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Vanguard
®
ID Total Knee
Surgical Technique
Figure 36
Tibial Tray Implantation
If a tourniquet above the knee is not already in use,
place and/or inflate throughout preparation of bone
for cementation, as well as mixing, application and
hardening of bone cement.
Perforate cancellous bone on the tibial side of the knee
by drilling or punching an array of 2 mm holes, 3–4
mm deep, spaced 5 to 8 mm apart to improve cement
penetration.
If the femoral side is dense or sclerotic, perforate it as
well.
Cleanse all cement-receiving bone surfaces thoroughly
using pulse lavage.
Dry with a clean, dry lap sponge.
Mix 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
layer over the entire underside of the tibial component.
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 anteriorly.
Apply cement to the tibia and pressurize the cement,
striving for penetration of 3 to 5 mm:
– Use of a cement gun/cartridge equipped with a
pressurizing nozzle is recommended to deliver
and pressurize cement into the prepared holes
and across the flat surface (Figure 36).
– Or, cement may be applied manually and
pressed forcefully into the bone using a 1/2 inch
(12.7 mm), or wider, flat osteotome.
