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2.2 Intramedullary fixation

Diaphyseal intramedullary reaming

In order to ensure good stability for the axis of the diaphyseal reamer, which serves as a guide and support during surgery, gradual intramedullary
reaming is performed with a depth according to the length of the stem which is going to be used.

Diameter of the reaming:

The recommended diameters for this reaming are normally around Ø9-10 or 11 mm, although the suitability of the final

diameter for the femoral diaphysis to be used is always at the discretion of the surgeon and, through gradual reaming, it may even be close to that
of the inner cortex diameter fitting. This is the case when a 200 mm stem must be inserted.

Depth:

Generally, the diaphyseal reamer is inserted up to the second 70-120-200 mark, because at this depth greater stability, accuracy, tighte-

ning and safety are achieved for the installation of the femoral cutting guide. If it is not possible to penetrate this deeply (short femur, fracture
callus which closes the medullary cavity…), at a minimum it must penetrate as far as the 70 mark in order to house a stem which is 70 mm long.

As the femoral time is being performed, the depths must be adjusted to the marks close to the initial F, as indicated in the image below.

Reaming guides with cannulated reamers

Deciding the length of the stem which is going to be used prior to the operation, ream with a cannulated reamer to the depth which was chosen, reaming
with an incremental diameter.

Depth:

To install a 70 mm stem, penetrate as far as the first 70 mark. If, on the other hand, the stem must be 102 or 200 mm, ream until the second

120-200 mark. As this is the femoral time, pay attention to the depth marks closest to the initial F.

Set 0. Upper tray

Set 0. Lower tray

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Содержание Genutech CCK

Страница 1: ...Surgical Technique Genutech CCK total knee revision system ...

Страница 2: ......

Страница 3: ... FEMORAL TIME 10 2 1 Measuring of the femoral component 10 2 2 Intramedullary fixation 11 2 3 Distal cut 14 2 4 Femoral cuts 15 2 5 Verification of stability during flexo extension 20 2 6 Reaming to house the femoral post 21 2 7 Assembly of the trial femoral component 23 3 TIBIAL TIME II 24 4 MOBILITY STABILITY CHECK 29 5 PATELLA TIME 30 6 FINAL IMPLANT 31 ANNEXES 32 IMPLANTS AND INSTRUMENTS 44 Ta...

Страница 4: ...rtex diameter fitting This is the case when a 200 mm stem must be inserted Depth Generally the diaphyseal reamer is inserted up to the second 70 120 200 mark because at this depth greater stability accuracy tighte ning and safety are achieved for the installation of the tibial cutting guide If it is not possible to penetrate this deeply short tibia fracture callus which closes the medullary cavity...

Страница 5: ...iameter Carry out gradual reaming in order to carve the cavity which will house the tibial stem Note When using a 200 m stem the diameters of the reamers diaphyseal and cannulated will be the same because in order to reach a reaming depth of 200 mm you use part of the length of the reaming which has already been completed to secure the diaphyseal reamer See other examples of intramedullary reaming...

Страница 6: ...rt a 120 or 200 mm stem The sleeves must be inserted with the revision sleeve inserter extractor at a minimum depth as indicated on the axis of the inserter according to the readings which correspond to the surgical time we are performing tibia or femur and the type of surgery being carried out Semi Constrained Revision REV or Primary Semi Constrained PRIM 1 2 Assembly and fitting of the tibial cu...

Страница 7: ... the steps we take This system must be adjusted into position 0 before it is used In order to find reference 0 insert the probe hook into the standard cutting slot slot 0 and the whole system travels on the axis of the reamer until the tip of it rests on the most prominent area of the tibia In this position tighten the blocking screws or fixation screws of the transverse connector and of the teles...

Страница 8: ...plateau with the most wear and the following situations may arise a The 8 mm arm of the 0 8 probe does not fit In this case cut to 8 and install an 8 mm tibial supplement below the tibial tray on that side b The 8 mm arm is not in contact In this situation assemble the 0 12 probe trying to ensure contact with its 12 mm arm and the following situations may arise b1 The 12 mm arm does not fit leavin...

