Opening Wedge Osteotomy Tibial Opening Wedge Osteotomy System Opening Wedge Osteotomy with Titanium

download Opening Wedge Osteotomy Tibial Opening Wedge Osteotomy System Opening Wedge Osteotomy with Titanium

of 6

  • date post

    29-Jul-2020
  • Category

    Documents

  • view

    9
  • download

    0

Embed Size (px)

Transcript of Opening Wedge Osteotomy Tibial Opening Wedge Osteotomy System Opening Wedge Osteotomy with Titanium

  • O pe

    ni ng

    W ed

    ge O

    st eo

    to m

    y

    Tibial Opening Wedge Osteotomy System with Titanium Plates and Screws and OSferion® B-TCP Osteotomy Wedge

    Surgical Technique

    Arthrex, Inc. 1370 Creekside Boulevard, Naples, Florida 34108-1945 • USA

    Tel: 239-643-5553 • Fax: 239-598-5534 • Web site: www.arthrex.com

    Arthrex GmbH Liebigstrasse 13, 85757 Karlsfeld/Munich • Germany

    Tel: +49-8131-59570 • Fax: +49-8131-5957-565

    Arthrex Iberoamérica Howard Hughes Tower, 6701 Center Drive West, Suite 550, Los Angeles, California 90045 • USA

    Tel: 310-670-6080 • Fax: 310-670-6087

    Arthrex S.A.S. 5 Avenue Pierre et Marie Curie, 59260 Lezennes • France

    Tel: +33-3-20-05-72-72 • Fax: +33-3-20-05-72-70

    Arthrex Canada Lasswell Medical Co., Ltd., 405 Industrial Drive, Unit 21, Milton, Ontario • Canada L9T 5B1

    Tel: 905-876-4604 • Fax: 905-876-1004 • Toll-Free: 1-800-224-0302

    Arthrex GesmbH Triesterstrasse 10/1 • 2351 Wiener Neudorf • Austria

    Tel: +43-2236-89-33-50-0 • Fax: +43-2236-89-33-50-10

    Arthrex BvbA Technologiepark Satenrozen, Satenrozen 1a, 2550 Kontich • Belgium

    Tel: +32-3-2169199 • Fax: +32-3-2162059

    Arthrex Ltd. Unit 16, President Buildings, Savile Street East, Sheffield S4 7UQ • England

    Tel: +44-114-2767788 • Fax: +44-114-2767744

    Arthrex Hellas - Medical Instruments SA 103, Ethnikis Antistasseos str., N. Psichico 154 51 Athens • Greece

    Tel: +30-210-8079980 • Fax: +30-210-8000379

    Arthrex Sverige AB Turbinvägen 9, 131 60 Nacka • Sweden

    Tel: +46-8-556 744 40 • Fax: +46-8-556 744 41

    Arthrex Korea Rosedale Building #1137, 724 Sooseo-dong, Gangnam-gu, Seoul 135-744 • Korea

    Tel: +82-2-3413-3033 • Fax: +82-2-3413-3035

    Arthrex Mexico, S.A. de C.V. Insurgentes Sur 600 Mezanine, Col. Del Valle Mexico D.F. 03100 • Mexico

    Tel: +52-55-91722820 • Fax: +52-55-56-87-64-72

    Arthrex Swiss AG Müllerenstrasse 3, 8604 Volketswil • Switzerland Tel: +41-43-399-45-20 • Fax: +41-43-399-45-29

    This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use

    their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct

    a thorough review of pertinent medical literature and the product’s Directions For Use.

    Designed in conjunction with Giancarlo Puddu, M.D., Rome, Italy; Peter J. Fowler, M.D., London, ONT, Canada; and Ned Amendola, M.D., Iowa City, Iowa.

