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Vanguard

®

ID Total Knee

Surgical Technique

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Summary of Contents for Vanguard ID Total Knee

Page 1: ...Vanguard ID Total Knee Surgical Technique ...

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Page 3: ...on Femoral Sizing 4 in 1 Femoral Cuts Tibial Preparation 14 Tibial Resection Stem Preparation Sizing Chart 22 Trial Reduction 23 Bearing Compatibility Chart 24 Implant Reduction 26 Tibial Tray Implantation Femoral Component Implantation Patellar Component Implantation Tibial Bearings and Locking Bar Implantations Table of Contents ...

Page 4: ...l XP AS XP AS XP XP Medial XP XP Medial XP XP Medial XP AS XP XP Medial XP AS XP AS XP XP Medial XP AS XP XP Medial XP AS XP XP Lateral XP AS XP XP Lateral Warning Only use the above combinations The use of XP XP Lateral Bearings on the medial side has not been evaluated and could lead to premature failure of the device If additional implant constraint is desired the Vanguard PS or PS System can b...

Page 5: ...ision applications Specialty components are available including femoral stems femoral screws femoral augments tibial stems tibial screws tibial augments tibial cement plugs and modular pegs The Vanguard ID Total Knee is designed to offer the flexibility to individually treat the medial and lateral compartments to match the patient s soft tissue envelope The transition between each constraint level...

Page 6: ...l component size using lateral view X ray Note Confirmation of the appropriate size component intraoperatively is critical for normal kinematics Incision The Vanguard ID Knee utilizes the Vanguard XP Total Knee Instrumentation which is also designed for standard surgical approaches Figure 2 Ensurethatthepatellatendontibiainterfaceisreleased so the patella can easily sit in the lateral gutter of th...

Page 7: ...Remove the osteophytes and peripatellar tissues down to the level of the quadriceps and patellar tendon insertion Determine the patella thickness and resection amount by using the patella caliper Figure 3 Thepatellasawguidestyluscanbeutilizedtodetermine the appropriate resection level Figure 4 Use the patella clamp surface cut guide to perform the initial flat patellar resection Note Careshouldbet...

Page 8: ...ckness beyond pre resection height 3 peg patellar component Place the appropriately sized 3 peg drill guide onto the resected patella and use the 1 4 inch patellar drill to prepare for the component pegs Figure 5 Option 2 Patella Milling Tilt the patella for patella preparation Removetheosteophytesandperipatellartissuesdown to the level of the quadriceps and patellar tendon insertion Determine the...

Page 9: ...r marked Bit to the adjustable depth stop Set the adjustable stop by depressing the button on its side and slide the stop down until the bottom of the spacer touches the mill bushing Note The magnetic spacer bit includes the depth of the peg Do not sink the drill bit prior to setting the adjustable stop Remove the magnetic spacer and ream until the adjustable stop touches the mill bushing Removeth...

Page 10: ...1cmabovetheinsertionof theposteriorcruciateligament PCL andslightlymedial in the intercondylar notch Note Irrigation and suction of the femoral canal can be performed to decrease canal contents Option 1 Adjustable Distal Femoral Resection Guide Settheadjustabledistalcutguidetothedesiredvalgus angle by pressing and turning the valgus angle dial Figure 9A Select the depth of distal resection by turn...

Page 11: ... by sliding the magnetized distal cut block into the adjustable distal adaptor Attachtheadjustabledistaladaptoranddistalcutblock totheadjustabledistalcutguidebyslidingthetwolegs on the adjustable distal adaptor through the anterior holes of the adjustable distal cut guide Figure 10 Continue sliding the adjustable distal adaptor until the block is sitting against the anterior cortex Pin the distal ...

Page 12: ...proper resection Note Avoid over resecting the distal femur to prevent raising the joint line Aim to resect 1 to 2 mm into the femoral notch Distal Femoral Resection cont Option 2 Fixed Distal Femoral Resection Guide cont Choose the appropriate left or right valgus wing and assemble it onto the IM rod by sliding it through the central hole Slowly introduce the IM rod to the femoral canal to depres...