Страница 9: ... Note For the 0 10 rod which is only used for primary semi constrained surgery the 0 probe coincides with the deepest point of the rod unlike the 0 8 and 0 12 rods used for revision surgery 1 3 Tibial resection Once the tibial cutting guide is in the correct position it is fixed to the tibia using pins Then the telescopic intramedullary system is removed loose ning all of the fixation screws movin...

Страница 10: ... kept by way of a reference point to make it possible to make the 2 mm recut If after removing the pins we want to recover this reference point it is recommended to put back the cutting guide by inserting the probe hook through the corresponding cutting slot supporting it on the resected surface and making use of the drill holes which have already been made in order to reinsert the pins and thus f...

Страница 11: ...ents can be taken from this mark It is essential that the interline is located in the right place in order to ensure proper knee function Example If a is the height from the insertion of the patellar ten don with the ATT to the tibial osteotomy and knowing that the thickness of the tibial tray is approximately 4 mm and the interline is approximately 25 mm from the insertion of the patellar tendon ...

Страница 12: ... femoral sizing guide which will indicate the correct size supporting the posterior condyles and tapping with the rod on the anterior cortex In this case the sizing guide is inserted with the diaphyseal reamer through the centring sleeve So for primary surgeries ream with the diaphyseal reamer and then measure the size of the femoral component Note At this moment check and assess the size which wa...

Страница 13: ...because at this depth greater stability accuracy tighte ning and safety are achieved for the installation of the femoral cutting guide If it is not possible to penetrate this deeply short femur fracture callus which closes the medullary cavity at a minimum it must penetrate as far as the 70 mark in order to house a stem which is 70 mm long As the femoral time is being performed the depths must be ...

Страница 14: ...ameters of the reamers diaphyseal and cannulated will be the same because in order to reach a reaming depth of 200 mm you use part of the length of the reaming which has already been completed to secure the diaphyseal reamer See other examples of intramedullary reaming according to the length of the stem being implanted in Annex I Set 0 Lower tray Surgical Technique ...

Страница 15: ...70 mark or a long one if reaming has reached the 120 200 mark The sleeves must be inserted with the revision sleeve inserter extractor with its threaded cap which protects the extracting thread at a minimum depth as indicated on the axis of the inserter according to the readings which correspond to the surgical time we are performing femur and the type of surgery being carried out Semi Constrained...

Страница 16: ...or Semi Constrained Revision surgery In the case of Primary surgery cut the support area to 8 mm and for Revision surgery cut to 1 mm We will also find slots marked for additional recuts of 4 8 and 12 mm to enable sanitising or on condylar cuts In these cases we will use distal supplements with the same thickness as the distal cut which has been made Note Before fitting the mask and making the cut...

Страница 17: ...er and the concentric positioner A Revision or Primary rod has been fitted onto the cutting guide depending on the type of surgery Then check whether or not the rod is resting on the anterior cortex REVISION rod PRIMARY rod If it is being supported offsetting is not necessary If it is not being supported remove the concentric positioner and put the eccentric positioner in its place rotating it to ...

Страница 18: ...12 mm dis tal supplements which must be installed to provide pro per distal support to the cutting mask mainly in those cases where recuts have been necessary on the distal condyles 3 of external rotation With the knee at 90 flexion and the posterior condyles resting on the surface of the tibia which has previously been cut insert the 3 external rotation system into the posterior cutting slots of ...

Страница 19: ...essary because the stem must be fixed to both the trial and final femoral components To take this reading it is important to pay attention to the number of the insert positioner which coincides with the mark of the eccentric positioner Alignment bar Tibial axis Alignment of bar with tibial crest ...

Страница 20: ...e unstable if we only insert the pin as far as the slot because only the tip of the pin will reach the bone If it is inserted deeper this will present an obstacle when removing the diaphyseal reamer and sleeve Therefore it is recommended to initially insert the pin as far as the slot and once the intramedullary components have been removed finish inserting the pin until it penetrates the threaded ...

Страница 21: ...the size of the femur the cuts are made from the front of the femur Intercondylar cut template In order to guide the saws better there is the option of installing the intercondylar insert of the appropriate size and frontally finishing the sides of the intercondylar box With all of the femoral cuts made remove the cutting mask ...

