Surgical Technique Intramedullary Procedure *smith&nephew

TC-PLUS™ REVISIONRevision Knee System

Sawblade Thickness: 1.00 mm

Complex Primary Knee System

TC-PLUS™ RevisionIM Procedure

Table of Content

Introduction ............................................................................................. 3Concept/Description ............................................................................... 4Indications .............................................................................................. 8Contraindications .................................................................................... 9Case Study ............................................................................................ 10Preoperative Planning ............................................................................ 12Surgical Technique ................................................................................. 15

• Femoral Preparation ...................................................................... 19

• Tibial Preparation ......................................................................... 31

• Offset Stem Option ....................................................................... 39

• Posterior-Stabilized Option .......................................................... 43

• Patellar Preparation ..................................................................... 46

• Assembling the Implants-Components .......................................... 48

• Implanting the Components ......................................................... 53

Postoperative Treatment ........................................................................ 56Sterilization ............................................................................................ 57Implants ................................................................................................ 59Instruments ........................................................................................... 68

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Product Overview ( Combination Tables ) ............................................. 90

Nota Bene

The technique description herein is made available to the healthcare professional to illustrate the author’s suggested treatment for the uncomplicated procedure. In the final analysis, the preferred treatment is that which addresses the needs of the patient.

Disclaimer

The following technique is for informational and educational purposes only. It is not intended to serve as medical advice. It is the responsibility of treating physicians to determine and utilize the appropriate products and techniques according to their own clinical judgment for each of their patients. For more information on the TC-PLUS Revision knee system, including its indications for use, contraindications, and product safety information, please refer to the product's label and the Instructions for Use packaged with the product.

Prior to performing this technique, please consult the Instructions for Use documentation provided with each device for additional health and safety information, including indications, contraindications, warnings and precautions.

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Introduction

The TC-PLUS™ Revision knee prosthesis, with the posterior-stabilized version, has been developed to extend the indication range of the primary TC-PLUS knee system.

The TC-PLUS Revision knee system use the same joint design (femur/insert) and resections as the TC-PLUS Primary knee system. Just additional stem connection and blocks fixation have been added.

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General Warnings and Comments

WarningsThey are written in orange. They must be followed as they relate to critical functions or this information should be noted as it contains valuable advice which helps the user to clinically apply the system..

TrainingOnly adequately trained operators should use the TC-PLUS™ Revision knee system. This Surgical Technique must be fully read and understood as part of the training.If any part of this documentation is not clear, please contact your Smith & Nephew representative.

ImplantsTC-PLUS Revision knee system components are only designed for use with the indicated Smith & Nephew implants and instruments. Implants and instruments must be used in accordance with the instructions in all other relevant Surgical Techniques.

ResponsibilityIt is the responsibility of the user of the TC-PLUS Revision knee system to review all relevant information concerning the product before use. All the information provided in the Instructions for Use and in the Surgical Technique are to help the user in preparing for use of the product. The user must check all recommendations concerning the product in the Instructions for Use and in the Surgical Technique and is responsible for all clinical decisions taken.

Cleaning and SterilizationAll instruments must be sterilized before use. Detailed information on cleaning and sterilization of instruments is contained in the separate cleaning and sterilization instructions No. 03389.

Additional WarningsWarnings and comments cited in other Surgical Techniques relating to TC-PLUS knee systems must also be followed.

Femoral Components

The femoral components are manufactured from CoCrMo alloy and are asymmetrical. They are identical to the primary TC-PLUS femoral components in terms of design, kinematics properties and bone resections.

The femoral patellar groove is deeply hollowed-out and present a 6° oblique patella tracking. The revision femoral component has a 6° valgus connection that allows the use of different stems.

To compensate femoral bone defects, distal and/or posterior femoral augmentation blocks can be fixed to the femoral component.

The femoral components, both the standard and the posterior-stabilised version, are available in sizes 2, 4, 6, 8 and 10.

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Concept / Description

The TC-PLUS™ Revision knee system is the revision version of the primary tricompartmental TC-PLUS knee system. In addition, the TC-PLUS PS Revision knee system is the „posterior-stabilized“ option of the TC-PLUS Revision and the corresponding revision version of the primary TC-PLUS PS knee system.

As the TC-PLUS Revision implants offer the same resections as the tricompatimentalTC-PLUS Primary knee prosthesis, this permits if necessary an easy intraoperative switchover from the resurfacing to the condylar revision knee.

The femoral and tibial components of the TC-PLUS Revision correspond, apart from the connection for the stems and the blocks, to those of the TC-PLUS Primary knee system. The tibia inserts are identical; therefore the femoral and tibial components of both knee systems are fully cross compatible. The range includes femoral and tibial components fitted with stem couplings; the corresponding Ti6Al4V stems for non-cemented application and in CoCrMo stems for cemented application. CoCrMo blocks are available to compensate femoral and tibial bone defects.

All stems of the TC-PLUS Revision can be combined with the femoral and tibial components of the TC-PLUS Revision. The same applies for the femoral components of the TC-PLUS PS Revision.

The implants are available in five sizes ( corresponding to TC-PLUS sizes 2, 4, 6, 8 and 10 ). Each size can be combined with the next size up or down ( see product overview from page 90 ).

Product Description

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Patellar Component

The all-poly ( UHMW-polyethylene ) patellar component has a symmetrical biconcave surface for better tracking.

The patellar component are identical to those in theTC-PLUS™ portfolio.

Tibial Inserts

The tibial inserts present a snapping fixation and is additionally secured by a screw.

The tibial inserts are identical to those used in the primary TC-PLUS knee portfolio, they are manufactured from UHMW-polyethylene and are available in six different heights of 9 mm, 11 mm, 13 mm, 15 mm, 17 mm and 19 mm for the ultracongruent tibia inserts and in seven different heights of 9 mm, 11 mm, 13 mm, 15 mm, 17 mm and 19 mm ( optionally 21 mm ) for the posterior-stabilised tibia inserts. The target is, independent to the degree of tibial bone substance loss, to be able to restore the joint line.

The minimum effective PE thickness in the load zone is6 mm.

Please see the available sizes in the implant table ( on page 59 ff ).

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Tibial Component

The femoral and tibial blocks are manufactured from CoCrMo alloy.

In order to compensate different femoral and/or tibial bone defects, there are distal femoral blocks available in heights of 5 mm, 10 mm and 15 mm, posterior femoral blocks in heights of 5 mm and 10 mm and proximal tibial blocks in heights of 5 mm, 10 mm and 15 mm.

The same femoral blocks are used for both standard and posterior-stabilised femoral components. The same tibial blocks, except height of 15mm, are used for the medial- as for the lateral-condyle of the tibial component.

The blocks have to be assembled to the femoral and tibial components with screws and can then be cemented.

The symmetrical tibial component is manufactured from CoCrMo alloy.

In order to minimize polyethylene wear inside the tibial component, the base plate is polished on the inside and the insert is completely enclosed along its entire circumference.

The revision tibial component has a 3° slope connection that allows the use of different stems.

To compensate tibial bone defects, proximal tibial blocks can be fixed on the tibial component.

The tibial component is available in sizes 2, 4, 6, 8 and 10.

Femoral and Tibial Blocks

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Cemented Stem

The femoral and tibial components can be intramedullary anchored in the bone by cemented conical stems, made of forged CoCrMo alloy.

Available in lengths; 80 mm, 110 mm and 150 mm.

Zementfreie Schäfte

The femoral and tibial components can also be stabilised into the bone by using non-cemented cylindrical stems, made of forged Ti6Al4V alloy.

These stems are not suitable for primary anchorage; therefore they are not designed for osseo-integration. For matching the different patients anatomy, a wide stems range with straight stems, 2° valgus stems (for femur valgus of 4° or 8°) and 3.75 mm offset stems (placed 360° on the tibia), in various diameters ( Ø 10, Ø 12, Ø 14, Ø 16, Ø 18 and Ø 20 mm) and lengths ( 40 mm, 80 mm, 110 mm and 150 mm ) are available.

Please see the available sizes in the implant table ( on page 59 ff ).

2° 3.75 mm

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Indications

The principal preoperative planning factor is the correct diagnosis. It has to be determined whether the bone and stability situation allow the implantation of an uncoupled prosthesis.

The main indications for implantation of TC-PLUS™ Revision are :

• Degenerative or posttraumatic arthrosis

• Rheumatoid arthritis

• Avascular necrosis of the femoral condyles

• Joint destruction with restricted function and requirement for additional stabilizationwith longer stems andreconstruction of bone defects

• Marked contractures and axial deformity less than 20 - 25°

• Failure after surface replacement ( e.g. infection, loosening ) - Revision of a primaryprostheses

• Trauma - induced femoral or tibial fractures

ImportantDue to the design, it is possible to switch with relatively little effort, even intra-operatively, from theTC-PLUS™ knee system ( or TC-PLUS™ PS ) to the TC-PLUS™Revision knee system ( or TC-PLUS™ PS Revision ),since the resections and prosthesissizes are identical

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• Acute or chronic, local or systemic infections ( or in the case of a correspondinganamnesis )

• Severe muscle, nerve or vascular diseases that endangers the affected extremity

• Laking bone substance or inadequate bone quality that endangers a stable seating of theprothesis

• Distinct collateral ligament instability

• Pronounced genu recurvatum

• Axial misalignment over 25°

• All concomitant diseases that may endanger the function of the implant. These include inparticularextreme insufficiency of the knee extensor mechanism, which can lead toexcessive joint distortion; orsevere adiposity which can lead to a dorsal impingement,which leads to instability of the components. Inthese cases it may be advisable to use aconstrained rotating or a tumor prosthesis

• Patient hypersensitivities or allergies to the materials used

• Strenuous physical activity ( e.g. competitive sport, hard physical work )

See also instructions in package insert

Contraindications

Contraindications are :

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Preoperative situation

Case Study

Patient with varus displaced or implanted tibia, with a medial instability that must be revised because of pain and swelling.

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Postoperative Result

Immediately postoperative; functional and pain-free reconstruction with TC-PLUS™ Revision knee.

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Preoperative Planning

A full-leg X-ray with the patient in the standing position is recommended for preoperative planning purposes. If this is not possible, an X-ray of the thigh, including the femoral head, should be taken. The X-ray images of the knee joint at three levels should be available for planning the surgery. A tangential patellar exposure, a frontal and a sagittal to the leg axis exposure must be taken.

For preoperative planning there are X-ray templates available: with scale of 1.15:1 Lit. No. 1354 / 1355 and with scale of 1:1 Lit. No. 1511 / 1512 ( see page 89 ). The lateral view of the condyles is decisive. If these are no longer completely intact, it is possible to switch to the condylar width. In cases of doubt, the smaller implant should be selected to prevent the prosthesis components from protruding. In normal cases, the size determination and the correct positioning of the prosthesis are controlled intraoperatively with relevant instruments and planning may also be possible on the unrestored opposite side leg.

Important

The femoral and tibial component sizes can all be combined with the next size up or down ( see product overview on page 90 ff ).

Large deviations of the femoral neck angle as well as severe deformities of femur and tibia ( e.g. posttraumatic axial deformities ) must be taken into consideration during surgical planning.

In cases of deformities away from the knee joint that adversely influence the mechanical axis, additional corrective osteotomies may be indicated.

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Planning the surgery using the radiograph

The following procedure is recommended for the anterior-posterior whole leg imaging process:

A Anatomical femoral axisB Anatomical tibial axisC Mechanical leg axisD Mechanical femoral axisE Tibial resection depth (mm)a Valgus angle

Post-opPre-op

1. The femoral axis A (anatomical axis) is drawnonto the radiograph.

2. A line is drawn from the femoral head to thecenter of the knee (mechanical axis D) on theradiograph.

3. The angle measured between the anatomicaland the mechanical axis = angle a determinesthe valgus angle.

4. The tibial axis B is drawn in and the tibialresection plane E is determined to avoid excessive resection, especially if defectsare present.

5. The component sizes and resection depths aredetermined preoperatively using the X-Raytemplates (see page 87) in anterior/posterior(A/P) and the lat eral planes.

6. The mechanical leg axis C should merge withlines D and B after correction.

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Positioning of the patient for the surgery

Surgical Technique

In case of an implant revision, where components must be removed at the beginning of the surgery, Smith & Nephew with the RENOVATION Knee set, offers the surgeons a knee specific implant extraction system that contents different instrument options to facilitate the removal of different femur and tibia components (loose first and then extract).

