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11

Planning of Surgery Using the Radiograph

A  Anatomical femoral axis
B  Anatomical tibial axis
C Mechanical leg axis
D Mechanical femoral axis
E  Tibial resection depth (mm)

 Valgus 

angle

Preop.

Postop.

   The following procedure is recommended for 

the anterior-posterior whole leg imaging pro-
cess:

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 

 determines 

the valgus angle.

4.   The tibial axis B is drawn in and the tibial re-

section plane E is determined to avoid exces-
sive resection, especially where there are 
 defects.

5.   The component sizes and resection depths 

are determined preoperatively using the 
X-ray templates (Lit. No. 1135 or 1584) in A/P 
and the lateral planes.

6.  The mechanical leg axis C should merge with 

lines D and B after correction.

Postop.

Preop.

Содержание RT-PLUS

Страница 1: ...Text Titel Surgical Technique Intramedullary Application smith nephew RT PLUS Modular Rotating Hinged...

Страница 2: ......

Страница 3: ...Treatment 51 References 52 Sterilization 53 Implants 54 Instrumentation 60 Product Overview Combination Tables 74 Nota Bene The technique description herein is made available to the healthcare profess...

Страница 4: ...2...

Страница 5: ...and it represents a valuable addition to bicondylar surface replacement The functional design allows extremely sparing resections The joint components features anatomical geometry as it s also used to...

Страница 6: ...cessary an intraoperative switchover from the resurfacing to the constrained rotating knee The femoral and tibial components of RT PLUS Modular are identical to those of RT PLUS with the exception of...

Страница 7: ...slocation but the components can nevertheless be easily coupled Because of the design of the con dyles physiological rollback of 9 mm is possible which improves the exion capa bility of the joint The...

Страница 8: ...ess in the load zone is 8mm The selected manufacturing method the design condyles and the high quality material combine to form the proven wear resistance of the insert The tibial inserts are identica...

Страница 9: ...and can then be cemented on the tibia respectively on the femur Cemented stem The femoral and tibial components can be intramedullary anchored in the bone by cemented conical stems made of forged CoC...

Страница 10: ...intraoperatively from the TC PLUS knee system to the RT PLUS Modular knee system since the resections and prosthesis sizes are matching Contraindications Contraindications are Acute or chronic local...

Страница 11: ...ion Case Study Patient with severe joint instability varus gonarthrosis as well as medial joint destruction Postoperative result Immediately postoperative functional and pain free reconstruction with...

Страница 12: ...cases of doubt the smaller implant should be selected to prevent the prosthesis com ponents from protruding In normal cases the size determination and the correct posi tioning of the prosthesis are c...

Страница 13: ...n 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 determines the valgus angle 4 The tibial...

Страница 14: ...12...

Страница 15: ...eps 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 a...

Страница 16: ...tting out of the box Remove residual posterior condyles if present Note To avoid the risk of a condyle fracture we recommend to prepare the box after tibial preparation 4 Tibial resection and optional...

Страница 17: ...ptional posterior augment resection 3 Chamfer resections and cutting out of the box Remove residual posterior condyles if present Note To avoid the risk of a condyle fracture we recommend to prepare t...

Страница 18: ...16...

Страница 19: ...outside contours as well as ventrally according to the anterior posterior resections and the medial lateral contours Note The line in the sagittal view of the femoral sizer shows the position of the...

Страница 20: ...carefully reference for the femoral position to prevent the development of a relative ex tension position risk of notching or flexion position projecting patella Preparing the femoral anchorage Reamer...

Страница 21: ...th the 10 16mm stepped reamer until the laser marking corresponding to the resection level IM positioning and control with trial stems The chosen trial stem is attached to the extension for trial stem...

Страница 22: ...mm Align the device with regard to rotation Note that the removable handles are parallel to the epicondylar axis After preliminary drilling with the 3 2 mm drill from distal the femoral suspension dev...