Страница 22: ... to maintain the position of the interline For example If the necessary increase is 2 mm the thickness of the tibial insert must be increased by 2 mm because the Genutech CCK system does not have 2 mm femoral supplements If the increase is 4 mm 4 mm bilateral distal supplements are placed on the femur If the increase is 6 mm a tibial insert which is 2 mm bigger and 4 mm bilateral distal supplement...

Страница 23: ...lined pins which are necessary to ensure the mask is properly secured 2 6 Reaming to house the femoral post The necessary distal and posterior supplements are fitted onto the intercondylar mask in order to impact it onto the femoral cuts which have been made securing it with 2 pins located on the front edge Set 4 Upper and lower tray ...

Страница 24: ...um depth possible with the Ø 16 mm reamer designed for that purpose Note During this step you must be careful with the potential obstacles for the posterior cortex above all at small sizes when the offset has been per formed close to the lower polar positions Set 4 Upper and lower trays Surgical Technique ...

Страница 25: ...mponent see Annex VI Position between the stem and the femoral component if it has been necessary to perform an offset fit the stem while ensuring that the mark of the stem coincides with the number displayed on the femoral component which originates from the reading which was last taken with the eccentric positioner on the insert positioner see 2 4 Reading of the Offset Using the femoral componen...

Страница 26: ...e central pins which had been installed beforehand to enable subsequent tibial recuts reinsert the diaphyseal intramedullary reamer and the sleeve which were last inserted into the tibial time see 1 1 On its axis install the concentric chisel and on this place the tibial template of the established size see 1 4 Furthermore it must be ascertained whether the template s support on the surface of the...

Страница 27: ...hisel This is the position in which the stem must be fixed to the tibial tray In this position the tibial template is fixed to the tibia with pins At this moment you can optionally perform a flexo extension check by fitting the trial insert onto the tray taking care to use the housings marked on the template for pins ...

Страница 28: ...ial component has been made during flexo extension it is possible to reinforce the tibial template with more pins and then impact the chisel to the depth which has been marked on it Box 1 Lower tray Then create the housings for the fins of the keel through a keel impactor which will be placed on the eccentric or concentric keel Surgical Technique ...

Страница 29: ...he housing for the post of the tibial tray are not properly centred due to the offset Set 1 Lower tray If tibial supplements have been used use the hemi keel right or left to assist with the anterior posterior cut which is made around the two plateaus so that there is no obstruction for the tibial supplements ...

Страница 30: ...l Component The trial tibial tray and the stem are fitted in the predetermined position Set 6 Upper and lower trays It is then impacted and the corresponding tibial insert is fitted see annexes VII and VIII Surgical Technique ...

Страница 31: ...29 4 MOBILITY STABILITY CHECK Trial components The check is carried out with the trial femoral and tibial components fitted to assess the mobility stability and alignment of the limb ...

Страница 32: ...vial tissue around the patella border are removed until the quadriceps and tendon and patella are visible With the patella resection clamps closed over the patella so that its anterior cortex rests on the bolts and the turret is set to 12 14 mm the patella cut is made Box 7 Lower tray The mobile arm of the clamp is positioned so that the perforation of the prosthetic pivot is slightly medialised i...

Страница 33: ...g the polyethylene insert to the tibial tray with bolts perform the mobility and stability test again After performing the check and ensuring that it is to be used as the final insert it is finally fixed to the tibial tray inserting the metal reinforced post of the tibial insert and anterior safety bolt Example ...

Страница 34: ... CANNULATED REAMING ACCORDING TO THE STEM TO BE IMPLANTED T 70 T 70 1st DIAPHYSEAL REAMING 2nd CANNULATED REAMING Insertion of 70 mm stems in the tibia greater intramedullary stability T 70 T 70 1st DIAPHYSEAL REAMING 2nd CANNULATED REAMING T 70 T 70 T 70 T 70 Surgical Technique ...

Страница 35: ...T 120 Insertion of 120 mm stems in tibia T 200 1st DIAPHYSEAL REAMING 2nd CANNULATED REAMING T 200 T 120 T 120 T 200 T 200 The diameters of the diaphyseal reamer and cannulated reamer must be the same because the 200 mm stem uses part of the depth created by the diaphyseal reamer øC øD øC øD ...

