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Zimmer Biomet Persona Скачать руководство пользователя страница 65

63 |

Persona

®

Revision

Knee System

Surgical Technique

Appendix F: Component Removal

PS, CPS and CCK Bearing Removal

In the event that the bearing needs to be removed
from the tibial baseplate implant, begin by removing
the screw, if equipped (Figure 1). Next, engage the
hook on the bearing extractor instrument with the
mating slot on the front of the tibial baseplate and
squeeze the handle to disengage the bearing from the
tibial baseplate implant (Figure 2).

Note:

The bearing extractor instrument should not

be used for provisional or TASP removal.

Figure 1

Figure 2

Tibial Baseplate Removal

In the event that the tibial baseplate needs to be
removed, disrupt the bone cement interface using a
flexible osteotome or thin saw blade with an oscillating
saw. Once the prosthetic bone interface is loosened,
consider using a punch or stacking osteotomes
between the prosthesis and bone interface to lift the
component out of the tibia.

A

PPE

N

D

IX

F

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Содержание Persona

Страница 1: ...Persona Revision Knee System Surgical Technique...

Страница 2: ...on Only Offset Stem Preparation Only Straight and Offset Stem Housing Preparation Keel Preparation 17 Tibial Baseplate Provisional Assembly and Insertion 18 Optional Tibial Augment Resection 20 Femora...

Страница 3: ...l Medium Large Tibial Central Cone Preparation Only Optional Tibial Defect Sizing Optional Drill Guide Medium Large Tibial Central Cone Preparation Only Silver Gold Broach Preparation Gold Broaches Ti...

Страница 4: ...n Step 10 Optional Distal Femoral Resection and Augment Preparation Step 11 Optional Femoral Sizing and Positioning Step 4 Tibial Sizing and Positioning Step 12 Femoral Stem Housing Preparation Step 8...

Страница 5: ...Resurfacing Step 17 Final Trialing Step 18 Implant Assembly Step 13 Femoral Provisional Assembly and Insertion Step 19 Two Stage Cementing Technique Step 14 Trial Reduction TASP Step 20 Bearing Assem...

Страница 6: ...oral 4 in 1 Cut Block Cone provisionals Removes the Pin puller Attaches to Canal Reamers Stem extension post Broach pilot adapter Cannulated reamers Tilt reamers 5 mm hex driver Tapered stem drill bit...

Страница 7: ...d Slap Hammer Note Can be locked in the up or down position using lock unlock lever Loosens Tightens the Tibial boom knob Valgus alignment guide knob Tibial resection cut guide Rotates the Offset stem...

Страница 8: ...Technique Instrumentation Overview cont Thick Femoral Depth Line Distal Cut Thin Tibial Depth Line Proximal Cut Femoral Tibial Depths A Tilt Reamer B Canal Reamer C Stem Extension Post D Broach Pilot...

Страница 9: ...to preoperatively plan for necessary implants Figure 1 Patient Preparation If desired provide a thigh tourniquet and inflate with the knee in hyperflexion to maximize the portion of the quadriceps th...

Страница 10: ...apers This allows for direct access to the stem once the tibial component is removed Once access to the stem is achieved disrupt the cement interface around the stem with either osteotomes or a pencil...

Страница 11: ...m the tibial intramedullary canal to the appropriate depth progressively increasing the reamer diameter size until cortical chatter is achieved The Persona Revision Reamer shafts are marked with the m...

Страница 12: ...esection cut guide to the IM tibial resection boom Secure by tightening the tibial resection cut guide knob in a clockwise direction Figure 9 Use the resection guide angel wing to determine the amount...

Страница 13: ...tion boom and reamer can be removed if additional space is needed To remove loosen the tibial resection cut guide knob and the tibial resection boom knob in a counterclockwise direction Figure 13 To r...

Страница 14: ...gh the cut guide to the planned depth Figure 15 Use an oscillating saw to make a 5 mm or 10 mm bone resection Figure 16 Remove the instruments and finish cuts if needed Note If two 10 mm or 15 mm tibi...

Страница 15: ...eamer adapter are not adequate choose another tibial size or the use of an offset stem may be required Note If an offset stem is required proceed to the Offset Stem Preparation section on page 14 If a...

Страница 16: ...reamer adapter to the tibial sizing plate and slide over the reamer Confirm that the ANT marking on the offset stem reamer adapter is facing anterior Figure 21 Rotate the tibial offset stem reamer ad...

Страница 17: ...or the keel Tibial rotation cannot be adjusted after the keel has been prepared Remove the reamer using the slap hammer or T handle if necessary Figure 24 Figure 23 Tibial Stem Housing Preparation Str...

Страница 18: ...uirebeingtappedintothecanal until the tibial depth line of the stem extension post is level with the tibial plateau Figure 26 Figure 27 Figure 28 Figure 29 Figure 30 If an offset stem is utilized make...

Страница 19: ...the DR handle by pulling back the lever on the handle and rotating until locked Figure 31 Place the tibial keel broach over the stem extension post and align with the marks made on the tibial plateau...