The instrument set consists of a basic set (no. SAP 75210243 / 0944290) and sterile packaged, single-use chisel-blades and saw-blades (see surgical technique Lit. No. 04044 (2025)).

Surgery is performed whilst the patient is supine. It is recommended that the blood supply be partially blocked with the use of a tourniquet. But this is not absolutely necessary. The leg must be covered, so as to allow movement and secured to the operating table in such a way that the knee joint is brought into a stable 90° flexion position. Most of the surgical steps are performed in this position.

Surgical procedure

The skin incision can be a midline incision or a parapatellar incision. If there are scars from skin incisions made during previous surgery, it is advisable to use them for access in order to reduce the risk of cutaneous blood flow disorders. Medical arthrotomy is recommended, or an approach adapted to the pathological situation.

After the usual preparation (meniscus resection, removal of osteophytes and synovectomy if necessary), the cruciate ligaments are sectioned close to the bone.

Implant component removal

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It is important that the flexion and extension gaps are identical.

1. Distal femoral resection and optional distalaugment resection

3. Chamfer and trochlea resections and cuttingout of the box if the PS version is required

Remove residual posterior condyles ifpresent

4. Tibial resection and optional augmentresection

5. Patellar resection ( optional )

Overview of the resections sequences for primary application

Important

For the standard instrument set, use 1.00mm saw blades for all bone resections!For the 1.27mm instrument slot option, use the corresponding 1.27mm saw blades. See Lit. No. 01218 for corresponding connection.

2. A/P femoral resections and optional posterioraugment resection

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The bone resections are refreshed after extraction of the primary implants.

1. Distal femoral resection and optional distalaugment resection

2. A/P femoral resections and optional posterioraugment resection

3. Chamfer and trochlea resections and cuttingout of the box if the PS version is required

Remove residual posterior condyles ifpresent

Overview of the resection sequences for revision application

ImportantFor the standard instrument set, use 1.00mm saw blades for all bone resections!For the 1.27mm instrument slot option, use the corresponding 1.27mm saw blades. See Lit. No. 01218 for corresponding connection.

4. Tibial resection and optional augmentresection

5. Patellar resection ( optional )

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Use of Speed-Pins

We also offer speed-pins as an alternative for fixing the instrument to the bone.

The speed-pins are available in different lengths and types:

Speed-Pins with Rim Ø 3.2 / 30mm – 6x PAC (Art. Nr. 42000089/75006487)

Speed-Pins Ø 3.2 / 65mm

– 6x PAC (Art. Nr. SYS251354/75009338)Speed-Pins Ø 3.2 / 80mm

– 6x PAC (Art. Nr. SYS251355/75009339)Speed-Pins Ø 3.2 / 110mm

– 6x PAC (Art. Nr. SYS251356/75009340)

AO Adapter for Speed-Pins (Art. Nr.: SYS251316/75009310)

The speed-pins are delivered non-sterile and for multi-use (limitation of use is defined as the standard pin and can be used until functionality is no longer ensured)

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Femoral size determination

The adjustable IM femoral drill guide is set to the planned size of the femoral components ( size marking «2», «4», «6», «8» or «10» ) and inserted under the quadriceps into the centre of the femur. The distal stop should be on the medial condyle. Make sure that the guide is flat on the anterior femoral cortical bone in the direction of the femoral axis.

Open the femoral IM canal with the Ø 8 mm IM drill.

ImportantTo ensure an optimal position of the femoral drill guide on the condyles, gently tap the medial/lateral (M/L) area, not the drill guide section of the instrument.

By using the femoral sizer («2», «4», «6», «8» or «10») the size is determined, sagittaly according to the inside / outside contours as well as ventrally according to the anterior / posterior resections and the medial / lateral contours.

Important

The line in the sagittal view of the femoral sizer shows the position of the femoral intramedullary (IM) canal, i.e. the position of the stem.

During measurement note the marks corresponding to medial and lateral «LEFT» and « medial».

Femur opening

Femoral Preparation

Access: Please refer to the relevant surgical textbooks for the initial access to the knee.

Important

In addition to the bone resections, it is important to correct any ligament imbalance by appropriate soft-tissue procedures. If necessary, a general release should be performed on the side of the contracture.

The leg is flexed and any osteophytes on the femur and tibia should be removed. This will provides good exposure of the knee joint, which facilitates size determination.

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The Ø 8 mm IM rod is carefully inserted using the modular handle to approximately the isthmus of the femoral IM canal and removed again. It is important to work carefully to prevent excess pressure in the IM canal.

The IM rod with the modular handle is now removed.

The femoral IM canal is opened further with the Ø 8/14 mm stepped drill. Note that the drill is positioned at the entry point of the femoral IM canal, previously determinated by the IM drill. The drill direction is along the femoral axis. Drill as far as the stop.

Important

The femoral IM canal, which determines the implants stem position, must be opened carefully (reference for the femoral position) to prevent the development of a relative extension position (risk of notching) or flexion position (projecting patella).

Preparing the femoral anchorage

Reamers are used carefully and in progressive stages ( starting with «Ø 10» ) to ream to the required stem diameter and depth.

Important

Reamers are available in diameter «Ø 10», «Ø 12», «Ø 14», «Ø 16», «Ø 18» and «Ø 20».The depth indicator is on the reamer: observe the recessed notch markings and the depths marked «IM» when using this technique «IM80», «IM110» and «IM150. The laser markings are for extramedullary use and are described with the corresponding surgical technique.

The 40 mm stem length is only available for extramedullary application.

When using cemented stems, the Ø 12 mm reamer is used to drill to the desired depth and the corresponding non-cemented trial stem is used. Cemented stems are available in 80 mm, 110 mm and 150 mm lengths.

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Controlling the stem position

An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in axial alignment and depth (the end of the reamer alignment guide corresponds to the tip of the reamer).

Preparing the femoral stem connection

IM positioning and control with trial stems

The stem connection recess is drilled with the Ø 10/20 mm stepped drill until the engraved marking «Femur» respectively «Femur PS» (corresponding to the joint line).

The chosen trial stem is attached to the extension for trial stem (Ø 8 mm) and with the modular handle carefully inserted into the femoral IM canal so the line marked with «MIN.» is approximately level to the distal bone resection. The modular handle is now removed. It is important to avoid putting excessive pressure in the femoral IM canal.

Important

With too short IM guidance, the alignment may be incorrect (varus / valgus, extension / flexion). Therefore the 40 mm trial stems can’t be used for the IM application!

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Locating the distal femoral cutting block

Before performing the distal femur resection, check that the revision femoral / tibial cutting block ( select the valgus angle «4°», «6°» or «8°» ) is perpendicular to the mechanical leg axis. By attaching the handle with the axial alignment rod on the femoral / tibial cutting block, the mechanical axis can be controlled by reference to the hip head centre.

ImportantIf the valgus angle is not correct, the femoral / tibial cutting block can be adjusted by changing the femoral bushing.

Select the femoral bushing, «4°», «6°» and «8°» bushings are available, in accordance with the angle � measured in the preoperative planning. The femoral bushing is inserted into the femoral suspension device, so that depending on which side is the operation, the mark «L» for left knee or «R» for right knee is visible on the arrow « ».

Important

Make sure that the femoral bushing is inserted in the correct ( «L» or «R» ) position. Adjustment and correction occurs with removing, rotating by 180° and re-inserting the femoral bushing.

The femoral / tibial revision cutting block is screwed to the femoral suspension device and positioned over the trial stem extension ( Ø 8 mm ). The handles can be attached.

Important

In revision cases, the 7 mm distal revision spacer for femoral condyle is attached to the femoral suspension device ( black plastic component in picture ). This substitutes the missing distal bone substance. The resulting resection remains still 2 mm.

Align the device with regard to rotation. Note that the removable handles are parallel to the epicondylar axis.

After preliminary drilling with the Ø 3.2 mm drill, from distal the femoral suspension device is fixed with a bone pin( 75 mm long ).

Controlling the alignment

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After preliminary drilling with the Ø 3.2 mm drill, the femoral / tibial revision cutting block is fixed with two bone pins ( 75 mm long ) through the holes marked «0». This position resects 9 mm from the distal femur, which corresponds to the distal thickness of the femoral prosthesis without femoral blocks.

Important

For preventing any conflict with the trial stem, the most lateral «0» pin hole of the femoral / tibial revision cutting block is preferred.

The bone pin on the femoral suspension device is removed with pin extractor. After loosening the fixation screw the trial stem with extension ( Ø 8 mm ) are removed using the modular handle.

The suspension device is now removed.

Important

The resection depth can be adjusted proximally and distally in 2 mm increments ( ± 4 mm ).

The side handles can be removed from the femoral suspension device and attached on the femoral / tibial revision cutting block.

Distal femoral resection

The femoral / tibial revision cutting block is slid onto the bone. The distal femoral resection is then performed using a 1 mm saw blade through the «0» saw slot ( closed slot with facet ).

Important

For locking the femoral / tibial revision cutting block, an additional pin can be inserted into the oblique holes market with «AUX». After resection, the pin can be removed.

When using distal femoral augmentation blocks the resection is performed through the open saw slots. Augmentation blocks of 5 mm, 10 mm and 15 mm are available.

Important

If there is an extension deficit, it is recommended to move the distal resection 2 - 4 mm proximally to adjust the extension gap. For hyper-mobile patients, a 2 mm smaller distal femoral resection is recommended.

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The distal resection is the reference for the following steps and has to be checked for accuracy.

The femoral / tibial revision cutting block does not have to be removed yet because it will be used later (Depending the following chosen steps)!

The side handles can be removed from the femoral / tibial revision cutting block and attached on the femoral A/P femoral cutting block revision.

Locating the A/P femoral cutting block

The rotation can be adjusted visually in relation to the epicondylar axis with the aid of two bone pins ( 75 mm long ) which are inserted laterally into the A/P femoral cutting block revision.

The groove stone is mounted on the A/P femoral cutting block n trial stem is attached to the extension for trial stem ( Ø 8 mm ) and inserted into the femoral IM canal. The A/P femoral cutting block revision is placed on top.

Important

When using distal femoral augmentation blocks the corresponding blocks must be fixed on the A/P femoral cutting block revision. Respect the thickness ( «5mm», «10mm» or «15mm») and size ( «2, 4» or «6, 8, 10» ).

Setting the femoral rotation

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The rotation can be as well adjusted by applying anteriorly the femoral / tibial revision cutting block.

After preliminary drilling with the Ø 3.2 mm drill, the A/P femoral cutting block revision is fixed with two bone oblique pins ( 38 mm with head ) through the lateral 45° oblique holes.

The femoral / tibial cutting block is now removed.

Controlling the resections

With the resection stylus, the anterior and posterior resection plane and height are checked.

Important

In the case of over-resection or under-resection a correction can be made by loosening the groove stone and moving the A/P femoral cutting block revision. In this case the cleared position of the stem does not match the selected stem (a thinner stem must be selected).

A/P and chamfer resections

The anterior femoral resection is made through the closed saw slot with the 1 mm saw blade ( anterior slot with facet).

The posterior femoral resection is made through the two open posterior saw slots (slots with facet).

When using posterior femoral augmentation blocks, the resection is made through the open 5 mm and 10 mm saw slots.

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Positioning the femoral reamer guide

The chosen femoral reamer guide of the previously defined femoral size is positioned on the prepared bone and aligned intramedullary with the femoral valgus adapter ( «4°», «6°» or «8°» ) and Ø 8 mm alignment bushing is positioned over the extension for trial stem ( Ø 8 mm ).

The femoral valgus adapter is inserted into the femoral reamer guide, so that depending on which side is the operation, the mark «LEFT» for left knee or «RIGHT» for right knee is visible on the arrow «ANTERIOR ».

Important

When using distal and / or posterior femoral augmentation blocks the corresponding blocks must be fixed to the femoral reamer guide. Note the corresponding thickness ( «5 mm», «10 mm» or «15 mm» ).

Note that only plastic hammers or the available plastic impactor may be used to hit the femoral reamer guide. Do not hit with metal instruments.

The femoral chamfer resections are made through the corresponding slots ( slots with facet ).

The A/P femoral cutting block revision is removed.

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The femoral trial is screwed with the femoral trial adapter ( corresponding to the preset valgus angle ) and the trial stem ( corresponding to the last reamer ).

The femoral trial is inserted with the impactor.

Important

When using distal and/or posterior femoral augmentation blocks, corresponding femoral trial blocks ( «5mm», «10mm» or «15mm» ) are available, which are fixed laterally on the femoral trial.

