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Surgical Technique

Our surgeon design team first implanted the Preservation™ Unicompartmental Knee System in 2001. The system was developed with over 100 years combined unicompartmental knee replacement experience.

In its design, our objective was to develop specialist instruments and a new concept of specific technique that allowed the surgeon to achieve accurate, reproducible alignment and balance for long-term clinical results. Since its launch, this technique has evolved with the experience of our designing surgeon team and is incorporated into this Surgical Technique manual.

Appropriate implant alignment and articulation, as well as flexion and extension space balancing must be achieved to obtain optimal results. The relatively small working area available for unicompartmental surgery means that the cementing technique is also critical to long term fixation. If these fundamentals are respected, excellent outcomes can be achieved with early return of function, outstanding range of motion, and a very high level of patient satisfaction.

The clinical results to date have been enlightening and rewarding. With 5 years of clinical experience, we continue to follow hundreds of patients enjoying ongoing clinical success with the Preservation™ Unicompartmental Knee.

We believe the implant will continue to perform well for years to come.

The Preservation™ Design Group

Dr. Dave Dalury - Baltimore, USA

Dr. Dave Fisher – Indianapolis, USA

Dr. James McAuley – London, Canada

Dr. Wolfgang Herzberg – Hamburg, Germany

Dr. Greg Keene – Adelaide, Australia

Dr. Ed Newman – Christchurch, New Zealand

Dr. Gerry Engh – Arlington, USA

FOREWORDPRESERVATION™ UNICOMPARTMENTAL KNEE SYSTEM

1

CONTENTS

Contents 1

Introduction 2

Templating 3

Approach and Exposure 5

Tibial Jig Alignment 7

Proximal Tibial Resection 10

Extension Gap 12

Flexion Gap 13

Alignment and Femoral Resection 14

Femoral Sizing and Rotation 15

Femoral Chamfer Cuts 18

Trial Reduction 19

Femoral Fin Slot 21

Femoral Peg 22

Tibial Keel Preparation 23

Component Trial 24

Cementing Preparation 25

Cementing the Tibial Components 26

Cementing the Femoral Component 30

Possible Flexion/Extension Gap Adjustment 32

Implant Product Codes 33

Instrument Product Codes 35

2

INTRODUCTIONPRESERVATION™ UNICOMPARTMENTAL KNEE SYSTEM

Precise Alignment The exposure for the Preservation™ Unicompartmental Knee System leaves the patella in its natural position over the femoral condyles and avoids disruption of the extensor mechanism.

Varus/valgus alignmentThe key to precise varus/valgus alignment is the approach to femoral resection. For the Preservation™ Unicompartmental Knee System, the distal femoral cut is made with the leg in extension, with the cutting block resting on the resected tibia. This allows the surgeon to assess the joint for natural balance and alignment with the patella close to it’s normal position, before the final cut is made.

True component to component alignmentAdjustment to medial/lateral alignment at the trial stage ensures that the femoral and tibial component are truly aligned for optimum articulation, throughout the range of motion.

Preserved Natural Balance Preventing over correction The joint balance is checked in natural alignment to ensure even load distribution across the joint, using the Preservation™ Unicompartmental Knee System distal cutting block and shims. This avoids over correction of the unaffected compartment.

Balanced flexion and extensionThe flexion and extension gaps are checked before any femoral cuts are made. This allows fine adjustments to be made to balance the knee.

Joint line restorationPositioning the implant based on a joint line reference with the distal femoral cutting block allows good function throughout gait.

Restores Joint Function Established articulating geometry The Preservation™ Unicompartmental Knee System “J” curve sagittal geometry, with its anterior kick-back, provides good coverage of the femoral condyle. This allows smooth, pain free kinematic patella function. Its coronal profile is curved to optimise bearing contact, avoiding edge loading in varus or valgus lift off.

Optimal, intra-operative bearing selection to suit each patientThe Preservation™ Unicompartmental Knee System offers a range of all-polyethylene, modular fixed and mobile bearing options, to suit the needs of each patient.

GUR 1020 Cross-linked bearing materialGUR 1020 cross-linked, ‘closed’ foil pack sterilised polyethylene is used in the Preservation™ Unicompartmental Knee System for its resistance to oxidation and wear.

Keeled tibial fixationThe keel design ensures the tray or bearing is mechanically stable on the tibial plateau. It also adds strength to the tibial component and allows a minimum bearing thickness of 7 mm for the all-polyethylene option.

