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Figure 1

Exposure

A standard anterior midline incision can be utilized .

Any previous incision can be used or incorporated

to decrease risk of skin slough .

The capsule can be entered through a modified mid-

vastus approach, which makes a skin incision medial

to the patella from just above the tibial tubercle to

just above the patella .

Use a soft tissue approach that allows adequate

patella visualization and sufficient knee flexion .

Tibial

Preparation

Triathlon

Knee System

Single-Use Instruments Surgical Protocol

Figure 3

This surgical technique describes cutting the tibia first,

followed by the femur and then patella . The sequence

may be varied based upon surgeon preference .

In some patients it may be difficult to cut the femur first

and get proper rotation due to the tibia being in the way

of the placement of the femoral sizer . In these cases it

may be beneficial to cut the distal femur, then tibia, and

then go back to size and finish the femoral cuts .

Tibial Preparation

The tibia is prepared using the Triathlon

extramedullary alignment system . Retractors may be

placed medially, laterally, and posteriorly to expose

the tibial plateau for preparation . It is important to

remove all osteophytes, menisci and remaining soft

tissues . Menisci can be removed before or after the

bone cut . If the PCL has been retained, an optional

retractor is available to cradle the PCL for increased

exposure . The knee is flexed anywhere from 45

degrees to more than 90 degrees of flexion depending

on surgeon preference . The tibia may be subluxed or

dislocated as required .

The tibial plateau referencing arm of the proximal

rod is placed on the proximal tibia just anterior to

the ACL insertion . A rongeur may remove any

osteophytes that prevent satisfactory positioning .

Rotational Alignment

The assembly must be in the proper rotational

alignment . The most common landmark referenced

is the tibial tubercle . The assembly should be

aligned with the medial third of the tibial tubercle .

Once the rotational alignment is determined, a

headless pin is placed through the posterior fixation

hole in the proximal assembly to lock it in place .

Either the anterior or posterior fixation holes may

be used to set the flexion extension and rotational

alignment .

Figure 2

Headless

Pin

Locking

Switch

Содержание Triathlon

Страница 1: ...Surgical Protocol Orthopaedics TRIATHLON Single Use Instruments ...

Страница 2: ......

Страница 3: ...al Intramedullary Alignment 10 Distal Femoral Resection 14 Femoral A P Sizing 15 Femoral Anterior Posterior and Chamfer Resections 18 PS Box Preparation 20 Femoral Trial Assessment 21 Tibial Component Sizing 24 Tibial Keel Punching 25 Patella Preparation 26 Trial Assessment 27 Component Implantation 28 PS or CR Femoral Component Cemented Cementless 28 Tibial Component Implantation Cemented Cementl...

Страница 4: ...cessful knee replacement or other procedure Fracture of the distal femur and or proximal tibia that cannot be stabilized by standard fracture management techniques Additional Indications for Posterior Stabilized PS Components Ligamentous instability requiring implant bearing surface geometries with increased constraint Absent or non functioning posterior cruciate ligament Severe anteroposterior in...

Страница 5: ...tion or prior implantation which cannot provide adequate support and or fixation to the prosthesis Skeletal immaturity Severe instability of the knee joint secondary to the absence of collateral ligament integrity and function The Triathlon Single Use Instruments are intended for use in a single Total Knee Arthroplasty See package insert for warnings precautions adverse effects and other essential...

Страница 6: ...Part Numbers Size 5555 2201 1 5555 2202 2 5555 2203 3 5555 2204 4 5555 2205 5 5555 2206 6 5555 2207 7 5555 2208 8 Triathlon CR Single Use Tibial Prep Kit Part Numbers Size 5555 2321 1 5555 2322 2 5555 2323 3 5555 2324 4 5555 2325 5 5555 2326 6 5555 2327 7 5555 2328 8 Triathlon Single Use Tibial Sizer Prep Kit Part Number Sizes 5555 4600 1 8 ...

