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AKS - ANATOMIC KNEE SYSTEM

28.30 - Cemented Anatomic Knee ProsthesisSurgical Technique

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28.30 - Surgical TechniqueCemented Anatomic Knee Prosthesis

AKS – Anatomic Knee System

Material:Cr Co Mo Casting Alloy ASTM F-75Polyethylene – UHMWPE NBR ISO 5834-2

Indications:• Primary Osteoarthritis of the Knee• Post - Traumatic Osteoarthritis• Rheumatoid Arthritis• Traumatic and Non Traumatic Non-septic Avascular Necrosis• Degenerative Articulate Diseases in the Knee with

Pan – Articulate Commitment

TTTTTrays codes:rays codes:rays codes:rays codes:rays codes:CG.150, CG.151, CG.152.1 e CG.154CG.152 (Minimally Invasive)CG.152.2 (size 7)CG.154.1 e CG.154.2 (Revision)

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Initial holeMake the central hole with the initial BR.24 bit in theregion of the intercondylea, about 10mm before theinsertion point of the posterior crossed ligament.

Placement of the intramedular guidePlace the ME.20 guide in the hole so that it touches thedistal face of the femur, then, support the guide on theprevious cortical and on the posterior condyles. Measureand record the size of the femur, if the marking isbetween two sizes, chose the lower size.

To obtain the external rotation of 3o, place the fixationpin FG.27.2 in the suitable hole, according to theaffected side.

BR.24

ME.20

FG.27.2

Planning - Pre SurgicalTrace out the femur’s mechanical axis and central axis on the X-ray, with the template, determine the angle betweenthe center of the femur and the mechanical axis. Then, with the help of the templates, determine the size of theimplants to be used. After the definition of the implants use the corresponding instruments to make the respectivecuts.

Acces wayAfter the surgical access according to surgeon’s preferences, and the correct equilibrium of the soft portions thatshould follow the principles established in the literature, proceeding as follows:

Impact on the pin until it makes the hole in the boneitself.

Note: The external rotation will not be obtained whenthe condyles become deformed.

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GS.76.A/B

Correct Alignment

Incorrect Alignment

GS.76.A/B

GS.89GS.77

IP.60

Alignment guideThe intramedular guide is available in 2 shaft lengths,short guide GS.76.B and the long guide GS.76A, wherethis last one is most indicated for a perfect alignment.

Place the GS.76.A/B guide in the hole, place the guidewith an external rotation of 3o using the previously madeholes, place the FG.27.2 pin in the guide slot and thehole. Impact on the guide with the IP.60 impactor untilit touches the condylum, fix it with the respective pins.

Anterior cut guideAssemble the GS.89 gauge device on the anterior cutguide GS.77. Fit the cut guide to the alignment guideGS.76.A/B, until the gauge device touches the anteriorcortical, fix it and make the anterior cut.

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Distal cut guideAssemble the distal cut guide GS.79 on the alignmentguide GS.76.A/B, leaving the “D“ (right side) or “E“(left side) indication upwards according to the affectedside, Fit the guide pin in the hole Alignment guide thenfit the pin FG.27.2 at the angle ( 2o, 3o, 4o, 5o, 6o, 7o, 8o,9o, 10o and 11o ) as determined in the pre-surgical guide.Fix the guide with the respective pins.

Optional alignmentWith the guide pin fitted in the hole of the alignmentguide the GS.82 guide over the distal cut guide GS.79.Next, fit the mobile shaft GS.75.A/B to the GS.82 guide.The middle of the shaft should coincide with the centerof the femur head. As such the guide will be positionedto carry out the distal cut. Remove the alignment guideGS.76.A/B with the aid of the extractor EX.16.

GS.75.A/B

GS.79

GS.82

GS.76.A/B

GS.76.A/B

GS.79

FG.27.2

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RasgoProximal

GS.79RasgoDistal

Distal cutMake the distal cut of the femur using the distal slot ofthe guide GS.79. This cut removes the same quantityof bone that will be filled out by the femoral component"AKS" definitive. The proximal slot removes 3.5mm morebone than the distal slot. This cut may be use in theevent of contraction to the flexion or if the surgeon needsto cut out more of the bone due to other reasons.

Optional distal cutting outThe distal femur cutting out guide GS.78, allows for theremoval of another 3 or 5mm of distal bone. Place theFG.27.2 pins in the respective holes of 3 or 5mm forcutting out, support the guide on the anterior face ofthe femur and the pins on the previously cut distal face,fix the guide with the pins or with FG.27.3 screws andcarry out the cut through the suitable slot.

Definition of size of the definitivefemoral componentPlace the ME.21 measurer, supported on the distal faceof the Femur as previously cut, with the two forcepssupported on the condyles and the support pin on theprevious face. Check the size of the femoral component.If the marking is between two sizes, choose the smalleroption.

