Surgical TechniqueIntramedullary Procedure

Rotating Hinge Knee System

Sawblade Thickness: 1.00mmOptional Thickness: 1.27mm

Product Identifiers – Knees II

Page 2 of 2 As of 06/02/2008

*smith&nephewRT-PLUS™ Rotating Hinged Knee

*smith&nephewRT-PLUS™

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*smith&nephewTC-PLUS™ REVISION Revision Knee System

*smith&nephewTC-PLUS™ REVISIONRevisions-Kniesystem

*smith&nephewRT-PLUS™ Rotating Hinged

*smith&nephewRT-PLUS™ Modular achsgeführtes Rotations nie -K

*smith&nephewRT-PLUS™ Modular Rotating Hinged

*smith&nephewRT-PLUS™

MODULAR Modulaire rotatoire à charnière

*smith&nephew

RT-PLUS™IM Procedure

Table of Contents

Introduction ........................................................................... 2General Warnings and Comments ........................................ 3Concept/Description ............................................................. 4Indications ............................................................................ 8Contraindications .................................................................. 8Case Study ............................................................................ 9Preoperative Planning ......................................................... 10Surgical Technique .............................................................. 13 - Femoral Preparation ...................................................... 17 - Tibial Preparation .......................................................... 27 - Patellar Preparation ...................................................... 35 - Implanting the Components ......................................... 37 Postoperative Treatment ..................................................... 41Sterilization ......................................................................... 42Implants .............................................................................. 44Instruments ........................................................................ 46Product Overview (Combination Tables) .............................. 57

1

Nota Bene

The technique description herein is made available to the healthcare professional to illustrate the author’s suggested treatment for the 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 RT PLUS™, 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.

2

The RT-PLUS prosthesis, that is in clinical use since 19961-9, is a valuable addition to bicondylar surface replacement.

With the rising number of implantations we are increasingly being confronted by cases which are difficult to treat and which require the use of special prosthetic systems using a higher degree of coupling. The RT-PLUS prosthesis has been designed to take this development into account.

For a rotating hinge knee, the functional design allows sparing resections. The joint components feature anatomical geometry, as also current primary knees, and can be either used for primary or revision cases.

Special attention was also paid to the development of a user-friendly instrument set.

Introduction

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 RT-PLUS™ knee systems. 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.

ImplantsRT-PLUS 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 RT-PLUS knee systems 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 responsiblefor 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 toRT-PLUS knee systems must also be followed.

General Warnings and Comments

3

4

Concept/Description

The RT-PLUS™ is a constrained rotating knee prosthesis for cemented implantation.

The prosthesis is designed to allow an internal/external rotation of approximately 10° in each direction, which is locked by the tibial insert when extended. The peg design provides the prosthesis with elongation capability, i.e., for distraction between the femoral and tibial components. In an extreme flexed position, the femoral component can be lifted off the tibial insert, which is intended to reduce the saggital leverage forces that have an effect on the prosthesis stem in this load situation.

The implant allows sparing resections. The cut compatibility with the tricompartmental prosthesis TC-PLUS permits, if necessary, an intraoperative switchover from the resurfacing to the constrained rotating knee.

The femoral and tibial components of RT-PLUS are identical to those of RT-PLUS Modular, with the exception of the additional option to connect stems and augmentation blocks. Since the tibial inserts are the same, the femoral and tibial components in both these systems are entirely cross-compatible.

The implants are available in five size (corresponding to TC-PLUS sizes 2, 4, 6, 8 and 10). Apart from size 2, the sizes can be combined with the next size up or down (see product overview on page 57).

The femoral and tibial components are anchored in the bone by cementable intramedullary stems. These are comparatively slim and short in design, in order to enable anchoring in narrow or dysplastic medullary cavities.

In the RT-PLUS knee system, the required stability and absorbtion of acting forces are assured by the joint mechanism between tibial and femoral components, the condylar articulating surfaces, the anchoring elements in the tibia and the femur and the still intact soft tissue structures.

Important

RT-PLUS requires condylar support for the femoral/tibial components. The forces have to be absorbed by both the condyles and the stems.

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Product DescriptionFemoral component

The femoral component, which is asymmetrical, is manufactured using a CoCrMo alloy.

The femoral patellar groove is deeply hollowed out and present a 6° oblique patella tracking.

The joint mechanism is contained in a narrow box (only 25mm) that keep an anterior bone bridge and require minimum bone resection, thereby reducing the risk of femoral condyle fracture.

The 40mm rotation peg enables a stable distraction up to 20 mm, thus providing protection against dislocation and ensuring smooth coupling characteristics of the components.

The special joint mechanisms are designed to enable a physiological roll-back of 9mm, which is intended to improve the flexion capacity of the joint. Furthermore, the rotation peg enables physiological internal and external rotation of 10° from 15° flexion.

The joint mechanism has been designed in such a way, that all metal components (rotation peg and transversal axis) are lined with UHMWPE to absorb the stress forces.

The slender tapered femoral stems allows a stable anchorage, even when the medullary cavity is restricted.

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

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 the TC-PLUS portfolio.

Please see the available sizes in the implant table (on page 44 ff).

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Tibial insert

The simple anchored tibial insert is manufactured from UHMW polyethylene and in order to restore the joint line, independently to the degree of tibial bone loss, three different heights (8, 11 and 14 mm) of tibial inserts are available.

ImportantThe tibial components thickness of 3mm need to be added to the tibial insert height of 8mm resulting in a total tibial height of 11mm, 14mm for a tibial insert of 11mm and 17mm for a tibial insert of 14mm, respectively.

The minimum effective PE thickness in the load zone is 8mm.

The special anchorage design of the polyethylene insert and method to place into the tibial component, enables an easy coupling of the prosthesis, for which only minimal distraction is required.

While the tibial insert is in place, it is additionally secured by a clamp that is locked with a PE pin.

The tibial inserts are identical to those in theRT-PLUS™ Modular portfolio.

Tibial component

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.