Page 13: ...zing Assemble the selected right or left A P sizer feet to the A P sizer body Feet options include Adjustable A P sizer dial feet left and right with the ability to set external rotation from 0 to 10 degrees Figure 14 Fixed three degree A P sizer feet left and right Figure 15 00 00 ...

Page 14: ...e to place the A P sizer flush with the resected femoral distal surface Drill the two 4 in 1 cutting block location holes utilizingthe1 8inchquickreleasedrillpins Figure16A Leave the pins in place The femoral component size can now be read from the central scale Figure 16B Vanguard ID Tip If the size indicated is in between sizes use the smaller of the two sizes in order to not overstuff the patel...

Page 15: ...the threaded headed pins can be placed in the angled side holes provided on the femoral 4 in 1 block Figure 17A Once the block position is satisfactory resect the anterior and posterior bone and the anterior and posterior chamfers with a 1 37 mm thick saw blade in a standard configuration Figure 17 After making the anterior resection assess the anterior resection relative to the anterior cortex If...

Page 16: ...the long axis of the tibia gives seven degrees of posterior slope Adjusttheinitialguideheightaccordinglybyplacingthe universal tibial cutting block against the proximal tibia at the estimated resection level Figure 19 Figure 18 Tibial Resection Resection Attach the tibial universal cutting block which has a 7 degrees posterior slope built in to the EM tibial guide Position the EM tibial guide on t...

Page 17: ...tion cont Resection cont Attach the tibial stylus to the universal tibial cutting block by placing the appropriate stylus tongue into the slot on the universal tibial cutting block Figure 20 Select 4 mm off the medial low or 12 mm off the lateral high When measuring the depth of resection aim for a loose 4 mm or 12 mm to ensure the tibia is not over resected The center of the universal tibial cutt...

Page 18: ...e knee ligaments Gently apply pressure to the lever toward the body of the handle Adequate extension space will allow the lever to rest easily on the body of the handle If moderate to excessive force is needed to fully depress the lever adjust the depth of the tibial cutting block by using the height adjustment thumb wheel to resect more tibial bone and confirm the extension space by easily depres...

Page 19: ...nt Remove the tibial resection spacer After the horizontal resection level is set place one 1 8 inch quick release drill pin in the middle hole of one side of the universal tibial cutting block and another one on the opposite side Figure 24 To create a captured cut slot secure the tibial cutting block insert onto the universal tibial cutting block Figure 25 ...

Page 20: ...g block as a reference Figure 27 Tibial Resection cont Fine Tuning Tibial Resection Height cont The cut block may be used as a surface block by not attaching the tibial cutting block insert Figure 26 Resect the tibial plateau Note To preserve the integrity of the soft tissues avoiddislocatingthetibiawhilemakingtheresection At the same time take care to protect the insertion point of the PCL ...

Page 21: ...sterior femoral osteophytes have been removed Note An alignment rod can also be used with the spacerblocktoassurepropervarus valgusalignment and slope Tibial Sizing Place the knee in maximum flexion with a Z retractor medially and laterally to provide maximum exposure Select the tibial template size that provides the appropriate A P and M L coverage Figure 29 Performanextramedullaryalignmentcheckb...

Page 22: ...al component using the lug drill Determine final rotation of the tibia and mark the position in the following way Extend the anterior marks of the tibial trial onto the anterior tibia with electrocautery Figure 30 Vanguard ID Tip When trialing range of motion if the medial and lateral bearings rise up in flexion a Confirm the tibial tray is not undersized b Confirm that the posterior slope is adeq...

Page 23: ...lanes using the tibial template Base tibial template rotation relative to the tibial tubercle and the malleolar axis or the marks after free floating your trial Perform an extramedullary alignment check by placing the 1 4 inch alignment rod through the tibial template handle Note To optimize patellofemoral tracking slight external rotation is preferable Assemble the tibial punch mask onto the tibi...

Page 24: ...ndimpacttheassembledprimarytibialtray trial into the tibia Trialing The following bearing combinations are options based on implant size see the below sizing chart Note Medial and lateral bearings may differ in thickness up to but no greater than 2 mm in order to accommodate the soft tissue envelope of the knee Bearing articulation may also differ see bearing compatibility chart page 24 XP CR 59 6...