Страница 7: ...555 2252 2 5555 2253 3 5555 2254 4 5555 2255 5 5555 2256 6 5555 2257 7 5555 2258 8 Triathlon PS Single Use Tibial Prep Kit Part Numbers Size 5555 2361 1 5555 2362 2 5555 2363 3 5555 2364 4 5555 2365 5 5555 2366 6 5555 2367 7 5555 2368 8 Triathlon Single Use Tibial Sizer Prep Kit Part Number Sizes 5555 4600 1 8 ...

Страница 8: ... alignment system Retractors may be placed medially laterally and posteriorly to expose the tibial plateau for preparation It is important to remove all osteophytes menisci and remaining soft tissues Menisci can be removed before or after the bone cut If the PCL has been retained an optional retractor is available to cradle the PCL for increased exposure The knee is flexed anywhere from 45 degrees...

Страница 9: ...nment can be made by depressing the button located on the inferior left hand side of the distal assembly 2 Flexion and extension alignment is proper when the long axis of the assembly parallels the weight bearing axis of the tibia in both the coronal and sagittal planes Usually there is less space between the assembly and the tibia proximally than there is distally Alignment can be verified using ...

Страница 10: ...raction of the proximal rod arm is performed by pressing the bronze button 1 and sliding the arm away from the knee 2 Alternatively by placing the tibial resection guide with the 2 referencing end the resection carried out would be 2mm lower then the point chosen For a coarse gross adjustment the bronze wheel can be pressed and the assembly slid up or down For the final fine adjustment the bronze ...

Страница 11: ...eral tibial plateau near Gerdy s tubercle Once the resection guide is removed final resection can be completed either with an oscillating saw bone file or a rongeur Note Leaving the pins in place will allow for an additional 2mm or 4mm of tibial resection The pins must be removed prior to cutting the tibial keel Tibial Preparation 6541 6 700 MIS Uncaptured Tibial Resection Guide Right 6541 6 701 M...

Страница 12: ... 16 IM Rod Insert the IM Rod into the MIS Femoral Alignment Guide The MIS Femoral Alignment Guide is designed for use on either the left or right knee and may be set between 2 and 9 of valgus Note this is typically set between 5 and 7 Set the instrument to the desired angle by pulling back on the black knob of the MIS Femoral Alignment Guide and placing it in the appropriate notch Advance the rod ...

Страница 13: ... bone that is being resected to ensure the appropriate level is set Slide the Adjustment Block Assembly posteriorly within the Femoral Alignment Guide until the Distal Resection Guide contacts the anterior surface of the femur Femoral Preparation 6541 4 801 Universal Driver 6541 4 538 3 8 IM Drill 6541 4 800 T Handle Driver 6541 4 516 5 16 IM Rod 6541 5 601 MIS Femoral Adjustment Block 6541 5 629 ...

Страница 14: ...isfactory alignment is achieved remove the Femoral EM Alignment Tower and the Universal Alignment Rod 12 Pin the Distal Resection Guide to the anterior femur using Headless Pins Insert the pins into the Headless Pin Driver which is inserted into the Universal Driver and drill through the set of holes marked 0 on the Distal Resection Guide The pins are automatically released from the driver as it i...

Страница 15: ...nment Guide and the Adjustment Block may be removed by pressing the black button on top of the Adjustment Block Femoral Preparation 6541 5 601 MIS Femoral Adjustment Block 6541 7 808 MIS Femoral EM Alignment Tower 6541 4 801 Universal Driver 6541 4 602 Universal Alignment Rod 6541 4 809 Headless Pin Driver 6541 5 721 MIS Distal Resection Guide Left 6541 5 722 MIS Distal Resection Guide Right 6541 ...