Страница 23: ...If there is an extension deficit it is recommended to move the distal resection 2 4 mm proximally to adjust the extension gap For hypermobile patients a 2 mm smaller distal femoral resection is recom...

Страница 24: ...he rotation of the A P femoral cutting block revision is adjusted by applying anteriorly the femoral tibial revision cutting block Note If the rotation of the A P femoral cutting block revision has to...

Страница 25: ...terior slot with facet The posterior femoral resection is made through the two open posterior saw slots slots with facet When using posterior femoral augmentation blocks the resection is made through...

Страница 26: ...the trial stem already used with the trial stem extension 8 mm into the femoral IM canal again using the modular handle and now detach the modular handle Slide the box saw guide IM positioning device...

Страница 27: ...tioner using the trial stem handle which is attached to the trial stem extension The IM box saw guide guide for size 2 and sizes 4 10 can be slid in the positioning device Perform the cuts with a spec...

Страница 28: ...narrow saw blade or an osteotome is intro duced for cutting the posterior cortical box bone Important To protect the important posterior soft tissues a Hohman is placed centered onto the posterior con...

Страница 29: ...se this can cause breakage of the femoral condyle Controlling the femoral resections and anchorage The femoral trial is screwed with the trial stem corresponding to the last reamer and in serted with...

Страница 30: ...e damage to the polyethylene insert by these bony projec tions Notes The femoral trial is used as reference for resection of the bone with the curved osteo tome The femoral trial can be removed by usi...

Страница 31: ...femoral component use the centering template which is inserted through the anterior saw slot of the A P femoral revision cutting block in regard to the femoral size to make a mark e g with an electro...

Страница 32: ...de is inserted up to the RT 45 mark Note Protect the vessels and nerves in the popliteal fossa In the case of the guide for sizes 4 10 make the anterior box cut in the saw slot of the re spective size...

Страница 33: ...stem diameter and depth Notes Reamers are available in diameter 10 12 14 16 18 and 20 The depth indicator is on the reamer observe the laser markings 95 120 160 and 200 When using cemented stems the 1...

Страница 34: ...th the 10 16 mm stepped reamer until the laser marking corresponding to the resection level IM positioning and control with trial stems The chosen trial stem is attached to the ex tension for trial st...

Страница 35: ...vision cutting block is rst lifted upwards by pressing the button so the tibial stylus can be attached Setting the resection height The tibial stylus is positioned on the tibial plateau The tibial sty...

Страница 36: ...l grub screw is used for assem bling the femoral tibial revision cutting block only After preliminary drilling with the 3 2 mm drill the femoral tibial revision cutting block is xed with two bone pins...

Страница 37: ...m high are available As guidance for the vertical tibial augmenta tion block cut two bone pins length 75 mm or 100 mm are inserted into the two proximal holes level with closed saw slot The vertical c...

Страница 38: ...e proximal bone resection The modular handle is now removed It is important to avoid putting excessive pressure in the tibial IM canal The tibial sizer trial and the handle are assembled and placed in...

Страница 39: ...illing with the 3 2 mm drill the tibial sizer is xed with at least two bone pins with head Remove the chisel guide and the trial stem and re t the chisel guide Note Positioning of the chisel guide is...

Страница 40: ...bial trial at this point With the tibial rasp the proximal tibial cavity is de nitively prepared The rasp must be knocked in far enough to ensure that the top of the rasp is ush with the more proximal...

Страница 41: ...not fit a trial stem at all The femoral trial together with the trial stem depending on the last reamer diameter and depth are inserted with using the impactor Note When using blocks there are approp...

Страница 42: ...instructions on page 43 ff Remove the trial components with the slap hammer starting with the femur Note As reference it is recommended to leave as sembled the trial components with stem and eventual...

Страница 43: ...residual bony pa tella should not be less than 12 mm See also the Milling section on page 42 After placing the patellar cutting guide on the patellar clamp with the ratchet grasp the patella with the...

