide Utilizing Short Spindle for a Proximal Femoral Replacement 18 cm Replacement Length is Illustrated 7 cm 5 cm 5 cm 1 cm OSS Small Head Small Thread Locking Screw optional ...

Page 56: ...al Stacking Adapter OSS Compress Taper Adapter 5 cm Compress Locking Cap optional Compress Spindle 1 cm Compress Anchor Plug OSS Low Profile Proximal Femur 7 cm Screw Placement Guide Utilizing Short Spindle for a Low Profile Proximal Femoral Replacement 18 cm Replacement Length is Illustrated 7 cm 5 cm 5 cm 1 cm OSS Small Head Small Thread Locking Screw optional ...

Page 57: ...55 Compress Device Surgical Technique Tibial Preparation To prepare the tibia reference the surgical steps utilized in the OSS Surgical Techniques ...

Page 58: ...56 Compress Device Surgical Technique Notes ...

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Page 60: ...pendent judgment in the diagnosis and treatment of an individual patient and this information does not purport to replace the comprehensive training surgeons have received As with all surgical procedures the technique used in each case will depend on the surgeon s medical judgment as the best treatment for each patient Results will vary based on health weight activity and other variables Not all p...

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