Страница 20: ...s with the tabs on the underside of the tibial baseplate provisional Figure 34 Attach the stem provisional to the tibial baseplate provisional Hold the baseplate screw in place with your index finger...

Страница 21: ...Provisional Assembly and Insertion cont Assemble the tibial impactor pad to the QC handle Figure 38 Insert the tibial construct in the tibial canal while ensuring proper rotation Impact the construct...

Страница 22: ...finish the cut when the provisional is removed Figure 43 Remove the tibial augment cut guide and all provisional components and complete the remaining bone cuts Reassemble the tibial construct with t...

Страница 23: ...coupler along the anatomical axis of the femur Using a T handle or power ream the femoral intramedullary canal to the appropriate depth progressively increasing the reamer diameter size until cortica...

Страница 24: ...onfirm the location of the cut with the resectionguide angelwing throughthe0mmcutslot Figure 50 After the location has been confirmed pin the distal cut guide and resect the minimum amount of femoral...

Страница 25: ...ng cut guide matches the equivalent sized femoral implant Check the coverage of the femoral sizing cut guide and determine if an offset is required based on overhang and resection assessments Figure 5...

Страница 26: ...achieved which provides the best femoral coverage while maintaining rotational alignment Resize the femur if necessary Note The numbers on the offset stem reamer adapter determine the selected offset...

Страница 27: ...r Augment Resection The 5 and 10 mm posterior augment cut slots are available for augment preparation Figure 60 Note Posterior augments can also be cut using a femoral provisional at a later stage in...

Страница 28: ...section on page 54 To prepare the femur for a metaphyseal cone reference the Persona Revision Large Defect Surgical Technique 2723 1 GLBL en for surgical steps Verifythatthefemoraldepthlineonthesteme...

Страница 29: ...determined previously with the posterior line on the femoral provisional Figure 69 Insert the femoral provisional construct into the femur by hand Note Ifnecessary usearongeurtoremoveanterior femoral...

Страница 30: ...TASP bottom top and shim Select the TASP bottom that matches the tibial baseplate provisional Select the TASP top that matches the same size tibial baseplate provisional and the femoral provisional Th...

Страница 31: ...ruct 10 mm be inserted into the joint space with the knee in greater than 30 degrees of flexion to perform an initial range of motion assessment Apply gentle manual pressure while inserting without im...

Страница 32: ...le attached to the TASP construct Figure 78 Once the anterior lip of the TASP bottom is above the anterior rail of the tibial baseplate provisional rotate the TASP out of the joint space medially or l...

Страница 33: ...ing Offset the femur anteriorly and use thinner tibial bearing Offset the femur anteriorly and use thicker tibial bearing Stable in Flexion Resect additional distal femur Gaps balanced Use distal femo...

Страница 34: ...e 83 If an augment provisional is difficult to insert pull the femoral provisional out of the femoral canal slightly and insert the augment provisional into position Note Alternatively the femoral siz...

Страница 35: ...s the same size and side as the femoral provisional until fully seated Figure 86 Recut the femoral box if unable to insert the box provisional It is likely that bone is obstructing assembly Note The f...

Страница 36: ...s needed The CPS and CCK TASPs provide an increase in constraint CPS and CCK Bearing TASP Assembly Select the TASP bottom that matches the tibial baseplate provisional Select the CPS or CCK TASP top t...

Страница 37: ...move Insert a new shim by aligning withtheTASPtopandbottomandpushingposteriorly Ifsignificantresistanceisexperiencedduringinsertion realign and reinsert Lightly tighten the provisional lockdown screw...

Страница 38: ...ounterclockwise direction Remove the provisional lockdown screw from the joint Flex the knee greater than 30 degrees push in the TASP posteriorly to disengage anteriorly 1 and lift 2 the tibial sizing...

Страница 39: ...dix D Tibial Central Cone Implant Assembly on page 57 and or Appendix E Femoral Central Cone Implant Assembly on page 60 for assembly instructions Tibial Implant Assembly Prior to assembly of the fina...

Страница 40: ...the impaction base The arrow on the femoral impaction saddle will align with L or R on the impaction base depending on if a left or right knee is being used Figure 99 Place the femoral implant on the...

Страница 41: ...the handle so it will break to prevent over torquing Implant Assembly cont Place the stem in the femur If using a straight splined stem align the slots of the stem so that one slot runs directly A P...

Страница 42: ...e for cementation as well as mixing application and hardening of bone cement If the tibial bone is dense or sclerotic it may be necessary to perforate the tibia by drilling with the 3 2 mm drill 3 4 m...

Страница 43: ...the entire stem with a layer of cement Note If cone preassembly is required the cone will need to be lifted in order to cement the underside of the tibial baseplate including the keel and stem tibial...

Страница 44: ...f preparing the tibial bone for a Trabecular Metal Augment ensure the distal surface of the Trabecular Metal Augment will have bony contact with the resected tibia Insert the tibial component into the...

Страница 45: ...ringthefemoralboneforaTrabecular MetalAugment ensurethesurfaceoftheTrabecular Metal Augment will have bony contact with the resected femur Note The 30 and 75 mm stems are intended for full cemented us...

