Columbus Knee System Knee Arthroplasty Surgical Technique

Columbus® Knee System

Knee Arthroplasty Surgical Technique with IQ Instruments

Aesculap Orthopaedics Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

1. The IQ Instruments

The Columbus IQ instrumentation has been designed The Columbus IQ instruments are stored in the specifically to facilitate the workflow not only for the surgeon, but designed ortho trays. Together, the IQ instruments and the the operating room (OR) team as a whole, by enhancing ortho tray offer a high end reprocessing solution. The trays ergonomics and operative efficiency. IQ stands for “Intuitive not only store the instruments in a secure and safe manner and Quick“. The system offers multiple options across but also clearly facilitate the reprocessing procedure for different implantation philosophies that allow each surgeon the CSU (Central Sterilization Unit) as the instruments to follow his/her preferred surgical technique. can remain in the tray during the washing process. This time-saving solution generates an economic advantage Some aspects that will facilitate the surgical process in the and eliminates a potential source of error as complete set operating room are: reassembling is not necessary. ■ Precision with less instruments ■ Quick couplings ■ Ergonomic handles ■ Color coding The IQ instruments as well as the instrument trays are color coded to enable instrumentation and organization during the complete workflow:

■ red = femur ■ blue = tibia ■ yellow = general instruments ■ grey = patella

2 2. Contents 1. The IQ Instruments 2 2. Content 3 3. Indications for Use/Contraindications 4 4. Preoperative Planning 5 5. Approach 6 6. Assembly Instructions and Instrument Handling 8 7. Workflow Synopsis 14 8. Tibia Preparation 18 9. Femur Preparation 31 10. Gap Balancing 39 11. Patella Preparation 43 12. Trial Reduction 45 13. Preparation and Assembly of Extension Stems 46 14. Component Implantation 47 15. Cementing Technique 50 16. Closure 51 17. Instruments 52 18. Sawblades 75 19. Dimensions 76 20. Overview of Extension Stem Lengths/Overview of Patella Sizes 78 21. Order Information 80 22. Implant Matrix 88

3 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

3. Indications for Use/Contraindications

cemented Plasmapore® cemented

CR DD UC PS

cemented Plasmapore cemented

The Columbus Knee System offers a wide implant range Contraindications: which enables the surgeon to choose the right option per Contraindications include, but are not limited to: case. Indications for Use: ■ Joint conditions that can be treated by reconstructive surgery (e.g. osteotomy) The Columbus Knee System is indicated for use in ■ Acute or chronic infections near the joint, or systemic infections reconstruction of the diseased knee joint caused by ■ Secondary diseases that could influence joint functionality osteoarthritis, rheumatoid arthritis, post-traumatic ■ Systemic diseases and metabolic disorders arthritis, the need to revise failed arthroplasties or ■ Severe osteoporosis or osteomalacia osteotomies where pain, deformity or dysfunction persist, ■ Severely damaged bone structures that could prevent stable and for patients suffering from correctable valgus or varus implantation of implant components deformity and moderate flexion contracture. ■ Bone tumors in the region of implant fixation ■ Bone malformations, axial misalignments or other bone Posterior Stabilized (PS) components are also for absent conditions that rule out implantation of a prosthetic joint or non-functioning posterior cruciate ligament and severe ■ Predictable overload of the joint implant (e.g. due to adiposity) anteroposterior instability of the knee joint. ■ Dependency on pharmaceutical drugs, drug abuse, or alcoholism The Columbus Knee System is designed for use with bone ■ Fever, infection or inflammation (systemic or local) cement. ■ Pregnancy ■ Mental illness ■ Severe osteopenia (or any other medical or surgical finding) that would preclude any benefit from the implants ■ Combination with implant components from other manufacturers ■ Inadequate patient compliance ■ Foreign body sensitivity to the implant materials ■ All cases not listed under indications

4 4. Preoperative Planning

For every Total Knee Arthroplasty, careful preoperative The angle between the X-ray planning is recommended in order to determine mechanical and anatomical precisely the following parameters: femur axes is measured with ■ Varus/Valgus deformity the combination template for ■ Angle between the anatomical and mechanical axis measurements. The center femoral axes of the joint, the joint line and ■ Entry point(s) of the intramedullary alignment rods the mechanical femur axis can (manual IM technique) be measured. To determine the ■ Joint line level tibia resection, the template ■ Femur resection heights showing representations of ■ Tibia resection heights the tibial components is superimposed over and aligned ■ Component sizing with the X-ray image. The resection height is given at a ■ Implant positioning 10-20 mm graduation. A complete set of radiographic ■ Potential areas of bone loss and location of templates is provided for the preoperative determination osteophytes of the appropriate implant sizes. The localization of the The following X-ray images are required to conduct the osteophytes facilitates their removal, improving the mobility radiographic analysis: of the joint. ■ Knee joint in A/P projection: knee extended, centered The Columbus® Knee System provides a complete set of over the distal patella radiographic templates in different magnitudes (1.1 and ■ Knee joint in lateral projection: knee in 30° flexion, 1.15). centered above the distal patella The results of the preoperative planning should be ■ Image of the whole leg (from hip to ankle) in documented in the patient’s file and available during the monopodal stance operative procedure for reference. ■ Patella-tangential image (Merchant View) with the knee at 30°flexion

5 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

5. Approach

Fig. 1 Fig. 2

(Fig. 1) The Columbus IQ instrumentation is designed for Three basic types of arthrotomies are recommended for use with or without the OrthoPilot® Navigation System for use to carry out the intra-articular exposure: the medial both conventional and less invasive approaches to the knee. parapatellar, the mid-vastus or the sub-vastus. The initial skin incision is a straight midline or slightly oblique parapatellar skin incision starting 2 to 4 cm 5.1 Medial Parapatellar Arthrotomy (Fig. 2) proximal to the superior pole of the patella and extending With the knee in flexion or extension, perform the distally to the medial aspect of the tibial tubercule. The arthrotomy starting proximally to the superior pole of the surgeon should decide on a patient basis which length of patella, incising the rectus femoris tendon longitudinally. an incision is necessary for proper visualization of the knee Continue the arthrotomy distally around the medial aspect anatomy. A parapatellar skin incision will be of benefit to of the patella, and end medially to the tibial tubercule. patients when attempting to kneel after the operation. The length range of the incision is generally between 8 and 14 cm symmetrically distributed above and below the joint line. Extension of the skin incision may be necessary during the procedure depending on the patient anatomy, the soft tissues and the skin tension.

6 Fig. 3 Fig. 4

5.2 Mid-vastus Arthrotomy (Fig. 3) 5.3 Sub-vastus Arthrotomy (Fig. 4) With the knee in flexion; perform the arthrotomy starting With the knee in flexion, perform the arthrotomy starting by a split of the fibers from the vastus medialis oblique with a 4 to 6 cm incision of the fascia at the inferior border (VMO), continuing distally around the medial aspect of the of the VMO, running horizontal to the medial aspect of the patella, and ending medially to the tibial tubercule. patella, continuing and ending distally medial to the medial tubercule.

5.4 Final Exposure Perform fat pad excision to facilitate the exposure and improve the patella mobility. Perform the necessary medial release at this time that corresponds to the deformity. The patella can then be everted or sub-luxated laterally.

7 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

6. Assembly Instruments and Instrument Handling

A – Tibia Extra-Medullary Alignment page 9 B – Tibia Intra-Medullary Alignment page 10 C – Femur Intra-Medullary Alignment page 10 D – A/P and Rotation Alignment Guide page 11 E – Tibial-Distal Cutting Guide page 13

8 A - Tibia Extra-Medullary Alignment - Assembly Instructions 1 2 3

Push and hold

■ Press the upper button on the ■ Turn the wheel of the tibial ■ Push on the adjusting wheel to bimalleolar clamp. alignment handle to the open release the locking mechanism. ■ Engage the support in the groove. position. OP-EN will be displayed. ■ Engage the holding rod in the ■ When the neutral position is ■ Engage the handle onto the handle. reached, release the button. bimalleolar support. ■ Release the wheel when the ■ Adjust to the neutral position. desired level is reached. ■ Turning the wheel will allow a fine adjustment on the height.

4 5 6

■ Engage the holding rod in one ■ Set the proximal fixation through ■ Engage the connection square of the connection squares of the the proximal opening of the of the stylus in one of the tibial cutting guide. holding rod. connection squares of the tibial ■ Lock the assembly by turning the ■ Turn the tab into a horizontal cutting guide. frontal wheel right. position to fix the assembly. ■ Fix the connection by locking the wheel on the stylus. ■ Adjust the resection height to the desired bone cut level. ■ The stylus can be placed over the proximal fixation.

Note: Refer to pages 18-20 for tibia preparation. 9 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

B - Tibia Intra-Medullary Alignment

■ Push on the button of the ■ Choose the IM tibia orientation ■ Mount the IM assembly into the T-handle to release the locking sleeve corresponding to the desired alignment system. mechanism. posterior slope resection of the ■ Connect the alignment system to ■ Couple the T-handle to the IM tibia (default is 0° sleeve; sleeves the tibia cutting guide in one of rod. with 3°, 5° and 7° posterior slope its connection squares. ■ R elease the button to lock the are optionally available). Threads ■ Tighten the fixation screw by assembly. are marked red. using the locking mechanism. ■ Connect IM orientation sleeve to the tibia IM stylus. Note: Refer to pages 22-24 ■ Connect the sleeve to the IM for tibia preparation. alignment system.

C - Femur Intra-Medullary Alignment

■ Push on the button of the ■ Choose the IM femur orientation ■ Mount the assembly into the T-handle to release the locking sleeve corresponding to the desired alignment system. mechanism. valgus alignment (standard 5°, 6° ■ Connect the alignment system ■ Couple the T-handle to the IM or 7°; optionally available 8° and to the tibia cutting guide in the rod. 9°). Threads are marked blue. central connection square. ■ Release the button to lock the ■ Connect the sleeve to the IM ■ Fix the connection by locking the assembly. alignment system. wheel. ■ Connect a distal femur contact Note: Refer to pages 31-32 plate, standard: large (small for femur preparation. optionally available).

10 D - A/P and Rotation Alignment Guide

Screw for fixation/release (rotation and translation) of the anterior stylus Size markings in A/P and proximal-distal Guides for control of the anterior cut level with check plate Screw for A/P sliding fixation/release Holes for placement of headless pins after final orientation Adjustment screw for setting the Pin holes to evaluate the Posterior fixation holes axial rotation transepicondylar line for enhanced stability

■ Option 1: The rotation is pre-fixed to a desired value before the guide is put in place. ■ Option 2: The rotation is free and the guide is placed in contact with the distal femur and the posterior condyles; the rotation can be modified by turning the posterior wheel, checking the alignment of the A/P window with the femur A/P plane (Whiteside’s line). ■ Due to the fixed distance between the pin placement holes and the anterior cortex stylus, the placed pins can be used for any femoral size chosen by the surgeon. Oversizing or downsizing the femur is achieved simply by choosing a different 4-in-1 cutting guide size and placing on the same previously placed pins.

11 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

D - A/P and Rotation Alignment Guide ■ The anterior point to be palpated is located on the lateral anterior cortex, avoiding the risk of anterior notching. ■ If the palpation is done at the middle of the anterior femur, the grand piano sign will be bigger providing a larger surface of contact. ■ The stylus can be adjusted in the caudo-cranial direction in order to get a congruence between the A/P sizing and the proximo-distal sizing determined by the scale on the upper part of the stylus.

■ After defining the right axial rotation of the guide, if an exact femoral size is measured as in the example on the left, fix the A/P sliding by tightening the corresponding screw, and place two headless pins in the placement holes.

■ After defining the right axial rotation of the guide, if the measured size is in between two exact sizes as in the example on the left, fix the A/P sliding by tightening the corresponding screw, and place two headless pins in the placement holes. ■ In this case, choose the direct upsize or downsize based on the assessment of the medio-lateral dimension and the flexion-extension gap situation. A smaller size will enlarge the flexion gaps; a bigger size will reduce the flexion gaps.

12 E - Tibial-Distal Cutting Guide Distal resection or tibial resection with a standard approach ■ The connection to the alignment system to be used is the central one marked “C“, denoted by the green square in the left picture. ■ The fixation holes for the headless pins to be used correspond to the groups marked “C“, shown by the red circles in the left picture. ■ Enhanced fixation is achieved with one or two converging pins in the holes marked with the blue circles.

Right knee tibial resection with a less invasive approach ■ The connection to the alignment system to be used is the one marked “R“, shown by the green square in the left picture. ■ The fixation holes for the headless pins to be used correspond to the groups marked “R“, shown by the red circles in the left picture. ■ Enhanced fixation is achieved with one converging pin in the hole marked with the blue circle.

Left knee tibial resection with a less invasive approach ■ The connection to the alignment system to be used is the one marked “L“, shown by the green square in the left picture. ■ The fixation holes for the headless pins to be used correspond to the groups marked “L“, shown by the red circles in the left picture. ■ Enhanced fixation is achieved with one converging pin in the hole marked with the blue circle.

13 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

7. Workflow Synopsis

optional

1a 2

Tibia First 1a. EM Alignment 1b. Tibia IM 2. Tibia Resection 3. Gap Balancing (optional) optional 4. Femur IM Alignment 5. Distal Resection 6. Femur A/P Sizing and Rotation 8 7. Femur APC Resections 3 8. PS Box Preparation (optional) 1 9. Trial Reduction

10. Tibia Keel and/or Stem 4

Preparation 2 11. Patella Preparation (optional) 7 12. Component Implantation Chamfer Resection Planes 1 Anterior 3 Posterior Chamfer 2 Posterior 4 Anterior Chamfer

14 3

4 5 6

optional

9 10 12

15 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

7. Workflow Synopsis(continued)

1 2 Femur First 1. Femur IM Alignment 2. Distal Resection 3. Femur A/P Sizing and Rotation 4. Femur APC Resections 5. PS Box Preparation (optional) 6a. EM Alignment 6b. Tibia IM 7. Tibia Resection 6b 8. Gap Balancing (optional) 9. Trial Reduction 10. Tibia Keel and/or Stem Preparation 11. Patella Preparation (optional) 12. Component Implantation 6a 7

16 Chamfer Resection Planes 1 Anterior 3 Posterior Chamfer 2 Posterior 4 Anterior Chamfer

1 optional

3 4

optional

8 11

9 10 12

17 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

8. Tibia Preparation

Fig. 5

8.1 Extramedullary (EM) Referencing ■ When the rotation has been adjusted to the mid-third of the tibial tuberosity and the second toe axis (or according ■ Place the EM alignment system assembly in parallel with the frontal tibia with the leg positioned in flexion. to the patient’s individual anatomy since these landmarks may not be in line with the mechanical axis of the tibia), ■ Fix the bimalleolar clamp, previously set in a neutral the second spike can be impacted defining the final tibia position, around the lower limb just above the ankle joint rotation. and centered on the tibio-tarsian joint.