Страница 16: ... Instruments are designed to provide control of the saw blade during bone resections When using captures or cutting through slots a 050 1 25mm thick blade is used 14 Remove the modular capture and check the resection for flatness Remove the Headless Pins in the Distal Resection Guide using the Pin Puller Remove the Distal Resection Guide and check the resection for flatness Note If the X pin hole ...

Страница 17: ...te The MIS Femoral Stylus uses two sizing references First read the A P scale by viewing the position of the indicator lip of the femoral stylus against the A P scale on the medial side of the A P sizer Second adjust the superior inferior position of the stylus to match the first A P scale reading Check to verify the two sizing references match If the A P scale reading then changes reset the S I s...

Страница 18: ...es an optional A P translation feature may be used Simply use the Hex Driver found on the reverse side of the Femoral Flexion Impactor to translate the A P Femoral Sizer up or down 1 5mm Triathlon Primary prosthesis grows in the anterior direction approximately 3mm between sizes A tertiary check to verify external rotation is to assess A P axis with the Blade Runner through the slot in the top of ...

Страница 19: ...lation Additionally it is recommended that an irrigation system be available and that the joint be thoroughly irrigated after use of the block Femoral Preparation 6541 5 500 MIS AP Sizer Adjustment Housing 6541 5 508 MIS AP Sizer Body Left 6541 5 509 MIS AP Sizer Body Right 6541 5 510 MIS Femoral Stylus 6541 4 802 1 8 Hex Drive 6541 4 518 1 8 Peg Drill 6541 4 801 Universal Driver 6541 4 300 Headed...

Страница 20: ...y utilizing the width of the Single Use 4 1 Cutting Block as marked on the backside of the block Femoral Anterior Posterior and Chamfer Resections Complete the remaining four femoral bone resections The use of a 050 1 25mm thick saw blade is recommended The order of bone resections is not critical however a recommended sequence for improved stability of the 4 1 Cutting Block is 1 Anterior cortex 2...

Страница 21: ... resections are complete Note Do not over torque the Femoral Impactor Extractor during engagement with the Single Use 4 1 Cutting Block Upon removal of the Single Use 4 1 Cutting Block irrigate thoroughly Figure 28 Femoral Preparation 6541 4 810 Impaction Handle 6541 4 807 Femoral Impactor Extractor 6541 4 801 Universal Driver 6633 7 605 Pin Puller 6541 4 003 Headless Pins 3 See Catalog Triathlon ...

Страница 22: ...sen a PS knee then the intercondylar notch must be resected In order to accomplish this the Single Use PS Box Cutting Guide is placed onto the distal femur Since the width of the distal portion of the guide represents the exact width of the implant it should be centered and placed in the desired position flush with the distal resection The box guide is then pinned to the femur using the Headless P...

Страница 23: ...Femoral Trial Extractor 6541 4 807 Femoral Impactor Extractor Figure 32 21 Femoral Trial Assessment The remaining portion of the technique should be used for a Posterior Stabilized or Cruciate Retaining knee Assemble the appropriate size symmetrical Single Use PS or CR Femoral Trial to the Femoral Impactor Extractor with the Impaction Handle or use the Femoral Trial Extractor pictured in Figure 32...

Страница 24: ...al Impactor Extractor The Femoral Trial is then impacted onto the prepared distal femur and the Impactor Extractor is removed The fit of the Femoral Trial is checked to ensure that there is a flush fit The Triathlon CR knee has integral medial and lateral femoral pegs Therefore if a CR implant is chosen the 1 4 peg drill is assembled to the Universal Driver and distal fixation peg holes are drille...

Страница 25: ...or Figure 35 23 Figure 36 Tibial Preparation Femoral Preparation Attach the Femoral Impactor Extractor or the Femoral Trial Impactor to the Single Use PS or CR Femoral Trial and remove from the femur Tibial Component Sizing Retractors are placed to expose the tibial plateau The Single Use Femoral Trial may be left in place Triathlon Single Use Instruments include color coded Tibial Sizers for prop...