Страница 46: ...exposed Trabecular Metal Material that may come in contact with soft tissues with cement or biological material to prevent soft tissue irritation or attachment With the knee in deep flexion insert th...

Страница 47: ...nique cont The knee should be placed in extension for the cement to cure A TASP can be used to assist with compression on the cement Insert a TASP 2 mm thicker than the final bearing in order to incre...

Страница 48: ...ing the insert packaged with the bearing into the slot on the CCK bearing Figure 123 Once the insert has been assembled set the CCK bearing on the tibial baseplate PS CPS and CCK Bearing Assembly Note...

Страница 49: ...the tibial baseplate and close the lever with your index finger This locks the inserter to the tibial baseplate Figure 125 Squeeze the handle of the articular surface inserter to fully seat the beari...

Страница 50: ...t and move the knee through flexion and extension It is recommended that the torque wrench is tightened two times to the target 95 in lbs Close Incision Freely irrigate the wound to ensure unwanted de...

Страница 51: ...late Figure 1 Ensure the ANT mark on the tibial drill guide is facing anterior The tibial drill guide should sit flush against the tibial sizing plate Using the appropriate 30 mm or 75 mm tapered stem...

Страница 52: ...al cone provisional that approximates the size and depth of the defect Invert the cone provisional to simulate the size of distal void that the cone will accommodate and insert it over the stem extens...

Страница 53: ...equentially larger broaches until the desired fit is achieved Note If the broach was not prepared at or distal to the proximal surface of the tibia it will cause the tibial baseplate to sit proud Note...

Страница 54: ...1 Verify that the cut outs on the tibial cone provisional match up with the marks for the keel locations If necessary lightly tap into the tibia Note The broaches are designed to clear out an addition...

Страница 55: ...l preassembly of the cone provisional on the tibial baseplate provisional is required This assembly step applies to the final implant assembly as well Figure 13 Figure 14 Figure 12 Ensure the provisio...

Страница 56: ...over the stem extension post Figure 4 Figure 5 Figure 2 Figure 3 Figure 1 Optional Drill Guide Medium Large Extra Large Femoral Central Cone Preparation Only Note The intent of the drill guide is to c...

Страница 57: ...move the DR handle broach rotate the lever to the unlocked position and use the slap hammer to remove the broach from the femur Figure 8 Figure 7 Figure 6a Note If the broach is not proximal enough in...

Страница 58: ...gree angle of the femoral stem housing Note If the cone provisional is difficult to remove use the non threaded end of the slap hammer to hook under the cone Figure 11 Insert the femoral provisional c...

Страница 59: ...section on page 58 for assembly instructions if necessary Assemble the appropriate tibial central cone impactor head to the QC handle by pulling back on the lever and attach Figure 1 Implant the Trabe...

Страница 60: ...the Trabecular Metal Tibial Central Cone Implant over the tibial stem housing making sure to properly align the Trabecular Metal Tibial Central Cone Implant with the fins of the keel Figure 7 If usin...

Страница 61: ...ction Once both screws have been started align the augment with the perimeter of the tibial baseplate implant as desired Tighten the screws until the augment is rigidly attached to the tibial baseplat...

Страница 62: ...sible for Left and Right anatomy Orient the cone impactor with the correct side facing anterior Assemble the appropriate femoral cone impactor head to the QC handle by pulling back the lever on the ha...

Страница 63: ...emented Smooth SML 16 mm 16 mm MED 16 mm 16 mm LRG 17 mm 18 mm XLRG 17 mm 18 mm Femoral Central Cones The femoral impaction saddle may be used to aid in assembling the femoral augments and stem to the...

Страница 64: ...offset splined stem insert the stem into the femur and rotate the stem until the predetermined number lines up with the reference mark on the posterior of the stem housing Figure 9a While protecting t...

Страница 65: ...queeze the handle to disengage the bearing from the tibial baseplate implant Figure 2 Note The bearing extractor instrument should not be used for provisional or TASP removal Figure 1 Figure 2 Tibial...

Страница 66: ...ral component from the bone Persona Revision Femurs have medial and lateral notches to help facilitate removal of the femoral component Figure 3 Figure 4 Figure 5 Figure 3 Stem Removal In the event th...

Страница 67: ...l Component 1 1 3 3 5 5 7 7 9 9 11 11 13 Persona All Poly UHMWPE Patellar Component 42 5400 000 XX Vivacit E Patellar Component 42 5402 000 XX mm sizes 26 i i i i i i i i i i i i i 29 i i i 32 i i i 3...

Страница 68: ...n Primary Porous Patellar Component 00 5878 065 XX mm sizes 32 i i i 35 38 41 i INSET patella with Persona Revision Femoral Component Compatible Incompatible Persona Revision Femoral Component Used wi...

Страница 69: ...Notes...

Страница 70: ...Notes...

Страница 71: ......

Страница 72: ...d duplicated or disclosed in whole or in part without the express written consent of Zimmer Biomet This material is intended for health care professionals Distribution to any other recipient is prohib...

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