Page 25: ...rial onto the patella Final Trial Range of Motion With the trial components in place check the range of motion and stability of the knee Femur With all bone surfaces and soft tissues prepared complete a trial reduction Place the femoral trial onto the femur with dedicated femoral impactor Figure 34 The femoral trial should be centered medially and laterally over the femoral notch Tibia Basedonthes...

Page 26: ... 5 10 15mm 55 55 57 5 60 62 5 65 67 5 70 72 5 75 80 Note Vanguard SSK and SSK 360 Femoral Augments are compatible with Vanguard XP Femoral Components 5 10 mm augments only Vanguard XP CR ID Tibial Tray XP XP Bearing Compatibility XP CR ID Tibial Trays 59 63 65 67 69 71 73 75 79 83 87 91 XP XP Bearings 59 63 71 79 87 Vanguard XP CR ID Tibial Tray XP AS Bearing Compatibility XP CR ID Tibial Trays 59...

Page 27: ...ilized High constraint medially Low constraint laterally XP AS Left Medial Bearing XP XP Left Lateral Bearing Partially Intact Non Functioning PCL Bearing Right Knee Levels of Articulation Medial Side Lateral Side Standard AS High constraint medially High constraint laterally XP AS Right Medial Left Lateral Bearing XP AS Right Lateral Left Medial Bearing Lateral Stabilized High constraint laterall...

Page 28: ...26 Vanguard ID Total Knee Surgical Technique Vanguard ID Constructs Anterior Stabilized Cruciate Retaining Medial Stabilized Lateral Stabilized ...

Page 29: ...ix a single 40g unit of cement Note Use of a vacuum mixing cartridge is recommended as well as application of new gloves Implant Reduction As soon as the cement properties permit apply a thin layerovertheentireundersideofthetibialcomponent Avoid contamination of the implant cement interface The cement should just overfill the pockets on underside of the tray up to 1 mm proud posteriorly and 2 mm a...

Page 30: ... be carefully dried using an osteotome wrappedinaclean drylapspongepriortofinalimplant placement Note While drying blood or saline make sure not to remove the cement that was just placed on to the surface Insert the tibial component Impact the tray with the tibial impactor Figure 37 Remove any excess cement from the posterior aspect of the tibia using an angled elevator Woodson Theangledelevatorca...

Page 31: ... 2 mm Apply cement to the prepared femur and pressurize the cement strivingforpenetrationof3 5mm withspecial attention given to pressurizing cement into the anterior facet asseatingoftheimplantwillnotcontributemuch to cement penetration in this area Figure 38 Any cement remaining proud on the posterior facet should be scraped flush to the bone before proceeding so that it is not displaced and inac...

Page 32: ...ner Figure 39 Withthekneeflexedtoapproximately70degrees insert thelateraltibialtrialbearingbyhandorusingahemostat as the trial bearing handle was not intended to work when placing trial bearings on the implant Reduce the patella and insert the medial tibial trial bearing Vanguard ID Tip The lateral tibial bearing is easier to insert with the medial tibial bearing absent Once the patella is reduced...

Page 33: ...rt Patellar Component Implantation Pulse lavage and dry patella With the knee in full extension apply a 2 to 3 mm thick layer of cement onto the appropriate patellar component Place component into the patella Push into position with finger pressure so the peg s engage s the prepared hole s Position the patellar clamp onto the component and tighten the handle until the clamp head contacts the compo...

Page 34: ...he anterior tibial tray bearing slot as far as possible using finger pressure Note The locking bar is packaged with the Vanguard XP CR Tibial Tray Place the large curved end of the locking bar inserter etched bar in the notch on the locking bar The end etched tray shouldbeplacedinthenotchonthelateral side of the Vanguard XP CR Tibial Tray Anterior Post Figure 43 Make sure the smaller square end en...

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Page 36: ...tendedforlaypersons Eachsurgeonshouldexercise his or her own independent 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 thetechniqueusedineachcasewilldependonthesurgeon s medical judgment as the best treatment for each patient Results will vary based ...

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