To improve flexion, the tibial component is designed with 3° posterior slope and need therefore to be aligned in rotation.

The slender tapered femoral and tibial stems allows a stable anchorage, even when the medullary cavity is restricted.

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

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Please see the available sizes in the implant table (on page 44 ff).

Tibial blocks (PE)

In order to compensate tibial bone defects, there are proximal tibial blocks available in height of 10mm.

The tibial blocks are manufactured from UHMW PE and are cemented both side (on bone & tibial component).

Before applying the cement on the tibial block, make sure that the component is clean of any fluid and particles.

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The principal preoperative planning factor is correct diagnosis. The surgeon must determine if the bone condition and stability require a constrained prosthesis implant.

The main indications for an RT-PLUS™ implant are:

• High grade joint destruction, with considerable loss of function and the need for additional stabilization using stems

• Severe joint instability that predictably cannot be corrected through suitable bone reconstruction (bone grafts) or soft tissue intervention

• Marked contractures and axial displacements exceeding 15-20°

• Failure after surface replacement (e.g., infection, loosening) revision of a primary prosthesis

Important

Due to the design, it is possible to switch with relatively little effort, even intraoperatively, from the TC-PLUS knee system to the RT-PLUS Modular knee system, since the resections and prosthesis sizes match.

Contraindications

Contraindications are:

• Acute or chronic local or systemic infections (or if a corresponding anamnesis occurs)

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

• A lack of bone substance or inadequate bone quality that endangers stable seating of the prosthesis

• Severe obesity

• All concomitant diseases that may endanger implant function. These include, in particular, extreme insufficiency of the knee extensor mechanism, which can lead to excessive joint distortion, or severe obesity, which can lead to dorsal impingement and possible uncoupling of the components. Use of a hinged or tumour prosthesis may be advisable in these cases

• Patient hypersensitivity or allergy to the materials used

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

Indications

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Case Study

Patient presenting with severe joint instability (valgus gonarthrosis), with a valgus angle of 25° and medial joint destruction.

Preoperative picture

Postoperative result

Immediately postoperatively: functional and pain-free reconstruction with RT-PLUS™ knee.

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A full leg x-ray, with the patient in 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. X-ray images of the knee joint at three levels should be available for planning the surgery. A tangential patellar view, a frontal view, and a view sagittal to the leg axis must be recorded.

X-ray templates with scales of 1.15:1 (Lit. No. 1069) and 1:1 (Lit. No. 1585) (see page 56) are available for preoperative planning. The lateral view of the condyles is decisive. If these are no longer completely intact, the condylar width can be used instead. In doubtful cases, the smaller implant should be selected to prevent the prosthesis components from protruding. The size determination and the correct positioning of the prosthesis are normally controlled intraoperatively using the relevant instruments, and planning may also be possible on the unrestored opposite leg.

Important

All femoral and tibial component sizes can be combined with the next size up or down (see product overview, starting page 57). This does not apply to combinations of sizes 2 and 4.

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 while planning the surgery.

Additional corrective osteotomies may be indicated, in rare cases of deformities away from the knee joint that negatively influence the mechanical leg axis.

Preoperative Planning

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

1. Femoral axis “A” (anatomical axis) is drawn onto the radiograph.

2. A line is drawn from the femoral head to the centre of the knee (mechanical axis “D”) on the radiograph.

3. Angle measured between anatomical and mechanical axes: Angle determines the valgus angle.

4. Tibial axis “B” is drawn in and tibial resection plane “E” is determined, in order to avoid excessive resection, especially if defects are present.

5. Component sizes and resection depths are determined preoperatively, using the x-ray templates (See page 57) in the A/P and lateral planes.

6. Mechanical leg axis “C” should merge with lines “D” and “B” after correction.

Planning the Surgery Using the Radiograph

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

Pre-op Post-op

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Surgical Technique

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Positioning the patient for surgery

Surgery is performed while the patient is supine.

The operation can be performed with or without tourniquet. It is recommended to use a flexible cover for the leg which allows a stable positioning of the knee joint in 90° of flexion.

Most of the surgical steps are performed in this position.

Surgical procedure

The skin incision can be a midline or a parapatellar incision.

If scars are present from skin incisions made during previous operations, use these for access is advisable in order to reduce the risk of cutaneous blood flow disorders. Medial arthrotomy or an approach adapted to the pathologic situation is recommended.

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

Implant components removal

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).

Overview of the Resection Sequences for Primary Application

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It is important to have identical flexion and extension gaps.

1. Distal femoral resection.

2. A/P femoral resection.

3. Chamfer resections and cutting out the box. Remove residual posterior condyles if present.

Important

To avoid the risk of a condyle fracture, we recommend preparing the box after tibial preparation.

4. Tibial resection and optional augment resection.

5. Patellar resection (optional).

Important

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

Overview of the Resection Sequences for Revision Application

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

1. Distal femoral resection.

2. A/P femoral resection.

3. Chamfer resections and cutting out the box. Remove residual posterior condyles if present.

Important

To avoid the risk of a condyle fracture, we recommend preparing the box after tibial preparation.

4. Tibial resection and optional augment resection.

5. Patellar resection (optional).

Important

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

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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 / 30 mm – 6x PAC (Art. No. 42000089)

Speed-Pins with Rim Ø 3.2 / 45mm– 6x PAC (Art. No. 42000176/75018973)

Speed-Pins Ø 3.2 / 65 mm – 6x PAC (Art. No. SYS251354)

Speed-Pins Ø 3.2 / 80 mm – 6x PAC (Art. No. SYS251355)

Speed-Pins Ø 3.2 / 110 mm – 6x PAC (Art. No. SYS251356)

AO Adapter for Speed-Pins (Art. No. SYS251316)

The speed-pins are delivered non-sterile and for multiple use. The limitation use of the speed pin is defined as the standard pin, until the functionality is no longer ensured.

Femoral Preparation

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Access: For initial access to the knee, refer to the relevant surgical textbooks.