The trochlear chisel guide is attached to the femoral reamer guide.

The trochlear recess is prepared with the trochlear chisel.

ImportantThe label «ANTERIOR» on the trochlear chisel guide must be visible on the arrow «ANTERIOR ».

The trochlear chisel guide is removed.

Controlling the femoral resections and anchorage

The posterior M/L dimension of the femoral reamer guide corresponds to the M/L implant dimension. The external contour of the femoral reamer guide corresponds to the anterior lateral femoral flange contour, the anterior laser markings to the anterior medial femoral flange contour.

After preliminary drilling, the femoral reamer guide is fixed with bone pins ( 75 mm long or 38 mm with head ) through the anterior and lateral oblique holes.

Important

Be aware that the anterior bone pins must be inserted before the distal bone pins.

The trial stem and the alignment bushing are removed with the modular handle. The femoral valgus adapter can now be removed as well.

If a PS femoral component is required, the surgical technique for the posterior-stabilized version is performed ( see instructions from page 43 ).

Preparing the trochlear recess

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Removing the dorsal condyle residue

Important: This must be checked in all cases!

After having completed the femoral resections, use the curved osteotome to remove all osteophytes as well as protruding posterior condyles. At this point, a posterior contracture can also be released. This will improve flexion and prevent possible damage to the polyethylene insert by these bony projections.

This is especially important for the posterior-stabilized version.

Important

The femoral trial is used as reference for resection of the bone with the curved osteotome.

The femoral trial can be removed with using the slap hammer. If necessary, can be left in place for protecting the femoral condyle during tibial preparation.

It is recommended to leave the femoral trial component assembled with stem and eventually augmentation blocks to be used as reference, respectively as comparison component when assembling the definitive implant.

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Tibial opening

Open the tibial IM canal with the Ø 8 mm drill or directly with the Ø 8 / 14 mm stepped drill.

Position the hole centrally M/L and one third from anterior.

Reamers are used carefully and in progressive stages ( starting with «Ø 10» ) to ream to the required stem diameter and depth.

Important

Reamers are available in diameter «Ø 10», «Ø 12», «Ø 14», «Ø 16», «Ø 18» and «Ø 20».

The depth indicator is on the reamer: observe the recessed notch markings and the depths marked «IM» when using this technique ( «IM80», «IM110» and «IM150 ). The laser markings are for extramedullary use and are described with the corresponding surgical technique.

The 40 mm stem length is only available for extramedullary application.

When using cemented stems, the Ø 12 mm reamer is used to drill to the desired depth and the corresponding non-cemented trial stem is used. Cemented stems are available in 80 mm, 110 mm and 150 mm lengths.

Controlling the stem position

An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in axial alignment and depth ( the end of the reamer alignment guide corresponds to the tip of the reamer ).

Tibial Preparation

The leg is flexed and any remaining osteophytes and the intercondylar eminence are removed.

Preparing the tibial anchorage

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Preparing the tibial stem connection

The chosen trial stem is attached to the extension for trial stem ( Ø 8 mm ) and with the modular handle carefully inserted into the tibial IM canal so the line marked with «MIN.» is approximately level to the distal bone resection. The modular handle is now removed. It is important to avoid putting excessive pressure in the tibial IM canal.

Important

With too short IM guidance, the alignment may be incorrect ( varus / valgus, extension / flexion ). Therefore the 40 mm trial stems can’t be used for the IM application!

The stem connection recess is drilled with the Ø 10 /20 mm stepped drill until the larger laser marking ( corresponding to the tibial resection with the smallest 9 mm tibial insert ). The engraved marking «Tibia» correspond to the joint line.

Important

The laser markings «+5», «+10», «+15» and «+20» correspond to the augmentation blocks resection depth.

Locating the tibial cutting block

The two tibial resection guide IM components are coupled together by jointing arrow «» to arrow «» and pressing the button.

The femoral / tibial revision cutting block is attached to the tibial resection guide IM with the top small grub screw and slid completely onto the Ø 8 mm extension for trial stem.

Important

Ensure the lock lever is set to «OPEN» to slide in place the tibial resection guide IM. The lock lever is then reversed to fix the tibial resection guide IM in place.

The femoral / tibial revision cutting block is first lifted upwards by pressing the button so the tibial stylus can be attached.

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Setting the resection height

The alignment is checked again with the axial alignment rod. The rod tip must point to the centre of the ankle joint.

The tibial stylus can now be removed.

The resection height is checked with the resection stylus. The femoral / tibial cutting block can be adjusted using the large grub screw ± 6 mm.

Important

The top small grub screw is used for assembling the femoral / tibial revision cutting block only.

The tibial stylus is positioned on the tibial plateau. The tibial stylus can be used for both primary resections ( «11 mm» marking ) and for revisions resections ( «1 mm» marking ).

Important

In primary revision procedures, the «11 mm» tibial stylus is positioned on the lowest point of the less damaged condyle.

In revision procedures where no tibial augmentation blocks are required, the «1 mm» tibial stylus is positioned on the lowest area of the tibial plateau.

In revision procedures where augmentation blocks are required, «1 mm» tibial stylus is positioned on the lowest point of the less damaged condyle.

Controlling the alignment and the tibial resection

34

After preliminary drilling with the Ø 3.2 mm drill, the femoral / tibial revision cutting block is fixed with two bone pins ( 75 mm or 100 mm long ) through the holes marked «0».

Handles can be attached.

The tibial resection is performed using a 1 mm saw blade through the «0» saw slot ( closed slot with facet ).

Important

For locking the femoral / tibial revision cutting block, an additional pin can be inserted into the oblique holes market with «AUX». After resection, the pin can be removed.

The ligaments must be protected during all resections.

When using tibial blocks the resection is conducted through the open saw slots. Blocks 5 mm, 10 mm and15 mm high are available.

The lock lever is set to «OPEN» and the tibial resection guide IM is removed from the femoral / tibial revision cutting block by unscrewing the top small grub screw. The trial stem with the extension are also removed using the modular handle.

The femoral / tibial revision cutting block is slid onto the bone.

Tibial resection

35

The ligament tension in flexion and extension is checked with spacers. The tibial spacers («9», «11», «13», «15», «17», «19» and optional «21» for the TC-PLUS™ PS Revision only) represent the full tibial height ( tibial component and tibial insert ). The metal femoral condyle spacer, which represents the height of the femoral component, is attached to the tibial spacer.

Important

When using augmentation blocks the corresponding spacer blocks must be fixed to the spacer. Note the corresponding thickness ( «5 mm», «10 mm» or «15 mm» . These can be fixed either on the tibial side or on the femoral side.

The flexion and extension gaps are checked by inserting the spacer in the joint gap. If necessary further release or resection are performed.

Important

If distal and posterior femoral augmentation blocks of different thicknesses are used, using the femoral trial component is recommended rather than the femoral condyle spacer.

The mechanical axis can be checked by inserting the axial alignment rod in the handle.

To release the spacer blocks, a long pin can be inserted in the hole and used as a lever.

The two bone pins in the tibia are then removed.

As guidance for the vertical tibial augmentation block cut, two bone pins (length 75 mm or 100 mm are inserted into the two proximal holes level with closed saw slot. The vertical cut is performed between the two pins to the depth of the augmentation block.

Important

If the femoral / tibial revision cutting block is distally or proximally relocated ( purpose of thicker or thinner bone resection ), this is moved to the right (± 2 mm) or parallel (± 4 mm). Should the relocation be moved to the right, the vertical cut should be performed external to the right pin rather than between the pins.

The femoral / tibial revision cutting block is now removed.

Controlling the joint gaps

36

Tibial size determination

The chosen trial stem is attached to the extension for trial stem ( Ø 8 mm ) and with the modular handle carefully inserted into the tibial IM canal so the line marked with «MIN.» is approximately level to the distal bone resection. The modular handle is now removed. It is important to avoid putting excessive pressure in the tibial IM canal.

The tibial sizer handle with the axial alignment rod is assembled onto tibia sizer trial.

The tibial rotation is determined anatomically statically (orientation to the tibial tuberosity and the axial alignment rod).

After preliminary drilling with the Ø 3.2 mm drill, the tibial sizer is fixed with at least two bone pins two bone pins with head (25 mm or 38 mm) through the anterior inclined holes..

The tibial sizer trial assembled with the tibial slope adapter «3°» and the alignment bushing «8» are intramedullary placed over the extension for trial stem ( Ø 8 mm ) and applied onto the proximal bone resection. The tibial sizer trial should completely cover the cortex without projecting beyond the tibia. In case of doubt a lateral projection is preferred, because a medial projection may cause irritation of the pes anserinus. If the projection is not acceptable, a smaller size should be used ( pay attention to the combination! ). The correct tibial size is then determined.

Important

By use of tibial blocks, the corresponding blocks are to be attached to the tibial sizer. Note the corresponding heights («5 mm», «10 mm» or «15 mm») and side ( «Rlat/Lmed» or «Llat/Rmed» ). The 15mm tibial blocks are anatomically bent M/L and posterior. Therefore, the under contour is always a size smaller than the upper contour.

If an offset stem is required, see instructions page 39.

Setting the tibial rotation

37

Then the tibia slope adapter «3°», the alignment bushing «8», the extension of the trial stem ( Ø 8 mm ) and the trial stem itself are removed.

The tibial sizer is additionally fixed with two or four bone pins with heads (25 mm or 38 mm).

Now the relationships are checked in flexion and tension position.

This manipulation is used to check the scope of movement, the patella guide and the tension of the soft-tissue apparatus.

The corresponding manipulation tibial insert, which had previously been defined with the joint gap spacer, is placed on the tibial sizer.

The manipulation femoral component is screwed to the manipulation femoral adapter (corresponding to the preset valgus angle) and the trial stem (corresponding to the last reamer diameter and depth).

The manipulation femoral component is inserted with the hammer.

Trial reduction

38

Preparing the tibial medullary cavity

The test reposition is used to check the scope of movement, the patella guide and the tension of the soft-tissue apparatus.

The manipulation tibial component consists of the previously used tibial sizer, which is tensioned between the tibial stem holder and the tibial anchorage connection, and the trial stem (corresponding to the diameter and depth of the last reamer), which is screwed in place.

The manipulation tibial component is inserted with the hammer.

Important

When using tibia blocks, appropriate manipulation tibia blocks («5 mm», «10 mm» and «15 mm») are available. They are fixed laterally on the manipulation tibial component ( tibial sizer ).

See page 42 for the following steps.

The tibia rasp guide is positioned on the tibial sizer and fixed with the retaining screw.

The proximal tibia marrow space is definitively prepared with the tibia rasp.

The tibia rasp is tapped in to the stop.

ImportantThe small tibia rasp guide and tibia rasp are used for tibia sizes 2 and 4 («2, 4»), and the large for tibia sizes 6 to 10 («6, 8, 10»).

Then the tibia rasp guide and the tibial sizer are removed.

Trial reduction ( tibial component )

39

Positioning the tibial sizer for offset stems

When using tibia blocks, appropriate manipulation tibia blocks («5 mm», «10 mm» and «15 mm») are available. They are fixed laterally on the manipulation tibial component ( tibial sizer ).

The tibial sizer is positioned with the transfer guide so it does not project. It should in good contact on the cortical bone all round.

Important

When using tibial blocks place the corresponding blocks on the tibial sizer. Note the corresponding thickness («5 mm», «10 mm» or «15 mm») and side ( «Rlat/Lmed» or «Llat/Rmed» ). The 15mm tibial blocks are anatomically bent M/L and posterior. Therefore, the under contour is always smaller a size than the upper contour.

If the decision is made that an offset stem is not required, see page 36 for the following steps.

When the rotation has been adjusted, the tibial sizer is fixed with the inclined bone pin holes.

Important

The vertical bone pins must be inserted before preparation of the stem connection.

Offset Stem Option

Preparing the tibial anchorage for offset stems.

40

Fixing the stem transfer guide

After insertion of the vertical bone pins with head, the transfer guide can be placed in the tibial component.

The transfer guide takes the offset position by clamping the lever and acts as a guide for assembly of the manipulation prosthesis and later for assembly of the implant.

Hold the transfer guide when tensioning the lever.

Now the transfer guide must be removed and the trial stem can be pulled out.

Important

Never open the lever of the stem transfer guide till the end of the surgery.

Insert the 2 plastic centering rings into the transfer guide (3.75 mm) for improved centering of the instrument.