Indications Unicompartmental Knee Replacement (UKR) is indicated for patients with osteoarthrosis that is isolated to the medial or lateral tibial-femoral compartment. In these cases, the remaining opposite compartment articular cartilage is physically and biomechanically intact and capable of bearing normal loads.

In very young and active patients, a high tibial osteotomy may still remain the treatment of choice for advanced single compartmental disease.

Contraindications UKR is contraindicated for patients with inflammatory arthritis, significant chondrocalcinosis of the articular surface, advanced involvement of the other compartments or a significant extra-articular deformity.

3

TEMPLATING

X-ray TemplatingTemplating the Anterior/Posterior (A/P) X-ray will indicate the amount of tibia to be resected (Figure 1). The lateral X-ray is used to determine the size of the femoral component and the angle of the posterior tibial slope. It is recommended that each patient is X-ray templated prior to the procedure.

Anterior Posterior Template: TibiaThe A/P template is placed over the A/P X-ray with the thick red horizontal line 2 mm above the lowest point of the superior tibial bone on the non-arthritic side (Figure 2). This indicates the new joint line on the arthritic side.

Select the thinnest tibial prosthesis that will remove the defect. The minimum thickness of a fixed bearing all-polyethylene is 7 mm. A fixed bearing modular metal backed or mobile bearing minimum thickness is 9.5 mm. This thickness will determine the tibial resection. If the gap from the joint line to the lowest point of the worn side is 3 mm, then only 4 mm of tibia is resected. If there has been greater wear of the tibia and a thicker tibial component is necessary, simply adjust the measurements accordingly. This predicted tibial resection must be checked intra-operatively before tibial resection.

Anterior posterior X-ray and template

Joint Line3 mm

4 mm tibial resection

+5 mm

Joint Line

-5 mm

-10 mm

New Joint Line

7 mm tibial component

3 mm

4 mm tibial resection

Figure 1 Figure 2

4

Lateral Template: FemurThe lateral template is positioned in the coronal plane at a right angle to the long axis of the femur (Figure 3). Align the template with the planned distal femoral cut to remove the defect. The template outline should be 1-2 mm larger than the bony margin of the X-ray, and should match the outline of the articular surface (2 mm thick). The posterior condyle of the prosthesis must not excessively overlap the superior bony margin of the adjacent posterior condyle of the femur.

The posterior slope of the upper tibia should also be templated on the lateral X-ray as this is set at the time of tibial resection (Figure 4). This can vary from 0 to 15˚ and affects tightness of the prosthesis in flexion.

A preliminary arthroscopy may also be used at an earlier stage to provide an initial assessment.

Femoral sizing on the lateral X-ray Posterior tibial slope on the lateral X-ray

TEMPLATING

Figure 3 Figure 4

5

The Approach - Medial or Lateral CompartmentAn antero-medial or antero-lateral skin incision is performed. The incision should begin 1 cm proximal to the superior border of the patella. It should extend 6 -10 cm distally along the edge of the patella and patella tendon, and end 2 cm distal to the joint line (Figure 5). A longer incision is advised when first starting to use the procedure or if the patient is obese. The joint capsule is entered with a parapatellar incision (Figure 6). Once the joint is exposed, a final assessment can be made of the extent of arthritic damage and the suitability of the joint for this procedure.

ExposureThe deep menisco-tibial layer of the medial or lateral capsule should be carefully retracted to provide good access to any tibial osteophytes and allow accurate wound closure. Any excess deep synovium is excised to provide clear sight of the joint. If required, all or part of the fat pad may also be excised to improve vision and allow inspection of the opposite compartment. Two large rake or ‘z’ retractors are then introduced to maintain access to the capsule during all stages of the procedure. Retraction of skin edges should be avoided. No ligament releases should be performed as part of this procedure as this is a contraindication.

APPROACH AND EXPOSURE

Figure 5 Figure 6

6

In order to achieve medial-lateral (M/L) alignment and joint stability, it is vital that all osteophytes are removed from the entire medial or lateral edges of the femur and tibia (Figure 7). A retractor is used on the patella rim to draw the patella into a central position. Any significant osteophytes on the edge of the patella should also be excised.

With the knee in full extension, mark the ‘tidemark’ on the femoral condyle with a pen or electrocautery. This should be used as a projection of the limit of the tibia in full extension and can be used to help size the femoral component at a later stage (Figure 8).