Important

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

The leg is flexed and any osteophytes on the femur and tibia are removed. This will provide good exposure of the knee joint and thus facilitate size determination.

Femoral size determination

The femoral sizers (2, 4, 6, 8, and 10) are used to determine the size sagittally, based on the inside/outside contours, and ventrally, based on the anterior/posterior resections and the medial/lateral contours.The additional marking lines correspond to the augmentation blocks.

ImportantThe red line in the sagittal view, as well as the hole in the frontal view of the femoral sizer, shows the position of the femoral IM canal, i.e., the position of the stem.

While taking measurements, note the marks corresponding to medial and lateral: LEFT and medial.

Femur opening

Set the adjustable IM femoral drill guide to the planned size of the femoral component (size marking 2, 4, 6, 8, or 10) and insert under the quadriceps into the centre of the femur. The distal stop should rest on the medial condyle. Make sure the gauge lies flat against the anterior femoral cortical bone in the direction of the femoral axis.

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Important

To ensure optimal positioning of the femoral drill guide on the condyles, gently tap the M/L area – not the drill guide section of the instrument.

Open the femoral IM canal as far as the stop, using the ∅ 8/14 mm IM stepped drill. The drill direction is along the femoral axis.

Important

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

Using the modular handle, carefully insert the ∅ 8 mm IM rod approximately up to the isthmus of the femoral IM canal and then remove.

It is important to work carefully, to prevent excessive pressure in the IM canal.

Preparing the femoral anchorage

Open the femoral IM canal with the long ∅ 14 mm reamer until the mark on the reamer reaches the intercondylar notch, or the bone resection if performing a revision.

The reamer should be aligned parallel to the femoral anatomical axis, both anteriorly and laterally. Now remove the modular handle.

If an intramedullary obstacle is encountered (e.g., a hip implant), the short reamer may be used as an alternative.

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Locating the distal femoral cutting block

The 6° femoral bushing corresponds to the angle α that was determined in the preop-erative planning. The femoral bushing is inserted into the femoral suspension device, so that, depending on the operated leg, the mark L for “left knee” or R for “right knee” is visible on the arrow .

Important

Make sure the femoral bushing is inserted in the correct position (“L” or “R”). If necessary, this can be corrected by removing, rotating 180°, and reinserting the femoral bushing.

Screw the femoral/tibial cutting block to the femoral suspension device and position over the reamer extension (∅ 8 mm). The handles can then be attached.

Important

In revision cases, the revision spacer for femoral condyle is attached to the femoral suspension device. This serves as a substitute for the missing distal bone substance. The resulting resection is still 2 mm.

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

After preliminary drilling with the ∅ 3.2 mm drill, set the femoral suspension device in place distally using a bone pin (75 mm long).

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After preliminary drilling with the ∅ 3.2 mm drill, set the femoral/tibial cutting block in place by inserting two bone pins (75 mm long) through the holes marked “0”. This position resects 9 mm from the distal femur – a distance corresponding to the distal thick-ness of the femoral prosthesis.

Important

To prevent any conflict with the reamer, the most lateral 0 pinhole of the femoral/tibial cutting block should be favoured.

Remove the bone pin on the femoral suspension device, using the pin extractor. After loosening the fixation screw, remove the reamer (∅ 14 mm) using the modular handle.

Now remove the suspension device.

Important

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

If the resection stylus is used, the distal femoral resection can be checked.

Distal femoral resection

Slide the femoral/tibial cutting block onto the bone. Perform the distal femoral resection using a 1 mm (or 1.27 mm option) saw blade through the 0 saw slot (closed slot with facet).

Important

To lock the femoral/tibial cutting block, an additional pin can be inserted into the ob-lique holes marked “AUX”. Remove the pin after resection.

If an extension deficit is present, moving the distal resection 2–4 mm proximally to adjust the extension gap is recommended. For hypermobile patients, a 2 mm smaller distal femoral resection is recommended.

The distal resection serves as a reference for the following steps, and has to be checked for accuracy.

Important

The femoral/tibial cutting block should not be removed yet, since it will be used later.

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Controlling the femoral size

Recheck and definitively determine the femoral size.

Important

During medial/lateral (M/L) measurement, use the sizer external width as a reference.

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

Locating the A/P femoral cutting block

Reinsert the reamer into the femoral IM canal and mount the A/P femoral cutting block on the reamer.

The rotation of the A/P femoral cutting block is adjusted by applying the femoral/tibial cutting block anteriorly.

Important

If the rotation of the A/P femoral cutting block has to be readjusted, it is set visually in relation to the epicondylar axis using the attached side handles.

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

Checking the resections

Using the resection stylus, check the anterior and posterior resection planes and heights.

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A/P and chamfer resections

Perform the anterior femoral resection through the closed saw slot with the 1 mm (or 1.27 mm option) saw blade (anterior slot with facet).

Important

If the M/L ligaments have not been resected, they must be protected during all resections.

Perform the posterior femoral resection through the two open posterior saw slots (slots with facets).

Perform the femoral chamfer resections through the corresponding slots (slots with facets).

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Preparing the femoral box (EM)

Use the centring template to position the femoral box saw guide and femoral compo-nent mediolaterally. Insert the template through the anterior saw slot of the A/P femoral cutting block based on femoral size, to make a mark (e.g., using electrocautery or a pin) on the anterior cortical bone.

Important

To improve support for the Hohmann, we recommend preparing the femoral box after tibial preparation.

Anterior bone substance must be available for this procedure!

Remove the A/P femoral revision cutting block and check the femoral resections.

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Align the femoral box saw guide (guides for size 2 and sizes 4–10) with the anterior cortical bone marking, and set in place with bone pins.

Important

It is important that the box saw guide is flush with the resections.

The side handles can be attached to the box saw guide.

Perform the resections using a special 13 mm wide saw blade. Insert the saw blade up to the RT 45 mark (this corresponds to a depth of 45 mm).

Important

Protect the vessels and nerves in the pop-liteal fossa.