Posterior cut guide, chamfer and

GS.78

ME.21

FG.27.2

Previouslycut distal face

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cutting outSelect the final cut guide GS.81.3/4/5/6/7 as determinedin the previous procedure. Support on the anterior anddistal faces of the femur and centralize it middle –laterally. Fix the guide by the central holes with twoFG.27.1. pins

For a better stabilization of the guide, place the FG.27.3screws in the lateral holes. The screws may be placedmanually with the aid of the CH.75.B screw driver, orwith the FG.28 chuck attached to a drill.

For a greater stability of the cut guide during theresections, make the final cuts to the femur obeyingthe following sequence:1. Posterior Cut2. Posterior Chamfer3. Anterior Cut4. Anterior Chamfer

Use the central slot of the guide to make the cut to thebase of the trochlea. Use a narrow and long blade.

GS.81.Ref.

FG.27.3

GS.81.Ref.

GS.81.Ref.

1 2

3 4

FG.27.3

CH.75.B

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Use the slots of the anterior face of the guide to carryout the lateral cut of the trochlea.

Central cut for prosthesis withposterior stabilizationSelect the central cut guide GS.80.3/4/5/6/7 asdetermined by the size established by the previousguide. Support the guide on the anterior face and thedistal face of the femur, centralize it using the cut ofthe trochlea with the center of the guide as reference.Fix the guide with the aid of the FG.27.3 screws or theFG.27.1 and FG.27.2 pins. Make the central, lateral/medial cut, and then the intercondylar base.

GS.80.Ref.

FG.27.3

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Placement and extration ofthe fixing screwPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT – Fit the hex portion of the FG.27.3 screwto the hex portion of the chuck FG.28 and screw intothe bone until the hex portion of the chuck comes apartfrom the screw hex.

EXTRACTIONEXTRACTIONEXTRACTIONEXTRACTIONEXTRACTION – Push the cover until the chuck hexfits into the screw hex. Turn the chuck anti-clockwise toremove the screw.

Proximal tibial cutintramedullary guideMake the central hole with the BR.21.B bit in the positionanterior to the insertion of the anterior crossed ligamentand centralized in the middle-lateral position.

Place the GS.83 intramedullary shaft in the tibia’s hole,until the point of larger diameter of the shaft. Assemblethe GS.86 connection on the GS.88 cut guide, and thenassemble the guide set over the intramedullary shaft.Adjust the guide to the shaft and place the cut guideagainst the previous face of the tibia.

GS.83

GS.86

GS.88

FG.28

FG.27.3

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Use the GS.75.A guide shaft to check if the tibial cutguide is perpendicular to the mechanical axis of thetibia. If necessary, adjust the guide angle until itbecomes perpendicular.

Observe that the ME.19 gauge device has two flanges,one flange marking 2mm that is used to check the depthof the damaged tibial plateau and carry out the minimalresection, and a flange marking 10mm that is used tocheck the measurement of the intact plateau and makingan anatomic cut. Fit the 2mm flange in the cut guideslot and support the gauge device on the deepest pointof the tibial plateau.

GS.75.A

ME.19

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Fix the cut guide with the FG.23.3 screws. Then, remo-ve the intramedullary shaft with the aid of the EX.16extractor and the connector GS.86.

Carry out the proximal cut of the tibia through the guideslot.

EX.16

GS.83

GS.86GS.88

ME.19

FG.23.3

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Proximal tibial cutextramedullary guideThe GS.87 extramedullary guide tibial cuts permits avariation in thickness of the bone cut, after its alignment.As reference, align the mechanical axis of the tibia.

After the guide is fixed to the distal portion of the tibia,the proximal cut guide can be adjusted manuallyaccording to the deformity of the tibia.

GS.87

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Fit the 2mm flange in the guide slot and support theME.19 gauge device on the deepest point of the tibialplateau to carry out the minimum cut, or fit the 10mmflange in the guide slot and support the gauge deviceon the intact plateau to making an anatomic cut. Fixthe cut guide with the aid of the FG.27.3. screws.

With the GR.90 resection guide, check the cut positionon the medial, lateral and posterior portion of the tibia.

Carry out the proximal cut of the tibia through the guideslot.

GS.87

ME.19

GR.90

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Optional - cutting outthe tibial plateauUse the GS.84 - 2mm parallel cutting guide to cutmore than 2mm off the tibial plateau.

Use the GS.85 angled cutting guide to carry out theangled cut.

Preparation of the tibial plateauSelect the tibial plateau cut guide TT.30.3/4/5/6/7.Aaccording to the size of the guides used in the femoralcut. Assemble the plateau guide on the CH.80.A cableguide, pull the cable guide pin and assemble using a “V “ connection.