Страница 26: ... Single Use Universal Tibial Template ensure that the Single Use Tibial Insert Trial is inserted posterior to the Headed Nails Note Do not impact the Single Use Tibial Insert Trial In the event that excessive resistance is encountered during insertion of the Single Use Tibial Insert Trial remove reposition and reinsert the Single Use Tibial Insert Trial Ensure all excess debris bone and soft tissu...

Страница 27: ...d on the handle to lock the Keel Punch Guide to the Single Use Universal Tibial Template See Catalog Triathlon Single Use Instruments Tibial Kit Tibial Insert Trial See Catalog Triathlon Single Use Instruments Femoral Prep Kit CR Universal Femoral Trial See Catalog Triathlon Single Use Instruments Femoral Prep Kit PS Universal Femoral Trial See Catalog Triathlon Single Use Instruments Tibial Kit T...

Страница 28: ...move all pins and remove the Single Use Universal Tibial Template unless using again for patella trial assessment Patellar Preparation Remove all osteophytes and synovial insertions around the patella and measure thickness using a caliper After determining the depth of the cut with a caliper affix the stylus in the appropriate slot to the patella resection guide and capture the patella between the...

Страница 29: ...ace correct size Patella Trial Symmetric or Asymmetric onto the prepared patella Replace all Trials and assess patellar tracking by taking the knee through a ROM The patella should track normally throughout the ROM with out tendency for tilting or lateral subluxation Tibial Preparation Component Implantation 6541 4 003 Headless Pins 3 6541 4 809 Headless Pin Driver 6541 4 801 Universal Driver 6541...

Страница 30: ...the Femoral Impactor Extractor to the Impaction Handle and attach to the appropriate size and side Femoral Component Place the Femoral Component on the femur and impact it until fully seated Posterior Stabilized Knee If Modular Femoral Distal Fixation Pegs are to be used assemble the pegs to the Femoral Component using the 1 8 Hex Drive and the Slip Torque Handle prior to implantation The Femoral ...

Страница 31: ...ng bone cement clear excess bone cement while maintaining baseplate position Component Implantation See Catalog Symmetric Asymmetric Patella Trials 6541 3 524 All Poly Patella Drill w Stop 6633 7 744 Patella Clamp See Catalog Express Symmetric Asymmetric Patella Drill Templates 6633 7 738 Patella Stylus 6633 7 736 Slotted Patella Resection Guide See Catalog PS Femoral Component Cemented or Cementl...

Страница 32: ...e locking wire locks under barbs on anterior interior surface of baseplate Note The Tibial Insert Impactor 6541 4 813 which is available in the standard Triathlon Primary Instrument set may be used for the final seating of the Tibial Insert 30 Patellar Component Cemented Cementless Place the Patella Component onto the prepared patella making certain the fixation peg holes are aligned to the corres...

Страница 33: ...ent Cap 6633 7 744 Patella Clamp See Catalog PS Femoral Component Cemented or Cementless See Catalog CR Femoral Component Cemented or Cementless See Catalog Primary Tibial Baseplate Cemented or Cementless Figure 51 Instrument Bar 31 Assess the joint in flexion and extension Closure For Cemented Components After cement polymerization and removal of all residual cement thoroughly irrigate the joint ...

Страница 34: ... Driver 1 6541 4 003 Headless Pins 3 4 6541 4 805 Baseplate Impactor Extractor 1 OR 6541 4 812 Tibial Baseplate Impactor 1 6541 4 807 Femoral Impactor Extractor 1 OR 6541 7 807 MIS Femoral Trial Extractor 1 6541 4 809 Headless Pin Driver 1 6541 4 810 Impaction Handle 1 6541 5 500 MIS AP Sizer Adjustment Housing 1 6541 5 508 MIS AP Sizer Body Left 1 6541 5 509 MIS AP Sizer Body Right 1 6541 5 510 M...