If using the guide for sizes 4–10, make the anterior box cut through the saw slot of the appropriate size.

Remove the box saw guide.

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Excavate the femoral box along the outer limits marked and prepared with the saw blade, using a thin, straight osteotome and a Luer. (Using the osteotome, carefully extend the two lateral box cuts posteriorly.)

From the anterior side, introduce the narrow saw blade (or an osteotome) into the IM canal hole in order to cut the posterior cortical box bone.

Important

To protect the important posterior soft tissues, place a Hohmann centrally on the posterior condyle.

Cut off the upper bone edge to provide space for the rounding from the patellar shield to the box wall.

Important

It may be helpful to prepare a “cross” with the saw used for removing the femoral box. The remaining triangle of bone is finally removed with a Luer.

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Check box position and box depth, and finalize with the box rasp (rasps for size 2 and for sizes 4–10).

Important

Introduce the box rasp only in the longitudi-nal direction; do not jam or tilt it, since this can cause breakage of the femoral condyle.

Controlling the femoral resections and anchorage

Insert the femoral trial using the impactor.

Removing residual dorsal condyles

Important

This must be checked in all cases!

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

Important

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

The femoral trial can be removed by using the Knock In/Out instrument. If necessary, it can be left in place to protect the femoral condyle during tibial preparation.

Tibial Preparation

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

Opening the tibia

Remove the intercondylar eminence.

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

Position the hole centrally M/L, 1/3 of the distance from the anterior surface.

Carefully insert the ∅ 8 mm IM rod using the modular handle approximately to the isthmus of the tibial IM canal, then remove.

It is important to work carefully, to prevent excessive pressure in the IM canal.

Preparing the tibial anchorage

Open the tibial IM canal with the long ∅ 14 mm reamer until the mark on the reamer reaches the bone level, or the bone resection if performing a revision.

The reamer should be aligned parallel to the tibial anatomical axis, both anteriorly and laterally. Now remove the modular handle.

If an intramedullary obstacle is encountered, the short reamer may be used as an alternative.

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Join the two tibial resection guide IM compo-nents by aligning arrow with arrow and pressing the button.

Attach the femoral/tibial cutting block to the tibial resection guide IM with the small top grub screw and slide fully onto the reamer extension (∅ 8 mm).

Important

Ensure the lock lever is set to “OPEN” so that the tibial resection guide IM can be slid into place. Then reverse the lock lever to set the tibial resection guide IM in place.

First, lift the femoral/tibial cutting block upwards by pressing the button so that the tibial stylus can be attached.

Setting the resection height

Position the tibial stylus on the tibial plateau. The tibial stylus can be used for both primary resections (11 mm marking) and revision resections (1 mm marking).

Important

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

In revision procedures, the 1 mm tibial stylus is positioned on the lowest point of the less damaged condyle.

In cases where a tibial augmentation block is required (10 mm bone defect compensa-tion is possible), the 1 mm tibial stylus is positioned on the lowest point of the less damaged condyle.

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Checking alignment and tibial resection

Recheck the alignment using the axial align-ment rod. The rod tip must point to the centre of the ankle joint.

The tibial stylus can now be removed.

Check the resection height using the resection stylus.

After preliminary drilling with the ∅ 3.2 mm drill, set the femoral/tibial cutting block in place by inserting two bone pins (75 mm or 100 mm long) through the holes marked “0”.

Set the lock lever to “OPEN” and remove the tibial resection guide IM from the femoral/ tibial cutting block by unscrewing the top grub screw.

Remove the reamer (∅ 14 mm), using the modular handle once again.

Slide the femoral/tibial cutting block onto the bone.

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Tibial resection

Perform the tibial resection using a 1 mm (or 1.27 mm option) saw blade through the 0 saw slot (closed slot with facet).

To lock the femoral/tibial cutting block securely, an additional pin can be inserted into the oblique holes marked “AUX”. Remove the pin after resection.

Important

If the M/L ligaments have not been resected, they must be protected during all resections.

When using a tibial augmentation block, the femoral/tibial cutting block can be shifted downward by positioning one of the two bone pins in the holes marked “10”.

Checking the joint gaps

Check the tension in both flexion and extension with spacers. The spacers (8, 11, and 14) represent the heights of the femoral component and the full tibial component (tibial component and tibial insert).

Important

When using a 10 mm tibial augmentation block, attach two 10 mm corresponding spacer blocks to the spacer.

If necessary, perform additional release or resection.

Important

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

Next, remove the two bone pins in the tibia.

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Tibial size determination

Assemble the tibial sizer trial and handle, and place on the resected bone surface.

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 combi-nation!). The correct tibial size is then determined.

Important

A size 2 tibial component cannot be com-bined with a size 4 femoral component.

Setting the tibial rotation

The tibial rotation is determined anatomically and statically (orientation in relation to the tibial tuberosity, and the axial alignment rod tip must point to the centre of the ankle joint).

After preliminary drilling with the ∅ 3.2 mm drill, set the tibial sizer in place using at least two bone pins with heads.

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Preparing the tibial IM canal

Prepare the proximal tibial anchorage using the osteotome and rasp.

Using the thin, narrow 10 mm chisel; prepare the tibial cavity initially along the internal sizer contour, thereby avoiding bone frac-tures especially if the bone quality is poor.

Important

If sclerotic bone is present, preparation of the fins is especially important! These can also be used as a reference for the tibial rotation positioning.

The tibial sizer can be removed if necessary.

Using the tibial rasp, complete preparation of the proximal tibial cavity. The rasp must be knocked in far enough to ensure the top of the rasp is flush with the (more proximal) bone resection (or flush with the height of the lower plane of the tibial sizer).

Important

To avoid bone fractures, knock the rasp in carefully.

To protect the sharp threads of the rasp, perform rasping without the tibial sizer if necessary. In this case, use a thin chisel or electrocautery to mark the tibial anchorage fin positions on the bone in order to guide the rasp.