■ Proximally, the EM alignment system can be stabilized with the proximal fixation first by engaging the longest spike between the tibia spines.

A B C D E A: Bimalleolar clamp NS345R, B: Bimalleolar clamp support NS344R, C: Alignment system handle NS342R, D: Holding rod for cutting guide NS341R, E: Tibia cutting guide NS334R 18 Refer to pages 8-9 for instrument assembly. 1 2

Fig. 6 Fig. 7

Varus-Valgus Alignment Pushing the knob 1 at the bimalleolar clamp and Tibia Slope Alignment sliding the alignment system medially or laterally allows By releasing the fixation wheel 2 at the bottom part of the adjustment of the varus/valgus of the proximal tibia alignment system (by aligning OPEN), the alignment system resection. The distance between the laser marked lines on can be shifted anteriorly in order to increase the slope of the scale corresponds to a 1° adjustment for a 40 cm long proximal tibia resection. The distance between the laser tibia. marked lines on the scale corresponds to a 1° adjustment for a 40 cm long tibia.

F G F: Proximal fixation NS343R, G: Tibia stylus NS347R

19 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

8. Tibia Preparation

Fig. 8 Fig. 9

Height Adjustment 3 ■ The planned value is set on the stylus, which is then ■ The resection height is determined in preoperative mounted into the tibia cutting guide. Then lower the planning. The aim is to remove any defect on the tibial extramedullary alignment instrument until the stylus joint surface as completely as possible in order to create comes into contact with the chosen point. a bed for the tibia plateau on intact bone for optimal support of the implant. ■ Referencing the healthy tibia plateau is helpful to determine the level of the joint line. Referencing the deepest point of the worn side of the tibia helps to reduce the cut by resecting only 2 mm. Preoperative planning and surgeon preference are used to determine which reference to use.

■ Fix the cutting guide with two headless pins in position ■ Disconnect the EM tibia alignment system from the “0“. The +/-2 mm pinholes are available on the resection tibia cutting guide by turning the connection wheel guides to further adjust the resection level if needed. To counterclockwise. Remove the proximal fixation by avoid movements during the resection, additional pins disengaging the spike from the tibial spine. are set in convergent holes as marked.

F G H I J F: Proximal fixation NS343R, G: Tibia stylus NS347R, H: Headless pins 63 mm NP583R, I: Pin driver NP613R, J: Acculan® drill

Refer to page 9 for instrument assembly. 21 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

8. Tibia Preparation

Fig. 12 Fig. 13

8.2 Intramedullary Referencing

■ ■ The medullary canal of the tibia is opened with the Insert the intramedullary rod into the prepared canal 9 mm starting drill bit. The surgeon must pay close with the help of the T-handle after the contents are attention to the drilling direction in order to avoid irrigated and suctioned. Once the T-handle is removed, cortical violation of the posterior metaphysis. mount the intramedullary alignment system on the rod with the chosen posterior slope angle sleeve (0° standard, 3°, 5°, or 7° optional) and the cutting guide.

A B C D A: Drill 9 mm NS330R, B: T-handle NE198R, C: IM alignment rod NS331R, D: IM alignment system NS332R

22 Fig. 14 Fig. 15

■ Set the stylus on the deepest point of the tibia plateau ■ The alignment of the cutting guide can be checked with to define the 0-level cut. The height of the cut is then the alignment rod. adjusted by turning the tuning wheel to the desired amount of resection in millimeters.

Note: Minimum thickness of tibia baseplate with PE (polyethylene) is 10 mm.

E F G H E: Tibia cutting guide NS334R, F: Tibia IM stylus for orientation sleeves NS847R, G: Alignment rod long NP471R, H: Tibia orientation sleeve NS843R-NS846R Refer to page 10 for instrument assembly. 23 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

8. Tibia Preparation

Fig. 16 Fig. 17

8.3 Tibia Resection

■ Fix the cutting guide with two headless pins in position ■ Once the cutting guide is positioned and fixed, perform “0“. The +/-2 mm pinholes are available on the resection the proximal tibial resection. (See Note) guides to further adjust the resection level if needed. ■ After performing the proximal tibial resection, the guide In order to avoid movements during the resection, is removed and the resected bone taken away. A careful additional pins are set in convergent holes. inspection of the peripheral resection is mandatory in ■ Remove the IM tibia alignment system in one step with order to check that no remaining bone stock is present. the T-handle after unlocking the cutting guide from the Further removal of meniscal remnants and osteophytes alignment system by turning the locking fixation screw that affect the posterior capsule is then performed. counterclockwise. NOTE: The protection of the surrounding soft tissue of the knee joint is important. Use the Hohmann retractors, collateral retractors and PCL retractor to protect all soft tissue during the resection.

A B C D E F A: IM alignment system NS332R, B: Tibia IM stylus for orientation sleeves NS847R, C: Tibia cutting guide NS334R, D: Headless pins 63 mm NP583R, E: Tibia Orientation Sleeve NS843R-NS846R, F: IM alignment rod NS331R 24 8. Tibia Preparation - Option: Hemi Spacer for Tibia Augmentation

Fig. 18 Fig. 19

■ For small defects of the tibia plateau, the Columbus® Knee Insert two additional headless pins in the requested System offers hemi spacers in heights of 4 mm and 8 mm. depth. After removing the tibia move guide and the first two parallel pins, the tibia cutting guide can be placed ■ After the standard resection, remove the tibia cutting guide. Depending on the used holes of the tibia cutting over the new drilled pins. When the cutting guide is fixed guide, the tibia move guide is placed over the two headless with two convergent pins, the hemi spacer resection can pins with frontal side “C“ or “L R“ (see picture below). be performed.

A B C D E A: Tibia cutting guide NS334R, B: Headless pins 63 mm NP583R, C: Tibia move guide NQ1078R, D: Acculan® drill, E: Pin driver NP613R

25 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

8. Tibia Preparation - Option: Hemi Spacer for Tibia Augmentation

Fig. 20 Fig. 21

■ Please note when testing with the trial implants, the correct hemi spacer must be clicked under the trial tibia plateau. While measuring the extension and flexion gap, the height of the hemi spacer is added at the cut tibia side. A Columbus CRA/PSA tibia plateau which offers the possibility to screw hemi spacer must be used for definitive implantation (see picture on right).

A B C D E F G A: Tibia cutting guide NS334R, B: Headless pins 63 mm NP583R, C: Acculan® saw, D: Screwdriver NQ1070R, E: Tibia trial/preparation plateau NQ1079R-NQ1089R, F: Trial hemi spacer NQ1160-NQ1196, G: Plug remover for final CRA/PSA tibia plateau NP744R 26 medial lateral

internally rotated

medial lateral

Fig. 22 Fig. 23

8.4 Tibia Keel Preparation

■ ■ The size of the tibia is determined by placing the Another option consists of building the tibia and femur different tibia preparation plateau sizes onto the created trial implant with the adequate trial gliding surface. surface, trying to reach a proper transverse rotational By exercising flexion extension movements combined alignment of the trial baseplate while avoiding ML and with slight rotational stresses, the tibia plateau will find A/P overhang. a natural position under the femur trial. This position is marked anteriorly using the electric cautery exactly ■ Place the chosen tibia trial preparation flush onto the where the plateau has a central anterior laser marking. tibia resection and assess the rotation with the help of Care should be taken to assess the stability of the the EM rod placed through the holder. References for the extensor mechanism before accepting this “free float” rotation are the mid-third of the anterior tuberosity and alignment of the tibial baseplate. the second toe axis of the leg. These two landmarks often do not coincide with mechanical axis of the tibia, and the surgeon should consider the rotation with respect to the tubercle to maintain extensor mechanism alignment. Fix the plateau by the short headed pins in the marked holes.

A B C D E A: Acculan® drill, B: Tibia trial/preparation plateau NQ1079R-NQ1089R, C: Tibia trial/preparation plateau holder NQ378R, D: Headed pins 30 mm NP585R, E: Pin driver NP613R 27 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

8. Tibia Preparation

Fig. 24 Fig. 25

■ Remove the holder. Place the guiding tower on the tibia ■ Perform the wing stem preparation by using the keel plateau by engaging the posterior teeth first. The anterior chisel connected to its handle through the guiding tower part can be maintained steady by replacing and locking down to the stop. If necessary, remove using the slap the holder back in place. hammer or, if no stem preparation is utilized remove the handle. ■ According to the planned tibia size, place the corresponding tibia drill sleeve on the guiding tower. ■ For every tibia size, there is keel chisel, as the tibia wing stem of the final implant grows by size. ■ The drill with stop is first used to prepare the bone for the keel chisel. The drill is available in 12 mm as standard for sizes T1-T3+ and in 14 mm as standard for sizes T4-T5.

A B C D E F G A: Tibia trial/preparation plateau NQ1079R-NQ1089R, B: Headed pins 30 mm NP585R, C: Guide for keel chisel NQ1096R, D: Drill with stop NQ1116R, NQ1126R, E: Acculan® drill, F: Tibia drill sleeve NQ1111R-NQ1113R, NQ1124R-NQ1125R, G: Tibia trial/prep. plateau holder NQ378R 28 Fig. 26 Fig. 27

8.5 Tibia Stem Preparation

■ In case of poor bone quality, the primary fixation can Length and diameter of this long drill should be assessed be enhanced by using a stem extension. Based on the on the preoperative X-rays. Perform the drilling through surgeon’s philosophy, a cemented stem or a pressfit stem the tibia drill sleeve on the guiding tower. The diameter can be chosen. (12, 14 or 16 mm) corresponds to the trial stem diameter. Option 1: Priority to the Tibia Resection Two laser markings are available on the drill in order to define the right depth for short or long stems. For the keel In this case, the tibia preparation is performed following preparation, the corresponding trial tibia stem is connected the steps described previously (8.1 to 8.4). At the last stage, to the keel chisel for the final preparation. instead of using the drill with stop, a long drill is used for preparing the site of the future stem. Please note that this option is indicated for cemented stems.

NOTE: The cemented implant stems have diameters 10, 12 and 14 mm in order to have a 1 mm cement mantle thickness around the stems.

A B C D A: Keel chisel/Trial keel NQ1090R-NQ1095R, B: Osteodenser holder NQ1097R, C: Drill for cemented stem NS376R-NS377R, NS380R, D: Trial stem cemented NS384T-NS389T 29 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

8. Tibia Preparation

Fig. 28 Fig. 29

Option 2: Prior to the Extension Stem Fixation

In this case, open the medullary canal of the tibia according Adjust the height of the cut by turning the tuning knob 1 . to the preoperative planning (entry point) with the The alignment of the cutting guide can be checked with the 9 mm drill. The thinnest reamer (for short or long stem) EM alignment rod. Fix the cutting guide with two headless is then coupled to the T-handle and inserted into the pins in position “0“; the +/-2 mm pinholes are available on tibia medullary canal as deeply as possible until a primary the resection guides to further adjust the resection level if stability is achieved and a depth laser marking reaches needed. In order to avoid movements during the resection, the estimated level of the tibia resection according to the additional pins are set in convergent holes, if necessary. planned tibia size (T0-T5). If not, use a thicker diameter Remove the IM tibia alignment system in one step with until stability is achieved. Once the T-handle is removed, the T-handle after unlocking the cutting guide from the mount the intramedullary alignment system on the reamer alignment system. Please note that this option is indicated with the 0° angle sleeve (do not use an angled sleeve for for pressfit stems, and the surgeon must take into account slope) and the cutting guide. Set the stylus on the deepest the alignment of the tibia as directed by the pressfit stem point of the tibia plateau to define the 0-level cut. since it may not coincide with the mechanical axis of the tibia. Note: For the pressfit stems, the reamer diameter corresponds to the final implant stem diameter.

A B C D E F A: Reamer for cementless stem NQ1151R-NQ1156R, B: IM alignment rod NS331R, C: IM alignment system NS332R, D: Tibia IM stylus for orientation sleeves NS847R, E: Tibia cutting guide NS334R, F: Tibia orientation sleeve 0° NS843R 30 9. Femur Preparation

Fig. 30 Fig. 31

9.1 Femur Intramedullary Alignment

■ Open the medullary canal of the femur according to the ■ A laser marking on the alignment system shows in which preoperative planning (entry point) with the drill 9 mm. direction the sleeve must be assembled. For a right leg, Insert the rod into the intramedullary canal using the the “R“ on the sleeve is connected with the laser marking T-handle. Once the rod is inserted, the T-handle can be on the alignment system. For a left leg, the “L“ on the removed. sleeve is connected with the laser marking.

■ In order to compensate the anatomical valgus angulation ■ Adjust the planned height of the distal resection by of the femoral bone, the appropriate angle sleeve 5°, 6° turning the knob 1 until the desired thickness matches or 7° according to the preoperative planning is set into the anterior laser marking. The standard resection is the intramedullary alignment system. Connect the distal 9 mm and corresponds to the distal thickness of the femur contact plate and the cutting guide to this system. implant. Place the assembly on the IM rod in contact with at least one distal condyle.

A B C D E F G A: Drill 9 mm NS330R, B: Acculan® drill, C: T-handle NE198R, D: Tibia alignment system NS332R, E: Distal femur contact plate NS834R, F: Femur orientation sleeve NS335R-NS337R, G: Tibia cutting guide NS334R 31 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

9. Femur Preparation

Fig. 32 Fig. 33

9.2 Distal Resection

■ ■ Fix the cutting guide with two headless pins in position Remove the intramedullary alignment system completely “0“. To avoid movement during resection, additional pins in one step with the T-handle by unlocking the are set in convergent holes. connection to the cutting guide. ■ Perform the distal femoral resection by cutting through the guide with a 1.27 mm thick oscillating saw blade. Make sure that the resection is fully completed and that no remaining bone structures are prominent to the resection plane.