APPROACH AND EXPOSURE

Figure 7 Figure 8

Tidemark

7

Figure 10A

Ankle clamp

Tibial cutting block

Figure 10B

Natural AlignmentIt will not be possible for some patients to achieve a neutral mechanical axis (Figure 9) without major soft tissue release which is a contraindication. In such cases; after osteophyte removal, spacer block insertion and achieving good collateral ligament tension, the alignment achieved should be accepted. At this stage an intra-operative assessment can be made of the femoral and tibial damage. The assessment should be used in conjunction with the pre-operative templating to decide how much tibial bone is resected.

Tibial Resection - Aligning the Tibial JigThe knee is placed in 90° of flexion and the ankle clamp is attached proximal to the malleoli (Figure 10A). The midline of the tibia is approximately 3 mm medial to the transaxial midline. The lower assembly of the ankle clamp is translated medially (usually to the second vertical mark). There are scribe marks at 3 mm and 6 mm for reference, aligning to the middle of the talus. Tighten the lower front varus/valgus screw to lock (Figure 10B). The tibial cutting block is then raised to just below the level of the joint line. It is important to note that accurate alignment of instrumentation to anatomical references in the initial stages of this procedure will minimise tibial bone loss and establish accurate implant alignment.

TIBIAL JIG ALIGNMENT

Figure 9

Joint line

Valgus angle

Mechanical axis

Anatomic axis

Adjust proximally to achieve varus/valgus alignment

Intramedullary axisof the tibia

Axis of the tibial alignment rod

8

TIBIAL JIG ALIGNMENT

The tibial cutting block is now positioned 2 mm medial to the centre of the tibial tubercle. Medial/lateral adjustment should be made proximally to achieve varus/valgus alignment that is parallel to the transmalleolar axis (Figure 11).

The medial lateral position of the cutting block is pinned and stabilised. The pin is drilled percutaneously (a stab incision is required with plastic drapes) into the tibia through the vertical slot in the rod (Figure 12). Further varus/valgus adjustment can be made at the ankle clamp if required at this stage. The A/P slope of the tibia is now set. The lower assembly is translated to bring the alignment rod parallel with the intramedullary axis of the tibia in the sagittal plane. The anterior crest of the tibia can be used as a reference proximally. In this position the tibial cutting block will dictate a 0˚ posterior tibial slope.

Figure 11 Figure 12

9

TIBIAL JIG ALIGNMENT

Further anterior translation of the distal assembly will adjust this slope angle. The slope should be set to the figure determined from templating the lateral X-ray (Figure 13). One scribe on the ankle clamp equals approximately 2˚, dependant on leg length.

The tibial stylus height is referenced to the pre-operative tibial resection templating and intra-operative assessment of the defect. The tibial stylus is inserted into the tibial cutting block using either the open or slotted foot and its tip is brought to rest on the tibial plateau (Figure 14).

Vertical movement of the proximal assembly is now stabilised to fix varus/valgus and inferior/superior position. The knob on the proximal alignment rod is locked and one or two additional percutaneous pins are introduced through the bottom row of holes in the cutting block (Figure 14). The tibial stylus is then removed.

Figure 14

A/P slope of the tibia

Tibial stylus assembled with slotted foot

Figure 13

10

PROXIMAL TIBIAL RESECTION

The L-cut guide may be used to stabilise the reciprocating saw blade. The leading edge of the L-cut should be just medial or lateral to the anterior cruciate ligament insertion. The L-cut guide is attached to the tibial cutting block with its foot located in one of the four available tibial sizing slots (Figure 15). The aim is to allow the largest tibial prosthesis to be implanted, covering the maximum area of cortical bone in both the A/P and M/L planes. The L-cut is then taken with a reciprocating saw. The L-cut may need to be re-cut at a later stage to adjust the tibial tray position to allow for optimal prosthesis to prosthesis contact. Care must be taken to avoid over resecting the bone or weakening the anterior cruciate ligament.

The transverse cut is made through the slot in the tibial cutting guide or on the open cutting surface (Figure 16). It is important to use the Preservation™ Uni saw blade attached to an oscillating saw for the cut.

