This publication is not intended for distribution in the USA. SURGICAL TECHNIQUE

INTRODUCTION S-ROM NOILES Rotating Hinge Knee System 2 SURGICAL TECHNIQUE Initial Preparation of the Tibia 4 Preparation of the Metaphyseal Bone - Tapered Reamer 6 Proximal Tibial Resection - Tapered Reamer 7 Preparation of the Metaphyseal Bone - Broach 9 Final Preparation of the Tibia 10 Preparation of the Femoral Diaphysis 11 Reaming the Medullary Canal 12 Preparation of the Metaphysis (for Sleeve Use) 14 Femoral Anterior, Chamfer, and Box Cuts 20 APPENDIX Cemented Tibial Stem Preparation 35 Step Wedge Preparation 38 Thick Tray Preparation 41...

The S-ROM NOILES Rotating Hinge features: • S-ROM Femoral Components available in three sizes • Seven degree physiological valgus, fixed in the femoral component • Deep femoral trochlear groove • Modular textured sleeves to accommodate bone defects of the Engh Type II and Type III classification* and allow possible bone ingrowth • Slotted tibial and femoral stems to enhance torsional stability and fixation into intact medullary bone1 • Broad, congruent contact areas between femoral and tibial components to best distribute surface and subsurface stresses in the polyethylene • A rotating hinge...

The M.B.T. Revision Knee System is comprised of the following components: • Tibial Components are available in eight sizes, 1 mm, 1.5 mm, 2 mm, 2.5 mm, 3 mm, 4 mm, 5 mm and 6 mm • Tibial Metaphyseal Sleeves are available in 29 mm, 37 mm, 45 mm, 53 mm and 61 mm sizes (M/L dimension) • Tibial Wedge Augmentation Components: Step Wedge in 5, 10 and 15 mm thicknesses • 75, 115 and 150 mm Fluted Universal Stem lengths in 10 to 24 mm diameters in 2 mm increments • 30 and 60 mm Cemented Universal Stem lengths in 13 mm diameters. 90, 120, 150 mm Cemented Tapered Universal stem lengths in 13 mm diameters •...

INITIAL PREPARATION OF THE TIBIA The Tibial Alignment System When preoperative evaluation and X-rays indicate that fluted stem extensions, metaphyseal sleeves or wedges are required, it is recommended that the proximal tibia be prepared with reference to the position of the IM rod. Where a cemented Universal Stem Extension is indicated, see Appendix 1. Place the knee in maximal flexion with the patella laterally retracted and the tibia distracted anteriorly and stabilised. Release fibrosis around the tibial border or excise as required to ensure complete visualisation of its periphery. Approximate...

INITIAL PREPARATION OF THE TIBIA Reaming the Medullary Canal Assemble the straight reamer to the T-handle. If power reaming, it will be necessary to attach the modified Hudson adapter to the straight reamer. The shaft of the reamer contains markings in 25.4 mm increments. Each marking is numbered to use as a reference when reaming to the appropriate depth. Universal fluted stem lengths are available in 75, 115 and 150 mm. Determine the length and diameter of the prosthetic stem extension with templates (Cat. No. 2178-30-100) applied to preoperative X-rays. Utilising the reamer depth scale and...

PREPARATION OF THE METAPHYSEAL BONE – TAPERED REAMER For Diaphyseal Engaging Stem and Metaphyseal Filling Sleeve Attach the appropriately sized stem trial to the end of the reamer. Note: Assembly of the stem trial may be aided by the pre-attachment of the T-handle. Taper ream to the planned proximal tibial resection level (Figure 4). Note: Use the “cemented” taper reamer when requiring a cement mantle or when utilising a sleeve. Use the press-fit tapered reamer when lineto-line fit is desired and a sleeve will not be utilised. Use end-cutting primary reamer (Cat. No. 217863-199) when a stem or...

PROXIMAL TIBIAL RESECTION – TAPERED REAMER Attach the 2 degree tibial cutting block to the I.M. tibial referencing device. Attach the I.M. tibial referencing device to the shaft of the tapered reamer. Position the I.M. tibial referencing device with the pre-attached 2 degree cutting block onto the shaft and allow it to descend to the proximal tibial surface. Since considerable bone stock may have been sacrificed in the primary total knee arthroplasty, minimise the amount resected: no more than 1-2 mm from the resected proximal tibia, managing residual lateral tibial defects with either prosthetic...

PROXIMAL TIBIAL RESECTION Note: If a metaphyseal sleeve is to be used, tibial resection using the 2 degree tibial cutting device is unnecessary as the tibial resection will be performed using the tibial sleeve broach. (see page 9, Figure 8) Note: There is a slotted and non-slotted end to the stylus. The difference between the two is 5 mm. Remove the I.M. device while leaving the 2 degree cutting block in place. Remove the tapered reamer and resect the proximal tibia (Figure 6) (Maximum saw blade thickness 1.5 mm). Note: At this point determine whether a step wedge is necessary on either the medial...

PROXIMAL TIBIAL RESECTION Optional For Sleeve Utilisation Only Note: The M.B.T. Revision Tibial Tray will accept either a tibial metaphyseal sleeve or a tibial step wedge if using sleeve sizes 37, 45, 53 and 61 mm, but not both. Only the 29 mm sleeve is indicated for use with a tibial step wedge. Attach the M.B.T. revision broach handle to the smallest broach and then attach the appropriately sized stem trial. The broaches are asymmetrical. Tibial Resection Plane Position the “ANT” engraving on the broach anteriorly. Impact the broach into the tibia until the top surface of the broach is at the...

FINAL PREPARATION OF THE TIBIA Place the knee in full extension and determine appropriate rotation of the tibial tray (Figure 10). Mark the appropriate rotation with electrocautery on the anterior tibial cortex at the centre and sides of the alignment handle. Position the tibial tray trial with a stem extension and sleeve trial if applicable (sleeve trial allows 20 degrees of rotation) into the prepared tibial canal. Assess proximal tibial coverage and rotation of tibial component. Impact the appropriate keel punch (utilise the cemented keel punch if a cement mantle is desired or the press-fit...