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Aesculap®
Aesculap® OrthoPilot®

Aesculap® OrthoPilot®

Product catalog summary

Overview: The document provides a detailed guide on the OrthoPilot® system for Total Knee Arthroplasty (TKA), highlighting its application, setup, and procedural steps. It focuses on the system's non-image-based navigation, which enhances precision in knee and hip endoprostheses implantation without requiring CT or MRI scans.

Key Specifications:

The OrthoPilot® system integrates seamlessly into surgical workflows with minimal extension of operation time.
It is user-friendly, ergonomic, and provides intraoperative documentation.
Used by over 600 hospitals, supported by international studies confirming improved alignment.

Procedures:

Preoperative Planning: Involves radiographic imaging to assess axis deviation, implant alignment, and joint gap, considering soft tissue condition, extensor mechanism functionality, and bone preservation.
Patient Preparation: Standard positioning and draping procedures are recommended, using a leg holder for leg control.
OrthoPilot® Setup: Instructions on positioning the system, including femoral and tibial transmitter placement and camera adjustment for visibility.
Data Entry: Enter patient and hospital information, including implant and tool set specifications.

Instrumentation:

Includes general instruments, standard and MIOS® instruments, and IQ instruments, with components like drills, sawing guides, and alignment blocks.

Recommendations:

Ensure optimal positioning of the camera and transmitters for continuous visibility.
Utilize system features for precise alignment and documentation during surgery.

Conclusion: The OrthoPilot® system offers a sophisticated, non-invasive approach to TKA, enhancing surgical precision and patient outcomes through advanced navigation technology.

Palpation of Tibial Reference Points:

Medial and Lateral Cutting Height Indicators: Reference points recorded using landmarks like the deepest points of defects or joint surfaces.
Optional Software Configuration: Allows recording of one reference point if needed.

Determination of Tibia Centre:

Anterior Cruciate Ligament Reference: If absent, use the middle of the medial-lateral diametral line of the tibial head.

Ankle Joint Palpations:

Anterior Ankle Joint Point: Located at the anterior edge of the distal tibia, near the ankle joint gap.
Medial and Lateral Malleolus: Recorded using a pointer at their centers.

Registration of Hip Joint Centre:

Procedure: Performed with the leg stationary, moving the femur in a circular motion to register data.
Precautions: Ensure visibility of the femur transmitter and avoid pelvic movement.

Registration of Knee Joint Centre:

Procedure: Movement of the femur transmitter is tracked relative to the tibia transmitter to determine the knee joint centre.

Representation of Mechanical Leg Axis:

Dynamic Display: Shows the relationship between the mechanical tibial and femoral axes.

Resection of Tibia Plateau:

Procedure: Tibial cutting block is attached and adjusted for desired varus/valgus and slope values.
Precautions: Avoid contamination of marker spheres on transmitters.

Reassessing Tibial Resection:

Procedure: Use tibia control plate to reassess and record the resection surface orientation.

Condyle Recording:

Procedure: Distal and posterior condyles are recorded using an orientation block.
Importance: Ensures accurate femur component size proposal and gap value display.

Optimization of Anterior Cortex:

Procedure: Optimize anterior points on the femur using a pointer to ensure correct implant size.

Measuring Joint Gap in Extension and Flexion:

Procedure: Use distractor to measure medial and lateral gap distances in both extension and flexion positions.

Femoral Planning:

In Extension: Displays cutting height, remaining extension gap, and varus/valgus alignment.
In Flexion: Displays posterior cutting height, remaining flexion gaps, and rotation.

Specifications and Procedures: The document outlines procedures for using the OrthoPilot® TKA system in Total Knee Arthroplasty, including steps for distal femur resection, control, and rotational orientation. The resection block is fitted with a passive transmitter, and precise resection height is determined by moving the cutting guide. Emphasizes reaching target values for varus/valgus angle, resection height, and slope, indicated by a color change to green on the display.

Reassessment and Rotational Alignment: Reassessment of the distal femur resection is performed using orientation guides. Rotational alignment is set with the femur orientation guide or a 4-in-1 cutting guide, with instructions for fixing the cutting guide and performing cuts in a specific order.

Mechanical Axis and Implantation: The mechanical axis achieved postoperatively can be checked using trial implants. Lists various implant systems and provides guidance on implant assembly.

Instrument Set Overview: Provides a comprehensive list of instruments required for the OrthoPilot® TKA procedure, including rigid bodies, cutting blocks, and various screws and guides, with optional MIOS® instrumentation sets.

Software and Consumables: Mentions the software module for OrthoPilot® TKA and lists consumable passive marker spheres required for the procedure.

Schematic Program Flow for Total Knee Arthroplasty (TKA):

Tibia First Approach:

Registration of lateral malleolus and anterior ankle joint point.
Hip and knee center registration, followed by mechanical axis registration.
Planning and registration of tibia cut, including lateral and medial tibia references.
Selection of operating field and instruments, and input of patient data.

Femur First Approach:

Registration of distal and posterior condyles, and optimization of anterior cortex.
Planning and registration of femoral cut, with setting of 4-in-1 femoral cutting guide.
Registration of joint gaps in extension and flexion, followed by femoral planning.
Selection of operating field and instruments, and input of patient data.

General Notes:

Procedures involve multiple registrations and planning steps to ensure accurate alignment and cuts.
Use of OrthoPilot® TKA system for guidance in total knee arthroplasty.
All procedures are subject to technical changes and are protected under registered trademarks of Aesculap AG.