If a 10 mm tibial augmentation block is used, rasping down to the resection level is not necessary. The rasp must be impacted until the 10 mm line marked on it is flush with the bone resection.

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Trial reduction

The purpose of the trial reduction is to check the radius of movement, the patellar tracking, and the tension of the soft tissue mecha-nism. Insert the tibial trial first, followed by the femoral trial using the impactor.

Important

If a 10 mm tibial augmentation block is used, appropriate block trials, which can then be applied to the tibial trial, are available.

Attach the appropriate tibial insert trial, which has been previously defined with the spacer, to the rotation peg of the femoral trial in the 90° flexed position, and insert into the tibial trial by hand.

Check implant fit, knee joint kinematics, and patellar function.

Important

At this point, a definitive decision regarding patella replacement should be made (see instructions, starting page 35).

34

When the definitive implants have been selected, prepare the components for implantation (see instructions, starting page 37).

Remove the trial components with the Knock In/Out instrument, starting with the femur.

Patellar Preparation

35

The leg should be 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, all osteophytes should be removed from the patella, which is then denerved.

Positioning the patellar clamp and performing patella resection

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

An alternative option is the “inlay” technique, in which the implant is partially countersunk (3 to 5 mm). Here, the patella is only resect-ed approximately 7 to 5 mm below the ridge. The thickness of the residual bony patella should be no less than 12 mm. See also the “Milling” section on page 36.

After placing the patellar cutting guide on the patellar clamp with the ratchet, grasp the patella with the clamp. A patellar thickness reading can be taken using the mm scale on the handle.

Adjust the patella osteotomy insert (mm scale) to the height for resection, and resect the patella using the oscillating saw (1 mm saw blade with unset teeth or 1.27 mm respectively).

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

Patellar size determination

Determine patellar size using the patellar sizer. Supplied sizes are ∅ 26, ∅ 29, ∅ 32, and ∅ 35 mm. Note that the patellar compo-nent is implanted with a slight medial offset, thus matching the position of the natural patellar ridge. Small implant sizes are recom-mended for small patellas, to enable repro-duction of this offset.

36

Milling

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

Select the patellar reamer that will match the patella size. Depending on the selected anchoring technique, mill briefly (“onlay” technique) or countersink by 3 to 5 mm (“inlay” technique). Milling down to the stop will produce a depth of 5 mm.

Important

Patellar implants 10 mm high are recom-mended as standard. Implants with a height of 8 mm are available as an alternative for thin patellas.

Drill anchoring holes

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

Trial reduction

Patellar trials are available for trial reduction.

Implanting the Components

37

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

The RT-PLUS™ knee is used with cement. Cement the tibial component first, followed by the femoral component. Filling the IM canals using a cement gun is recommended.

Important

When the stems are inserted halfway, ensure the rotational alignments of the femoral and tibial components correspond to the definitive implant positions.

In the presence of sclerotic bone, we recommend drilling several holes using a 3.2 mm drill. This improves anchorage between the bone cement and the bone.

Insert the corresponding 10 mm tibial augmentation block size based on the selected tibial component size. The tibial augmentation block must be cemented on both sides, between the tibial component/tibial augmentation block and the tibial augmentation block/bone resection. Ensure the tibial augmentation block is clean and dry before applying the cement!

Insert the intramedullary plugs as needed, 10 cm into the tibia and 12 cm into the femur for sizes 4 to 10, or 9 cm into the tibia and 11 cm into the femur for size 2.

Implanting the tibial and femoral components

In the 90° flexed position, hammer in the tibial component (see page 44 ff) using the corresponding impactor. Carefully remove excess cement. The implant components must be under continuous pressure while the cement is setting.

Important

Make sure cement is applied between the fin and stem connections when using tibial blocks.

38

Hammer in the femoral component (see page 44 ff) using the impactor. Here too, continu-ous pressure must be maintained and excess cement removed.

Important

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

Before the femoral component cement has set, the plastic lug that protects the box from cement infiltration must be removed.

Final check

Use the tibial insert trial for a final trial reduction prior to definitive assembly of the tibial insert.

Before the cement has set, remove any excess cement in extension.

Insertion of tibial insert

The tibial insert of the corresponding size (see page 44 ff) can only be inserted when the cement has fully hardened.

In the 90° flexed position, place the tibial insert on the femoral component rotation peg and slide into the tibial component by hand.

Important

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

Handle the tibial insert carefully, to prevent the anterior metal clamp from falling out.

39

Fixation of the tibial insert

Place the impacting attachment on the plug inserter.

In the extension position, fully insert the tibial insert clamp by hand, in an anterior to poste-rior direction, using the plug inserter with the impacting attachment fitted.

It should end up flush against the tibial insert and the tibial component.

Remove the impacting attachment from the plug inserter.

To secure the clamp, insert the plug inserter, in the 90° flexed position, into the anterior tibial insert hole over the polyethylene plug. Set the polyethylene plug in the clamp by applying pressure until the stop on the plug inserter is reached.

Important

If a tibial insert needs to be removed from the tibial component, drill the polyethylene plug to a depth of 6–8 mm using a 3.2 mm drill and remove the clamp from the anterior side. Ensure any tibial inserts that were removed are not reused.

40

Implanting the cemented patellar component

If patellar replacement is indicated, the patellar component (see page 44 ff) of the TC-PLUS™ knee system is used since the geometry of the patellar groove is matched to this implant.

Mount the patellar inserter on the patellar clamp with the ratchet. Use cement to coat the back of the patellar component and to fill the three peg holes of the patella. Insert the patellar component by hand with the leg extended and press in, using the patellar clamp with the ratchet fitted with the patellar inserter. Remove excess cement. Leave the clamp in place until the cement has completely set.

Wound closure

The wound must again be rinsed out thor-oughly after the implant process. Close the wound in layers, inserting two intraarticular and one subcutaneous Redon drain(s).