Страница 36: ...34 FEMUR Insertion of 70 mm stems in femur F 70 F 70 Surgical Technique ...

Страница 37: ...35 Insertion of 70 mm stems in the femur greater intramedullary stability F 70 120 200 F 70 ...

Страница 38: ...36 Insertion of 120 mm stems in femur F 120 F 120 Surgical Technique ...

Страница 39: ...n of 200 mm stems in femur F 200 F 200 ø C ø D ø C ø D The diameters of the diaphyseal reamer and cannulated reamer must be the same because the 200 mm stem uses part of the depth created by the diaphyseal reamer ...

Страница 40: ...mers Given that the instruments used for the following steps are cannulated using it will not alter the surgical steps described in these instructions RETAINER CABLE OF DIAPHYSEAL REAMERS Box 0 Upper tray ANNEX III The surgeon has a T handle with quick coupling for AO hexagonal connectors to enable manual diaphyseal and cannulated reaming T HANDLE FOR MANUAL REAMING Note Diaphyseal reamers require...

Страница 41: ... sheave of the tibial cutting guide WRENCH 14 mm wide ANNEX V The pin impactor can also be used as an extractor rod passing it through holes made for that purpose for instruments which because of the way in which they are operated can become stuck or difficult to extract keel impactors femoral component inserter extractor etc PIN IMPACTOR ...

Страница 42: ...ewing of the posterior supplements into the femoral components the Genutech CCK set of instruments has a ball head screwdriver Box 6 Upper tray to enable oblique screwing unscrewing BALL HEAD SCREWDRIVER OF Ø 2 5 mm Surgical Technique ...

Страница 43: ...ay and then pressing both pieces until they clip together CLIPPING AND EXTRACTION OF TIBIAL INSERTS To extract the tibial insert insert the flat tip of the extractor in one of the slots which is left in the tibial insert when it has been clipped into the tibial tray turning it slightly do not pry open ...

Страница 44: ...e the fully assembled tibial component to be impacted protecting both the tibial post and the surface of the joint This impactor of the tibial component can also help to clip the tibial insert into its tray in the unlikely event of it being impossible to do so manually TIBIAL IMPACTORS Tibial Tray Impactor Tibial Insert Impactor Surgical Technique ...

Страница 45: ...K set of instruments Box 7 Lower tray contains a patellar compression clamp to cause bone cement overflow and maintain pressure during the necessary setting time so that the patella is properly fitted PATELLAR COMPRESSION CLAMPS ...

Страница 46: ... ø 18 mm 70 mm 120 mm 200 mm 70 mm 120 mm Ref D8024503E ø 18 mm 200 mm Ref D8024601E ø 20 mm 70 mm Ref D8024602E ø 20 mm 120 mm Straight revision stem Ref D8025101E Ref D8025102E Ref D8025103E Ref D8025201E Ref D8025202E Ref D8025203E ø 10 mm ø 10 mm ø 10 mm ø 12 mm ø 12 mm ø 12 mm 70 mm 120 mm 200 mm 70 mm 120 mm 200 mm Ref D8025303E ø 14 mm 200 mm Ref D8025301E Ref D8025302E ø 14 mm ø 14 mm 70 m...

Страница 47: ...l supplement Ref D8026150E 1 Ref D8026190E 1 Ref D8026195E 1 Ref D8026250E 2 Ref D8026290E 2 Ref D8026295E 2 4 mm 8 mm 12 mm 4 mm 8 mm 12 mm Ref D8026350E 3 Ref D8026390E 3 4 mm 8 mm Ref D8026395E 3 12 mm Ref D8026450E 4 Ref D8026490E 4 4 mm 8 mm Ref D8026495E 4 12 mm Tibial supplement Ref D8032710E 1 Ref D8032715E 1 Ref D8032720E 2 Ref D8032725E 2 Ref D8032730E 3 Ref D8032735E 3 8 mm 12 mm 8 mm 1...