Figure 15 Figure 16

It is important to use the Preservation™ Uni saw blade

L-cut guide

Transverse cut

L-cut

11

Vertical slot pin is removed

Graspers

Bristow retractor

PROXIMAL TIBIAL RESECTION

In order to remove the cut tibia, first remove the vertical slot pin and then remove the tibial jig. Use an osteotome to open the saw cut to prevent the fragment from breaking so that it can be removed in one piece. Hold the bone fragment with graspers and lever out at a 30˚ angle with a Bristow retractor. Any bone fragments or meniscal rim should be removed from the posterior area (Figure 17).

Figure 17

7 mm

12

Check Extension GapThe distal femoral cutting block is mounted onto the system handle. This is used to check the extension gap. If the distal femur is severely worn, then a 2 mm femoral shim can be used (Figure 18). This can be assessed by extending the leg. When using the 7 mm all polyethylene fixed bearing, no shims need to be added to the tibial side of the distal cutting block. When using the mobile bearing or the modular fixed bearing, the appropriate shims can be added where necessary on the tibial side.

At this stage in natural alignment the tibial implant thickness, extension gap, stability of the collateral ligaments, lower leg alignment and ability to achieve full extension can be checked.

If the extension gap is found to be too tight, then remount the upper portion of the tibial jig on the pins and re-cut.

If the extension gap is too loose this may suggest that the tibia has been over-cut. Add the next size tibial shim for a thicker tibial prosthesis until the desired ‘feel’ in extension is achieved.

If the extension gap is acceptable or only slightly loose, the flexion gap can now be checked.

EXTENSION GAP

Figure 18

2 mm distal femoral shim

13

Check Flexion GapBefore checking the flexion gap, ensure that the 2 mm femoral shim is removed if used. The distal femoral cutting block and the attached tibial shims are inserted into the flexion space (Fig 19).

The block should slide in and out with minimal pressure. If it does not, then remove 2 mm of bone from the posterior femoral condyle and not from the tibia. Any resection of the tibia can affect the size selection of the tibial component.

Figure 19

Femoral damage

Remove the 2 mm distal femoral shim before checking the flexion gap

7 mm

FLEXION GAP

14

Check AlignmentWith the leg held in full extension, the alignment guide and the extramedullary alignment rod are assembled onto the distal femoral cutting block and long leg alignment is checked (Figure 20). Proximally, the tip of the rod is aligned with the centre of the femoral head and distally over the second metatarsal. Care should be taken to avoid overcorrection at this stage. The alignment guide and the extramedullary alignment rod are now removed. The leg is maintained in extension, which stabilises the distal femoral cutting block in position.

Resect Distal FemurThe leg is flexed to replicate the approximate slope of the tibial resection. The angle for the distal femoral resection is determined by the posterior slope of the tibial resection. This will ensure an appropriate flexion angle for the femur. For example – with a 5˚ distal slope, the leg is placed at approximately 5˚ of flexion. The system handle on the distal femoral cutting block is now removed.

A Preservation™ Uni sawblade (1.27 mm thickness) should be used through the distal femoral cutting block slot to initiate the cut (Figure 21). To avoid capsular damage posteriorly, this cut should be completed with the distal femoral cutting block removed. Once the resected distal bone is removed, any remaining soft tissue should be cleared from the meniscal rim and posterior tibia.

ALIGNMENT AND FEMORAL RESECTION

Figure 21

Distal femoral cutting block

Alignment guide

Alignment rodJoint line

Valgus angle

Mechanical axis

Anatomic axis

Figure 20

15

FEMORAL SIZING AND ROTATION

Femoral Sizing and Rotation The femoral size established during pre-operative templating is checked using the femoral rotation and sizing guide. The anterior tip profile and M/L width of the guide is the same as the femoral prosthesis. The aim is to ensure a smooth transition of the patella from the trochlea onto the anterior tip of the femoral prosthesis. The M/L position is initially chosen to be centred on the condyle after osteophyte removal.

The final M/L position is chosen later with the femoral trial.

The ‘tidemark’, which we had previously marked in extension to match the anterior margin of the tibial articular surface, sets the A/P limit (Figures 22 & 23).

Tidemark

Tidemark

Distal cut

Figure 23Figure 22

16

Figure 24 Figure 25

Anterior tip profile and M/L width are the same as the

femoral prosthesis

Tidemark 10˚ Maximum rotation

The knee is placed in 90˚ of flexion and the appropriate size of femoral sizing and rotation guide is positioned under the posterior condyle using the system handle (Figure 24).