Postoperative Treatment*

41

Rehabilitation

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

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

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

*Postoperative care is individualized and is determined by the physician based on the patient's injury pattern, unique patient anatomy, and pathologic kinematics. Not all patients will have the same surgical procedure or timelines for rehabilitation.

The views and opinions expressed for postoperative care are for informational and educational purposes only. Smith & Nephew does not provide medical advice. In no event shall Smith & Nephew be liable for any damages whatsoever (including, without limitation, damages for loss of business profits, business interruption, loss of business information, or other pecuniary loss) arising out of the use of or inability to use the expressed views.

42

Implants

All the implants described in this Surgical Technique are sterile when they are delivered by the manufacturer. Implants must never be re-sterilized.

Instruments

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 document no. 03389).

The applicable settings should be verified by the user in accordance with the instructions for use issued by the autoclave manufacturer. Instrument manufacturers and dealers accept no responsibility for sterilization of products by the customer.

Sterilization

43

44

RT-PLUS™ Implants for cemented procedure

Set SAP No. 75300029 (8 mm)75300028 (10 mm)

Set SAP No. 75300187

Femoral components left

SAP No. Art. No. Size75005499 24122 275005500 24124 475005501 24126 675005502 24128 875005503 24130 10

Patellar components

SAP No. Art. No. Size Height75004784 * 21182 * ∅ 26 mm 8 mm75004787 21192 ∅ 26 mm 10 mm 75004785 * 21183 * ∅ 29 mm 8 mm75004788 21193 ∅ 29 mm 10 mm 75004786 * 21184 * ∅ 32 mm 8 mm75004789 21194 ∅ 32 mm 10 mm 75004790 21195 ∅ 35 mm 10 mm

* Special sizes (on request)

right Set SAP No. 75300186

SAP No. Art. No. Size75005494 24102 275005495 24104 475005496 24106 675005497 24108 875005498 24110 10

Implants

Tibial components

SAP No. Art. No. Size75005504 24142 275005505 24144 475005506 24146 675005507 24148 875005508 24150 10

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

Tibial inserts SAP No. Art. No. Size Height75005461 24046 2 8 mm75005470 24047 2 11 mm75005481 24048 2 14 mm 75005482 24056 4 8 mm75005483 24057 4 11 mm75005484 24058 4 14 mm 75005485 24066 6 8 mm75005486 24067 6 11 mm75005487 24068 6 14 mm 75005488 24076 8 8 mm75005489 24077 8 11 mm75005490 24078 8 14 mm 75005491 24086 10 8 mm75005492 24087 10 11 mm75005493 24088 10 14 mm Tibial blocks SAP No. Art. No. Size Height75005509 24151 2 10 mm75005510 24153 4 10 mm75005511 24155 6 10 mm75005512 24157 8 10 mm75005513 24159 10 10 mm

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

Set SAP No. 75300189

Set SAP No. 75300188

45

46

RT-PLUS™ Instrument Set (1mm) Instrument Set: SAP No. 75210206Art. No. 0944260

Femoral Instruments Case Set: SAP No. 7521023 Art. No. 0944270

SAP No. Art. No. Description Size Quantity 75005069 22000403 Case Femoral Instruments, Empty – 1 75007661 990019 Case lid – 11 75005077 22000416 IM Femoral Drill Guide, Adjustable – 12 75005902 252746 Resection Stylus 1 mm 13 75007148 600187 Femoral Suspension Device Revision – 14 75007144 600183 Femoral Distal Spacer Revision 7 mm 15 75007145 600184 Femoral Bushing 6° 16 75005057 22000380 Femoral Sizer 2 1 75005058 22000381 Femoral Sizer 4 1 75005059 22000382 Femoral Sizer 6 1 75005060 22000383 Femoral Sizer 8 1 75005061 22000384 Femoral Sizer 10 17 75005052 22000373 Femoral Cutting Block (1 mm) 2 1 75005053 22000374 Femoral Cutting Block (1 mm) 4 1 75005054 22000375 Femoral Cutting Block (1 mm) 6 1 75005055 22000376 Femoral Cutting Block (1 mm) 8 1 75005056 22000377 Femoral Cutting Block (1 mm) 10 18 75100222 22000548 Centring Template 1 mm 19 75005857 252068 Quick Lock Handle – 2 75005663 251073 IM Drill with Starter Tip ∅ 8 mm 1 75005079 22000418 Stepped Drill ∅ 8/14 mm 1 75005659 251065 Pin Drill ∅ 3.2 mm 2 75007140 600179 Bone Pin 75 mm 4 75007141 600180 Bone Pin 100 mm 4 75007138 600177 Bone Pin with Head 25 mm 4 75007139 600178 Bone Pin with Head 38 mm 4 75018329 MEM01179 Allen Wrench SW 3.5 1 75005420 240391 Pin Extractor – 1 75005455 240451 Box Rasp 2 1 75005456 240452 Box Rasp 4–10 1 75099152 22000539 Box Saw Guide – EM (1 mm) 2 1 75099153 22000540 Box Saw Guide – EM (1 mm) 4–10 1

Instruments

47

7

1

4

2

8

6

9

5

3

48

Femoral Trials Case Set: SAP No. 75210233 Art. No. 0944272

SAP No. Art. No. Description Size Quantity 75005070 22000404 Case Femoral Trials, Empty – 1 75007661 990019 Case lid – 11 75005327 240051 Femoral Trial Left 2 1 75005314 240023 Femoral Trial Left 4 1 75005315 240024 Femoral Trial Left 6 1 75005316 240025 Femoral Trial Left 8 1 75005328 240052 Femoral Trial Left 10 12 75005329 240053 Femoral Trial Right 2 1 75005320 240040 Femoral Trial Right 4 1 75005321 240041 Femoral Trial Right 6 1 75005322 240042 Femoral Trial Right 8 1 75005330 240054 Femoral Trial Right 10 13 75007169 600238 Curved Osteotome – 14 75005359 240135 Knock In/Out Instrument – 15 75005063 22000395 Adapter to Modular Handle SW 6 1 Optional Drill with AO Connection (on request) Set: SAP No. 75210232 Art. No. 0944271