Important

The 2 plastic centering rings must be inserted with the inclination downwards (see arrows).

Preparing the tibial stem connection and IM canal

After insertion of the tibia slope adapter «3°» and the largest reamer bushing «20», the preparation of the stem connection of the tibial component can be conducted.

Final preparation of the tibial anchorage using the standard drill Ø 20 mm and the tibia rasp (stem connection and ribs are prepared).

Important

The stepped drill Ø 10 / 20 mm cannot be used because of the eccentricity.

Removal of the guide and instruments.

Preparing the transfer guide

41

Preparing the tibial trial

The corresponding tibial sizer with the matching tibial anchorage connection and «OFFSET» stem holder are mounted as the manipulation tibial component.

Important

Assembly is carried out on the instrument table.

The transfer guide (3.75 mm) is positioned based on the fins.

The manipulation tibial component is inserted with the hammer.

Important

When using tibia blocks, appropriate manipulation tibia blocks («5 mm», «10 mm» and «15 mm») are available. They are fixed laterally on the manipulation tibial component ( tibial sizer ).

See page 42 for the following steps.

The selected trial stem is fixed to the manipulation tibia eccentric adapter (3.75 mm).

Important

The position is set by the projections.

Finally the trial stem with the manipulation tibial component is fixed by a screw in the specified offset position.

Trial positioning ( tibial component )

42

Trial reduction ( femoral component )

The manipulation femoral component is screwed to the manipulation femoral adapter (corresponding to the preset valgus angle) and the trial stem (corresponding to the last reamer).

Important

There is a danger that the same trial stem will be needed on the femur and on the tibia. In this case a shorter trial stem of the same diameter is mounted on the manipulation femoral component or a trial stem of the same length and smaller diameter or no trial stem at all is used.

The manipulation femoral component is inserted with the hammer.

Important

When using distal and / or posterior tibia blocks, appropriate manipulation femoral blocks («5 mm», «10 mm» and «15 mm») are available. They are fixed laterally on the manipulation femoral component.

The corresponding manipulation tibial insert is positioned.

The implant seat, the kinematics of the joint and the patella function are checked.

The final decision in favour of a patella replacement is made at this point (see instructions from page 46).

If the definitive implants are specified, the components are prepared for assembly ( see instructions from page 48 ).

The manipulation components are removed with the hammer, starting with the femur.

Important

However, we recommend leaving the manipulation components with stem and any blocks mounted as a reference. They are used as a check and as a comparison to the definitive implant.

43

After the A/P and facet resections the chisel guide is positioned on the femoral reamer guide and fixed in place with a retaining screw.

The proximal limit of the box is accurately defined first with the femoral box chisel.

Posterior-Stabilized Option

In the case of complete insufficiency of the posterior cruciate ligament or if it is cut during surgery, e.g. with bending contractures greater than 30°, dorsal instability in bending position is possible.

A posterior-stabilized model (PS) for cemented application is available as compensation. It includes a revision femoral component which includes a box in the intercondylar region designed to accept a PS tibial insert with a higher pin. The movement of the femoral box on the tibial pin in bending results in the physiological roll-back and prevents displacement of the femoral-tibial contact point in the ventral direction (to the tibia).

SURGICAL TECHNIQUE FOR PS KNEE REPLACEMENT

The PS case is also used for the posterior-stabilized type (PS). Preparation of the demur for receiving the box requires a box saw guide with the femoral box chisel and the drill with the PS stop.

Important

To prevent unwanted fractures in the femoral condyle during preparation of the tibia ( by Hohman support ), the femoral box and the femoral anchorage can also be prepared at the end after preparation of the tibia.

Preparing the femoral box

44

According to the predetermined valgus angle, the corresponding femoral valgus adapter ( «4°», «6°» or «8°» ) is inserted on the femoral reamer guide.

The femoral valgus adapter is inserted into the femoral reamer guide, so that depending on which side is the operation, the mark «LEFT» for left knee or «RIGHT» for right knee is visible on the arrow «ANTERIOR ».

The reamer bushing with the smallest diameter («Ø10») is inserted into the femoral valgus adapter.

Important

Reamer bushings and reamers in diameter «Ø10», «Ø12», «Ø14», «Ø16», «Ø18» and «Ø20» are available.

Reamers are used carefully and in progressive stages ( starting with «Ø10») with use of the corresponding bushing, to ream to the required stem diameter and depth.

Important

The depth indicator is on the reamer: observe the laser markings when using this technique. The recessed notch markings are for the IM application and are described in the corresponding surgical technique.

When using cemented stems, the Ø 12 mm reamer is used to drill to the desired depth. Cemented stems are available in 80 mm, 110 mm and 150 mm lengths.

The box is prepared medially and laterally with the oscillating saw.

Important

The medial and lateral saw cuts are aligned at an inclination to make it easy to place the IM-guided femoral component (valgus) in the correct position.

Preparing the femoral box

45

An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in axial alignment and depth ( the end of the reamer alignment guide corresponds to the tip of the reamer ).

Preparing the femoral stem connection

For reduction, femoral trials PS revision and tibial insert trials PS are available.

See page 42 for the next step.

The largest reamer bushing «20» is inserted into the femoral valgus adapter ( «4°», «6°» or «8°» ). TheØ 20 mm drill is then drilled to the stop to prepare the recess for the stem connection.

Important

Because the femoral stem connection for the PS femoral component is deeper, the specific Ø 20 mm drill with PS stop must be used.

Proceed with tibia preparation from page 31.

Preparing the femoral stem connection

46

Positioning the patella clamp and patella resection

Determine patellar size using the patellar sizer. Supplied sizes are Ø 26, Ø 29, Ø 32 and Ø 35 mm. Note that the patellar component is implanted with a slight medial offset, thus matching the position of the natural patellar ridge. Small implant sizes are recommended for small patella to enable this offset to be reproduced.

Patellar Preparation

The leg is extended. Soft tissue on the posterior surface of the patella is exposed preserving the ligaments.

If the posterior surface of the patella is not replaced, the patella is freed osteophytes and denerved.

The patellar instruments permit the use of the « onlay » technique in which 10 mm of the bone are resected and replaced by a 10 mm thick patellar implant ( if an 8 mm thick patellar implant is planned, resect just 8 mm accordingly ).

An alternative option is the « inlay » technique, in which the implant is partially countersunk ( 3 mm to 5 mm ). Here, the patella is only resected approx. 7 mm to 5 mm below the ridge. The thickness of the residual bony patella should not be less than 12 mm. See also the« Milling » section on page 47.

After placing the patellar cutting guide on the patellar clamp with the ratchet, grasp the patella with the clamp. The patellar thickness can be read from the mm scale on the handle.

Adjust the patella osteotomy insert ( mm scale ) to the height to be resected and resect the patella with the oscillating saw ( 1 mm saw blade with unset teeth, see page 89 ).

Important

When resecting, ensure that the saw blade does not wander, e.g. due to sclerotic bone sectors.

Patellar size determination

47

Milling

Trial reduction

Patellar trials are available for trial reduction.

Mount the patellar bushing onto the patellar clamp with the ratchet.

Select the patellar reamer to match the corresponding patella size. Depending on the selected anchoraging technique, mill briefly ( « onlay » technique ) or countersink by 3 mm to 5 mm ( « inlay » technique ). Milling down to the stop results in a depth of 5 mm.

Important

Patellar implants with a height of 10 mm are recommended as standard. Implants with a height of 8 mm are available as an alternative for thin patella.

Drill anchoring holes

Using patellar drill guide and the patellar drill with stop, prepare the anchoring holes for the pegs.

48

Assembling the tibial component

Assembling the Implants - Components

The assembling block is essential for safe and gentle assembling of the implants.

ImportantWhen assembling the implant component, always start with the stem first. Then the blocks can be fixed. Otherwise the block screw may come loose during impacting.

Be aware; if any screw or PE pin is missing from the respective component or for any reason is not sterile, a set of replacement screws and PE pins ( page 67 ) is available.

The prepared automatic hammer with adapter is placed on the stem. The stem is securely attached to the tibial component by three times impacting on the stem.

ImportantA stem connection with 3° "posterior slope" is integrated on the tibial component as standard.

The tibial component ( page 59 ) is positioned in the specified position on the assembling block.

The stem ( page 64 and 65 ) is inserted into the taper.

Important

Pay attention that the tapered connection is undamaged, clean and dry before mounting and by using non-cemented stems that a pocket is anterior, not a rib.

If an offset stem is planned, see mounting instructions from page 49.

Fixing the stem ( cemented / non-cemented ) to the tibial component

49

Assembling by using offset stems

With the stem screw is the stem additionally secured.

ImportantThe stem screwdriver is intentionally slim designed and has to be used carefully.

The stem screw has to be tight with the provided screwdriver with torque. The required torque is reached when the line reaches the Stem/Block position ( 4.5 Nm ).

Important

The screwdriver with torque is maintenance-free. However, make sure that the marking is at Position «0» when it is not under tension. Otherwise the wrench must be returned.

The offset stem ( page 65 ) is inserted into the taper on the assembling block and set to the offset position with the aid of the transfer guide ( pre-assembled with the centering rings and straight surface on the elbow on the stem must be flush with the straight internal surface of the transfer guide ).

Important

Pay attention that the tapered connection is undamaged, clean and dry before mounting.

The prepared automatic hammer with adapter is placed on the stem. The stem is securely attached to the tibial component by three times impacting on the stem.

Then the transfer guide is removed.

Securing the stem

50

Assembling the tibial blocks

There are blocks with a thickness of 5 mm, 10 mm and 15 mm available for the tibial component ( page 63 ).

To enable tibial block assembly the required PE pegs must first be removed.

Important

The tibial blocks can be inserted either medially or laterally ( excepted tibial blocks size 15 mm ).

The tibial blocks are also fixed mechanically with the pre-assembled screws with the screwdriver with torque. The required torque is reached when the line reaches the « Stem/Block » position ( 4.5 Nm ).

Important

The screws are screwed into the block through the tibial component and must always be countersunk.

Assembling the femoral component

The femoral component ( page 59, or page 66 for PS ) is placed in the specified position on the assembling block.

51

Fixing the stem ( cemented / non-cemented ) to the femoral component

When using a 2° valgus stem ( page 65 ) the markings on the femoral stem connection and stem ( «4°» or «8°» ) must match.

The stem ( page 64 and 65 ) is inserted into the taper.

ImportantPay attention that the tapered connection is undamaged, clean and dry before mounting and by using non-cemented stems that a pocket is anterior, not a rib.

If a valgus stem is planned, see instructions below.

The prepared automatic hammer with adapter is placed on the stem. The stem is securely attached to the femoral component by three times impacting on the stem.

ImportantWhen using the straight stem the valgus angle is 6°. This angle is integrated into the stem connection.

Assembling by using valgus stems

52

Securing the stem

Blocks 5 mm, 10 mm and 15 mm thick ( 15 mm distal only ) are available for the femoral components ( page 61 and 62 ).

Important

When using blocks note that the femoral implants must be clean and dry. Note the corresponding size combinations.

The femoral blocks are also fixed mechanically with the premounted retaining screws with the screwdriver with torque. The required torque is reached when the line reaches the Stem/Block position ( 4.5 Nm ).

Important

The posterior femoral blocks are the same for medial and lateral use.

In the case of distal femoral blocks make sure that the correct blocks are selected for the desired position, because there are three different blocks matching the contours.

When using distal and posterior blocks, it is recommended to screw tightly the posterior block first and then the distal block. This is particularly advisable by use of a 15 mm distal block.

The stem is additionally secured with the stem retaining screw. The retaining screw must be tightened with the screwdriver with torque. The required torque is reached when the line reaches the Stem/Block position ( 4.5 Nm ).

Important

The stem retaining screw for retaining the stem is packaged with the femoral component.

Assembling the femoral blocks

53

Implanting the tibial and femoral components

The tibial component is tapped in with the hammer bent at 90°. Excess cement is carefully removed. While the cement is setting the implant components must be under continuous pressure.

The tibial insert of the corresponding size must not be placed until the cement has fully hardened. Ultracongruent tibial inserts ( page 60 ) and PS inserts( page 66 and 67 ) are available.

Important

Make sure that cement is placed between the fin connection and stem connection when using tibial blocks.

The femoral component is hammered using the impactor. Here too continuous pressure must be maintained and excess cement removed.

Important

Make sure that the posterior femoral condyles do not come into contact with the tibial component when impacting the femoral component. We recommend covering the tibial component with a compress.