    U.S. PATENT NOS. 5,620,448; 5,749,875 and PATENT PENDING

    © Copyright Arthrex Inc., 2007. All rights reserved. LT0113E

    Opening Wedge Osteotomy System Set (AR-13305S) includes: Osteotomy Wedge AR-13300 Osteotome Handle AR-13301 Osteotome Blades, 10 mm AR-13302-10 Osteotome Blades, 25 mm AR-13302-25 Osteotome Blades, 35 mm AR-13302-35 Parallel Guide Sleeve Body AR-13304-1 Parallel Guide Sleeve, qty. 2 AR-13304-2 Osteotomy Guide Assembly AR-13305 Osteotomy Cutting Guide AR-13306-01 Osteotomy Cutting Guide Pin AR-13306-02 Alignment Rod AR-13308 Femoral Osteotomy Retractor AR-13309 Radiolucent Retractor AR-13310 Universal Handle Extractor AR-13314 Cutting Guide for HTO AR-13315 Bone Graft Tamp AR-13317 Application Bar for HTO Plates AR-13318 Drill Guide for HTO AR-13320 Drill Guide for HTO Titanium Plates AR-13321 Bending Irons for HTO Plates, qty. 2 AR-13322 Depth Device for Osteotome Jack AR-13323G Osteotome Jack, 35 mm AR-13323-35 Osteotome Jack w/Screwdriver, 35 mm AR-13323-35S Wedge Trial for HTO AR-13324 A/P Sloped Osteotomy Wedge Trial, large AR-13325L A/P Sloped Osteotomy Wedge Trial, small AR-13325S Screwdriver, 3.5 mm hex AR-13326 Screwdriver, 90˚, 3.5 mm hex AR-13326-90 Locking Guide for HTO Titanium Plates AR-13327 Depth Device, large AR-4167 Opening Wedge Osteotomy System Instrumentation Case AR-13307 Storage Case for HTO Plates AR-13307P

    Accessories: Patellar Tendon Retractor AR-13312 Medial Retractor for HTO AR-13313 Osteotomy Guide Pins, 2.4 mm, qty. 6 (“breakaway”) AR-13303-2.4 Osteotomy Guide Pins, 3 mm, qty. 6 AR-13303-3.0 Drill for HTO Titanium Screws, qty. 6 AR-13319 Osteotome Jack, 25 mm AR-13323-25

    Bone Graft Substitute: OSferion Osteotomy Wedge, 7 mm x 30 mm AR-13370-1 OSferion Osteotomy Wedge, 10 mm x 30 mm AR-13370-2 OSferion Osteotomy Wedge, 12 mm x 35 mm AR-13370-3 OSferion Osteotomy Wedge, 15 mm x 35 mm AR-13370-4

    Titanium Screws: HTO Plate Screw, 4.5 mm x 34 mm, cortical AR-13334T HTO Plate Screw, 4.5 mm x 36 mm, cortical AR-13336T HTO Plate Screw, 4.5 mm x 38 mm, cortical AR-13338T HTO Plate Screw, 4.5 mm x 40 mm, cortical AR-13340T HTO Plate Screw, 4.5 mm x 42 mm, cortical AR-13342T HTO Plate Screw, 4.5 mm x 44 mm, cortical AR-13344T HTO Plate Screw, 4.5 mm x 46 mm, cortical AR-13346T HTO Plate Screw, 4.5 mm x 48 mm, cortical AR-13348T HTO Plate Screw, 4.5 mm x 50 mm, cortical AR-13350T HTO Plate Screw, 4.5 mm x 52 mm, cortical AR-13352T HTO Plate Screw, 4.5 mm x 54 mm, cortical AR-13354T HTO Plate Screw, 4.5 mm x 56 mm, cortical AR-13356T HTO Plate Screw, 4.5 mm x 58 mm, cortical AR-13358T HTO Plate Screw, 4.5 mm x 60 mm, cortical AR-13360T HTO Plate Screw, 6.5 mm x 35 mm, cancellous AR-13235T HTO Plate Screw, 6.5 mm x 40 mm, cancellous AR-13240T HTO Plate Screw, 6.5 mm x 45 mm, cancellous AR-13245T HTO Plate Screw, 6.5 mm x 50 mm, cancellous AR-13250T HTO Plate Screw, 6.5 mm x 55 mm, cancellous AR-13255T HTO Plate Screw, 6.5 mm x 60 mm, cancellous AR-13260T HTO Plate Screw, 6.5 mm x 65 mm, cancellous AR-13265T HTO Plate Screw, 6.5 mm x 70 mm, cancellous AR-13270T