Страница 44: ...rsink by 3mm to 5mm inlay technique Milling down to the stop results in a depth of 5 mm Note Patellar implants with a height of 10mm are recommended as standard Implants with a height of 8mm are avail...

Страница 45: ...urn the stem so that the security screw is positioned medially lower stress in this zone and that no n but a groove is anteriorly positioned thereby a larger surface is in contact with the internal co...

Страница 46: ...blocks care must be taken to ensure that the femoral implants are dry and clean Observe the appropriate size combi nations The tibial blocks are also xed mechanically with the preassembled screws with...

Страница 47: ...t a groove is anteriorly positioned thereby a larger surface is in contact with the internal cortical bone Important Pay attention that the tapered connection is undamaged clean and dry before mountin...

Страница 48: ...t be taken to ensure that the femoral implants are dry and clean Observe the appropriate size combi nations The femoral blocks are also xed mechani cally with the preassembled screws with the screwdri...

Страница 49: ...nt back of plateau and box The Ti6 Al4 V stems are not cemented Important When implanting Ti6 Al4 V stems pay attention that the rotation alignments of the femoral and tibial components correspond alr...

Страница 50: ...ly of the tibial insert it is possible to use the tibial insert trial for a nal trial reduction Before the cement has set the excess cement must be removed in extension Insertion of the tibial insert...

Страница 51: ...ent Remove the impacting attachment from the plug inserter In order to secure the clamp the plug inserter is in 90 exed position placed into the an terior tibial insert hole over the polyethylene plug...

Страница 52: ...back of the patellar component with cement and ll the three peg holes of the patella with cement Insert the patellar component by hand with the leg extended and press in using the pa tellar clamp with...

Страница 53: ...laxis is required until full load can be borne On the second postoperative day after remov ing the drains assisted movement exercises and the use of a motorized splint CPM are started The operated leg...

Страница 54: ...Malzer U Schuler P Ergebnisse mit dem RT PLUS Rotationsknie Orthop Praxis 36 10 2000 611 616 Stein A Fleming B Pope MH Howe JG Total Knee Arthroplasty Kinematics An in Vivo Evaluation of Four Differen...

Страница 55: ...by the usual methods in accordance with internal hospital regulations and sterilized in an autoclave in accordance with the legal regulations and guidelines appli cable in the relevant country For det...

Страница 56: ...4318 75005552 8 24320 75005553 10 Tibial components Art No Art No PLUS S N Size 24332 75005559 2 24334 75005560 4 24336 75005561 6 24338 75005562 8 24340 75005563 10 Patellar components Art No Art No...

Страница 57: ...482 4 8 mm 24057 75005483 4 11 mm 24058 75005484 4 14 mm 24066 75005485 6 8 mm 24067 75005486 6 11 mm 24068 75005487 6 14 mm 24076 75005488 8 8 mm 24077 75005489 8 11 mm 24078 75005490 8 14 mm 24086 7...

Страница 58: ...9 75005582 6 15 mm 24380 75005583 8 5 mm 24381 75005584 8 10 mm 24382 75005585 8 15 mm 24383 75005586 10 5 mm 24384 75005587 10 10 mm 24385 75005588 10 15 mm Femoral blocks posterior Art No Art No PLU...

Страница 59: ...mm 24305 75005544 6 10 mm 24392 75005591 6 15 mm R lal L med 24397 75005596 6 15 mm L lat R med 24306 75005545 8 5 mm 24307 75005546 8 10 mm 24393 75005592 8 15 mm R lal L med 24398 75005597 8 15 mm L...

Страница 60: ...521 12 mm 120 mm 24259 75005524 14 mm 120 mm 24257 75005522 16 mm 120 mm 24260 75005525 18 mm 120 mm 24258 75005523 20 mm 120 mm 24266 75005530 12 mm 160 mm 24267 75005531 14 mm 160 mm 24268 75005532...

Страница 61: ...59...