Implanting the Components

Mix the bone cement according to the respective manufacturer's instructions. Clean, wash and dry the bone bed sufficiently. Modern cementing techniques using a vacuum mixer and jet lavage are recommended.

The TC-PLUS™ Revision knee is used with cement, with the exception of non-cemented stems. First cement the tibial component and then the femoral component.

Important

With sclerotic bone it is recommended to drill several holes using an Ø 3.2 mm drill. This improves anchorage between the bone cement and the bone.

Ti6Al4V stems: The backs of the condyles and the box walls of the femoral component are coated with cement. The back of the tibial component is coated with cement (back of plateau and box). The Ti6Al4V stems are not cemented.

Important

When implanting Ti6Al4V stems, pay attention that the rotations alignments of the femoral and tibial components correspond already when the stems are inserted to the definitive implant positions. This prevents unnecessary rib notches occurring in the IM canal.

CoCr stems: The medullary plugs are accordingly placed deeper. It is recommended to fill up the medullary cavities using a cement gun.

54

Last controlling

Prior to definitive assembly of the tibial insert it is possible to use the tibial insert trial for a final trial reduction.

Before the cement has set, the excess cement must be removed in extension.

Insertion of the tibial insert

The ultracongruent tibial insert ( or PS tibial insert ) is slid onto the tibial component and positioned bent at 90°. If necessary, use the tibial insert tapping instrument with handle.

Important

Note the correct anatomical alignment. It is important to make sure that no soft tissue is coming between the tibial insert and the tibial component.

55

If a patella insert is indicated, the patella ( page 59 ) of the TC-PLUS™ knee system is used, because the geometry of the patella cavity is designed for this implant.

The press-in instrument is mounted on the patella gripper with lock. The back of the patella component is coated with cement and the three holes for pins in the patella are filled with cement. The patella component is positioned manually with the leg stretched and pressed in with the patella gripper with lock and press-in aid in position. The excess cement is carefully removed. The gripper is left until the cement has fully hardened.

After manual placement of the PE retaining screw into the tibial insert, the PE retaining screw is tightened with the screwdriver with torque. The required torque is reached when the line reaches the PE position ( 2.5 Nm ).

Important

The screwdriver with torque is maintenance-free. However, make sure that the marking is at Position «0» when it is not under tension. Otherwise the screwdriver with torque must be returned.

Implanting the cemented patellar component

56

Wound closure

The wound must again be rinsed out thoroughly after implantation. Close the wound in layers, inserting two intra-articular and one subcutaneous Redon drain.

Rehabilitation

The operated leg is immobilized in a splint and the knee joint is cooled. Isometric contraction exercises should be performed on the first postoperative day. Thrombosis prophylaxis is required until full load can be borne.

On the second postoperative day, after removing the drains, assisted movement exercises and the use of a motorized splint ( CPM ) are started. The operated leg can be generally bear a load early on.

Mobilization of the patient is initially occurs with a walking frame or crutches, which can be limited as steadiness of gait improves.

Postoperative Treatment

57

Sterilization

Implants

All the implants described in this Surgical Technique are sterile when they are delivered by the manufacturer. Resterilization is not allowed.

Instruments

System components and instruments are not sterile when they are delivered. Before use they must be cleaned by the usual methods in accordance with internal hospital regulations and sterilized in an autoclave in accordance with the legal regulations and guidelines applicable in the relevant country. (For detailed information please refer to leaflet Lit. No. 03389).

The correct settings are given in the instructions for use issued by the autoclave manufacturer. Instrument manufacturers and dealers accept no responsibility for sterilization of products by the customer.

58

59

Implants

TC-PLUS™ Revision implants for cemented application

Femoral components left

SAP No. Art. No.Size75005148 22482 2

75005149 22484 4

75005150 22486 6

75005151 22488 8

75005152 22490 10

Femoral components right

SAP No. Size75005143 22462 2

75005144 22464 4

75005145 22466 6

75005146 22468 8

75005147 22470 10

Tibial components

SAP No. Art. No. Size75005136 22302 2

75005137 22304 4

75005138 22306 6

75005139 22308 8

75005140 22310 10

Patella components

SAP No. Art. No. Height75004784* 21182 * Ø 26 mm 8 mm

75004787 21192 Ø 26 mm 10 mm

75004785* 21183 * Ø 29 mm 8 mm

75004788 21193 Ø 29 mm 10 mm

75004786* 21184 * Ø 32 mm 8 mm

75004789 21194 Ø 32 mm 10 mm

75004790 21195 Ø 35 mm 10 mm

* Special sizes ( on request )

The patellar components are the same as those of the TC-PLUS™ knee system

Size

Art. No.

60

Tibial inserts ultracongruent

SAP No. Art. No. Size Height75006065 25416 2 9 mm

75006066 25417 2 11 mm

75006067 25418 2 13 mm

75006059 25400 2 15 mm

75006069 25421 2 17 mm

75006068 25420 2 19 mm

75006070 25426 4 9 mm

75006071 25427 4 11 mm

75006072 25428 4 13 mm

75006060 25401 4 15 mm

75006074 25431 4 17 mm

75006073 25430 4 19 mm

75006075 25436 6 9 mm

75006076 25437 6 11 mm

75006077 25438 6 13 mm

75006061 25402 6 15 mm

75006079 25441 6 17 mm

75006078 25440 6 19 mm

75006080 25446 8 9 mm

75006081 25447 8 11 mm

75006082 25448 8 13 mm

75006062 25403 8 15 mm

75006084 25451 8 17 mm

75006083 25450 8 19 mm

75006085 25456 10 9 mm

75006086 25457 10 11 mm

75006087 25458 10 13 mm

75006063 25404 10 15 mm

75006089 25461 10 17 mm

75006088 25460 10 19 mm

The tibial inserts are the same as those of the TC-PLUS™ knee system

61

Femoral blocks distal / lateral

SAP No. Art. No. Size Height75005091 22228 2 5 mm

75005092 22229 2 10 mm

75005093 22230 2 15 mm

75005094 22231 4 5 mm

75005095 22232 4 10 mm

75005096 22233 4 15 mm

75005097 22234 6 5 mm

75005098 22235 6 10 mm

75005099 22236 6 15 mm

75005100 22237 8 5 mm

75005101 22238 8 10 mm

75005102 22239 8 15 mm

75005103 22240 10 5 mm

75005104 22241 10 10 mm

75005105 22242 10 15 mm

Femoral blocks distal / medial left

SAP No. Art. No. Size75005106 22249 2 5 mm

75005107 22250 2 10 mm

75005108 22251 2 15 mm

75005109 22252 4 5 mm

75005110 22253 4 10 mm

75005111 22254 4 15 mm

75005112 22255 6 5 mm

75005113 22256 6 10 mm

75005114 22257 6 15 mm

75005115 22258 8 5 mm

75005116 22259 8 10 mm

75005117 22260 8 15 mm

75005118 22261 10 5 mm

75005119 22262 10 10 mm

75005120 22263 10 15 mm

The femoral blocks are the same for the TC-PLUS™ Revision knee system and for the TC-PLUS PS Revision knee system

Height

62

Femoral blocks distal / medial right

SAP No. Art. No. Size Height75005121 22270 2 5 mm

75005123 22271 2 10 mm

75005124 22272 2 15 mm

75005125 22273 4 5 mm

75005126 22274 4 10 mm

75005127 22275 4 15 mm

75005128 22276 6 5 mm

75005129 22277 6 10 mm

75005130 22278 6 15 mm

75005131 22279 8 5 mm

75005132 22280 8 10 mm

75005133 22281 8 15 mm

75005134 22282 10 5 mm

75005135 22283 10 10 mm

75005136 22284 10 15 mm

Femoral blocks posterior

SAP No. Art. No. Size Height75005081 22212 2 5 mm

75005082 22213 2 10 mm

75005083 22214 4 5 mm

75005084 22215 4 10 mm

75005085 22216 6 5 mm

75005086 22217 6 10 mm

75005087 22218 8 5 mm

75005088 22219 8 10 mm

75005089 22220 10 5 mm

75005090 22221 10 10 mm

The femoral blocks are the same for the TC-PLUS™ Revision knee system and for the TC-PLUS PS Revision knee system

63

Tibial blocks

SAP No. Art. No. Size Height75005153 22512 2 5 mm

75005154 22513 2 10 mm

75005163 22532 2 15 mm R-lat/L-med

75005164 22533 2 15 mm L-lat/R-med

75005155 22514 4 5 mm

75005156 22515 4 10 mm

75005165 22534 4 15 mm R-lat/L-med

75005166 22535 4 15 mm L-lat/R-med

75005157 22516 6 5 mm

75005158 22517 6 10 mm

75005167 22536 6 15 mm R-lat/L-med

75005168 22537 6 15 mm L-lat/R-med

75005159 22518 8 5 mm

75005160 22519 8 10 mm

75005169 22538 8 15 mm R-lat/L-med

75005170 22539 8 15 mm L-lat/R-med

75005161 22520 10 5 mm

75005162 22521 10 10 mm

75005171 22540 10 15 mm R-lat/L-med

75005172 22541 10 15 mm L-lat/R-med

64

Cemented Stems ( conical ) [CoCrMo]

SAP No. Art. No. Height75007325 61000 80 mm

75007327 61002 110 mm

75007326 61001 150 mm

Non-cemented stems – straight [Ti6Al4V]

SAP No. Art. No. Size Height75007329 61100 Ø 10 mm 80 mm

75007330 61101 Ø 12 mm 80 mm

75007331 61102 Ø 14 mm 80 mm

75007332 61103 Ø 16 mm 80 mm

75007333 61104 Ø 10 mm 110 mm

75007334 61105 Ø 12 mm 110 mm

75007335 61106 Ø 14 mm 110 mm

75007336 61107 Ø 16 mm 110 mm

75007337 61108 Ø 18 mm 110 mm

75007345 61116 Ø 12 mm 150 mm

75007338 61109 Ø 14 mm 150 mm

75007339 61110 Ø 16 mm 150 mm

75007340 61111 Ø 18 mm 150 mm

75007341 61112 Ø 20 mm 150 mm

Cemented and non-cemented stems are identical for femoral and tibial components of the TC-PLUS™ Revision or TC-PLUS PS Revision knee systems

65

Non-cemented stems – 2° valgus [Ti6Al4V] ( for femoral component only )

Art. No. Size Height75007346 61120 Ø 10 mm 80 mm

75007347 61121 Ø 12 mm 80 mm

75007348 61122 Ø 14 mm 80 mm

75007349 61123 Ø 16 mm 80 mm

75007350 61124 Ø 10 mm 110 mm

75007351 61125 Ø 12 mm 110 mm

75007352 61126 Ø 14 mm 110 mm

75007353 61127 Ø 16 mm 110 mm

75007354 61128 Ø 18 mm 110 mm

75007359 61133 Ø 12 mm 150 mm

75007355 61129 Ø 14 mm 150 mm

75007356 61130 Ø 16 mm 150 mm

75007357 61131 Ø 18 mm 150 mm

75007358 61132 Ø 20 mm 150 mm

Non-cemented stems – 3.75° offset [Ti6Al4V] ( for tibial component only )

SAP No. Art. No. Size Height75007360 61140 Ø 10 mm 80 mm

75007361 61141 Ø 12 mm 80 mm

75007362 61142 Ø 14 mm 80 mm

75007363 61143 Ø 16 mm 80 mm

75007364 61144 Ø 10 mm 110 mm

75007365 61145 Ø 12 mm 110 mm

75007366 61146 Ø 14 mm 110 mm

75007367 61147 Ø 16 mm 110 mm

75007368 61148 Ø 18 mm 110 mm

75007373 61153 Ø 12 mm 150 mm

75007369 61149 Ø 14 mm 150 mm

75007370 61150 Ø 16 mm 150 mm

75007371 61151 Ø 18 mm 150 mm

75007372 61152 Ø 20 mm 150 mm

Non-cemented stems with 2° valgus are identical for the femoral component of the TC-PLUS™ Revision and TC-PLUS™PS Revision knee systems

2°

3.75 mm

SAP No.