■ Remove pins and cutting guide.

Note: The protection of the lateral structures is very important. Use Hohmann retractors to protect lateral structures during the resection.

A B C D E F G A: IM alignment rod NS331R, B: Tibia alignment system NS332R, C: Distal femur contact plate NS834R, D: Femur orientation sleeve NS335R-NS337R, E: Tibia cutting guide NS334R, F: Headless pins 63 mm NP583R, G: Acculan® drill 32 Fig. 34 Fig. 35

9.3 Femur A/P Sizing and Rotation

■ ■ Check the medio-lateral (ML) size of the resected femur The femur size is determined by reading the marked size with the ML femoral sizing gauge. One side specifies on the scale. Place the stylus tip at the intended exit standard sizes and the other side narrow sizes. point of the saw blade on the anterior lateral cortex in order to avoid any notching. A scale on the surface of the ■ Place the femur alignment guide flush onto the resected stylus indicates the femur size depth. The position can distal surface of the femur. The posterior foot plate must then be fixed by tightening the screw. be in contact with the posterior condyles. The femoral alignment guide is fixed with two headless pins against the distal femur through the posterior holes.

A B C D E F A: T-handle NE198R , B: Tibia protection plate NQ377R, C: Acculan® saw, D: ML femoral size gauge NS339R, E: Pin driver NP613R, F: Femur alignment guide NS340R 33 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

9. Femur Preparation

Fig. 36 Fig. 37

■ It is possible to adjust the external rotation by moving ■ Fix two long headless pins through the two frontal the posterior lever arm 1 in the right direction holes in order to reference the position of the 4-in-1 (clockwise for right knees, counterclockwise for left cutting guide. It is recommended to check the level of knees). Confirm the rotational position by assessing the the anterior resection by using the check plate in the trans-epicondylar axis perpendicularity or by checking alignment cutting guide. Choose the size by reading the the Whiteside‘s line through the cutting guide in the scale. middle of the instrument. Fix size and rotation by ■ Remove the posterior pins and the guide, leaving the tightening the screw at the bottom lever arm. headless pins in place.

A B C D A: Femur alignment guide NS340R, B: Headless pins 63 mm NP583R, C: Pin driver NP613R, D: Acculan drill

34 3

2 Fig. 38 Fig. 39

9.4 Femur Anterior, Posterior and Chamfer Resections

■ Place the 4-in-1 cutting guide that matches the femur ■ The resections are performed as follows: anterior cut, size over the two headless pins into the marked “0” mm posterior cut, removal of sizing pins, posterior chamfer, pinhole and press onto the distal resection. It is advised anterior chamfer. The maximum distal contact surface to check the level of the anterior resection by using the and cutting guide fixation is preserved up to the last check plate in the alignment cutting guide before placing resection, ensuring stability. the converging pins for fixation. ■ Remove the convergent pins and cutting guide, and ■ Before fixing the guide with convergent headless pins, it carefully check the resections to detect any remaining is possible to adjust the A/P position by using the holes bone stock. marked +/-2 mm in order to remain as close as possible to the anterior cortex without notching it. Refer to page 17 for Chamfer Resection Planes

A B C A: 4-in-1 femur cutting guide NQ1041R-NQ1048R, B: Cutting depth check blade NS850R, C: Acculan® saw

35 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

9. Femur Preparation

Fig. 40 Fig. 41

■ The quality of the resections and the fit of the prosthesis ■ When the headless pins have been removed, it is possible can be assessed by placing the femur trial implant onto to downsize the femur as follows: place the femur the bone preparation. Using the corresponding holder alignment guide on the distal resected bone. With the with the fitting insert (small for sizes F1-F5, large for help of the cutting depth check plate, the anterior sizes F6-F8), make sure to apply a force toward anterior reference can be found. When the alignment guide is in a to avoid a flexed position. proper position, drill the pins through the anterior holes. ■ For downsizing the femur, place a smaller 4-in-1 cutting Now a smaller cutting guide can be placed over the pins. guide directly onto the same anterior headless pins using ■ Drill the peg holes for the femoral implant with the 6 mm the same holes previously used (-2/0/+2 mm). Since the drill with stop. They determine the final position of the reference is anterior, the same anterior cut is achieved femoral implant. Therefore, it is strongly recommended but recut the posterior condyles, the posterior chamfer as that these holes are only drilled after the joint well as the anterior chamfer. This will open your posterior function test has been carried out. gaps correspondingly.

A B C D E F G H A: Trial femur insertion instrument NS600R, B: Trial femur NQ451R-NQ458R, NQ461R-NQ468R, NQ1052R-NQ1057R, NQ1062R-NQ1067R C: Tibia trial/preparation plateau NQ1079R-NQ1089R, D: Tibia trial/preparation plateau holder NQ378R, E: Trial gliding surface, F: Insert for NS600R, NQ1031R-NQ1032R, G: Drill with stop D 6 mm NQ449R, H: PS trial peg NQ499RM 36 Fig. 42 Fig. 43

9.5 PS Box Preparation

■ In order to perform the femoral preparation for the PS ■ Place the drilling guide for the 14 mm drill into the hole version, the trial femoral implant and the trial gliding of the PS preparation guide. Move in both lateral and surface must be removed. The trial tibia plateau can medial directions in order to drill the two box corners. remain on the bone. Attach the cutting guide for the 22.5 mm cutter and mill the bone with the cutter up to its stop. ■ Select the appropriately sized PS preparation guide (size of the femoral component) and insert with its two pegs in the peg holes for the femoral component. It should then be pressed firmly onto the bone. Fix the guide to the bone with two headed pins.

A B C D E F G A: PS femur box preparation guide NQ571R-NQ578R B: Headed pins 50 mm NP586R, C: Pin driver NP613R, D: Acculan® drill, E: Milling guide 14 mm NQ589R, F: Milling guide 22.5 mm NQ591R, G: Reamer with stop 14 mm NQ590R

37 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

9. Femur Preparation

Fig. 44 Fig. 45

■ Prepare both lateral and medial walls with the chisel cutting edge always positioned on the outside.

■ To check the intercondylar preparation, select the appropriately sized PS trial femoral box template and place into position with the holder. Confirm correct positioning through the equal height of the trial template and the distal resection as well as contact between the two pegs and the posterior chamfer resection.

A B C D E F A: Headed pins 50 mm NP586R, B: PS femur box preparation guide NQ571R-NQ578R, C: Blade chisel NQ593R, D: Femur box holder/extractor NS428R, E: Trial femur box NQ581T-NQ588T, F: Reamer with stop 22.5 mm NQ592R 38 10. Gap Balancing

Fig. 46 Fig. 47

10.1 Tibia First – Measurement with Spacers

■ After performing the tibia resection, check the plane of ■ If the flexion and extension gaps are incongruent, the resection by inserting the thinnest spacer guide (10 please refer to Chapter 10.4 strategies and define the mm) in the joint. If the resection needs correction, apply appropriate corrective action. the cutting guide accordingly and recut the proximal ■ The thickness of the last spacer that allows good balance tibia accordingly. The soft tissue gaps can be assessed by and stability of the knee corresponds to the polyethylene applying a varus/valgus stress in extension and in flexion. thickness that should be used. If the joint is too lax, insert the next spacer and repeat the operation until a spacer thickness allows the knee to ■ At each step, the leg axis can be checked by inserting the reach a stable point in flexion and extension. (Note: The alignment rod through the spacer handle; the rod should posterior cruciate ligament (PCL) must be released and point respectively at the femoral head center and the removed prior to assessing gaps in flexion and extension ankle joint center. since it will increase the flexion gaps once removed.) ■ The measurements can also be done after the distal

■ If the medial and lateral gaps are asymmetrical, it is resection is performed by adding the distal cut spacer for necessary to perform the appropriate release on the the extension measurement. contracted side and then repeat the gaps measurements with the spacers until stability is reached.

A B A: Tibia cut spacer NS852R-NS854R, B: Alignment rod long NP471R

39 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

10. Gap Balancing

Fig. 48 Fig. 49

10.2 Optional Tibia First – Measurement with Distractor

■ After performing the tibia resection, check the plane of ■ When the joint is balanced in extension, note the the resection so that it corresponds with the mechanical thickness of the gaps, and move to the flexion gap axis of the tibia. Insert the distractor into the joint and measurement and repeat the same operation. In flexion, use the clamp to distract sequentially the medial and the possible future rotation of the femoral component lateral gaps in extension. should be taken into account.

■ If the medial and lateral gaps are asymmetrical, it is ■ When the flexion gaps (FG) differ from the extension necessary to perform an appropriate release on the gaps (EG), calculate the needed thickness of the distal contracted side and then repeat the gaps measurements. resection in order to equalize flexion and extension: distal resection height = 9 mm – EG + FG. (Note: the PCL must be released and removed prior to this step since its removal will increase the flexion gaps.)

A B A: Distraction clamp NP609R, B: Femur-tibia distractor NP604R

40 Fig. 50 Fig. 51

10.3 Femur First – Measurement with Spacers

■ After completion of the femoral and tibial resections, the trial femur implant is placed on the femur. The height of the resection and flexion/extension gaps can be checked by inserting the spacers as in Chapter 10.1.

A B C A: Tibia cut spacer NS852R-NS854R, B: Added femur cut spacer NS498, C: Alignment rod long NP471R

41 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

10. Gap Balancing

Flexion gap optimal tight wide

■ increase tibia slope ■ posterior capsule release and thicker insert ■ ■ increase distal cut and thicker insert optimal downsize the femur ■ increase femur size

■ posterior capsule release ■ thinner insert ■ increase distal cut, release posterior

■ ■ capsule and thicker insert tight increase distal cut increase tibia cut ■ upsize femur and increase distal cut ■ upsize femur and release posterior capsule Extension gap

■ decrease distal cut ■ downsize femur and thicker insert ■ thicker insert

■ ■ downsize femur and decrease distal wide downsize femur and thicker insert cut ■ decrease distal cut

Fig. 52

10.4 Strategies When the flexion and extension gaps are incongruent, an individualized strategy must be defined in order to correct it. The table presents some possible options to follow in order to correct a situation where the flexion and extension gaps are not both equally optimal but either tight or wide. This is not an exhaustive and systematic solution matrix. Surgeons must make their own decisions depending on the clinical evaluation, the surgical situation, patient specific issues and surgeon experience.

42 11. Patella Preparation

Fig. 53 Fig. 54

■ Measure the thickness of the patella using the caliper. This thickness should not be exceeded after implantation of the patella implant. Calculate the level of bone resection. A minimum thickness of remaining patella bone should be no less than 12 mm.

■ Clamp the patella and adjust the level of the resection by turning the resection depth wheel to the planned level of remaining patellar bone thickness.

■ Perform the resection through the cutting guide with a 1.27 mm thick saw blade.

A B C A: Caliper AA847R, B: Patella resection clamp NS840R, C: Acculan® saw

43 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

11. Patella Preparation

Fig. 55 Fig. 56

■ Remove the patella resection clamp. Place the patella drill/impaction clamp onto the osteotomized patellar surface choosing a medialized position to recreate the resected apex of the articular surface; the trial patella can be placed on top of the drill guide in order to check its position to the medial rim and appropriate positioning in the superior and inferior direction.

■ Drill the pegs of the implant through the holes with the 6 mm drill until the stop is reached. The size of the patella is established with the corresponding trial patellar implant.

A B C D A: Patella drill/impaction clamp NS841R, B: Acculan® drill, C: Drill with stop 6 mm NQ449R, D: Trial Patella NQ281-NQ285

44 12. Trial Preparation

Fig. 57 Fig. 58

■ Place the trial femoral and tibial implants onto the The following sequence is recommended for trial prosthesis prepared bony surfaces. removal:

■ Place the polyethylene trial corresponding to the gap ■ PS peg measurements with the spacer or the distractor between ■ Trial gliding surface both trial implants. For the DD, UC and PS versions, the ■ Trial femoral prosthesis gliding surface range is from 10 to 20 mm. A 6 mm trial ■ Trial tibia wing stem with/without extension stem spacer is therefore supplied for each of the DD, UC and ■ Trial tibia plateau PS trial tibia plateaus. The 18 mm size is achieved using ■ Assess the stability of the joint by applying varus/valgus the 6 mm trial spacer + 12 mm trial gliding surface and stresses in extension and flexion. If the joint appears to the 20 mm size using the 6 mm trial spacer + 14 mm be lax (opening of gaps under stress), then test a thicker trial gliding surface. trial gliding surface. ■ For the PS version, connect the appropriate trial femoral ■ Assess the range of motion. Intraoperative limited prosthesis to the PS femoral box and place on the bone. extension and flexion and marked hyperextension must Fix the PS trial peg on the tibia trial implants using the be avoided. holder for the PS trial femoral box template. Check the knee kinematics with the help of the trial prostheses. Note: Bone rests in the dorsal region of the femur must be removed with a curved osteotome to avoid implant- bone conflicts in flexion (Fig. 58).

A B C D E F G A: Tibia trial/preparation plateau NQ1079R-NQ1089R, B: Tibia trial/prep. plateau holder NQ378R, C: Trial gliding surface, D: PS trial peg NQ499RM, E: Trial femur NQ451R-NQ458R, NQ461R-NQ468R, NQ1052R-NQ1057R, NQ1062R-NQ1067R, F: Trial spacer 6 mm NQ544, G: Osteotome NS366R 45 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

13. Preparation and Assembly of Extension Stems

Fig. 59 Fig. 60

■ The length that must be prepared for implanting the ■ For the assembly of the extension stem on the final pressfit extension stem can be determined with the implant, the stem must be tightened with a torque of marking on the reamer. The reamer (for short or long 20 NM. It is recommended to tighten the extension stem stem) must be inserted on the resected tibia until the on the table and ensure that the components are held by marking of the planned tibia size (T0-T5) is reached. To an assistant during the tightening. ensure that the final extension stem will fit, a trial stem can be inserted.