SAP No. Art. No. Description Size Quantity 75005078 22000417 Stepped Drill with Stop (AO) ∅ 8/14 mm 1 75005673 251097 IM Drill with Starter Tip (AO) ∅ 8 mm 1 75005672 251096 Drill (AO) ∅ 3.2 mm 1 Optional 1.27 mm Cutting Blocks (on request) Set: SAP No. 75210234 Art. No. 0944273

SAP No. Art. No. Description Size Quantity7 75000750 22000387 Femoral Cutting Block (1.27 mm) 2 1 75000751 22000388 Femoral Cutting Block (1.27 mm) 4 1 75000752 22000389 Femoral Cutting Block (1.27 mm) 6 1 75000753 22000390 Femoral Cutting Block (1.27 mm) 8 1 75000754 22000391 Femoral Cutting Block (1.27 mm) 10 13 75095269 22000524 Femoral/Tibial Cutting Block (1.27 mm) – 1 75023715 22000511 Box Saw Guide – EM (1.27 mm) 2 1 75023716 22000512 Box Saw Guide – EM (1.27 mm) 4–10 18 75100223 22000549 Centering Template (1.27 mm) 1.27mm 12 75017385 22000442 Resection Stylus (1.27mm) 1.27mm 1

49

A 2

3

5

4

50

Tibial Instruments Case Set: SAP No. 75210235Art. No. 0944274

SAP No. Art. No. Description Size Quantity 75005071 22000405 Case Tibial Instruments, Empty – 1 75007661 990019 Case lid – 11 75023718 22000514 Holder Tibial Resection Guide IM – 12 75023727 22000523 Support Tibial Resection Guide IM ± 6 mm 13 75099151 22000538 Femoral/Tibial Cutting Block (1mm) – 14 75010947 600173 Tibia Stylus 1 mm/11 mm 15 75007168 600232 IM Rod ∅ 8 mm 16 75005067 22000401 Reamer, Long ∅ 14 mm 1 75005068 22000402 Reamer, Short ∅ 14 mm 17 75007098 600112 Reamer Handle – 18 75007202 600300 Modular Handle – 29 75005076 22000415 Adapter to Modular Handle SW 3.5 1 75007190 600288 Impactor Small – 1 75007191 600289 Impactor Large – 1 75005457 240455 Spacer 8 mm 1 75005458 240456 Spacer 11 mm 1 75005459 240457 Spacer 14 mm 1 75005382 240230 Spacer Attachment 10 mm 2 75018080 22000443 Chisel Handle – 1 75100517 75100517 Chisel Blade 12mm/40mm 1

51

8

7

1

9

B

3

5 46

52

Tibial Trials Case Set: SAP No. 75210236 Art. No. 0944275

SAP No. Art. No. Description Size Quantity 75100392 22000569 Case Tibial Trials, Empty – 1 75007661 990019 Case Lid – 11 75005331 240055 Tibial Trial 2 1 75005317 240026 Tibial Trial 4 1 75005318 240027 Tibial Trial 6 1 75005319 240028 Tibial Trial 8 1 75005332 240056 Tibial Trial 10 12 75005064 22000398 Tibial Insert Trial 2/8 mm 1 75005065 22000399 Tibial Insert Trial 2/11 mm 1 75005066 22000400 Tibial Insert Trial 2/14 mm 13 75005333 240075 Tibial Insert Trial 8 mm 1 75005334 240076 Tibial Insert Trial 11 mm 1 75005335 240077 Tibial Insert Trial 14 mm 14 75005026 22000318 Tibial Sizer 2 1 75005027 22000319 Tibial Sizer 4 1 75005028 22000320 Tibial Sizer 6 1 75005029 22000321 Tibial Sizer 8 1 75005030 22000322 Tibial Sizer 10 15 75007137 600175 Tibial Sizer – Handle – 16 75007135 600172 Axial Alignment Rod (I/II) – 17 75005074 22000412 Tibial Rasp 2 18 75005075 22000413 Tibial Rasp 4–10 19 75005371 240176 Plug Inserter – 1 75005372 240177 Impacting Connection – 1

Optional Tibial Block Trials (on request) Set: SAP No. 75210237Art. No. 0944276

SAP No. Art. No. Description Size Quantity 75005375 240200 Tibial Block Trial 2/10 mm 1 75005376 240201 Tibial Block Trial 4/10 mm 1 75005377 240202 Tibial Block Trial 6/10 mm 1 75005378 240203 Tibial Block Trial 8/10 mm 1 75005379 240204 Tibial Block Trial 10/10 mm 1 75005382 240230 Spacer Attachment 10 mm 2

53

2

1

3

87

9

6

54

54

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

SAP No. Art. No. Description Size Quantity 75018088 22000451 Case Patellar Instrument, Empty – 1 75007661 990019 Case Lid – 11 75005702 251204 Patellar Clamp – 12 75005881 252203 Patellar Clamp Cutting Guide 1 mm 1 75005723 251292 Patellar Trial ∅ 26 / 10 mm 1 75005724 251293 Patellar Trial ∅ 29 / 10 mm 1 75005725 251294 Patellar Trial ∅ 32 / 10 mm 1 75005726 251295 Patellar Trial ∅ 35 / 10 mm 1 75005717 251278 Patellar Drill with Stop ∅ 5.5 mm 1 75005719 251282 Patellar Sizer – 1 75005716 251277 Patellar Inserter – 1 75005707 251230 Patellar Clamp Bushing ∅ 26 mm 1 75005708 251231 Patellar Clamp Bushing ∅ 29 mm 1 75005709 251232 Patellar Clamp Bushing ∅ 32 mm 1 75005710 251233 Patellar Clamp Bushing ∅ 35 mm 1 75005711 251240 Patellar Drill Guide ∅ 26 mm 1 75005712 251241 Patellar Drill Guide ∅ 29 mm 1 75005713 251242 Patellar Drill Guide ∅ 32 mm 1 75005714 251243 Patellar Drill Guide ∅ 35 mm 1 75005706 251216 Patellar Mill with Stop ∅ 26 mm 1 75005720 251283 Patellar Mill with Stop ∅ 29 mm 1 75005721 251284 Patellar Mill with Stop ∅ 32 mm 1 75005722 251285 Patellar Mill with Stop ∅ 35 mm 1 275005034 2000327 Bone Thickness Sizer – 1