66

Posterior-Stabilised Version

TC-PLUS™ PS Revision implants for cemented application

Femoral components left

SAP No. Art. No. Size75007315 60102 2

75007316 60104 4

75007317 60106 6

75007318 60108 8

75007319 60110 10

Femoral components right

SAP No. Art. No. Size75007320 60122 2

75007321 60124 4

75007322 60126 6

75007323 60128 8

75007324 60130 10

Tibial inserts PS

SAP No. Art. No. Size Height75005173 22610 2 9 mm

75005174 22611 2 11 mm

75005175 22612 2 13 mm

75005176 22613 2 15 mm

75005177 22614 2 17 mm

75005178 22615 2 19 mm

75005181 22620 4 9 mm

75005182 22621 4 11 mm

75005183 22622 4 13 mm

75005184 22623 4 15 mm

75005185 22624 4 17 mm

75005186 22625 4 19 mm

75005189 22630 6 9 mm

75005190 22631 6 11 mm

75005191 22632 6 13 mm

75005192 22633 6 15 mm

75005193 22634 6 17 mm

75005194 22635 6 19 mm

SAP No. Art. No. Size Height75005197 22640 8 9 mm

75005198 22641 8 11 mm

75005199 22642 8 13 mm

75005200 22643 8 15 mm

75005201 22644 8 17 mm

75005202 22645 8 19 mm

75005205 22650 10 9 mm

75005206 22651 10 11 mm

75005207 22652 10 13 mm

75005208 22653 10 15 mm

75005209 22654 10 17 mm

75005210 22655 10 19 mm

The tibial inserts are the same as those of the TC-PLUS™ knee system

67

Tibial inserts PS ( on request )

SAP No. Art. No. Size Height75005179 22616 2 21 mm

75005187 22626 4 21 mm

75005195 22636 6 21 mm

75005203 22646 8 21 mm

75005211 22656 10 21 mm

The tibial inserts are the same as those of the TC-PLUS™ knee system.

Set of spare screws and PE pins

Art. Nr.SAP No. Quantity Description75005142 22390 1 Set of Spare Screws and PE Pins:

2 X Tibial PE Pins1 X Tibial Block Screw

1 X Femoral Stem Screw 1 X Tibial Stem Screw

68

Instrument Set: SAP No. 75200232 Art. No. 0944030

Case Set: SAP No. 75200215 Art. No. 0944012

Art. No.SAP No. Description Size Quantity75006024 253309 Case Basic Instrument, Empty – 175007661 990019 Case Lid – 1

� 75007192 600290 Alignment Bushing Ø 8 mm 1� 75007099 600115 Ø 10 mm 1 75007100 600116 Ø 12 mm 1 75007101 600117 Ø 14 mm 1 75007102 600118 Ø 16 mm 1 75007103 600119 Ø 18 mm 1 75007104 600120

Reamer BushingReamer BushingReamer BushingReamer BushingReamer BushingReamer Bushing Ø 20 mm 1

� 75007108 600125 Drill with Stop Ø 20 mm 1� 75005663 251073 IM Drill with Starter Tip Ø 8 mm 1� 75005902 252746 Resection Stylus 1 mm 1� 75005857 252068 Quick Lock Handle – 4� 75007137 600175 Tibial Sizer Handle – 1 75005659 251065 Ø 3.2 mm 1 75007140 600179 75 m m 6 75007141 600180 100 m m 2 75007138 600177 25 mm 75007139 600178 38 mm 75018329

DrillBone PinBone Pin Bone Pin with Head Bone Pin with Head Allen Wrench SW 3.5 1

75007233 600398 Femoral / Tibial Cutting Block (1 mm) – 1� 75007160 600214 Femoral Condyle Spacer 7 mm 1� 75006032 253360 9 mm 1 75006033 253361 11 mm 1 75006034 253362 13 mm 1 75006035 253363 15 mm 1 75006030 253359 17 mm 1 75006036 253364

Tibial SpacerTibial SpacerTibial SpacerTibial SpacerTibial SpacerTibial Spacer 19 mm 1

75007163 600223 5 mm 4 75007164 600224 10 mm 4 75007172 600248

Spacer Attachment Spacer AttachmentSpacer Attachment 15 mm 4

� 75005420 240391 Pin Extractor� 75007135 600172 Axial Alignment Rod ( I / II ) – 1

Instruments

TC-PLUS™ Revision Instrument Set

Basic Instruments

44

– 1

75018329

69

Optional Drill with AO Connection ( on request ) Set: SAP No. 75200233 Art. No. 0944031

SAP No. Art. No. Description 75005672 251096 Drill (AO) Ø 3.2 mm 1� 75005673 251097 IM Drill with Starter Tip (AO) Ø 8 mm 1� 75007109 600128 Drill with Stop (AO) Ø 20 mm 1 75005412 240374 Stepped Drill (AO) Ø 8/14 mm 1

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70

Trial Stems & Reamers Case Set: SAP No. 75200216 Art. No. 0944013

SAP No. Art. No. Description 75006017 253302 Trial Stems Case, Empty – 1

75007661 990019 – 1� 75007113 600132 Ø 10 / 40 mm 1

75007114 600133 Ø 12 / 40 mm 1

75007115 600134 Ø 14 / 40 mm 1� 75007116 600135 Ø 10 / 80 mm 1

75007117 600136 Ø 12 / 80 mm 1

75007118 600137 Ø 14 / 80 mm 1

75007119 600138 Ø 16 / 80 mm 1� 75007120 600145 Ø 10 / 110 mm 1

75007121 600146 Ø 12 / 110 mm 1

75007122 600147 Ø 14 / 110 mm 1

75007123 600148 Ø 16 / 110 mm 1

75007124 600149 Ø 18 / 110 mm 1� 75007125 600150 Ø 12 / 150 mm 1

75007126 600157 Ø 14 / 150 mm 1

75007127 600158 Ø 16 / 150 mm 1

75007128 600159 Ø 18 / 150 mm 1

75007129 600160 Ø 20 / 150 mm 1� 75007194 600292 Extension for Trial Stem Ø 8 mm 1

600112 � 75007098

253301

Reamer + Trial Stem Handle – 1

� 75004829 22000032 Stepped Drill Ø 10 / 20 mm 1 75005300 240003 Stepped Drill Ø 8 / 14 mm 1 75007168 600232 IM Rod Ø 8 mm 1� 75007235 600401 Reamer Ø 10 mm 1

75007236 600402 Reamer Ø 12 mm 1

75007237 600403 Reamer Ø 14 mm 1

75007238 600404 Reamer Ø 16 mm 1

75007239 600405 Reamer Ø 18 mm 1

75007240 600406 Reamer Ø 20 mm 1� 75005419 240387 Reamer Alignment Guide EM – 1

Case LidTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial StemTrial Stem

Tray Reamers, Empty 75006016 – 1

Size Quantity

71

Optional Cemented Trial Stems ( on request ) Case Set: SAP No. 75200281 Art. No. 0944094

SAP No. Art. No. Description 75007111 600130 80 mm 1

75007110 600129 110 mm 1

75007112 600131 150 mm 1

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Size Quantity

72

Femoral Instruments Case Set: SAP No. 75200217Art. No. 0944014

SAP No. Art. No. Description 75006015 253300 Case Femoral Trials, Empty – 1

75007661 990019 Case Lid – 1� 75006001 253275 Femoral Drill Guide IM, Adjustable – 1� 75007144 600183 Femoral Distal Spacer Revision 7 mm 1� 75007145 600184 6° 1

75007146 600185 4° 1

75007147 600186 8° 1� 75007148 600187 Femoral Suspension Device Revision – 1� 75007234 600399 – 1� 75007175 600257 Groove Stone for Femoral Cutting Block – 1� 75007213 600351 2 1

75007214 600352 4 1

75007215 600353 6 1

75007216 600354 8 1

75007217 600355 10 1 75007241 600407 2–4 / 5 mm 2

75007242 600408 6–10 / 5 mm 2 75007243 600409 2–4 / 10 mm 2

75007244 600410 6–10 / 10 mm 2� 75007245 600411 2–4 / 15 mm 2

75007246 600412 6–10 / 15 mm 2� 75007249 600441 2 1

75007250 600442 4 1

75007251 600443 6 1

75007252 600444 8 1

75007253 600445 10 1 75007195 600293 4° 1

75007196 600294 6° 1

75007197 600295 8° 1� 75007218 600371 2 1

75007219 600372 4 1

75007220 600373 6 1

75007221 600374 8 1

75007222 600375 10 1� 75007130 600161 – 1� 75007200 600298 – 1

Femoral BushingFemoral BushingFemoral Bushing

Femoral Stylus

Femoral Cutting Block Spacer Femoral Cutting Block SpacerFemoral Cutting Block Spacer Femoral Cutting Block Spacer

Femoral Cutting Block Spacer Femoral Cutting Block Spacer

Femoral SizerFemoral SizerFemoral SizerFemoral SizerFemoral SizerFemoral Valgus Adapter Femoral Valgus AdapterFemoral Valgus AdapterFemoral Reamer GuideFemoral Reamer GuideFemoral Reamer GuideFemoral Reamer GuideFemoral Reamer GuideTrochlear ChiselTrochlear Chisel Guide

Femoral Cutting Block (1 mm)Femoral Cutting Block Revision (1 mm)Femoral Cutting Block Revision (1 mm)Femoral Cutting Block Revision (1 mm)Femoral Cutting Block Revision (1 mm)

Size Quantity

73

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Femoral Trials Case Set: SAP No. 75200218 Art. No. 0944015

SAP No. Art. No. Description 75006018 253303 Femoral Trial Case, Empty – 1

75007661 990019 Case Lid – 1� 75007223 600381 2 1

75007224 600382 4 1

75007225 600383 6 1

75007226 600384 8 1

75007227 600385 10 1� 75007228 600391 2 1

75007229 600392 4 1

75007230 600393 6 1

75007231 600394 8 1

75007232 600395 10 1� 75007153 600200 0° 1� 75007155 600202 ± 2° 1� 75007158 600206 5 mm 6

75007159 600209 10 mm 6

75007171 600247 15 mm 4

75007173 600249 15 mm 2� 75007169 600238 – 1

Femoral Trial AdapterFemoral Trial AdapterFemoral Block TrialFemoral Block Trial Femoral Block Trial Femoral Block Trial

Femoral Trial RightFemoral Trial RightFemoral Trial RightFemoral Trial RightFemoral Trial Right

Femoral Trial LeftFemoral Trial LeftFemoral Trial LeftFemoral Trial LeftFemoral Trial Left

Curved Osteotome

Size Quantity

75

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Tibial Instruments Case Set No.: SAP No. 75200219 Art. No. 0944016

SAP No. Art. No. Description 75006019 253304 Case Tibial Instruments, empty – 1

75007661 990019 – 1� 75006025 253311 2 1

75006026 253312 4 1

75006027 253313 6 1

75006028 253314 8 1

75006029 253315 10 1� 75005920 253111 2 / 5 mm 1

75005925 253121 2 / 10 mm 1

75005983 253221 2 / 15 mm 1

75005921 253112 4 / 5 mm 1

75005926 253122 4 / 10 mm 1

75005984 253222 4 / 15 mm 1

75005922 253113 6 / 5 mm 1

75005927 253123 6 / 10 mm 1

75005985 253223 6 / 15 mm 1

75005923 253114 8 / 5 mm 1

75005928 253124 8 / 10 mm 1

75005986 253224 8 / 15 mm 1

75005924 253115 10 / 5 mm 1

75005929 253125 10 / 10 mm 1

75005987 253225 10 / 15 mm 1� 75006003 253281 2 / 5 mm 1

75006009 253291 2 / 10 mm 1

75005988 253241 2 / 15 mm 1

75006004 253282 4 / 5 mm 1

75006010 253292 4 / 10 mm 1

75005989 253242 4 / 15 mm 1

75006005 253283 6 / 5 mm 1

75006011 253293 6 / 10 mm 1

75005990 253243 6 / 15 mm 1

75006006 253284 8 / 5 mm 1

75006012 253294 8 / 10 mm 1

75005991 253244 8 / 15 mm 1

75006007 253285 10 / 5 mm 1

75006013 253295 10 / 10 mm 1

75005992 253245 10 / 15 mm 1

Tibial Sizer / TrialTibial Sizer / TrialTibial Sizer / TrialTibial Sizer / TrialTibial Sizer / Trial

Case Lid

Tibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial R-Lat / L-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-MedTibial Block Trial L-Lat / R-Med

Size Quantity

77

Tibial Instruments ( next )

SAP No. Art. No. Description � 75007247 600413 2–4 1� 75007248 600414 6–10 1� 75007132 600165 2–4 1� 75007133 600166 6–10 1

