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