A B C D E F A: Tibia holder for stem torque fixation NS390R, B: Torque wrench NE184RM, C: Stem Adapter for NE184RM for Extension stems 12, 14 mm NE185R, D: Stem Adapter for NE184RM for Extension stems 10 mm NS835R, E: Tibia Extension stem NX060K-NX068K, NX082K-NX087K, F: Reamer for cementless stem NQ1151R-NQ1156R 46 14. Component Implantation

Fig. 61

The following implant sequence is recommended: ■ Tibia implant ■ Femur implant ■ Gliding surface ■ Patella implant

■ The final tibia implant is brought precisely into the predefined position. The final positioning is achieved with the help of the tibia impactor.

Note: The obturator screw diameter 12 mm fits to the tibial plateau size T1-T3+. The obturator screw diameter 14 mm fits to the tibial plateau size T4-T5.

A B A: Tibia plateau impactor NS425, B: Tibia implant

47 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

14. Component Implantation

Fig. 62 Fig. 63

■ Using the femur holder and its insert of the ■ Use the femoral impactor to knock the implant into corresponding size group (small for sizes F1-F5, large for place. sizes F6-F8), bring the final femur implant into alignment and implant. Care must be taken to assure the holder is properly seated and attached to the femoral implant so that it does not dislodge during cementing. Special attention must be given to the sagittal orientation: forcing the holder to the anterior direction helps to avoid an implantation in a flexion position.

■ Open the femur holder by turning its handle counterclockwise.

A B C D E A: Implant holding/insertion instrument NS600R, B: Femur insert to NS600R, NQ1031/NQ1032, C: Femur impactor NS424, D: Femur implant, E: Tibia implant 48 Fig. 64 Fig. 65

■ If using a fixed platform, place the gliding surface into ■ The patella is implanted using the patella drill/impaction position by first inserting its posterior part in the tibia clamp and the concave plastic cap, which allows good plateau and impacting the anterior part with the help of transmission of forces during the cement hardening the tibia impactor. process.

Note: Use a trial insert and recheck joint motion and stability after the cement has cured.

Note: When placing the final cemented implants, it is recommended that, after inserting the polyethylene gliding surface into the tibia baseplate, the bone cement should be allowed to fully harden before inserting the fixation screw.

A B C D A: Gliding surface, B: Patella drill/impaction clamp NS841R, C: Inlay for NS841R, NS842, D: Patella implant NX041-NX045

49 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

15. Cementing Technique

■ Regardless of what fixation method is utilized, it is ■ Preparation of the bony surfaces and cancellous bone critical that correct techniques are employed in order to should be performed with pulsatile type lavage with the avoid complications and early failure. Even with accurate knee under a pressure tourniquet. This step allows for cuts, it is important to ensure that components are optimal cement penetration and interlocking to the bony fully seated, as it is easy for this to be obscured when prepared surfaces and also removes bone debris that can cementing is taking place. Varus-valgus alignment can be serve as third body particles that increase polyethylene significantly affected by unequal medial-lateral cement wear after surgery. The surfaces should be properly dried mantles and poorly seated components, and there can prior to cementation and appropriate exposure of all be a tendency to place femoral components in relatively bony surfaces achieved. All of the surfaces should be flexed positions if specific care is not taken. pressurized for optimal cement penetration. Emphasizing the importance of effective cementation of the posterior ■ Proper attention to the cementation steps must be taken. It should also be noted that when definitive components femoral condylar surfaces is also recommended since are cemented in, they may prove more stable and seat it can have a significant effect on the longevity of the better than the trials, which are often a little loose. It fixation of the femoral implant. Holding the knee in is therefore important to recheck the balancing and full extension while cement is hardening will help to stability at this point so that further adjustments can be compress components and possibly improve cement made if necessary. It is possible to relate poor cementing intrusion. techniques to early and continuous component migration, ■ Be certain to completely remove all excess cement that which in turn is of positive prognostic significance when protrudes from the implant bone interface. Any remnants predicting aseptic loosening. of overhanging cement can impinge on surrounding soft tissue or can provide a source of debris that can serve as a generator of third body wear and may contribute to the demise of the fixation earlier than expected.

50 16. Closure

After cement polymerization and removal of all cement excess, thoroughly irrigate the joint. If a tourniquet is used, hemostasis is achieved after its deflation. Close soft tissue in the normal layered fashion.

51 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

17. Instruments

Columbus IQ - ST1020, ST1022, ST1023, ST1024 ST0626 RESET Columbus IQ Manual Instrument Set Item No. Description Item No. Description NQ1001 Columbus IQ Set General Instruments NQ1500 RESET Columbus IQ Set General Instruments NQ1002 Columbus IQ Set Manual Instruments NQ1002 RESET Columbus IQ Set General Instruments NQ1003 Columbus IQ Set Femur Preparation NQ1511 RESET Columbus IQ Femur Prep. F1

Columbus IQ Set Trial Femur Components NQ1512 RESET Columbus IQ Femur Prep. F2 NQ1024 ST1020 Narrow NQ1513 RESET Columbus IQ Femur Prep. F3 NQ1005 Columbus IQ Set Tibia Preparation NQ1514 RESET Columbus IQ Femur Prep. F4 NQ1006 Columbus IQ Set Trial Gliding Surfaces DD NQ1515 RESET Columbus IQ Femur Prep. F5 NS709 IQ Set Universal Patella Preparation NQ1516 RESET Columbus IQ Femur Prep. F6 NQ1026 Columbus IQ Set Stem Preparation NQ1517 RESET Columbus IQ Femur Prep. F7 ST1022 NQ1008 Columbus IQ Set Trial Gliding Surfaces UC NQ1518 RESET Columbus IQ Femur Prep. F8

Columbus IQ Set Instruments for Tibia- NQ1520 RESET Columbus IQ Tibia Prep. T0/0+ (DD) ST1024 NQ1009 Hemispacer NQ1540 RESET Columbus IQ Tibia Prep. T0/0+ (UC)

Columbus IQ Set Preparation Instruments NQ1521 RESET Columbus IQ Tibia Prep. T1/1+ (DD) ST1023 NQ1010 PS NQ1541 RESET Columbus IQ Tibia Prep. T1/1+ (UC) NQ1522 RESET Columbus IQ Tibia Prep. T2/2+ (DD) NQ1542 RESET Columbus IQ Tibia Prep. T2/2+ (UC) NQ1523 RESET Columbus IQ Tibia Prep. T3/3+ (DD) X-ray Templates NQ1543 RESET Columbus IQ Tibia Prep. T3/3+ (UC) Item No. Description NQ1524 RESET Columbus IQ Tibia Prep. T4/4+ (DD) NQ192 Columbus X-ray templates set 1.1:1 NQ1544 RESET Columbus IQ Tibia Prep. T4/4+ (UC) NQ193 Columbus X-ray templates set 1.15:1 NQ1525 RESET Columbus IQ Tibia Prep. T5 (DD) NQ1545 RESET Columbus IQ Tibia Prep. T5 (UC) NS709 IQ Set Universal Patella Instruments NQ1009 Columbus IQ Set Instrument for Tibia Hemi-Spacer NQ1026 Columbus IQ Stem Preparation

Set Trial Preparation Instruments PS - IQ NQ1010 Instruments

52 ST1020 - Columbus® IQ Instrument Sets

B H C M N I O P D J Q E

F K R S G L

NQ1001 - Columbus IQ Set General Instruments Index Qty. Item No. Description Index Qty. Item No. Description A 1 NP684R Slap Hammer K 1 NS334R IQ Tibia/Distal Femur Cutting Guide B 1 NP471R Alignment Rod Long L 1 NS378R Stem Tightening Key C 1 NS366R IQ Osteotome Fine curved 20/205 mm M 4 NP582R Threaded Pin Headless 3.2 mm x 38 mm D 1 NE198R Revision Navigated T-Handle N 6 NP583R Threaded Pin Headless 3.2 mm x 63 mm E 1 NS852R IQ Spacer for Tibia Cut 10-12 mm O 4 NP585R Threaded Pin Headed 3.2 mm x 30 mm F 1 NS853R IQ Spacer for Tibia Cut 14-16 mm P 4 NP586R Threaded Pin Headed 3.2 mm x 50 mm G 1 NS854R IQ Spacer for Tibia Cut 18-20 mm Q 1 NP613R Threaded Pin Driver Attachment H 1 NS339R ML Femoral Size Gauge R 1 NQ377R Tibia Protection Plate Asym. I 1 GB414R Hexagonal Chuck (Targon) with Triang. Shank S 1 NS850R IQ Cutting Check Plate J 1 GB413R Acculan® LI Hexagonal Chuck (Targon)

A G

B C H

J I

F D1 M D2 L

E N

NQ1002 - Columbus IQ Set General Instruments Index Qty. Item No. Description Index Qty. Item No. Description A 1 NS330R IQ Stepped Drill for Intramedullary Alignment Rod H 1 NS341R IQ Holding Rod for Tibia Cutting Guide B 1 NS331R IQ Intramedullary Alignment Rod D 8.0 mm I 1 NS834R IQ Distal Femur Contact Plate Large C 1 NS340R Manual Femoral Alignment Guide J 1 NS342R IQ Tibia Alignment System Handle NS578R – K 1 NS347R IQ Tibia Stylus D1-2 1 ea. IQ Femur Orientation Sleeve 8°, 9° (pictures not available) NS579R L 1 NS332R IQ Intramedullary Alignment System E 1 NS847R IQ Tibia Stylus for Orientation Sleeves M 1 NS345R IQ Tibia Alignment System Bimalleolar Clamp F 1 NS843R IQ IM Tibia Orientation Sleeve 0° N 1 NS344R IQ Tibia Alignment System Support for Bimalleolar Clamp G 1 NS343R IQ Tibia Alignment System Proximal Fixation

53 Columbus® ST1020 - Columbus IQ Instrument Sets (Continued)

B A

D1 D3 D5 D7 C1

D4 D6 C2 D2 D8

E F

NQ1003 - Columbus IQ Set Femur Preparation Index Qty. Item No. Description Index Qty. Item No. Description A 1 NS424 IQ Femoral Component Impactor NQ1041R – D1-8 1 ea. Columbus IQ 4-in-1 Femur Cutting Guide F1 – F8 B 1 NQ449R Columbus Drill with Stop D 6.0 mm NQ1048R NQ1031 – E 1 NS600R IQ Implant Holding/Insertion Instrument C1-2 1 Columbus IQ Insert Femur for NS600R Small/Large NQ1032 F 1 NS498 Spacer for Added Femur Cuts

J M D O

A E G K

B F L H

N P I

NQ1024 - Columbus IQ Set Trial Femur Components Narrow Index Qty. Item No. Description Index Qty. Item No. Description NQ1052R – M 1 NQ461R Columbus Trial Femoral Component, F1R A-F 1 ea. Columbus IQ Narrow Trial Femur Component R F2N – F7N NQ1057R N 1 NQ468R Columbus Trial Femoral Component, F8R NQ1062R – O 1 NQ451R Columbus Trial Femoral Component, F1L G-L 1 ea. Columbus IQ Narrow Trial Femur Component L F2N – F7N NQ1067R P 1 NQ458R Columbus Trial Femoral Component, F8L

54 ST1020 - Columbus® IQ Instrument Sets (Continued)

G1 A G2 H1 I1 G3 B H2 G4 C I2 G5 H3

G6 I3 D G7 H4

E G8 I4 H5 G9

G10 I5 H6 F G11

NQ1005 - Columbus IQ Set Tibia Preparation Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1116R Drill with Stop 12 mm NQ1090R – H1-6 1 ea. Columbus IQ Keel Rasp/Trial Keel T0/0+ – T5 B 1 NQ1126R Drill with Stop 14 mm NQ1095R C 1 NQ1096R Columbus IQ Guide for Keel Rasp/Trial Keel NQ1111R – D 1 NQ378R Columbus Tibial Trial/Preparation Plateau Holder NQ1113R, I1-5 1 ea. Columbus IQ Tibia Drill Sleeve D 12 mm T0/1+ – T5 E 1 NQ1097R Columbus IQ Keel Impactor/Extractor NQ1124R - F 1 NS425 IQ Tibial Plateau Impactor NQ1125R NQ1079R – G1-11 1 ea. Columbus IQ Tibia Trial/Preparation Plateau T0 – T5 NQ1089R

A1 A3 A5

B1 D1 F1

B2 D2 F2

B3 D3 F3

A2 A4 A6

C1 E1 G1

C2 E2 G2

C3 E3 G3

NQ1006 - Columbus IQ Set Trial Gliding Surfaces CR DD Index Qty. Item No. Description Index Qty. Item No. Description NQ525 – Columbus CR/PS Trial Gliding Surfaces T2/2+ NQ504, D1-3 1 ea. NQ514, NQ527 10 mm, 12 mm, 14 mm NQ524, NQ535 – Columbus CR/PS Trial Gliding Surfaces T3/3+ A1-6 1 ea. Columbus CR/PS Trial Spacer 6 mm T0/0+ – T5 E1-3 1 ea. NQ534, NQ537 10 mm, 12 mm, 14 mm NQ544, NQ545 – Columbus CR/PS Trial Gliding Surfaces T4/4+ F1-3 1 ea. NQ554 NQ547 10 mm, 12 mm, 14 mm NQ505 – Columbus CR/PS Trial Gliding Surfaces T0/0+ NQ555 – Columbus CR/PS Trial Gliding Surfaces T5 B1-3 1 ea. G1-3 1 ea. NQ507 10 mm, 12 mm, 14 mm NQ557 10 mm, 12 mm, 14 mm NQ515 – Columbus CR/PS Trial Gliding Surfaces T1/1+ C1-3 1 ea. NQ517 10 mm, 12 mm, 14 mm

55 Columbus® ST1020 - Columbus IQ Instrument Sets (Continued)

C J

D G

H F B

E I

NS709 - Patella Preparation Index Qty. Item No. Description Index Qty. Item No. Description A 1 AA847R Caliper Measures In-Dia 100 mm F 1 NQ282 Trial Patella 3-Pegs P2 29x8 mm B 1 NS840R IQ Patella Preparation Clamp G 1 NQ283 Trial Patella 3-Pegs P3 32x9 mm C 1 NS841R IQ Patella Drilling and Impacting Clamp H 1 NQ284 Trial Patella 3-Pegs P4 35x10 mm D 1 NS842 IQ Insert for Patella Drilling and Impacting Clamp I 1 NQ285 Trial Patella 3-Pegs P5 38x11 mm E NQ281 Trial Patella 3-Pegs P1 26x7 mm J 1 NQ449R Columbus Drill with Stop D6.0 mm