75023718 22000514 Holder Tibial Resection Guide IM – 1

75023727 600173 Tibial Stylus 1 mm/11 mm 1� 75010947600167 Tibial Slope Adapter 3° 1� 75007134600296 2–4 1 75007198600297 6–10 1� 75007199600198 – 1� 7500715222000031 3.75 mm 1� 75004828

22000035 2–4 1� 75004832

22000036 6–10 1� 75004833

22000033 – 1

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Tibial Rasp

Tibial Anchoring ExtensionTibial Anchoring Extension Tibial Stem Retainer Tibial trial Eccentric Adapter Tibial Anchoring Extension, Offset Tibial Anchoring Extension, Offset Tibial Stem Retainer, Offset

22000523 Support Tibial Resection Guide IM

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1± 6 mm

Case Set No.: SAP No. 75200219 Art. No. 0944016

Size Quantity

78

Tibial Insert Trials CS Case Set No.: SAP No. 75200220 Art. No. 0944017

SAP No. Art. No. Description 75006020 253305 Case Tibial Insert Trials CS, empty – 1

75007661 990019 Case Lid – 1� 75005600 250400 2 / 9 mm 1

75005601 250401 2 / 11 mm 1

75005602 250402 2 / 13 mm 1

75005603 250403 2 / 15 mm 1

75005630 250431 2 / 17 mm 1

75005604 250404 2 / 19 mm 1� 75005605 250405 4 / 9 mm 1

75005606 250406 4 / 11 mm 1

75005607 250407 4 / 13 mm 1

75005608 250408 4 / 15 mm 1

75005631 250432 4 / 17 mm 1

75005609 250409 4 / 19 mm 1� 75005610 250410 6 / 9 mm 1

75005611 250411 6 / 11 mm 1

75005612 250412 6 / 13 mm 1

75005613 250413 6 / 15 mm 1

75005632 250433 6 / 17 mm 1

75005614 250414 6 / 19 mm 1� 75005615 250415 8 / 9 mm 1

75005616 250416 8 / 11 mm 1

75005617 250417 8 / 13 mm 1

75005618 250418 8 / 15 mm 1

75005633 250434 8 / 17 mm 1

75005619 250419 8 / 19 mm 1� 75005620 250420 10 / 9 mm 1

75005621 250421 10 / 11 mm 1

75005622 250422 10 / 13 mm 1

75005623 250423 10 / 15 mm 1

75005624 250435 10 / 17 mm 1

75005625 250424 10 / 19 mm 1

Size Quantity

Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)

Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)

Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)Tibial Insert Trials CS (ultracongruent)

79

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Assembly Instruments

SAP No. Art. No. Description Size Quantity75006021 253306 Case Assembly Instruments, empty

75007661 990019 � 75007142 600181 Slap Hammer � 75007143 600182 Adapter for Slap Hammer Flat 1� 75007149 600188 Adapter for Slap Hammer M6 1� 75006000 253273 Impactor Tibial Insert – 1� 75007190 600288 Impactor Small 1� 75007191 600289 Impactor Large 1� 75007202 600300 75005998 253271 75005999 253272 Adapter for Tibial Stem Screw SW 7 1� 75007188 600279 Adapter w. Spherical Hexagonal Head SW 3.5 2� 75007170 600239 75007166 600228 � 75007201 600299 Adapter for Automatic Hammer � 75004827 22000030 Tibia Eccentric Connection (I/II/III) 3.75 mm 1� 75004831 22000034 Transfer Guide (I/II) 3.75 mm 1� 75004834 22000037

Case Set No.: SAP No. 75200221 Art. No. 0944018

Case Lid

Screwdriver with TorqueModular Handle

Assembling BlockAutomatic Hammer

Centering Ring (I/II)

– 1

– 1– 1– 1

– 1

– 1– 1– 1

– 2

81

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SAP No. Art. No. Description 75006023 253308 Case Femoral Instrument PS, empty – 1

75007661 990019 Case Lid – 1� 75005777 251529 Femoral Box Chisel – 1� 75005994 253267 2–10 1� 75005995 253268 Drill with Stop, Femur PS Ø 20 mm 1� 75007150 600189 Adapter for Slap Hammer Hook 1� 75007203 600312 2 1

75007204 600314 4 1

75007205 600316 6 1

75007206 600318 8 1

75007207 600320 10 1� 75007208 600332 2 1

75007209 600334 4 1

75007210 600336 6 1

75007211 600338 8 1

75007212 600340 10 1

Optional 21 mm Tibial Insert PS (on request)

Art. No.SAP No. Description � 75006037 253365 Tibial Spacer 21 mm 1

Optional Drill with AO Connection (on request)

Art. No. Description � 75005996 253269 Drill with Stop, Femur PS (AO) 1

Size Quantity

Instrument Set: SAP No. 75200277Art. No. 0944090

Case Set: SAP No. 75200278Art. No. 0944091

Posterior-Stabilised Version

TC-PLUS™ PS Revision Instrument Set

Femoral Instruments PS

Chisel Guide for Box Chisel ( 1 mm )

Femoral Trial PS LeftFemoral Trial PS LeftFemoral Trial PS LeftFemoral Trial PS LeftFemoral Trial PS LeftFemoral Trial PS RightFemoral Trial PS RightFemoral Trial PS RightFemoral Trial PS RightFemoral Trial PS Right

Size Quantity

Size QuantitySAP No.Ø 20 mm

Set: SAP No. 75200280Art. No. 0944093

Set: SAP No. 75200233Art. No. 0944031

83

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Tibial Insert Trials PS

Art. No.SAP No. Description Quantity75006022 253307 Case Tibial Insert Trials PS, empty – 1

75007661 990019 Case Lid – 1� 75005930 253140 2 / 9 mm 1

75005931 253141 2 / 11 mm 1

75005932 253142 2 / 13 mm 1

75005933 253143 2 / 15 mm 1

75005934 253144 2 / 17 mm 1

75005935 253145 2 / 19 mm 1� 75005938 253150 4 / 9 mm 1

75005939 253151 4 / 11 mm 1

75005940 253152 4 / 13 mm 1

75005941 253153 4 / 15 mm 1

75005942 253154 4 / 17 mm 1

75005943 253155 4 / 19 mm 1� 75005947 253160 6 / 9 mm 1

75005948 253161 6 / 11 mm 1

75005949 253162 6 / 13 mm 1

75005950 253163 6 / 15 mm 1

75005951 253164 6 / 17 mm 1

75005952 253165 6 / 19 mm 1� 75005956 253170 8 / 9 mm 1

75005957 253171 8 / 11 mm 1

75005958 253172 8 / 13 mm 1

75005959 253173 8 / 15 mm 1

75005960 253174 8 / 17 mm 1

75005961 253175 8 / 19 mm 1� 75005965 253180 10 / 9 mm 1

75005966 253181 10 / 11 mm 1

75005967 253182 10 / 13 mm 1

75005968 253183 10 / 15 mm 1

75005969 253184 10 / 17 mm 1

75005970 253185 10 / 19 mm 1

Optional 21 mm Tibial Insert Trials PS (on request)

SAP No. Art. No. Description � 75005936 253146 2 / 21 mm 1

75005944 253156 4 / 21 mm 1

75005953 253166 6 / 21 mm 1

75005962 253176 8 / 21 mm 1

75005971 253186 10 / 21 mm 1

Case Set: SAP No. 75200279Art. No. 0944092

Size Quantity

Tibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PS

Size

Set: SAP No. 75200280Art. No. 0944093

Tibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PSTibial Insert Trials PS

85

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Patellar Instruments

SAP No. Art. No. Description 75018088 22000451 Case Patellar Instrument, Empty – 1

75007661 990019 Case Lid – 1� 75005702 251204 – 1� 75005881 252203 – 1� 75005723 251292 Ø 26 / 10 mm 1

75005724 251293 Ø 29 / 10 mm 1

75005725 251294 Ø 32 / 10 mm 1

75005726 251295 Ø 35 / 10 mm 1� 75005717 251278 Patellar Drill with Stop Ø 5.5 mm 1� 75005718 251280 – 1� 75005716 251277 – 1� 75005707 251230 Ø 26 mm 1

75005708 251231 Ø 29 mm 1

75005709 251232 Ø 32 mm 1

75005710 251233 Ø 35 mm 1 75005711 251240 Ø 26 mm 1

75005712 251241 Ø 29 mm 1

75005713 251242 Ø 32 mm 1

75005714 251243 Ø 35 mm 1 75005706 251216 Ø 26 mm 1

75005707 251283 Ø 29 mm 1

75005708 251284 Ø 32 mm 1

75005709 251285

Patellar Mill with StopPatellar Mill with StopPatellar Mill with StopPatellar Mill with Stop Ø 35 mm 1

� 75005034 22000327 – 1

86

Optional Patellar Trials 8mm (on request)

Ø 26 / 8 mm 1

75005704 251210 Ø 29 / 8 mm 1

75005705 251211 Ø 32 / 8 mm 1

Optional Reamer/Drill with AO Connection (on request)

� 75004871 22000038 Patellar Drill with Stop (AO) Ø 5.5 mm 1 75004989 22000280 Patellar Mill with Stop (AO)

Patellar Mill with Stop (AO)Patellar Mill with Stop (AO)Patellar Mill with Stop (AO)

Ø 26 mm 1

75004990 22000281 Ø 29 mm 1

75004991 22000282 Ø 32 mm 1

75004992 22000283 Ø 35 mm 1

Size Quantity

Size Quantity

Quantity

Case Set: SAP No. 75200207 Art. No. 0944003

Size

Patellar ClampPatellar Clamp Cutting Guide ( 1 mm )

Patellar SizerPatellar inserterPatellar Clamp BushingPatellar Clamp BushingPatellar Clamp BushingPatellar Clamp Bushing

Patellar TrialPatellar TrialPatellar TrialPatellar Trial

Patellar Drill GuidePatellar Drill GuidePatellar Drill GuidePatellar Drill Guide

Bone thickness Sizer

Patellar TrialPatellar TrialPatellar Trial

Set: SAP No. 75200212Art. No. 0944008

Set: SAP No. 75200251Art. No. 0944049

SAP No. Art. No. Description

SAP No. Art. No. Description

� 75005703 251209

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Documents

ImportantThe following documents are available for support

Product accompanying documents

Name Lit. No.

Surgical technique Extramedullar Procedure 15802-en (1356)Surgical technique Intramedullar Procedure 15801-en (1402)

X-ray templates "TC-PLUS™ Revision" (1.15:1) 1354-A1-A2-A3-B

X-ray templates "TC-PLUS PS Revision" (1.15:1) 1355-A1-A2-A3-B

X-ray templates "TC-PLUS Revision" (1:1) 1511-A1-A2-A3-B

X-ray templates "TC-PLUS PS Revision" (1:1) 1512-A1-A2-A3-B

Product overview "TC-PLUS Revision" 1358

Product overview "TC-PLUS PS Revision" 1497

01218Sawblade Portfolio

Product information 15873-en (1357)

90

Prod

uct o

verv

iew

(com

bina

tion

tabl

e)

TC-P

LUS™

Rev

isio

n

Fem

uror

al b

lock

sdi

stal

/ p

oste

rior

Tibi

al in

sert

sUl

trac

ongr

uent

Fem

oral

com

pone

nts

right

/ le

ft

Tibi

al c

ompo

nent

s

25

44

6 /

9

mm

25

44

7 / 1

1 m

m2

54

48

/ 1

3 m

m2

54

03

/ 1

5 m

m2

54

51

/ 17

mm

25

43

6 /

9

mm

25

43

7 / 1

1 m

m2

54

38

/ 1

3 m

m2

54

02

/ 1

5 m

m2

54

41

/ 17

mm

25

42

6 /

9 m

m2

54

27

/ 11

mm

25

42

8 /

13

mm

25

40

1 /

15 m

m2

54

31

/ 17

mm

25

45

6 /

9

mm

2

54

57

/ 1

1 m

m

25

45

8 /

13

mm

2

54

04

/ 1

5 m

m

25

46

1 / 1

7 m

m

25

416

/

9 m

m2

54

17 /

11

mm

25

418

/ 1

3 m

m2

54

00

/ 1

5 m

m2

54

21

/ 17

mm

Pate

llar c

ompo

nent

s

211

84

* /

8 m

m2

119

4 /

10 m

m

Ø29

Ø32

Ø35

Ø26

211

83

* /

8 m

m

211

93

/

10 m

m2

119

5/

10

mm

211

82

* /

8 m

m2

119

2 /

10 m

m

* Sp

ecia

l siz

es

Post

erio

r2

22

12 /

5

mm

22

213

/ 1

0 m

m2

22

14 /

5

mm

22

215

/ 1

0 m

m

Post

erio

r2

22

16 /

5

mm

22

217

/ 1

0 m

m

Post

erio

r2

22

18 /

5

mm

22

219

/ 1

0 m

m

Post

erio

r2

22

20

/ 5

mm

2

22

21

/ 10

mm

Post

erio

r

22

30

8

60

32

24

03

22

22

310

2

23

02

86

00

66

60

06

46

00

6

05

00

60

70

06

84

00

66

40

06

44

00

66

00

62

60

04

2

Size

6Si

ze 2

Size

8Si

ze 4

Size

10

22

22

8 /

5

mm

Dis

t / L

at:

22

23

1 /

5

mm

Dis

t / L

at:

22

23

4 /

5

mm

Dis

t / L

at:

22

23

7 /

5 m

mD

ist /

Lat

:2

22

40

/

5 m

m

22

22

9 /

10

mm

22

23

2 /

10

mm

22

23

5 /

10

mm

22

23

8 /

10

mm

22

24

1 /

10 m

m

Dis

t / L

at:

22

23

0 /

15

mm

22

23

3 /

15

mm

22

23

6 /

15

mm

22

23

9 /

15

mm

22

24

2 /

15

mm

22

24

9 /

5 m

m2

22

50

/ 10

mm

D

ist /

Med

L:

22

25

2 /

5

mm

22

25

3 /

10

mm

Dis

t / M

ed L

:2

22

55

/

5 m

m2

22

56

/ 1

0 m

mD

ist /

Med

L:

22

25

8 /

5

mm

22

25

9 /

10

mm

Dis

t / M

ed L

:2

22

61

/

5 m

m

22

26

2 /

10

mm

D

ist /

Med

L:

22

25

1 /

15 m

m2

22

54

/ 1

5 m

m2

22

57

/ 15

mm

22

26

0 /

15

mm

22

26

3 /

15

mm

22

270

/

5 m

m2

22

71 /

10

mm

Dis

t / M

ed R

:2

22

73 /

5

mm

22

274

/ 1

0 m

mD

ist /

Med

R:

22

276

/

5 m

m2

22

77 /

10

mm

Dis

t / M

ed R

: 2

22

79 /

5

mm

22

28

0 /

10

mm

Dis

t / M

ed R

:2

22

82

/

5 m

m

22

28

3 /

10

mm

D

ist /

Med

R:

22

272

/ 1

5 m

m2

22

75 /

15

mm

22

278

/ 1

5 m

m2

22

81

/ 15

mm

22

28

4 /

15

mm

Tibi

al b

lock

s2

25

16 /

5

mm

22

517

/ 1

0 m

m2

25

18 /

5

mm

22

519

/ 1

0 m

m2

25

20

/ 5

mm

2

25

21

/ 10

mm

2

25

14 /

5

mm

22

515

/ 1

0 m

m2

25

12 /

5

mm

22

513

/ 1

0 m

m2

25

36

/ 1

5 m

m2

25

38

/ 1

5 m

m2

25

40

/ 1

5 m

m

R-La

t / L

-Med

:R-

Lat /

L-M

ed:

R-La

t / L

-Med

: :de

M-L / taL-R

:deM-L / taL-

R2

25

34

/ 1

5 m

m2

25

32

/ 1

5 m

m2

25

37

/ 15

mm

22

53

9 /

15

mm

22

54

1 /

15 m

m

L-La

t / R

-Med

:L-

Lat /

R-M

ed:

L-La

t / R

-Med

: :de

M-R / taL-L

:deM-

R / taL-L2

25

35

/ 1

5 m

m2

25

33

/ 1

5 m

m

25

45

0 /

19

mm

25

44

0 /

19

mm

25

43

0 / 1

9 m

m2

54

60

/ 1

9 m

m

25

42

0 / 1

9 m

m

Tibi

al in

sert

s PS

Fem

oral

com

pone

nts

PS ri

ght /

left

Tibi

al c

ompo

nent

s

22

64

0 /

9 m

m2

26

41

/ 1

1 m

m2

26

42

/

13 m

m2

26

43

/

15 m

m2

26

44

/

17 m

m2

26

45

/

19 m

m2

26

46

* /

21

mm

22

63

0 /

9 m

m2

26

31

/ 1

1 m

m2

26

32

/

13 m

m2

26

33

/

15 m

m2

26

34

/

17 m

m2

26

35

/

19 m

m2

26

36

* /

21

mm

22

62

0 /

9 m

m2

26

21

/ 1

1 m

m2

26

22

/ 1

3 m

m2

26

23

/ 1

5 m

m2

26

24

/

17 m

m2

26

25

/ 1

9 m

m2

26

26

* /

21

mm

22

65

0 /

9

mm

2

26

51

/ 1

1 m

m

22

65

2 /

13 m

m

22

65

3 /

15 m

m

22

65

4

/ 17

mm

2

26

55

/

19 m

m

22

65

6*

/ 2

1 m

m

22

610

/

9 m

m2

26

11

/ 1

1 m

m2

26

12 /

13 m

m2

26

13 /

15 m

m2

26

14

/ 17

mm

22

615

/

19 m

m2

26

16*

/ 2

1 m

m

211

84

* /

8 m

m2

119

4 /

10 m

m2

118

3*

/ 8

mm

211

95

/ 1

0 m

m

211

82

* /

8 m

m2

119

3 /

10

mm

211

92

/

10 m

m

Ø29

Ø32

Ø35

Ø26

* Sp

ecia

l siz

es

22

30

8

60

32

24

03

22

22

310

2

23

02

22

30

8

60

32

24

03

22

22

310

2

23

02

82

10

66

21

06

42

10

6

01

10

60

31

06

80

10

66

01

06

40

10

66

012

26

010

2

Size

6Si

ze 2

Size

8Si

ze 4

Size

10

Tibi

al b

lock

s2

25

16 /

5

mm

22

517

/ 1

0 m

m2

25

18 /

5

mm

22

519

/ 1

0 m

m2

25

20

/

5 m

m

22

52

1 /

10 m

m

22

514

/

5 m

m2

25

15 /

10

mm

22

512

/

5 m

m2

25

13 /

10

mm

22

53

6 /

15

mm

22

53

8 /

15

mm

22

54

0 / 1

5 m

m

R-La

t / L

-Med

:R-

Lat /

L-M

ed:

R-La

t / L

-Med

: :de

M-L / taL-R

:deM-L / taL-

R2

25

34

/ 1

5 m

m2

25

32

/ 1

5 m

m2

25

37

/ 15

mm

22

53

9 /

15

mm

22

54

1 /

15 m

m

L-La

t / R

-Med

:L-

Lat /

R-M

ed:

L-La

t / R

-Med

: L-

Lat /

R-M

ed:

22

53

5 /

15

mm

22

53

3 /

15

mm

Post

erio

r2

22

12 /

5

mm

22

213

/ 1

0 m

m2

22

14 /

5

mm

22

215

/ 1

0 m

m

Post

erio

r2

22

16 /

5

mm

22

217

/ 1

0 m

m

Post

erio

r2

22

18 /

5

mm

22

219

/ 1

0 m

m

Post

erio

r2

22

20

/ 5

mm

2

22

21

/ 10

mm

Post

erio

r

22

22

8 /

5

mm

Dis

t / L

at:

22

23

1 /

5

mm

Dis

t / L

at:

22

23

4 /

5

mm

Dis

t / L

at:

22

23

7 /

5 m

mD

ist /

Lat

:2

22

40

/

5 m

m

22

22

9 /

10

mm

22

23

2 /

10

mm

22

23

5 /

10

mm

22

23

8 /

10

mm

22

24

1 /

10 m

m

Dis

t / L

at:

22

23

0 /

15

mm

22

23

3 /

15

mm

22

23

6 /

15

mm

22

23

9 /

15

mm

22

24

2 /

15

mm

22

24

9 /

5 m

m2

22

50

/ 10

mm

D

ist /

Med

L:

22

25

2 /

5

mm

22

25

3 /

10

mm

Dis

t / M

ed L

:2

22

55

/

5 m

m2

22

56

/ 1

0 m

mD

ist /

Med

L:

22

25

8 /

5

mm

22

25

9 /

10

mm

Dis

t / M

ed L

:2

22

61

/

5 m

m

22

26

2 /

10

mm

D

ist /

Med

L:

22

25

1 /

15 m

m2

22

54

/ 1

5 m

m2

22

57

/ 15

mm

22

26

0 /

15

mm

22

26

3 /

15

mm

22

270

/ 5

mm

22

271

/ 1

0 m

mD

ist /

Med

R:

22

273

/

5 m

m2

22

74 /

10

mm

Dis

t / M

ed R

:2

22

76 /

5

mm

22

277

/ 1

0 m

mD

ist /

Med

R:

22

279

/

5 m

m2

22

80

/ 1

0 m

mD

ist /

Med

R:

22

28

2 /

5

mm

2

22

83

/ 1

0 m

m

Dis

t / M

ed R

:

22

272

/ 1

5 m

m2

22

75 /

15

mm

22

278

/ 1

5 m

m2

22

81

/ 15

mm

22

28

4 /

15

mm

91

TC-P

LUS™

PS

Revi

sion

Fem

uror

al b

lock

sdi

stal

/ p

oste

rior

Pate

llar c

ompo

nent

s

92

Stra

ight

Ste

ms

Non

-cem

ente

d St

ems

Cem

ente

d St

ems

610

00

/ 8

0 m

m

610

02

/ 1

10 m

m

610

01

/ 15

0 m

m

611

14 /

4

0 m

m

611

01

/ 8

0 m

m

611

05

/ 1

10 m

m

611

16 /

15

0 m

m

611

15 /

4

0 m

m

611

02

/ 8

0 m

m

611

06

/ 1

10 m

m

611

09

/ 15

0 m

m

611

03

/ 8

0 m

m

611

07

/ 11

0 m

m

611

10 /

15

0 m

m

611

08

/ 1

10 m

m

611

11 /

15

0 m

m

611

12 /

15

0 m

m

611

13 /

4

0 m

m

611

00

/ 8

0 m

m

611

04

/ 1

10 m

m

Ø 1

2Ø

10

Ø 1

4Ø

16

Ø 1

8Ø

20

80

mm

150

mm

40

mm

110

mm

80

mm

150

mm

110

mm

93

2° V

algu

s St

ems

Non

-cem

ente

d St

ems

611

21

/

80

mm

6

112

5 /

110

mm

6

113

3 /

15

0 m

m

611

22

/

80

mm

6

112

6 /

110

mm

6

112

9 /

15

0 m

m

611

23

/

80

mm

6

112

7 / 1

10 m

m

611

30

/ 1

50

mm

611

28

/ 1

10 m

m

611

31

/ 15

0 m

m6

113

2 /

15

0 m

m

611

20

/ 8

0 m

m

611

24

/ 1

10 m

m

Ø 2

0Ø

18

Ø 1

6Ø

14

Ø 1

2Ø

10

80

mm

150

mm

110

mm

3,75

mm

Offs

et S

tem

s

Non

-cem

ente

d St

ems

611

41

/

80

mm

6

114

5 /

110

mm

6

115

3 /

15

0 m

m

611

42

/

80

mm

6

114

6 /

110

mm

6

114

9 /

15

0 m

m

611

43

/

80

mm

6

114

7 /

110

mm

6

115

0 /

15

0 m

m6

114

8 /

110

mm

6

115

1 /

150

mm

611

52

/ 1

50

mm

611

40

/ 8

0 m

m

611

44

/ 1

10 m

m

Ø 1

2Ø

14

Ø 1

6Ø

18

Ø 2

0Ø

10

94

611

21

/

80

mm

6

112

5 /

110

mm

6

113

3 /

15

0 m

m

611

22

/

80

mm

6

112

6 /

110

mm

6

112

9 /

15

0 m

m

611

23

/

80

mm

6

112

7 /

110

mm

6

113

0 /

15

0 m

m6

112

8 /

110

mm

6

113

1 /

150

mm

611

32

/ 1

50

mm

611

20

/ 8

0 m

m

611

24

/ 1

10 m

m

95

Note

96

Note

97

Note

ManufacturerSmith & Nephew Orthopaedics AG

Oberneuhofstrasse 10d6340 BaarSwitzerland

™ Trademark of Smith & Nephew 15801-en V1 (1402) 10/18

0 1 2 3

For further information please contactour local sales office.www.smith-nephew.com