Страница 62: ...m 240121 75005350 Trial Stem 12 160 mm 240122 75005351 Trial Stem 14 160 mm 240123 75005352 Trial Stem 16 160 mm 240124 75005353 Trial Stem 18 160 mm 240125 75005354 Trial Stem 20 160 mm 240126 750053...

Страница 63: ...ptional cemented trial stems on request Set No PLUS S N 0944045 75200247 Art No Art No PLUS S N Description Size 240109 75005338 Trial Stem 95 mm 240398 75005422 Trial Stem 120 mm 240110 75005339 Tria...

Страница 64: ...0309 75005393 Femoral Sizer 10 600187 75007148 Femoral Suspension Device Revision 600184 75007145 Femoral Bushing 6 600183 75007144 Femoral Distal Spacer Revision 7 mm 600398 75007233 Femoral Tibial C...

Страница 65: ...n Size 240374 75005412 Stepped Drill AO 8 14 mm 251097 75005673 IM Drill with Starter Tip AO 8 mm 251096 75005672 Drill AO 3 2 mm Optional EM Box Preparation on request Set No PLUS S N 0944047 7520024...

Страница 66: ...rial Left 6 240303 75005387 Femoral Trial Left 8 240304 75005388 Femoral Trial Left 10 240330 75005403 Femoral Trial Right 2 240331 75005404 Femoral Trial Right 4 240332 75005405 Femoral Trial Right 6...

Страница 67: ...65...

Страница 68: ...Tibial Sizer 6 240441 75000982 Tibial Sizer 8 240442 75000983 Tibial Sizer 10 600175 75007137 Tibial Sizer Handle 600172 75007135 Axial Alignment Rod I II 240372 75005410 Tibial Chisel Guide 2 240373...

Страница 69: ...67...

Страница 70: ...ck Trial R Lat L Med 10 10 mm 240474 75005475 Tibial Block Trial R Lat L Med 10 15 mm 240417 75005436 Tibial Block Trial L Lat R Med 2 5 mm 240419 75005438 Tibial Block Trial L Lat R Med 2 10 mm 24047...

Страница 71: ...69...

Страница 72: ...r Small 600289 75007201 Impactor Large 600239 75007170 Assembling Block 600228 75007166 Automatic Hammer 600299 75007201 Adapter for Automatic Hammer 600230 75007167 Stem Protector Cross 240093 750053...

Страница 73: ...71...

Страница 74: ...05712 Patellar Drill Guideg 29 mm 251242 75005713 Patellar Drill Guide 32 mm 251243 75005714 Patellar Drill Guide 35 mm 251216 75005706 Patellar Mill with Stop 26 mm 251283 75005707 Patellar Mill with...

Страница 75: ...73...

Страница 76: ...sterior 24352 5mm 24353 10mm Posterior 24354 5mm 24355 10mm Posterior 24356 5mm 24357 10mm Posterior 24358 5mm 24359 10mm 21183 8mm 21193 10mm 24046 8mm 24047 11mm 24048 14mm 24300 5mm 24301 10mm 2439...

Страница 77: ...ted stems 10 12 14 16 18 200 mm 1 60 mm 1 20 mm 95 mm 20 Non cemented stems 24251 95mm 24252 95mm 24256 120mm 24266 160mm 24261 200mm 24254 95mm 24259 120mm 24267 160mm 24264 200mm 24253 95mm 24257 12...

Страница 78: ...Lit No Product Portfolio PLUS SOLUTION KNEE FAMILY 1685 Sawblades for the PLUS SOLUTION KNEE FAMILY 1403 Surgical Technique Intramedullary Application 1313 Product Information 1330 X Ray Templates 1...

Страница 79: ......

Страница 80: ...ontact Smith Nephew Orthopaedics AG For further information please contact Erlenstrasse 4a our local sales of ce 6343 Rotkreuz www smith nephew com Switzerland Trademark of Smith Nephew Lit No 1313 e...

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