Optional Patellar Trials 8 mm (on request) Set: SAP No. 75200212 Art. No. 0944008

SAP No. Art. No. Description Size Quantity 75005703 251209 Patellar Trial ∅ 26 / 8 mm 1 75005704 251210 Patellar Trial ∅ 29 / 8 mm 1 75005705 251211 Patellar Trial ∅ 32 / 8 mm 1

Optional Reamer/Drill with AO Coupling Type (on request) Set: SAP No. 75200251 Art. No. 0944049

SAP No. Art. No. Description Size Quantity 75004871 22000152 Patellar Drill with Stop (AO) ∅ 5.5 mm 19 75004989 22000280 Patellar Mill with Stop (AO) ∅ 26 mm 1 75004990 22000281 Patellar Mill with Stop (AO) ∅ 29 mm 1 75004991 22000282 Patellar Mill with Stop (AO) ∅ 32 mm 1 75004992 22000283 Patellar Mill with Stop (AO) ∅ 35 mm 1

2 75100223 252203 Patellar Clamp Cutting Guide (1.27 mm) 1.27 mm 1

Optional Instrument Set (1.27mm) Set: SAP No. 75210387

55

1

2

3

6

5

47

98

56

Documents

Important

The following documents are available for your assistance.

Product-accompanying Documents

Description Lit. No.Sawblade Portfolio 01218Surgical Technique Intramedullary Procedure 15901 (1740)Product Information 15902 (1070)X-Ray Templates (1.15:1) 1069-A-BX-Ray Templates (1:1) 1585-A-BProduct Overview 1345System Specification Guide & Product Catalog 04805

Ø26

Ø29

Ø35

Ø32

Size

4Si

ze6

Size

8Si

ze10

Size

2

7500

5494

- 24

102

7500

5499

- 24

122

7500

5495

- 24

104

7500

5500

- 24

124

7500

5496

- 24

106

7500

5501

- 24

126

7500

5497

- 24

108

7500

5502

- 24

128

7500

5498

- 24

110

7500

5503

- 24

130

7500

5509

- 24

151

7500

5510

- 24

153

7500

5511

- 24

155

7500

5512

- 24

157

7500

5513

- 24

159

7500

5504

- 24

142

7500

5505

- 24

144

7500

5506

- 24

146

7500

5507

- 24

148

7500

5508

- 24

150

7500

5461

- 24

046

/ 8

mm

7500

5470

- 24

047

/ 11

mm

7500

5481

- 24

048

/ 14

mm

7500

5482

- 24

056

/ 8

mm

7500

5483

- 24

057

/ 11

mm

7500

5484

- 24

058

/ 14

mm

7500

5485

- 24

066

/ 8

mm

7500

5486

- 24

067

/ 11

mm

7500

5487

- 24

068

/ 14

mm

7500

5488

- 24

076

/ 8

mm

7500

5489

- 24

077

/ 11

mm

7500

5490

- 24

078

/ 14

mm

7500

5491

- 24

086

/ 8

mm

7500

5492

- 24

087

/ 11

mm

7500

5493

- 24

088

/ 14

mm

7500

4784

- 21

182

/ * 8

mm

7500

4787

- 21

192

/ 10

mm

7500

4785

- 21

183

/ * 8

mm

7500

4788

- 21

193

/ 10

mm

7500

4786

- 21

184

/ * 8

mm

7500

4789

- 21

194

/ 10

mm

7500

4790

- 21

195

/ 10

mm

* Spe

cial

siz

esPa

tella

r co

mpo

nent

s

Tibi

al c

ompo

nent

s

Tibi

al in

sert

s

Fem

oral

com

pone

nts

righ

t/le

ft

Tibi

al b

lock

s (O

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SAP

No.

/ A

rt. N

o.

Product overview (combination table) RT-PLUS™

57

Notes

58

Notes

59

Notes

60

Manufacturer

Smith & Nephew Orthopaedics AG For further information please contact

Oberneuhofstrasse 10d our local sales office.

6340 Baar www.smith-nephew.com

Switzerland

™ Trademark of Smith & Nephew 15901-en V2 (1740) 08/19 0123

Reference:

1. Malzer U, Schuler P. 5 years results with the RT-PLUS Solution constrained total knee (Poster), 7th EFORT Congress, Lisbon, Portugal, June 4-7, 2005 2. Müller C, Basad E, Melzer C. Mid-term result with a new rotating hinge TKA (Poster), AAOS Annual Meeting, San Francisco, USA, March 5-9, 2008 3. NJR-UK, Summary report knee primary (KP) femoral RT-PLUS, August 15, 2016 4. NJR-UK, Summary report knee revision (KR) femoral RT-PLUS, August 15, 2016 5. Kazakos K, Tilkeridis C. The RT-PLUS System as a primary implant, medium-term results, Congress, Dresden, Germany, 2006 6. Müller M, Schuler P. 9 Years results with the first RT-PLUS Solution rotating hinge TKA report, February 22, 2008 7. Büttner-Janz K, Kubacki C. 10 year results with the RT-PLUS Solution-Prospective Study, Congress, Dresden, Germany, 2006 8. Zacher J. Experiences with RT-PLUS & RT-PLUS Modular, Congress, Dresden, Germany, 2006 9. Wilke K, Kunze D, Hommel P, Hommel H. Rotating hinge TKA RT-PLUS Solution: A clinical and radiographic follow-up, J Orthopedics & Rheumatology, February 15, 2016 Vol.: 3, Issue: 1