Страница 35: ...mmetric Patella Drill Template 36mm 1 6541 3 639E Express Symmetric Patella Drill Template 39mm 1 6541 3 800E Express Cement Cap 1 6633 7 744 Patella Clamp 1 5550 T 278 Symmetric Patella 27mm x 8mm 1 5550 T 298 Symmetric Patella 29mm x 8mm 1 5550 T 319 Symmetric Patella 31mm x 9mm 1 5550 T 339 Symmetric Patella 33mm x 9mm 1 5550 T 360 Symmetric Patella 36mm x 10mm 1 5550 T 391 Symmetric Patella 39...

Страница 36: ...oral Adjustment Block 1 6541 5 629 MIS Femoral Alignment Guide 1 6541 5 721 MIS Distal Resection Guide Left 1 6541 5 722 MIS Distal Resection Guide Right 1 6541 5 723 MIS Modular Distal Capture 1 6541 6 611 MIS Proximal Rod EM 1 6541 6 700 MIS Uncaptured Tibial Resection Guide Right 1 6541 6 701 MIS Uncaptured Tibial Resection Guide Left 1 OR 6541 6 702 MIS Captured Tibial Resection Guide Right 1 ...

Страница 37: ...ntity 7 Not included in standard configuration but may be ordered separately Triathlon Tibial Sizer Kit Part Number 5555 4600 Triathlon Stryker Precision Tibial Sizer Kit 1 kit 5555 4601 Tibial Sizer 1 1 per kit 5555 4602 Tibial Sizer 2 1 per kit 5555 4603 Tibial Sizer 3 1 per kit 5555 4604 Tibial Sizer 4 1 per kit 5555 4605 Tibial Sizer 5 1 per kit 5555 4606 Tibial Sizer 6 1 per kit 5555 4607 Tib...

Страница 38: ...athlon CR Single Use Femoral Prep Kit Size 4 1 kit 5555 2104 4 1 Cutting Block Size 4 1 per kit 5555 0604 Universal Femoral Trial Size 4 1 per kit 5555 2205 Triathlon CR Single Use Femoral Prep Kit Size 5 1 kit 5555 2105 4 1 Cutting Block Size 5 1 per kit 5555 0605 Universal Femoral Trial Size 5 1 per kit 5555 2206 Triathlon CR Single Use Femoral Prep Kit Size 6 1 kit 5555 2106 4 1 Cutting Block S...

Страница 39: ...Size 4 1 per kit 5555 0804 Universal Femoral Trial Size 4 1 per kit 5555 1804 PS Box Cutting Guide Size 4 1 per kit 5555 2255 Triathlon PS Single Use Femoral Prep Kit Size 5 1 kit 5555 2105 4 1 Cutting Block Size 5 1 per kit 5555 0805 Universal Femoral Trial Size 5 1 per kit 5555 1805 PS Box Cutting Guide Size 5 1 per kit 5555 2256 Triathlon PS Single Use Femoral Prep Kit Size 6 1 kit 5555 2106 4 ...

Страница 40: ...l Insert Trial Size 4 11mm 1 per kit 5555 2424 CR Tibial Insert Trial Size 4 13mm 1 per kit 5555 2425 CR Tibial Insert Trial Size 4 16mm 1 per kit 5555 2315 Triathlon CR Single Use Tibial Prep Kit Size 5 1 kit 5555 2305 Tibial Template Size 5 1 per kit 5555 2429 CR Tibial Insert Trial Size 5 9mm 1 per kit 5555 2430 CR Tibial Insert Trial Size 5 11mm 1 per kit 5555 2431 CR Tibial Insert Trial Size ...