56 ST1020 - Columbus® IQ Instrument Sets (Continued)

A A

B L

D M

E C I N F

J O

G K P H

NQ1026 - Columbus IQ Set Stem Preparation Bottom Tray Index Qty. Item No. Description Index Qty. Item No. Description A 1 NS390R IQ Counter Torque for Stem Fixation I 1 NQ1121R Columbus IQ Tibia Drill Sleeve D 14 mm T0–1+ B 1 NE184RM Torque Wrench 20/27 nm J 1 NQ1122R Columbus IQ Tibia Drill Sleeve D 14 mm T2/2+ C 1 NE185R e.motion™ Adapter for Extension Stems for NE184R K 1 NQ1123R Columbus IQ Tibia Drill Sleeve D 14 mm T3/3+ D 1 NS835R IQ Adapter SW 5.0 for Extension Stems for NE184RM L 1 NQ1131R Columbus IQ Tibia Drill Sleeve D 16 mm T0–1+ E 1 NS385T IQ Trial Stem Short Cemented D 14 mm M 1 NQ1132R Columbus IQ Tibia Drill Sleeve D 16 mm T2/2+ F 1 NS386T IQ Trial Stem Short Cemented D 16 mm N 1 NQ1133R Columbus IQ Tibia Drill Sleeve D 16 mm T3/3+ G 1 NS388T IQ Trial Stem Long Cemented D 14 mm O 1 NQ1134R Columbus IQ Tibia Drill Sleeve D 16 mm T4/4+ H 1 NS389T IQ Trial Stem Long Cemented D 16 mm P 1 NQ1135R Columbus IQ Tibia Drill Sleeve D 16 mm T5

NQ1026 - Columbus IQ Set Stem Preparation Top Insert Index Qty. Item No. Description Index Qty. Item No. Description A 1 NS377R PS Drill for Extension Stem D 14 mm B 1 NS380R PS Drill for Extension Stem D 16 mm

57 Columbus® ST1022 - UC PE Trials Instrument Set - Columbus IQ Note: Not compatible with ST0448 (Columbus Streamlined Instrument Set)

A C E

G M S

H N T

O I U

B D F

J P V

K Q W

L R X

NQ1008 - Set Trial Gliding Surfaces UC - Columbus IQ Index Qty. Item No. Description Index Qty. Item No. Description NQ325 – Columbus UC Trial Gliding Surfaces T2/2+ 10 mm, 12 mm, NQ504, M-O 1 ea. NQ514, NQ327 14 mm NQ524, NQ335 – Columbus UC Trial Gliding Surfaces T3/3+ 10 mm, 12 mm, A-F 1 ea. Columbus CR/PS Trial Spacer 6 mm T0/0+ – T5 P-R 1 ea. NQ534, NQ337 14 mm NQ544, NQ345 – Columbus UC Trial Gliding Surfaces T4/4+ 10 mm, 12 mm, S-U 1 ea. NQ554 NQ347 14 mm NQ305 – Columbus UC Trial Gliding Surfaces T0/0+ 10 mm, 12 mm, NQ355 – Columbus UC Trial Gliding Surfaces T5 10 mm, 12 mm, G-I 1 ea. V-X 1 ea. NQ307 14 mm NQ357 14 mm NQ315 – Columbus UC Trial Gliding Surfaces T1/1+ 10 mm, 12 mm, J-L 1 ea. NQ317 14 mm

ST1023 - PS Preparation Set - Columbus IQ Note: Not compatible with ST0448 (Columbus Streamlined Instrument Set)

A Q I M E

R S B F J N

T C G K O U D H L P V

NQ1010 - Set Trial Preparation Instruments PS - Columbus IQ Index Qty. Item No. Description Index Qty. Item No. Description NQ581T – S 1 NQ591R Target Device D 22.5 mm for Femoral Box Preparation A-H 1 ea. Trial Femur Box F1 – F8 NQ588T T 1 NQ590R Reamer with Stop D 14 mm NQ571R – PS Femoral Box Preparation Guide U 1 NQ592R Reamer with Stop D 22.5 mm I-P 1 ea. NQ578R F1 – F8 V 1 NQ593R Blade Chisel Q 1 NQ499RM PS Tibial Trial Peg W 1 NS428R Femur Gauge Holder/Extractor R 1 NQ589R Target Device D 14 mm for Femoral Box Preparation X 1 NQ1070R PS Screwdriver

58 ST1024 - Primary Tibial Augments and Stems Preparation Set - Columbus® IQ Note: Not compatible with ST0448 - Columbus Streamlined Instrument Set, ST0292 - Columbus Streamlined Augment Instrument Set

A M B N C O D P E Q F R Y G S H T I U J V Z K W L X

NQ1009 - Columbus IQ Set Instruments for Tibia Hemi-Spacer Index Qty. Item No. Description Index Qty. Item No. Description NQ1160 – NQ1183 – A-B 1 ea. Columbus Trial Hemi-Spacer T0/0+ RM/LL 4 mm, 8 mm O-P 1 ea. Columbus Trial Hemi-Spacer T1/1+ RL/LM 4 mm, 8 mm NQ1161 NQ1184 NQ1163 – NQ1186 – C-D 1 ea. Columbus Trial Hemi-Spacer T1/1+ RM/LL 4 mm, 8 mm Q-R 1 ea. Columbus Trial Hemi-Spacer T2/2+ RL/LM 4 mm, 8 mm NQ1164 NQ1187 NQ1166 – NQ1189 – E-F 1 ea. Columbus Trial Hemi-Spacer T2/2+ RM/LL 4 mm, 8 mm S-T 1 ea. Columbus Trial Hemi-Spacer T3/3+ RL/LM 4 mm, 8 mm NQ1167 NQ1190 NQ1169 – NQ1192 – G-H 1 ea. Columbus Trial Hemi-Spacer T3/3+ RM/LL 4 mm, 8 mm U-V 1 ea. Columbus Trial Hemi-Spacer T4/4+ RL/LM 4 mm, 8 mm NQ1170 NQ1193 NQ1172 – NQ1195 – I-J 1 ea. Columbus Trial Hemi-Spacer T4/4+ RM/LL 4 mm, 8 mm W-X 1 ea. Columbus Trial Hemi-Spacer T5 RL/LM 4 mm, 8 mm NQ1173 NQ1196 NQ1175 – Y 1 NQ1078R Columbus IQ Tibia Pin Drill Guide 18.5 mm K-L 1 ea. Columbus Trial Hemi-Spacer T5 RM/LL 4 mm, 8 mm NQ1176 Z 1 NP744R Search Evolution Revision Tibia Plateau Plug Remover NQ1180 – AA 1 NQ1070R PS Screwdriver M-N 1 ea. Columbus Trial Hemi-Spacer T0/0+ RL/LM 4 mm, 8 mm NQ1181

59 Columbus® ST0626 - RESET Columbus IQ General Instruments (Continued)

K I

L A B P W C H D E G V

S R T

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NQ1500 - RESET Columbus IQ General Instruments Index Qty. Item No. Description Index Qty. Item No. Description A 4 NP582R Threaded Pin Headless 3.2 mm x 38 mm M 1 NQ502R Colmubus Tibia Protection Plate Asym. T2+3 B 6 NP583R Threaded Pin Headless 3.2 mm x 63 mm N 1 NQ503R Colmubus Tibia Protection Plate Asym. T4+5 C 4 NP585R Threaded Pin Headed 3.2 mm x 30 mm O 1 NS339R VEGA PS Ml Femoral Size Gauge D 4 NP586R Threaded Pin Headed 3.2 mm x 50 mm P 1 NQ1096R Columbus IQ Guide for Keel Rasp/Trial Keel E 1 NP613R Threaded Pin Driver Attachment Q 1 NS425 IQ Tibial Plateau Impactor F 1 NP471R Alignment Rod Long R 1 NQ1097R Columbus IQ Keel Impactor/Extractor G 1 NS850R IQ Cutting Check Plate S 1 NS852R IQ Spacer for Tibia Cut 10+12 mm H 1 NS424 IQ Femoral Component Impactor T 1 NS853R IQ Spacer for Tibia Cut 14+16 mm I 1 NQ1031 Columbus IQ Insert Femur Small for NS600R U 1 NS854R IQ Spacer for Tibia Cut 18+20 mm J 1 NQ1032 Columbus IQ Insert Femur Large for NS600R V 1 NS498 IQ e.motion Complementary Spacer 8.5 mm K 1 NS600R IQ Implant Holding/Insertion Instrument W 1 NP580R Fixation Pin Box (Insert for Trays) L 1 NS366R IQ Osteotome Fine Curved 20/205 mm

A D B

NQ1500 - RESET Columbus IQ General Instruments - Top Tray Index Qty. Item No. Description Index Qty. Item No. Description A 1 GB413R ACCULAN II Hexagonal Chuck (Targon) F 1 NQ1116R Drill with Stop D12 mm B 1 GB414R Hexagonal Chuck (Targon) with Triangle Shank G 1 NQ1126R Drill with Stop D14 mm C 1 NQ449R Columbus Drill with Stop D6.0 mm H 1 NE198R Revision Navigated T-Handle D 1 NS334R IQ Tibia/Distal Femur Cutting Guide I 1 NS378R Vega PS Stem Tightening Key E 1 NQ378R Columbus Tibial Trial/Preparation Plat. Holder

60 ST0626 - RESET Columbus® IQ General Instruments (Continued)

R I L H

J S S Q A G

P F B E M D

N C T O

NQ1002 - Columbus IQ / VEGA Sysem® PS Manual Instruments Index Qty. Item No. Description Index Qty. Item No. Description A 1 NS345R IQ Tibia Alignment System Bimalleolar Clamp K 1 NS423R IQ Screwdriver Sw 3.5 B 1 NS347R IQ Tibia Stylus L 1 NS330R IQ Stepped Drill for Intramedullary Alignment Rod C 1 NS847R IQ Tibia Stylus for Orientation Sleeves M 1 NS335R IQ Femur Orientation Sleeve Ap 5° D 1 NS843R IQ IM Tibia Orientation Sleeve 0° N 1 NS336R IQ Femur Orientation Sleeve Ap 6° E 1 NS844R IQ IM Tibia Orientation Sleeve 3° O 1 NS337R IQ Femur Orientation Sleeve Ap 7° F 1 NS845R IQ IM Tibia Orientation Sleeve 5° P 1 NS834R IQ Distal Femur Contact Plate Large G 1 NS846R IQ IM Tibia Orientation Sleeve 7° Q 1 NS332R IQ Intramedullary Alignment System H 1 NS342R IQ Tibia Alignment System Handle R 1 NS331R IQ Intramedullary Alignment Rod D8.0 mm I 1 NS343R IQ Tibia Alignment System Prox. Fixation S 1 NS340R Manual Femoral Alignment Guide J 1 NS344R IQ Tibia Alignment System Supp. for Bimalleolar Clamp T 1 NS341R IQ Holding Rod for Tibia Cutting Guide

61 Columbus® ST0626 - RESET Columbus IQ General Instruments (Continued)

NQ1511 - RESET Columbus IQ Femur Preparation F1 Index Qty. Item No. Description A 1 NQ1041R Columbus IQ 4-In-1 Femoral Cutting Guide F1 B 1 NQ451R Columbus Trial Femoral Component F1L C 1 NQ461R Columbus Trial Femoral Component F1R

NQ1512 - RESET Columbus IQ Femur Preparation F2 Index Qty. Item No. Description A 1 NQ1042R Columbus IQ 4-in-1 Femoral Cutting Guide F2 B 1 NQ1052R Columbus Trial Femoral Component F2N L C 1 NQ1062R Columbus Trial Femoral Component F2n R

62 ST0626 - RESET Columbus® IQ General Instruments (Continued)

NQ1513 - RESET Columbus IQ Femur Preparation F3 Index Qty. Item No. Description A 1 NQ1043R Columbus IQ 4-in-1 Femoral Cutting Guide F3 B 1 NQ1053R Columbus Trial Femoral Component F3N L C 1 NQ1063R Columbus Trial Femoral Component F3N R

NQ1514 - RESET Columbus IQ Femur Preparation F4 Index Qty. Item No. Description A 1 NQ1044R Columbus IQ 4-in-1 Femoral Cutting Guide F4 B 1 NQ1054R Columbus Trial Femoral Component F4N L C 1 NQ1064R Columbus Trial Femoral Component F4N R

63 Columbus® ST0626 - RESET Columbus IQ General Instruments (Continued)

NQ1515 - RESET Columbus IQ Femur Preparation F5 Index Qty. Item No. Description A 1 NQ1045R Columbus IQ 4-in-1 Femoral Cutting Guide F5 B 1 NQ1055R Columbus Trial Femoral Component F5N L C 1 NQ1065R Columbus Trial Femoral Component F5N R

NQ1516 - RESET Columbus IQ Femur Preparation F6 Index Qty. Item No. Description A 1 NQ1046R Columbus IQ 4-in-1 Femoral Cutting Guide F6 B 1 NQ1056R Columbus Trial Femoral Component F6N L C 1 NQ1066R Columbus Trial Femoral Component F6N R

64 ST0626 - RESET Columbus® IQ General Instruments (Continued)

NQ1517 - RESET Columbus IQ Femur Preparation F7 Index Qty. Item No. Description A 1 NQ1047R Columbus IQ 4-in-1 Femoral Cutting Guide F7 B 1 NQ1057R Columbus Trial Femoral Component F7N L C 1 NQ1067R Columbus Trial Femoral Component F7N R

NQ1518 - RESET Columbus IQ Femur Preparation F8 Index Qty. Item No. Description A 1 NQ1048R Columbus IQ 4-in-1 Femoral Cutting Guide F8 B 1 NQ458R Columbus Trial Femoral Component F8L C 1 NQ468R Columbus Trial Femoral Component F8R