Catalog excerpts

Aesculap® OrthoPilot® OrthoPilot® KneeSuite – TKA Total Knee Arthroplasty e.motion®, e.motion® Pro System, Columbus®, VEGA System® Aesculap Orthop

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OrthoPilot ® TKA – Total Knee Arthroplasty THA Cup only THA Cup & Stem THA Stem only THA Dysplasia Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK. Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty. 2005 Oct;20(7):832-9. Jenny JY, Miehlke RK, Giurea A. Learning curve in navigated total knee replacement. A multi-centre study comparing experienced and beginner centres. Knee. 2008 Mar;15(2):80-4. Epub 2008 Feb 11. Bäthis H, Shafizadeh...

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OrthoPilot® The OrthoPilot® system assists in the precise implantation of knee and hip endoprostheses.1 Integration in the surgical workflow as well as minimal prolongation of operation time were essential criteria in the development of the OrthoPilot® system2. At the same time, we focussed on a navigation system that is non-traumatic for the patient. From the beginning, a method was developed that dispenses with CTs and MRIs exposure or expenses that these entail, and requires only very little extra operation time. CT Scan not required Ergonomic instruments precisely aligned to the surgery n...

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OrthoPilot ® TKA – Total Knee Arthroplasty Content 1 Instrument overview 1.2 Standard and MIOS Instruments Preoperative planning using radiographic images Preoperative planning 5 OrthoPilot setup and transmitter position ® Entering patient-related information Anterior cortex point and posterior condyle line 7.1 Recording the medial and lateral posterior condyle 7.2 Recording the anterior cortex point Recording the epicondylar line - option Palpation of the tibial reference points 9.1 Reference for the medial cutting height indicator 9.2 Reference for the lateral cutting height indicator Determination...

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Femoral planning 20.3 Display and control elements (centre) 20.4 Control elements (bottom) Distal femur resection, control and rotational orientation 21.1 Distal femur resection 21.2 Reassessing the distal resection 21.3 Setting the rotational alignment Mechanical axis Femur First technique 23.1 Condyle recording/Recording Whiteside’s Line 23.2 Optimization of anterior cortex 23.3 Distal femur resection 23.4 Reassessing the distal resection 23.5 Setting the rotational alignment Mechanical axis Instrument set overview OrthoPilot TKA 25.3 Reset IQ instruments navigation 26.2 Consumeable passive...

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OrthoPilot ® TKA – Total Knee Arthroplasty 1 Instrument overview 1.1 General instruments Drill, drill sleeve, screw length gauge Tissue protection sleeve, bicort. screws, RB adapter Passive transmitters MIOS® tissue protection sleeve NQ941R Drill sleeve Screw length gauge Rigid Body Pointer, straight Tibia cut control plate Laminar spreader, spreading forceps Tibia control plate Laminar spreader Tibia control plate Pointer, straight Spreading forceps

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1.2 Standard and MIOS® Instruments* Femoral alignment block with foot plates Tibial sawing guide Standard right e.motion MIOS Standard left e.motion® MIOS® short MIOS® right MIOS left Columbus® MIOS® Columbus MIOS short Distal femoral sawing guide Note: * Not for VEGA System®.

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OrthoPilot ® TKA – Total Knee Arthroplasty 1 Instrument overview 1.3 IQ Instruments Femoral alignment block with foot plates Tibial/Distal femoral sawing guide and RB adapter, modular Alignment block Tibial/femoral sawing guide NS334R 4-in-1 Femoral sawing guide and RB adapter, modular e.motion® 4-in-1 Femoral sawing guide F2-F8 VEGA System® 4-in-1 Femoral sawing guide F1-F8 Columbus® 4-in-1 Femoral sawing guide F1-F8 8

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Preoperative planning using radiographic images The OrthoPilot® system and the TKA software can be used in all cases where total knee arthroplasty with a total knee endoprosthesis is indicated. There must be sufficient bone quality and hip joint mobility. Note: The corresponding notes in the respective surgical technique description, instruction for use and package inserts, in particular in the instruction for use for the OrthoPilot® application software TKA TA013595 must be observed.

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OrthoPilot ® TKA – Total Knee Arthroplasty 3 Preoperative planning Aesculap considers it necessary to carry out an adequate preoperative planning based on the following X-ray images: Selected information which can be obtained on the basis of the X-ray images: Whole leg image in standing position Knee joint in an A/P projection Knee joint in lateral projection Slope, A/P implant size Tangential image of the patella Patella shape, joint gap Axis deviation Implant alignment, joint gap, ML implant size

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The analysis of the need for a full knee endoprosthesis is essential in the preoperative planning. In addition to the standard radiological examinations, the surgeon should take the following points into consideration before performing a knee endoprosthesis surgery: Soft tissue situation Functionality of the extensor mechanism n Bone preservation n Restoration of good axis orientation n Functional stability n Restoration of the joint line The surgeon can obtain the following information when analysing the X-ray images with the help of the X-ray templates of the Aesculap prosthesis systems Columbus®,...

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OrthoPilot ® TKA – Total Knee Arthroplasty 4 Positioning and sterile draping of the patient is carried out according to the standard procedures which are also applied in the conventional technique. Aesculap recommends using a leg holder, which facilitates leg control during the various phases of the operation. In order to record the points to be registered and to carry out all the necessary bone cuts, it is necessary to change the leg position several times. The leg holder enables the knee position to be varied between full extension and full flexion. TIP To facilitate mobilisation of the quadriceps,...

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