GS.84

GS.85

TT.30.Ref.A

CH.80.A

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Place the tibial plateau guide over the cut tibia face,the guide should completely cover the tibial plateau.Use the GS.75.A/B alignment bar to check thealignment. Fix the guide with 02 small nails - FG.27.1.

Fit the GS.73 drill bit guide to the two existing fixedpins over the tibial plateau guide. Make the centralorifice of the tibia with the BR.21.A BR.21.A BR.21.A BR.21.A BR.21.A bit until the markingcoincides with the face of the bit guide GS.73.

GS.75.A/B

TT.30.Ref.A

GS.73

BR.21.A

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Fit the RP.14.A (3-4), RP.14.B (5-6) and RP.14.C (7)spreader to the CH.79 broach cable. The broach maybe assembled solely from the front. Pull on the lockingpin, attach and assemble the broach.

Fit the base of the impactor to the tibial plateau guideand impact the broach until the marking coincides withthe cable face, then remove the broach.

CH.79

RP.14.A/B/C

Marcação

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Component tests – IAssemble the stabilized test femoral component -TT.24.3/4/5/6/7.D/E on the femur and assemble thestabilized polyethylene tibial component test - TT.27.34/56.7/10/12/14/17/20, or the non-stabilized femoralcomponent test - TT.23.3/4/5/6/7.D/E femur andassemble the stabilized polyethylene tibial componenttest TT.26.34/56.7/10/12/14/17/20 and check the correctoperation of the set during the flexo-extension of theknee.

Component tests – IISelect the metallic tibial component test - TT.25.3/4/5/6/7, screw in the IP.57.A impactor and impact on thetibia. To extract the test, screw on the IP.57.B extractorcable and carry out the extraction with the EX.16extractor.

Component tests – IIIAssemble the stabilized test femoral component -TT.24.3/4/5/6/7.D/E on the femur and assemble thestabilized polyethylene tibial component test - TT.27.34/56.7/10/12/14/17/20, or the non-stabilized femoralcomponent test - TT.23.3/4/5/6/7.D/E femur andassemble the stabilized polyethylene tibial componenttest TT.26.34/56.7/10/12/14/17/20 and check the correctoperation of the set during the flexo-extension of theknee.

TT.30.Ref.A

TT.26.Ref.Non-StabilizedTibia

TT.27.Ref.StabilizedTibia TT.23.Ref.

Non-StabilizedFemur

TT.24.Ref.StabilizedFemur

TT.25.Ref.

IP.57.A/B

TT.25.Ref.

TT.26.Ref.Non-StabilizedTibia

TT.27.Ref.StabilizedTibia TT.23.Ref.

Non-StabilizedFemur

TT.24.Ref.StabilizedFemur

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Checking alignment andthickness testCheck the thickness and the alignment of the cuts withthe knee flexed and extended. With the knee flexed,fit the TT.29.10/12/14/17/20 spacer between the driedout surfaces of the femur and tibia, then place theGS.75.A guide shaft and check the alignment. Removethe spacer, and extend the knee, fit in the spacer andplace the GS.75.A/B guide shafts and check thealignment, where the shaft should coincide with themechanical axis. If the height of the spracers is notcorrect in flexion and extension, remove further boneor release the soft tissue, as much as necessary.

TT.29.Ref.

GS.75.B

GS.75.A

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Cutting and drilling of the patellaWith the CH.77 patella cutting forceps, fix it insupporting on the 10mm ridge.

Cut the patella articulation surface.

Fit the GS.74 drill bit guide over the cut surface,centralize the guide and make the central hole with theBR.22 drill bit. Use the patellar test component -TT.28.32/34/36 for the tests.

Implanting the femoral,tibial and patellar componentAfter selecting the definitive implants, check if thechosen sizes 3/4/5/6 and 7, are compatible betweeneach other, and that the thickness of the polyethyleneis correct, then check if the colored labels on the boxare of the same color.

CH.77

CH.77GS.74

BR.22

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To start the assembly, place the definitive tibialpolyethylene component over the definitive metallictibial component, in the direction of fitting theforelock, forcing it with ones hand. Fit thepolyethylene impaction forceps - CH.73 at thelowering of the definitive metallic tibial component,and then lock the forceps on the implant using thelower flange, and press on the polyethylene until itfits in.

Place the final implant on the tibia, femur and patella,following the conventional cementing techniques.

CH.73

Rev.2009.03

Baumer S.A.Av. Prefeito Antonio Tavares Leite, 181 • Parque da Empresa • P.O.Box 1081 • 13.803-330 • Mogi Mirim • SP • Phone: 55(11) 3670-0020 • Fax: 55(11) 3670-0053www.baumer.com.br • e-mail: [email protected]

EC REPGi. Bi. S.a.s. Di Bisegna TatianaVia Rodolfo Lanciani, 26 - 00019 - Tivoli - Roma - ItalyP. IVA 05513281005 - 39 0774 33 3997

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