65 Columbus® ST0626 - RESET Columbus IQ General Instruments (Continued)

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NQ1520 - RESET Columbus IQ Tibia Preparation DD T0/0+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1079R Columbus IQ Tibia Trial/Preparation Plateau T0 E 1 NQ504 Columbus CR/PS Trial Spacer T0/0+ 6 mm B 1 NQ1080R Columbus IQ Tibia Trial/Preparation Plateau T0+ F 1 NQ505 Columbus CR/PS Trial Gliding Surface T0/0+ 10 mm C 1 NQ1090R Columbus IQ Keel Rasp/Trial Keel T0/0+ G 1 NQ506 Columbus CR/PS Trial Gliding Surface T0/0+ 12 mm D 1 NQ1111R Columbus IQ Tibia Drill Sleeve D12 mm T0-1+ H 1 NQ507 Columbus CR/PS Trial Gliding Surface T0/0+ 14 mm

E D F

G C H

NQ1540 - RESET Columbus IQ Tibia Preparation UC T0/0+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1079R Columbus IQ Tibia Trial/Preparation Plateau T0 E 1 NQ504 Columbus CR/PS Trial Spacer T0/0+ 6 mm B 1 NQ1080R Columbus IQ Tibia Trial/Preparation Plateau T0+ F 1 NQ305 Columbus UC Trial Gliding Surface T0/0+ 10 mm C 1 NQ1090R Columbus IQ Keel Rasp/Trial Keel T0/0+ G 1 NQ306 Columbus UC Trial Gliding Surface T0/0+ 12 mm D 1 NQ1111R Columbus IQ Tibia Drill Sleeve D12 mm T0-1+ H 1 NQ307 Columbus UC Trial Gliding Surface T0/0+ 14 mm

66 ST0626 - RESET Columbus® IQ General Instruments (Continued)

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G C H

NQ1521 - RESET Columbus IQ Tibia Preparation DD T1/1+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1081R Columbus IQ Tibia Trial/Preparation Plateau T1 E 1 NQ514 Columbus CR/PS Trial Spacer T1/1+ 6 mm B 1 NQ1082R Columbus IQ Tibia Trial/Preparation Plateau T1+ F 1 NQ515 Columbus CR/PS Trial Gliding Surface T1/1+ 10 mm C 1 NQ1091R Columbus IQ Keel Rasp/Trial Keel T1/1+ G 1 NQ516 Columbus CR/PS Trial Gliding Surface T1/1+ 12 mm D 1 NQ1111R Columbus IQ Tibia Drill Sleeve D12 mm T0-1+ H 1 NQ517 Columbus CR/PS Trial Gliding Surface T1/1+ 14 mm

E D F

G C H

NQ1541 - RESET Columbus IQ Tibia Preparation UC T1/1+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1081R Columbus IQ Tibia Trial/Preparation Plateau T1 E 1 NQ514 Columbus CR/PS Trial Spacer T1/1+ 6 mm B 1 NQ1082R Columbus IQ Tibia Trial/Preparation Plateau T1+ F 1 NQ315 Columbus UC Trial Gliding Surface T1/1+ 10 mm C 1 NQ1091R Columbus IQ Keel Rasp/Trial Keel T1/1+ G 1 NQ316 Columbus UC Trial Gliding Surface T1/1+ 12 mm D 1 NQ1111R Columbus IQ Tibia Drill Sleeve D12 mm T0-1+ H 1 NQ317 Columbus UC Trial Gliding Surface T1/1+ 14 mm

67 Columbus® ST0626 - RESET Columbus IQ General Instruments (Continued)

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G C H

NQ1522 - RESET Columbus IQ Tibia Preparation DD T2/2+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1083R Columbus IQ Tibia Trial/Preparation Plateau T2 E 1 NQ524 Columbus CR/PS Trial Spacer T2/2+ 6 mm B 1 NQ1084R Columbus IQ Tibia Trial/Preparation Plateau T2+ F 1 NQ525 Columbus CR/PS Trial Gliding Surface T2/2+ 10 mm C 1 NQ1092R Columbus IQ Keel Rasp/Trial Keel T2/2+ G 1 NQ526 Columbus CR/PS Trial Gliding Surface T2/2+ 12 mm D 1 NQ1112R Columbus IQ Tibia Drill Sleeve D12 mm T2/2+ H 1 NQ527 Columbus CR/PS Trial Gliding Surface T2/2+ 14 mm

E D F

G C H

NQ1542 - RESET Columbus IQ Tibia Preparation UC T2/2+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1083R Columbus IQ Tibia Trial/Preparation Plateau T2 E 1 NQ524 Columbus CR/PS Trial Spacer T2/2+ 6 mm B 1 NQ1084R Columbus IQ Tibia Trial/Preparation Plateau T2+ F 1 NQ325 Columbus UC Trial Gliding Surface T2/2+ 10 mm C 1 NQ1092R Columbus IQ Keel Rasp/Trial Keel T2/2+ G 1 NQ326 Columbus UC Trial Gliding Surface T2/2+ 12 mm D 1 NQ1112R Columbus IQ Tibia Drill Sleeve D12 mm T2/2+ H 1 NQ327 Columbus UC Trial Gliding Surface T2/2+ 14 mm

68 ST0626 - RESET Columbus® IQ General Instruments (Continued)

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NQ1523 - RESET Columbus IQ Tibia Preparation DD T3/3+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1085R Columbus IQ Tibia Trial/Preparation Plateau T3 E 1 NQ534 Columbus CR/PS Trial Spacer B 1 NQ1086R Columbus IQ Tibia Trial/Preparation Plateau T3+ F 1 NQ535 Columbus CR/PS Trial Gliding Surface T3/3+ 10 mm C 1 NQ1093R Columbus IQ Keel Rasp/Trial Keel T3/3+ G 1 NQ536 Columbus CR/PS Trial Gliding Surface T3/3+ 12 mm D 1 NQ1113R Columbus IQ Tibia Drill Sleeve D12 mm T3/3+ H 1 NQ537 Columbus CR/PS Trial Gliding Surface T3/3+ 14 mm

E D F

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NQ1543 - RESET Columbus IQ Tibia Preparation UC T3/3+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1085R Columbus IQ Tibia Trial/Preparation Plateau T3 E 1 NQ534 Columbus CR/PS Trial Spacer T3/3+ 6 mm B 1 NQ1086R Columbus IQ Tibia Trial/Preparation Plateau T3+ F 1 NQ335 Columbus UC Trial Gliding Surface T3/3+ 10 mm C 1 NQ1093R Columbus IQ Keel Rasp/Trial Keel T3/3+ G 1 NQ336 Columbus UC Trial Gliding Surface T3/3+ 12 mm D 1 NQ1113R Columbus IQ Tibia Drill Sleeve D12 mm T3/3+ H 1 NQ337 Columbus UC Trial Gliding Surface T3/3+ 14 mm

69 Columbus® ST0626 - RESET Columbus IQ General Instruments (Continued)

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NQ1524 - RESET Columbus IQ Tibia Preparation DD T4/4+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1087R Columbus IQ Tibia Trial/Preparation Plateau T4 E 1 NQ544 Columbus CR/PS Trial Spacer T4/4+ 6 mm B 1 NQ1088R Columbus IQ Tibia Trial/Preparation Plateau T4+ F 1 NQ545 Columbus CR/PS Trial Gliding Surface T4/4+ 10 mm C 1 NQ1094R Columbus IQ Keel Rasp/Trial Keel T4/T4+ G 1 NQ546 Columbus CR/PS Trial Gliding Surface T4/4+ 12 mm D 1 NQ1124R Columbus IQ Tibia Drill Sleeve D14 mm T4/4+ H 1 NQ547 Columbus CR/PS Trial Gliding Surface T4/4+ 14 mm

E D F

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NQ1544 - RESET Columbus IQ Tibia Preparation UC T4/4+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1087R Columbus IQ Tibia Trial/Preparation Plateau T4 E 1 NQ544 Columbus CR/PS Trial Spacer T4/4+ 6 mm B 1 NQ1088R Columbus IQ Tibia Trial/Preparation Plateau T4+ F 1 NQ345 Columbus UC Trial Gliding Surface T4/4+ 10 mm C 1 NQ1094R Columbus IQ Keel Rasp/Trial Keel T4/T4+ G 1 NQ346 Columbus UC Trial Gliding Surface T4/4+ 12 mm D 1 NQ1124R Columbus IQ Tibia Drill Sleeve D14 mm T4/4+ H 1 NQ347 Columbus UC Trial Gliding Surface T4/4+ 14 mm

70 ST0626 - RESET Columbus® IQ General Instruments (Continued)

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NQ1525 - RESET Columbus IQ Tibia Preparation DD T5/5+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1089R Columbus IQ Tibia Trial/Preparation Plateau T5 E 1 NQ555 Columbus CR/PS Trial Gliding Surface T5 10 mm B 1 NQ1095R Columbus IQ Keel Rasp/Trial Keel T5 F 1 NQ556 Columbus CR/PS Trial Gliding Surface T5 12 mm C 1 NQ1125R Columbus IQ Tibia Drill Sleeve D14 mm T5 G 1 NQ557 Columbus CR/PS Trial Gliding Surface T5 14 mm D 1 NQ554 Columbus CR/PS Trial Spacer T5 6 mm

E D

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NQ1545 - RESET Columbus IQ Tibia Preparation UC T5/5+ Index Qty. Item No. Description Index Qty. Item No. Description A 1 NQ1089R Columbus IQ Tibia Trial/Preparation Plateau T5 E 1 NQ355 Columbus UC Trial Gliding Surface T5 10 mm B 1 NQ1095R Columbus IQ Keel Rasp/Trial Keel T5 F 1 NQ356 Columbus UC Trial Gliding Surface T5 12 mm C 1 NQ1125R Columbus IQ Tibia Drill Sleeve D14 mm T5 G 1 NQ357 Columbus UC Trial Gliding Surface T5 14 mm D 1 NQ554 Columbus CR/PS Trial Spacer T5 6 mm H 1

71 Columbus® ST0626 - RESET Columbus IQ General Instruments (Continued)

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72 ST0626 - RESET Columbus® IQ General Instruments (Continued) Note: Not compatible with ST0448 - Columbus Streamlined Instrument Set, ST0292 - Columbus Streamlined Augment Instrument Set

A M B N C O D P E Q

F R Y G S

H T I U J V K W Z L X

A I M E Q

R S B F J N

T C G K O U D H L P V

W X

73 Columbus® ST0626 - RESET Columbus IQ General Instruments (Continued)

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74 Knee Arthroplasty Surgical Technique with IQ Instruments

18. Sawblades

System Item No. Width Thickness Sawblades

Aesculap® GE266SU 13 mm 1.27 mm Comfort macro-Line

Acculan® GE271SU 19 mm 1.27 mm

40 80 Length 90 mm GE276SU 23 mm 1.27 mm

Aesculap Acculan 3 Ti

GE231SU 9 mm 1.27 mm 40

20 70 Length 75 mm

GE236SU 13 mm 1.27 mm Aesculap

Acculan 3 Ti GE241SU 19 mm 1.27 mm

50 10 30 Length 90 mm 80 GE246SU 23 mm 1.27 mm

Aesculap

Acculan 3 Ti GE249SU 19 mm 1.27 mm

50 10

30 10 Length 100 mm 80

Stryker System 2000 GE330SU 13 mm 1.27 mm

System 4 T R

XX 0123 E GE332SU S N

System 5 GE331SU 19 mm 1.27 mm I L

1,27 L

System 6 U F System 7 10 20 30 40 50 60 70 80 GE332SU 25 mm 1.27 mm Length 90 mm

Synthes Battery Power Line GE323SU 13 mm 1.27 mm Length 90 mm

Zimmer Universal GE326SU 25 mm 1.27 mm Length 90 mm

Conmed Linvatec / Hall GE327SU 13 mm 1.27 mm Power Pro Mpower Mpower 2 GE329SU 25 mm 1.27 mm Length 90 mm

You will find the sawblades with Aesculap coupling in our Burrs & Blades catalog O17599.

Reciprocating Sawblade 75/10/1.0/1.2 mm Reciprocating Sawblade 75/12/1.0/1.2 mm

GC769R GC771R

75 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

19. Dimensions

7° 3° 8 Box

C B 45° A 45° Z

ML AP

PS / UC Compatibility Chart Size ML AP Box A B C Peg Z Size F1 F2 F3 F4 F5 F6 F7 F8 F1 56 50 34 18.5 34 14 13.5 T0 F2/F2N 59/56 53 37 20 36.5 14.5 15 T1 F3/F3N 62.5/59 56.5 40 21.5 39.5 16 15 T2 F4/F4N 66.5/62.5 60.5 43.5 23 42.5 17.5 15 T3 F5/F5N 71/66.5 65 47.5 26 46 20 15 T4 F6/F6N 76/71 70 52 28 49.5 21.5 15 T5 F7 82 75.5 57 30 53.5 23 15 Ideal combination for optimum performance F8 82 80.5 63 32 58 26 15 Possible, but not recommended Not compatible

Standard and Narrow (N) Sizes of the Columbus CR/DD Compatibility Femur components ■ All femur sizes ■ Compatible with all tibia sizes ML ML ML ML ML ML ML Measurements Size F1 F2 F3 F4 F5 F6 F7 F8 F1 F2 F3 F4 F5 F6 F7 T0 AP F1 F1 T1 AP F2 F2N F2 T2 AP F3 F3N F3 T3 AP F4 F4N F4 T4 AP F5 F5N F5 T5 AP F6 F6N F6 Ideal combination for optimum performance AP F7 F7 AP F8 F8

76 6 3

F D

AP nails ML nails B

4 7 4

Overview – Table of Columbus® femoral implants for combined use with intramedullary nails Dimensions in mm AP nails CR AP nails PS ML nails T0/T0+ T1/T1+ T2/T2+ T3/T3+ T4/T4+ T5 F1 22.5 31 18 A 62 65 70 75 80 85 F2/F2N 24 32.5 19 B 41/44 43/46 45/49 48/52 51/55 56 F3/F3N 26 34 20.5 C 14/14.5 15/16 16/17.5 17.5/19 19/20.5 20.5 F4/F4N 28 36 21 D 28 28 33 38 43 48 F5/F5N 30 38 22 E 12.3 12.3 12.3 12.3 14.3 14.3 F6/F6N 32.5 40.5 23 F7 35 42.5 25 F8 39 47 25

77 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

20. Overview of Universal Extension Stem Lengths

Dimensions in mm - Universal Stems Extension stem lengths - Columbus

T0/T0+ T1/T1+ T2/T2+ T3/T3+ T4/T4+ T5 T0/T0+ T1/T1+ T2/T2+ T3/T3+ T4/T4+ T5 48 D 28 28 33 38 43 48 D 28 28 33 38 43

D + Stem D+ Short 80 80 85 90 95 100 52 mm Stem 80 80 85 90 95 100 52 mm D + Stem D+ Long 120 120 125 130 135 140 140 92 mm Stem 120 120 125 130 135 92 mm D + Stem 160 160 165 170 175 180 The overall length of the tibia plateau with the respective 132 mm extension stem is given by the dimension D in the upper table and the stem length Short (52 mm) or Long (92 mm). The overall length of the tibia plateau with the respective extension stem is given by the tibia keel length and the obturator 7 mm or the stem length 52 mm, 92 mm or 132 mm. Obturator screws are available in diameters 12 and 14 mm. All extension stems are available in diameters 10, 12 and 14 mm.