Страница 41: ... kit 5555 2624 PS Tibial Insert Trial Size 4 13mm 1 per kit 5555 2625 PS Tibial Insert Trial Size 4 16mm 1 per kit 5555 2355 Triathlon PS Single Use Tibial Prep Kit Size 5 1 kit 5555 2305 Tibial Template Size 5 1 per kit 5555 2629 PS Tibial Insert Trial Size 5 9mm 1 per kit 5555 2630 PS Tibial Insert Trial Size 5 11mm 1 per kit 5555 2631 PS Tibial Insert Trial Size 5 13mm 1 per kit 5555 2632 PS Ti...

Страница 42: ...ess Beaded w PA X 1 2 3 4 5 6 7 and 8 1 Each Size 5517 F X02 Triathlon CR Femoral Component Right Cementless Beaded w PA X 1 2 3 4 5 6 7 and 8 1 Each Size Triathlon PS Femoral Component Cemented Part Numbers 5515 F X01 Triathlon PS Femoral Component Left Cemented X 1 2 3 4 5 6 7 and 8 1 Each Size 5515 F X02 Triathlon PS Femoral Component Right Cemented X 1 2 3 4 5 6 7 and 8 1 Each Size Triathlon P...

Страница 43: ...ll 7 32 Please note Each Triathlon Tritanium Baseplate will be provided packaged together with an Impactor Pad 6541 4 901 which is required during the tibial baseplate impaction step and discarded immediately after For Triathlon Tritanium Baseplates please refer to the Triathlon Tritanium Surgical Protocol for procedure specific and instrument specific information For Triathlon All Polyethylene Ti...

Страница 44: ...Conventional Polyethylene and X3 Part Numbers Conventional Polyethylene Inserts 5532 P X09 Triathlon PS Tibial Insert Conventional Polyethylene 9mm X 1 2 3 4 5 6 7 and 8 1 Each Size 5532 P X11 Triathlon PS Tibial Insert Conventional Polyethylene 11mm X 1 2 3 4 5 6 7 and 8 1 Each Size 5532 P X13 Triathlon PS Tibial Insert Conventional Polyethylene 13mm X 1 2 3 4 5 6 7 and 8 1 Each Size 5532 P X16 T...

Страница 45: ...itanium S39mm x 11mm 1 Asymmetric Patellas Conventional Polyethylene and X3 Part Numbers Conventional Polyethylene Patellas 5551 L 299 Asymmetric Patella Conventional Polyethylene A29mm S I x 9mm 1 5551 L 320 Asymmetric Patella Conventional Polyethylene A32mm S I x 10mm 1 5551 L 350 Asymmetric Patella Conventional Polyethylene A35mm S I x 10mm 1 5551 L 381 Asymmetric Patella Conventional Polyethyl...

Страница 46: ...es 1 2 Triathlon PS Femoral Finishing Punch 6541 5 234 Sizes 3 4 Triathlon PS Femoral Finishing Punch 6541 5 256 Sizes 5 6 Triathlon PS Femoral Finishing Punch 6541 5 278 Sizes 7 8 Triathlon PS Femoral Finishing Punch 6541 5 814 Sizes 1 4 Triathlon PS Femoral Box Trial Protector 6541 5 858 Sizes 5 8 Triathlon PS Femoral Box Trial Protector 6541 8 122 Triathlon PS Box Preparation Sizes 1 8 Tray Not...

Страница 47: ... 4 4 4 Patella Type Femoral Components Asymmetric Asymmetric Metal Backed Symmetric Metal Backed Symmetric CR Cemented PS Cemented TS Cemented Cementless CR Beaded PS Beaded CR Beaded with PA PS Beaded with PA 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Insert Type Tibial Baseplates CR CS PS TS Cemented Cruciform No Cemented Universal Cementless Beaded Cruciform No Beaded Screw Fix No ...

Страница 48: ...nd or instructions for use before using any Stryker product The Triathlon Single Use Instruments depicted are CE marked according to the Medical Device Directive 93 42 EEC Products may not be available in all markets because product availability is subject to the regulatory and or medical practices in individual markets Please contact your Stryker representative if you have questions about the ava...

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