OSS ™ Orthopedic Salvage System Distal Femoral Replacement Surgical Technique

This brochure is presented to demonstrate the surgical technique utilized by John A. Abraham, MD; Prof. Lee M. Jeys; Jeffrey R. Kneisl, MD; Edward J. McPherson, MD, FACS; Michael D. Miller, MD; Robert J. Tait, MD.

3 cm OsseoTi Femoral Augments Standard 3 cm & 5 cm Distal Femurs Standard Auxiliary Parts Standard Tibial Baseplates Universal Auxiliary Parts

3 | OSS Orthopedic Salvage System Distal Femoral Replacement

4 | OSS Orthopedic Salvage System Distal Femoral Replacement Indications and Contraindications Effective as of January 1,2016 1. Painful and disabled joint resulting from avascular necrosis, osteoarthritis, rheumatoid arthritis, or traumatic arthritis. 2. Correction of varus, valgus, or posttraumatic deformity. 3. Correction of revision of unsuccessful osteotomy, arthrodesis or previous joint replacement. 6. Treatment of non-unions, femoral neck fracture, and trochanteric fractures of the proximal femur with head involvement, unmanageable using other techniques.1 7. Revision of previously failed...

5 | OSS Orthopedic Salvage System Distal Femoral Replacement Absolute contraindications include: infection, sepsis, and osteomyelitis. Relative contraindications include: 1) uncooperative patient or patient with neurologic disorders who are incapable of following directions, 2) osteoporosis, 3) metabolic disorders which may impair bone formation, 4) osteomalacia, 5) distant foci of infections which may spread to the implant site, 6) rapid joint destruction, marked bone loss or bone resorption apparent on roentgenogram, 7) vascular insufficiency, muscular atrophy, or neuromuscular disease.

7 | OSS Orthopedic Salvage System Distal Femoral Replacement Primary Femoral Preparation

8 | OSS Orthopedic Salvage System Distal Femoral Replacement Reamer/Trial/Stem Diameter Example* *16 mm stem trials are 16 mm in diameter PRIMARY FEMORAL PREPARATION Reaming © Note: If revising the distal femur, continue to page 17. Use a .375" intramedullary (IM) drill to penetrate the femoral canal (Figure 1). Start at full power prior to contact using the flexible reamers and progressively ream in 0.5 mm increments to the appropriate laser-etched markings (see Stem Length chart) until light cortical chatter is obtained (Figure 2). © *Note: For bowed stems, the final flexible reamer shaft diameter...

9 | OSS Orthopedic Salvage System Distal Femoral Replacement PRIMARY FEMORAL PREPARATION Reaming (cont.) For a 90 mm stem (Figure 3) select the following: 12.5- flare reamer = 8 mm through 12.5 mm flexible reamers 13+ flare reamer = 13 mm through 24 mm flexible reamers 12.5- Flare Reamer CP460477 13+ Flare Reamer CP460476 Reamers Tray 3 Flare Reamer Reamers Tray 3 For a 150, 225 or 300 mm stem, select the corresponding flare reamer based on the final diameter of the flexible reamer to prepare the canal for the femoral boss as well as the flared portion of the stem (Figure 4).

PRIMARY FEMORAL PREPARATION 10 | OSS Orthopedic Salvage System Distal Femoral Replacement Reaming (cont.) Start at full power prior to contact and advance the selected flare reamer to a depth equal to the amount of bone resection required (3 cm groove or 5 cm groove), aligning the appropriate groove to the joint line (i.e. ream to ‘3’ groove for a 3 cm and to ‘5’ for a 5 cm distal femoral replacements). Remove the reamer. Connect the stem trial to the stem trial adapter by aligning the arrow on the adapter with the stem trial’s anterior mark. Insert and rotate clockwise to lock (Figure 6a and...

11 | OSS Orthopedic Salvage System Distal Femoral Replacement PRIMARY FEMORAL PREPARATION Distal Resection Slide the left or right 5 degree valgus wing over the stem trial/stem trial adapter firmly against the distal femur. Assemble the distal femoral resection tower to the appropriate distal cut block (3 cm or 5 cm) and slide into the top of the valgus wing until it rests against the anterior cortex (Figure 7). Distal Femoral Resection Tower 110018759 Femoral Bone Prep Tray 1 Distal Femoral Resection Cut Blocks Femoral Bone Prep Tray 1 Distal Femoral Resection Valgus Wings 32-487025 & 32-487005...

PRIMARY FEMORAL PREPARATION 12 | OSS Orthopedic Salvage System Distal Femoral Replacement Distal Resection (cont.) Remove the distal femoral resection tower, valgus wing and stem trial/stem trial adapter (Figure 9). Make the distal resection through the selected slot using a standard .054” saw blade. For a primary 3 cm resection, use the cut block marked “3 cm” and cut through the slot marked “30 mm”. For a primary 5 cm resection, use the cut block marked “5 cm” and cut through the slot marked “50 mm

13 | OSS Orthopedic Salvage System Distal Femoral Replacement PRIMARY FEMORAL PREPARATION Distal Resection (cont.) Remove the distal resection cut block and reinsert the stem trial/stem trial adapter (Figure 11). Stem Trial Adapter 110030070 Femoral Bone Prep Tray 1 Stem Trials Short Provisional Stems Tray 7 Long Provisional Stems Tray 8 Slide the A/P cut block onto the stem trial/stem trial adapter through the appropriate left or right hole (Figure 12). Align the appropriate anterior arrow of the block with the established anterior mark. Distal Femoral A/P Cut Block 110018762 Femoral Bone Prep...

PRIMARY FEMORAL PREPARATION 14 | OSS Orthopedic Salvage System Distal Femoral Replacement Distal Resection (cont.) Anterior and Posterior Resection Secure the A/P cut block with 1/8” drills or threaded drill pins using the pin driver (Figure 13). Resect the anterior and posterior portions of the distal femur, using either the Standard Size or the Reduced Size “RS” (Figure 14). If a femoral augment is required go to page 26. Drill Pin 32-467619 Threaded Drill Pin 32-700379 Femoral Bone Prep Tray 1 Pin Driver 32-486261 Femoral Bone Prep Tra

15 | OSS Orthopedic Salvage System Distal Femoral Replacement PRIMARY FEMORAL PREPARATION 3 cm Resection Boss Preparation for use without OsseoTi Distal Femoral Augments (Standard Only) Insert the 3 cm resurfacing tapered boss reamer over the stem trial/stem trial adapter. Start at full power prior to engaging the metaphyseal bone and ream to mechanical stop (Figure 15 and Figure 16). Note: This step is only required if using a standard 3 cm distal femoral replacement. 3 cm Resurfacing Tapered Boss Reamer 110018807 Femoral Bone Prep Tray 1