78 Overview of Patella Sizes

Columbus® Patella Dimensions in mm Universal Patella Dimensions

Patella x H Size Diameter Height Patella P1 27 x 7 P1 26 7 Patella P2 30 x 8 P2 29 8 Patella P3 33 x 9 P3 32 9 Patella P4 36 x 10 P4 35 10 P5 38 11

79 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

21. Order Information Femoral Component CR/RP Cruciate Retaining/Cemented CoCr AS NN001K NN001Z Columbus CR/RP Femur F1L NN800K NN800Z Columbus CR/RP Femur F2N L NN002K NN002Z Columbus CR/RP Femur F2L NN801K NN801Z Columbus CR/RP Femur F3N L NN003K NN003Z Columbus CR/RP Femur F3L NN899K NN899Z Columbus CR/RP Femur F4N L NN004K NN004Z Columbus CR/RP Femur F4L NN900K NN900Z Columbus CR/RP Femur F5N L NN005K NN005Z Columbus CR/RP Femur F5L NN901K NN901Z Columbus CR/RP Femur F6N L CoCr AS NN006K NN006Z Columbus CR/RP Femur F6L NN909K NN909Z Columbus CR/RP Femur F4N R NN007K NN007Z Columbus CR/RP Femur F7L NN014K NN014Z Columbus CR/RP Femur F4R NN008K NN008Z Columbus CR/RP Femur F8L NN910K NN910Z Columbus CR/RP Femur F5N R NN011K NN011Z Columbus CR/RP Femur F1R NN015K NN015Z Columbus CR/RP Femur F5R NN810K NN810Z Columbus CR/RP Femur F2N R NN911K NN911Z Columbus CR/RP Femur F6N R NN012K NN012Z Columbus CR/RP Femur F2R NN016K NN016Z Columbus CR/RP Femur F6R NN811K NN811Z Columbus CR/RP Femur F3N R NN017K NN017Z Columbus CR/RP Femur F7R NN013K NN013Z Columbus CR/RP Femur F3R NN018K NN018Z Columbus CR/RP Femur F8R

Femoral Component CR/RP Cruciate Retaining/Plasmapore CoCr AS NN021K — Columbus CR/RP Femur F1L NN820K — Columbus CR/RP Femur F2N L NN022K — Columbus CR/RP Femur F2L NN821K — Columbus CR/RP Femur F3N L NN023K — Columbus CR/RP Femur F3L NN919K — Columbus CR/RP Femur F4N L NN024K — Columbus CR/RP Femur F4L NN920K — Columbus CR/RP Femur F5N L NN025K — Columbus CR/RP Femur F5L NN921K — Columbus CR/RP Femur F6N L CoCr AS NN026K — Columbus CR/RP Femur F6L NN929K — Columbus CR/RP Femur F4N R NN027K — Columbus CR/RP Femur F7L NN034K — Columbus CR/RP Femur F4R NN028K — Columbus CR/RP Femur F8L NN930K — Columbus CR/RP Femur F5N R NN031K — Columbus CR/RP Femur F1R NN035K — Columbus CR/RP Femur F5R NN830K — Columbus CR/RP Femur F2N R NN931K — Columbus CR/RP Femur F6N R NN032K — Columbus CR/RP Femur F2R NN036K — Columbus CR/RP Femur F6R NN831K — Columbus CR/RP Femur F3N R NN037K — Columbus CR/RP Femur F7R NN033K — Columbus CR/RP Femur F3R NN038K — Columbus CR/RP Femur F8R

80 Femoral Component PS Posterior Stabilized Cemented CoCr AS NN161K NN161Z Columbus® PS Femur F1L NN840K — Columbus PS Femur F2N L NN162K NN162Z Columbus PS Femur F2L NN841K — Columbus PS Femur F3N L NN163K NN163Z Columbus PS Femur F3L NN939K — Columbus PS Femur F4N L NN164K NN164Z Columbus PS Femur F4L NN940K — Columbus PS Femur F5N L NN165K NN165Z Columbus PS Femur F5L NN941K — Columbus PS Femur F6N L CoCr AS NN166K NN166Z Columbus PS Femur F6L NN949K — Columbus PS Femur F4N R NN167K NN167Z Columbus PS Femur F7L NN174K NN174Z Columbus PS Femur F4R NN168K — Columbus PS Femur F8L NN950K — Columbus PS Femur F5N R NN171K NN171Z Columbus PS Femur F1R NN175K NN175Z Columbus PS Femur F5R NN850K — Columbus PS Femur F2N R NN951K — Columbus PS Femur F6N R NN172K NN172Z Columbus PS Femur F2R NN176K NN176Z Columbus PS Femur F6R NN851K — Columbus PS Femur F3N R NN177K NN177Z Columbus PS Femur F7R NN173K NN173Z Columbus PS Femur F3R NN178K — Columbus PS Femur F8R

AS PS Fixation Screw for Meniscal Component CoCr AS — NN497Z Height 10/12 — NN498Z Height 14/16 — NN499Z Height 18/20

81 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

21. Order Information (continued)

Tibia plateau CR/PS Cruciate Retaining/ Posterior Stabilized Modular, Cemented CoCr AS NN070K NN070Z Columbus CR/PS Tibia Plateau T0 NN058K NN058Z Columbus CR/PS Tibia Plateau T0+ NN071K NN071Z Columbus CR/PS Tibia Plateau T1 NN072K NN072Z Columbus CR/PS Tibia Plateau T1+ NN073K NN073Z Columbus CR/PS Tibia Plateau T2 NN074K NN074Z Columbus CR/PS Tibia Plateau T2+ NN075K NN075Z Columbus CR/PS Tibia Plateau T3 NN076K NN076Z Columbus CR/PS Tibia Plateau T3+ NN077K NN077Z Columbus CR/PS Tibia Plateau T4 NN078K NN078Z Columbus CR/PS Tibia Plateau T4+ NN079K NN079Z Columbus CR/PS Tibia Plateau T5

Tibia plateau CR/PS Cruciate Retaining/ Posterior Stabilized Modular, Plasmapore CoCr AS NN081K — Columbus CR/PS Tibia Plateau T1 NN082K — Columbus CR/PS Tibia Plateau T1+ NN083K — Columbus CR/PS Tibia Plateau T2 NN084K — Columbus CR/PS Tibia Plateau T2+ NN085K — Columbus CR/PS Tibia Plateau T3 NN086K — Columbus CR/PS Tibia Plateau T3+ NN087K — Columbus CR/PS Tibia Plateau T4 NN088K — Columbus CR/PS Tibia Plateau T4+ NN089K — Columbus CR/PS Tibia Plateau T5

Tibia plateau CRA/PSA CR Augmentation/ PS Augmentation Modular Cemented CoCr AS NN470K NN470Z Columbus CRA/PSA Tibia Plateau T0 NN469K NN469Z Columbus CRA/PSA Tibia Plateau T0+ NN471K NN471Z Columbus CRA/PSA Tibia Plateau T1 NN472K NN472Z Columbus CRA/PSA Tibia Plateau T1+ NN473K NN473Z Columbus CRA/PSA Tibia Plateau T2 NN474K NN474Z Columbus CRA/PSA Tibia Plateau T2+ NN475K NN475Z Columbus CRA/PSA Tibia Plateau T3 NN476K NN476Z Columbus CRA/PSA Tibia Plateau T3+ NN477K NN477Z Columbus CRA/PSA Tibia Plateau T4 NN478K NN478Z Columbus CRA/PSA Tibia Plateau T4+ NN479K NN479Z Columbus CRA/PSA Tibia Plateau T5

82 Tibial Hemispacer with Screws CoCr AS NN560K NN560Z Columbus® Tibial Hemispacer T0/0+ 4 mm RM/LL NN561K NN561Z Columbus Tibial Hemispacer T0/0+ 8 mm RM/LL NN563K NN563Z Columbus Tibial Hemispacer T1/1+ 4 mm RM/LL NN564K NN564Z Columbus Tibial Hemispacer T1/1+ 8 mm RM/LL NN566K NN566Z Columbus Tibial Hemispacer T2/2+ 4 mm RM/LL NN567K NN567Z Columbus Tibial Hemispacer T2/2+ 8 mm RM/LL NN569K NN569Z Columbus Tibial Hemispacer T3/3+ 4 mm RM/LL NN570K NN570Z Columbus Tibial Hemispacer T3/3+ 8 mm RM/LL NN572K NN572Z Columbus Tibial Hemispacer T4/4+ 4 mm RM/LL NN573K NN573Z Columbus Tibial Hemispacer T4/4+ 8 mm RM/LL NN575K NN575Z Columbus Tibial Hemispacer T5 4 mm RM/LL NN576K NN576Z Columbus Tibial Hemispacer T5 8 mm RM/LL NN580K NN580Z Columbus Tibial Hemispacer T0/0+ 4 mm RL/LM NN581K NN581Z Columbus Tibial Hemispacer T0/0+ 8 mm RL/LM NN583K NN583Z Columbus Tibial Hemispacer T1/1+ 4 mm RL/LM NN584K NN584Z Columbus Tibial Hemispacer T1/1+ 8 mm RL/LM NN586K NN586Z Columbus Tibial Hemispacer T2/2+ 4 mm RL/LM NN587K NN587Z Columbus Tibial Hemispacer T2/2+ 8 mm RL/LM NN589K NN589Z Columbus Tibial Hemispacer T3/3+ 4 mm RL/LM NN590K NN590Z Columbus Tibial Hemispacer T3/3+ 8 mm RL/LM NN592K NN592Z Columbus Tibial Hemispacer T4/4+ 4 mm RL/LM NN593K NN593Z Columbus Tibial Hemispacer T4/4+ 8 mm RL/LM NN595K NN595Z Columbus Tibial Hemispacer T5 4 mm RL/LM NN596K NN596Z Columbus Tibial Hemispacer T5 8 mm RL/LM

83 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

21. Order Information (continued) PE Gliding Surface CR Cruciate Retaining Deep Dish NN200 Columbus CR Deep Dish gliding surface T0/0+ 10 mm NN201 Columbus CR Deep Dish gliding surface T0/0+ 12 mm NN202 Columbus CR Deep Dish gliding surface T0/0+ 14 mm NN203 Columbus CR Deep Dish gliding surface T0/0+ 16 mm NN204 Columbus CR Deep Dish gliding surface T0/0+ 18 mm NN205 Columbus CR Deep Dish gliding surface T0/0+ 20 mm NN210 Columbus CR Deep Dish gliding surface T1/1+ 10 mm NN211 Columbus CR Deep Dish gliding surface T1/1+ 12 mm NN212 Columbus CR Deep Dish gliding surface T1/1+ 14 mm NN213 Columbus CR Deep Dish gliding surface T1/1+ 16 mm NN214 Columbus CR Deep Dish gliding surface T1/1+ 18 mm NN215 Columbus CR Deep Dish gliding surface T1/1+ 20 mm NN220 Columbus CR Deep Dish gliding surface T2/2+ 10 mm NN221 Columbus CR Deep Dish gliding surface T2/2+ 12 mm NN222 Columbus CR Deep Dish gliding surface T2/2+ 14 mm NN223 Columbus CR Deep Dish gliding surface T2/2+ 16 mm NN224 Columbus CR Deep Dish gliding surface T2/2+ 18 mm NN225 Columbus CR Deep Dish gliding surface T2/2+ 20 mm NN230 Columbus CR Deep Dish gliding surface T3/3+ 10 mm NN231 Columbus CR Deep Dish gliding surface T3/3+ 12 mm NN232 Columbus CR Deep Dish gliding surface T3/3+ 14 mm NN233 Columbus CR Deep Dish gliding surface T3/3+ 16 mm NN234 Columbus CR Deep Dish gliding surface T3/3+ 18 mm NN235 Columbus CR Deep Dish gliding surface T3/3+ 20 mm NN240 Columbus CR Deep Dish gliding surface T4/4+ 10 mm NN241 Columbus CR Deep Dish gliding surface T4/4+ 12 mm NN242 Columbus CR Deep Dish gliding surface T4/4+ 14 mm NN243 Columbus CR Deep Dish gliding surface T4/4+ 16 mm NN244 Columbus CR Deep Dish gliding surface T4/4+ 18 mm NN245 Columbus CR Deep Dish gliding surface T4/4+ 20 mm NN250 Columbus CR Deep Dish gliding surface T5 10 mm NN251 Columbus CR Deep Dish gliding surface T5 12 mm NN252 Columbus CR Deep Dish gliding surface T5 14 mm NN253 Columbus CR Deep Dish gliding surface T5 16 mm NN254 Columbus CR Deep Dish gliding surface T5 18 mm NN255 Columbus CR Deep Dish gliding surface T5 20 mm