    Titanium Plates: Tibial A/P Sloped Osteotomy Plate, 5 mm AR-13200ST-05.0 Tibial A/P Sloped Osteotomy Plate, 7.5 mm AR-13200ST-07.5 Tibial A/P Sloped Osteotomy Plate, 9 mm AR-13200ST-09.0 Tibial A/P Sloped Osteotomy Plate, 10 mm AR-13200ST-10.0 Tibial A/P Sloped Osteotomy Plate, 11 mm AR-13200ST-11.0 Tibial A/P Sloped Osteotomy Plate, 12.5 mm AR-13200ST-12.5 Tibial A/P Sloped Osteotomy Plate, 15 mm AR-13200ST-15.0 Tibial A/P Sloped Osteotomy Plate, 17.5 mm AR-13200ST-17.5

    Tibial Opening Wedge Osteotomy Plate, 3 mm AR-13200T-03.0 Tibial Opening Wedge Osteotomy Plate, 5 mm AR-13200T-05.0 Tibial Opening Wedge Osteotomy Plate, 7.5 mm AR-13200T-07.5 Tibial Opening Wedge Osteotomy Plate, 9 mm AR-13200T-09.0 Tibial Opening Wedge Osteotomy Plate, 10 mm AR-13200T-10.0 Tibial Opening Wedge Osteotomy Plate, 11 mm AR-13200T-11.0 Tibial Opening Wedge Osteotomy Plate, 12.5 mm AR-13200T-12.5 Tibial Opening Wedge Osteotomy Plate, 15 mm AR-13200T-15.0 Tibial Opening Wedge Osteotomy Plate, 17.5 mm AR-13200T-17.5

  • A single blade from the Osteotome Jack may be used to complete the osteotomy. The “breakaway” guide pins are left in place with the osteotome used inferiorly. Fluoroscopic confirmation should be checked repeatedly throughout the cutting process.

    After reflecting back the superficial portion of the medial collateral ligament, the Cutting Guide for HTO is positioned at the medial tibia above the level of the tibial tubercle. Two Osteotomy Guide Pins are drilled through the guide to within 1 cm of the lateral cortex (angled towards the fibular head). An oscillating saw is positioned against the inferior surface of the guide to cut the tibial cortex medially, anteriorly and posteriorly.

    Using the full-length, standing A/P radiograph, a line is drawn from the center of the femoral head to the center of the tibial-talar joint. This demonstrates the patient’s mechanical axis. Another line is drawn from the center of the femoral head to a point midway* in the lateral knee joint. A final line is drawn from the center of the tibial-talar joint to the same point in the lateral knee joint. The angle formed by the intersection of these two lines determines the degree of correction required to return the patient’s mechanical axis to the point of intersection on the lateral side. Prior to final fixation, the alignment will be verified by external examination and fluoroscopy. *This point is located at 62.5% of the width of the proximal tibia (i.e., 80 mm [width of proximal tibia] x .625 = 50 mm)

    1

    Insert the Locking Guide into one of the proximal plate screw holes, making sure the guide teeth seat fully into the bushing. Align the guide's laser line with the slot of the washer. Insert the Drill Guide into the Locking Guide and drill a hole to the appropriate screw depth (screw length is determined by visual- izing the laser marks on the drill as it exits the drill guide (a)).

    Insert both blades of the Osteotome Jack in the bone cut aligning both blades to each other. Using the 3.5 mm hex screwdriver, turn the screw slowly, opening the Osteotome Jack to the desired correction (the Wedge Trial for HTO may be used to estimate the correction), being sure to maintain the lateral tibial cortex hinge.

    Insert the Wedge Trial into the osteotomy (inset) to check the alignment of the extremity to verify the degree of correction. Insert the plate into the osteotomy with the Application Bar for HTO Plates. Load the extremity to close the osteotomy onto the tooth of the plate, ensuring optimum bone-to-tooth contact.

    Screw a 6.5 mm diameter cancellous