Страница 48: ...n sleeves 3 Ref D8271406 Plug of inserter extractor of revision sleeves 4 Ref D8171110 Revision cannulated reamer 1 Ref D8171112 Ref D8171114 Ref D8171116 Ref D8171118 Ref D8171120 ø 10 mm ø 12 mm ø 14 mm ø 16 mm ø 18 mm ø 20 mm Diameter 2 Revision metaphyseal sleeves Diameter Ref D8271010 Ref D8271012 Ref D8271014 Ref D8271016 Ref D8271018 Ref D8271020 ø 10 mm ø 12 mm ø 14 mm ø 16 mm ø 18 mm ø 20...

Страница 49: ...e 6 Ref D8220290 Probe hook 7 Ref D8220520 Support handle for tibial template 8 Ref D8271470 14 mm open end wrench 9 Distal clamp for tibial guide Ref D8220140 10 Ref D8270301 1 Revision tibial template 11 Ref D8270302 2 Ref D8270303 3 Ref D8270304 4 Ref D8270305 5 Ref D8277200 Revision straight chisel 1 Ref D8277205 Revision eccentric chisel 2 Ref D8270400 Threaded rod for revision keel template ...

Страница 50: ...ecut mask 4 Genutech CCK Set 3 of femoral cutting instruments Revision femoral cutting mask 1 Ref D8271204 Revision distal mask shim 2 4 mm Length Ref D8271208 8 mm Ref D8271212 12 mm Revision semi constrained rod 3 Ref D8271251 1 Primary semi constrained rod 4 Ref D8271252 2 Ref D8271253 3 Ref D8271254 4 Ref D8271060 Rigth Revision insert positioner 5 Ref D8271065 Left Ref D8271210 Revision conce...

Страница 51: ...6350 Ref D8126390 3 3 4 mm 8 mm Ref D8126395 Ref D8126450 3 4 12 mm 4 mm Ref D8126490 Ref D8126495 4 4 8 mm 12 mm 1 1 2 3 Ref D8273110 Ref D8273210 Ref D8273310 Ref D8273410 Ref D8273120 Ref D8273220 Ref D8273320 Ref D8273420 4 1 Intercondylar mask 2 2 3 4 1 2 3 4 Ref D8271415S Inserter extractor of femoral components 3 Ref D8210210 Femoral impactor 4 Ref D8277130 Reamer for femoral component post...

Страница 52: ... ø 10 mm ø 12 mm ø 14 mm ø 16 mm ø 18 mm 200 mm 200 mm 200 mm 200 mm 200 mm Diameter Length Ref D8176503 1 1 Revision trial straight stem Diameter Length Ref D8175101 ø 10 mm 70 mm Diameter Length Ref D8175201 Ref D8175301 Ref D8175401 Ref D8175501 Ref D8175601 ø 12 mm ø 14 mm ø 16 mm ø 18 mm ø 20 mm 70 mm 70 mm 70 mm 70 mm 70 mm Diameter Length Upper tray Lower tray Ref D8175103 Ref D8175203 Ref ...

Страница 53: ... 1 Revision trial tibial insert Ref D8161100 1 Ref D8161120 1 Ref D8161140 1 Ref D8161160 1 Ref D8161180 1 Ref D8161200 1 10 mm 12 mm 14 mm 16 mm 18 mm 20 mm Length Length Ref D8161220 1 Ref D8161240 1 22 mm 24 mm Ref D8162140 2 14 mm Ref D8162100 2 Ref D8162120 2 10 mm 12 mm Size Length Ref D8162160 2 Ref D8162180 2 Ref D8162200 2 Ref D8162220 2 Ref D8162240 2 16 mm 18 mm 20 mm 22 mm 24 mm Ref D8...

Страница 54: ...ss support pin Diameter Ref D8210165 ø 3 4 mm 55 mm Length 5 Headless pin Diameter Ref D8210166 ø 3 4 mm 80 mm Length 6 Revision threaded pin Diameter Ref D8210172 ø 4 4 mm 75 mm Length Ref D8210171 ø 4 4 mm 100 mm 7 Fixation screw for trial tibial tray Ref D8232600 8 Support handle for fixing bolt Ref D8220530 9 Tornillo suplemento tibial de prueba Ref D8132760 8 mm Ref D8132762 12 mm 11 Screwdri...

Страница 55: ......

Страница 56: ...0318 IROGEKCA11 07 2015 Rev 1 El marcado CE es válido únicamente si también está impreso en la etiqueta del producto 0086 ...

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