84 PE Gliding Surface Cruciate Sacrificing UC Ultra Congruent NN400 Columbus® UC gliding surface T0/0+ 10 mm NN401 Columbus UC gliding surface T0/0+ 12 mm NN402 Columbus UC gliding surface T0/0+ 14 mm NN403 Columbus UC gliding surface T0/0+ 16 mm NN404 Columbus UC gliding surface T0/0+ 18 mm NN405 Columbus UC gliding surface T0/0+ 20 mm NN410 Columbus UC gliding surface T1/1+ 10 mm NN411 Columbus UC gliding surface T1/1+ 12 mm NN412 Columbus UC gliding surface T1/1+ 14 mm NN413 Columbus UC gliding surface T1/1+ 16 mm NN414 Columbus UC gliding surface T1/1+ 18 mm NN415 Columbus UC gliding surface T1/1+ 20 mm NN420 Columbus UC gliding surface T2/2+ 10 mm NN421 Columbus UC gliding surface T2/2+ 12 mm NN422 Columbus UC gliding surface T2/2+ 14 mm NN423 Columbus UC gliding surface T2/2+ 16 mm NN424 Columbus UC gliding surface T2/2+ 18 mm NN425 Columbus UC gliding surface T2/2+ 20 mm NN430 Columbus UC gliding surface T3/3+ 10 mm NN431 Columbus UC gliding surface T3/3+ 12 mm NN432 Columbus UC gliding surface T3/3+ 14 mm NN433 Columbus UC gliding surface T3/3+ 16 mm NN434 Columbus UC gliding surface T3/3+ 18 mm NN435 Columbus UC gliding surface T3/3+ 20 mm NN440 Columbus UC gliding surface T4/4+ 10 mm NN441 Columbus UC gliding surface T4/4+ 12 mm NN442 Columbus UC gliding surface T4/4+ 14 mm NN443 Columbus UC gliding surface T4/4+ 16 mm NN444 Columbus UC gliding surface T4/4+ 18 mm NN445 Columbus UC gliding surface T4/4+ 20 mm NN450 Columbus UC gliding surface T5 10 mm NN451 Columbus UC gliding surface T5 12 mm NN452 Columbus UC gliding surface T5 14 mm NN453 Columbus UC gliding surface T5 16 mm NN454 Columbus UC gliding surface T5 18 mm NN455 Columbus UC gliding surface T5 20 mm

85 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

21. Order Information (continued) PE Gliding Surface PS Posterior Stabilized incl. Fixation Screw NN500 Columbus® PS gliding surface T0/0+ 10 mm NN501 Columbus PS gliding surface T0/0+ 12 mm NN502 Columbus PS gliding surface T0/0+ 14 mm NN503 Columbus PS gliding surface T0/0+ 16 mm NN504 Columbus PS gliding surface T0/0+ 18 mm NN505 Columbus PS gliding surface T0/0+ 20 mm NN510 Columbus PS gliding surface T1/1+ 10 mm NN511 Columbus PS gliding surface T1/1+ 12 mm NN512 Columbus PS gliding surface T1/1+ 14 mm NN513 Columbus PS gliding surface T1/1+ 16 mm NN514 Columbus PS gliding surface T1/1+ 18 mm NN515 Columbus PS gliding surface T1/1+ 20 mm NN520 Columbus PS gliding surface T2/2+ 10 mm NN521 Columbus PS gliding surface T2/2+ 12 mm NN522 Columbus PS gliding surface T2/2+ 14 mm NN523 Columbus PS gliding surface T2/2+ 16 mm NN524 Columbus PS gliding surface T2/2+ 18 mm NN525 Columbus PS gliding surface T2/2+ 20 mm NN530 Columbus PS gliding surface T3/3+ 10 mm NN531 Columbus PS gliding surface T3/3+ 12 mm NN532 Columbus PS gliding surface T3/3+ 14 mm NN533 Columbus PS gliding surface T3/3+ 16 mm NN534 Columbus PS gliding surface T3/3+ 18 mm NN535 Columbus PS gliding surface T3/3+ 20 mm NN540 Columbus PS gliding surface T4/4+ 10 mm NN541 Columbus PS gliding surface T4/4+ 12 mm NN542 Columbus PS gliding surface T4/4+ 14 mm NN543 Columbus PS gliding surface T4/4+ 16 mm NN544 Columbus PS gliding surface T4/4+ 18 mm NN545 Columbus PS gliding surface T4/4+ 20 mm NN550 Columbus PS gliding surface T5 10 mm NN551 Columbus PS gliding surface T5 12 mm NN552 Columbus PS gliding surface T5 14 mm NN553 Columbus PS gliding surface T5 16 mm NN554 Columbus PS gliding surface T5 18 mm NN555 Columbus PS gliding surface T5 20 mm

86 Tibia Obturator Standard AS NN261K NN261Z Obturator 12 mm T0-T3+ NN264K NN264Z Obturator 14 mm T4-T5

Peek Plug NN260P Peek Plug T1-T5

Universal Tibia Stems Cemented AS NX060Z Tibia Stem, L 52 mm, 10 mm NX062Z Tibia Stem, L 52 mm, 12 mm NX063Z Tibia Stem, L 52 mm, 14 mm NX061Z Tibia Stem, L 92 mm, 10 mm NX064Z Tibia Stem, L 92 mm, 12 mm NX065Z Tibia Stem, L 92 mm, 14 mm

Universal Tibia Stems Pressfit AS NX082Z Tibia Stem, L 92 mm, 10 mm NX084Z Tibia Stem, L 92 mm, 12 mm NX085Z Tibia Stem, L 92 mm, 14 mm NX083Z Tibia Stem, L 132 mm, 10 mm NX086Z Tibia Stem, L 132 mm, 12 mm NX087Z Tibia Stem, L 132 mm, 14 mm

Columbus® Tibial Stems 52 mm 92 mm Size Qty. Short Long 12 mm 1 NN262Z NN263Z 14 mm 1 NN265Z NN266Z

Columbus Patellas NN481 Patella Size P1, 27 x 7 mm NN482 Patella Size P2, 30 x 8 mm NN483 Patella Size P3, 33 x 9 mm NN484 Patella Size P4, 36 x 10 mm

Universal Patellas NX041 VEGA System® Patella Size P1, 26 x 7 mm NX042 VEGA System Patella Size P2, 29 x 8 mm NX043 VEGA System Patella Size P3, 32 x 9 mm NX044 VEGA System Patella Size P4, 35 x 10 mm NX045 VEGA System Patella Size P5, 38 x 11 mm

87 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

22. Columbus Implant Matrix – AS Femoral Parts

AS Femur CR Cemented Types: F1 F2N F2 F3N F3 F4N F4 F5N F5 F6N F6 F7 F8 Left NN001Z NN800Z NN002Z NN801Z NN003Z NN899Z NN004Z NN900Z NN005Z NN901Z NN006Z NN007Z — Right NN011Z NN810Z NN012Z NN811Z NN013Z NN909Z NN014Z NN910Z NN015Z NN911Z NN016Z NN017Z —

AS Femur PS Cemented Types: F1 F2 F3 F4 F5 F6 F7 F8 Left NN161Z NN162Z NN163Z NN164Z NN165Z NN166Z NN167Z — Right NN171Z NN172Z NN173Z NN174Z NN175Z NN176Z NN177Z —

Columbus Implant Matrix – AS Tibial Parts

AS Tibia Cemented CR/PS CRA/PSA Types: T0 T0+ T1 T1+ T2 T2+ T3 T3+ T4 T4+ T5 CR/PS NN070Z NN058Z NN071Z NN072Z NN073Z NN074Z NN075Z NN076Z NN077Z NN078Z NN079Z CRA/PSA — — NN471Z NN472Z NN473Z NN474Z NN475Z NN476Z NN477Z NN478Z NN479Z

CRA/PSA Tibia Hemispacers with Screws 4 mm 8 mm Types: T0 T1 T2 T3 T4 T5 T0 T1 T2 T3 T4 T5 RM/LL NN560Z NN563Z NN566Z NN569Z NN572Z NN575Z NN561Z NN564Z NN567Z NN570Z NN573Z NN576Z RL/LM NN580Z NN583Z NN586Z NN589Z NN592Z NN595Z NN581Z NN584Z NN587Z NN590Z NN593Z NN596Z

Universal Tibia Stems Cemented Universal Tibia stems pressfit Types: 10 mm 12 mm 14 mm 10 mm 12 mm 14 mm 52 mm 92 mm 52 mm 92 mm 52 mm 92 mm 92 mm 132 mm 92 mm 132 mm 92 mm 132 mm T0-T5 NX060Z NX061Z NX062Z NX064Z NX063Z NX065Z NX082Z NX083Z NX084Z NX086Z NX085Z NX087Z

Obturator Peek Plug Fixation Screw for PS Gliding Surfaces Columbus Tibia Stems Cemented 12 mm 14 mm NN260P Types: 10/12 14/16 18/20 Size 52 mm Short 92 mm Long NN261Z NN264Z NN497Z NN498Z NN499Z 12 mm NN262Z NN263Z Note: CoCr fixations screw packaged with 14 mm NN265Z NN266Z PE. You must order AS Fixation screw seperately if using AS tibia.

88 Columbus® Implant Matrix − Femoral Parts

Femur CR Cemented Types: F1 F2N F2 F3N F3 F4N F4 F5N F5 F6N F6 F7 F8 Left NN001K NN800K NN002K NN801K NN003K NN899K NN004K NN900K NN005K NN901K NN006K NN007K NN008K Right NN011K NN810K NN012K NN811K NN013K NN909K NN014K NN910K NN015K NN911K NN016K NN017K NN018K

Femur PS Cemented Types: F1 F2N F2 F3N F3 F4N F4 F5N F5 F6N F6 F7 F8 Left NN161K NN840K NN162K NN841K NN163K NN939K NN164K NN940K NN165K NN941K NN166K NN167K NN168K Right NN171K NN850K NN172K NN851K NN173K NN949K NN174K NN950K NN175K NN951K NN176K NN177K NN178K

Femur CR Plasmapore® Types: F1 F2N F2 F3N F3 F4N F4 F5N F5 F6N F6 F7 Left NN021K NN820K NN022K NN821K NN023K NN919K NN024K NN920K NN025K NN921K NN026K NN027K Right NN031K NN830K NN032K NN831K NN033K NN929K NN034K NN930K NN035K NN931K NN036K NN037K

Tibia Cemented CR/PS CRA/PSA Types: T0 T0+ T1 T1+ T2 T2+ T3 T3+ T4 T4+ T5 CR/PS NN070K NN058K NN071K NN072K NN073K NN074K NN075K NN076K NN077K NN078K NN079K CRA/PSA NN470K NN469K NN471K NN472K NN473K NN474K NN475K NN476K NN477K NN478K NN479K

Tibia Plasmapore CR/PS Types: T0 T0+ T1 T1+ T2 T2+ T3 T3+ T4 T4+ T5 CR/PS — — NN081K NN082K NN083K NN084K NN085K NN086K NN087K NN088K NN089K

CRA/PSA Tibia Hemispacers with Screws 4 mm 8 mm Types: T0 T1 T2 T3 T4 T5 T0 T1 T2 T3 T4 T5 RM/LL NN560K NN563K NN566K NN569K NN572K NN575K NN561K NN564K NN567K NN570K NN573K NN576K RL/LM NN580K NN583K NN586K NN589K NN592K NN595K NN581K NN584K NN587K NN590K NN593K NN596K

Obturator Peek Plug Tibia Stems Cemented 12 mm 14 mm NN260P Types: 10 mm 12 mm 14 mm 10 mm 12 mm 14 mm 14 mm NN261K NN264K 52 mm 92 mm 52 mm 92 mm 52 mm 52 mm 92 mm T0-T5 — — NX062K — NX063K NX065K NX065K

89 Columbus® Knee System Knee Arthroplasty Surgical Technique with IQ Instruments

22. Columbus® Implant Matrix – Gliding Surfaces and Patellas

Gliding Surfaces DD UC PS T0/T0+ T1/T1+ Types: 10 12 14 16 18 20 10 12 14 16 18 20 DD NN200 NN201 NN202 NN203 NN204 NN205 NN210 NN211 NN212 NN213 NN214 NN215 UC NN400 NN401 NN402 NN403 NN404 NN405 NN410 NN411 NN412 NN413 NN414 NN415 PS NN500 NN501 NN502 NN503 NN504 NN505 NN510 NN511 NN512 NN513 NN514 NN515

T2/T2+ Types: 10 12 14 16 18 20 DD NN220 NN221 NN222 NN223 NN224 NN225 UC NN420 NN421 NN422 NN423 NN424 NN425 PS NN520 NN521 NN522 NN523 NN524 NN525

Gliding Surfaces DD UC PS T3/T3+ T4/T4+ 10 12 14 16 18 20 10 12 14 16 18 20 DD NN230 NN231 NN232 NN233 NN234 NN235 NN240 NN241 NN242 NN243 NN244 NN245 UC NN430 NN431 NN432 NN433 NN434 NN435 NN440 NN441 NN442 NN443 NN444 NN445 PS NN530 NN531 NN532 NN533 NN534 NN535 NN540 NN541 NN542 NN543 NN544 NN545

T5 10 12 14 16 18 20 DD NN250 NN251 NN252 NN253 NN254 NN255 UC NN450 NN451 NN452 NN453 NN454 NN455 PS NN550 NN551 NN552 NN553 NN554 NN555

Columbus Patellas Universal Patellas Size: 1 2 3 4 P1 P2 P3 P4 P5 NN481 NN482 NN483 NN484 NX041 NX042 NX043 NX044 NX045

90 Notes

91 All rights reserved. Technical alterations are possible. The information provided in this leaflet is distributed by Aesculap Implant Systems, LLC for educational purposes and not for the purpose of rendering medical advice. The material in this leaflet is not instructional and should NOT be relied upon by surgeons and staff as adequate training for performing the surgeries illustrated. This brochure is intended for health care professionals and employees, not for patients. The information presented is not a substitute for a medical examination and opinion by a licensed physician regarding a patient’s diagnosis or recommended course of treatment. This leaflet may be used for no other purposes than offering, buying and selling of our products. No part may be copied or reproduced in any form. In the case of misuse we retain the rights to recall our catalogs and price lists and to take legal actions.

Aesculap Implant Systems, LLC - a B. Braun company SOP-AIS-5001081 Rev. 01 DOC1172 Rev. B 500 2/19