It is important to start with the femoral sizing and rotation guide in a neutral orientation and centrally aligned over the tibial plateau. The femoral sizing guide should reach the tide mark anteriorly. Note the shape of the sizing guide anteriorly matches the actual shape of the prostheses which assists in positioning the guide.

A tibial trial or femoral spacer guide block can be temporarily located on the tibia to balance the joint. The femoral sizing and rotation guide may be rotated by a maximum of 10˚ to avoid overhang on the anterior aspect of the femur and ensure maximum coverage of resected bone (Figure 25). The femoral condyle should remain central to the tibial resection. This will allow the anterior aspect of the femoral prosthesis to articulate accurately in extension on the anterior aspect of the anatomically shaped tibial prosthesis.

FEMORAL SIZING AND ROTATION

17

Once in the correct position, the pin in the femoral rotation guide is pressed into the distal femur. Two holes are drilled through the guide to create a location for the femoral finishing guide (Figure 26). The system handle is then removed.

The curved gouge is used to cut the profile of the anterior tip of the femoral prosthesis. The gouge cut should be made about 2 mm anteriorly to the femoral rotation guide. This will mark the extent of the anterior chamfer cut (Figure 27).

FEMORAL SIZING AND ROTATION

Figure 26

Curved gouge

Curved gouge cut

Tidemark

Figure 27

18

Femoral ChamferThe femoral rotation guide is removed. The system handle should be used to stabilise the femoral finishing guide whilst the chamfer cuts are made. The cuts should be performed in the following order to prevent the guide from tilting.

The femoral finishing guide is inserted into the two holes in the distal femoral surface and is tapped firmly into position - as in position 1 (Figure 28).

The system handle can then be moved to Position 2 of the guide, and the posterior femur is resected through the guide slot using the Preservation™ Uni saw blade (Figure 29).

The system handle is relocated back to Position 1 and the posterior chamfer is cut (Figure 30)

With the system handle removed, the anterior chamfer is cut. It is important that the anterior chamfer cut extends no further than the previous curved gouge cut (Figure 31). The anterior chamfer cut can alternatively be made using an osteotome.

FEMORAL CHAMFER CUTS

Figure 28 Figure 29

Figure 30 Figure 31

Limit of anterior chamfer cut as previously resected by the curved gouge (tidemark)

Posterior femoral resection

Introduce the femoral finishing guide

Posterior chamfer cutAnterior cut

Position 1

Position 1 Position 2

19

TRIAL REDUCTIONFIXED BEARING

Trial ReductionThe leg is held in 90˚ of flexion. Trial the femoral component first. A femoral trial matching the final femoral rotation guide is attached to the femoral introducer, located on the distal femoral cut, and tapped into the bone. Impact the trial with the first few hits moving from posterior to anterior (Figure 32).

The appropriate tibial trial is selected, corresponding to the thickness determined by the distal femoral cutting block and shims. It is placed on the resected tibia and cortical bone coverage is assessed. Components can be up or down sized as per the chart below.

The fixed bearing trial can be attached to the systems handle and should insert easily using the handle system (Figure 33).

Femoral Size Fixed Bearing Tibia

1 2 3 4 5

1 X X

2 X X X

3 X X X

4 X X X

5 X X

Figure 32 Figure 33

2nd Impact

1st Impact

20

Figure 35

As with the fixed bearing, the mobile bearing size and position are critical. The largest possible trial tray for each patient should be selected and placed anteriorly on the resected tibia. This will allow the final trial mobile bearing component to be inserted easily onto the track, avoiding any contact with the anterior tibial eminence. When the final mobile bearing tray trial is in place, position the knee more valgus and flexed to about 60˚ to insert the mobile bearing trial component without moving the trial tray (Figure 34). If the anterior tibial eminence causes an obstruction, the excess bone should be removed using an osteotome.

Joint stability and rotational alignment are again assessed in flexion and full extension (Figure 35). Reference may also be made to the flexion and extension adjustment table on Page 32. M/L position of the femoral and tibial trials are checked.

TRIAL REDUCTIONMOBILE BEARING

Push

Assemble the tray and mobile bearing insert. Partially advance the mobile bearing insert under the posterior femoral condyle and then push the tibial tray into position

Figure 34

21

The femur should sit in the centre of the tibial trial in flexion and extension. The M/L position of both the femoral and tibial components can be adjusted at this stage. Tibial rotation can also be modified to match any femoral rotation introduced during the sizing step. It may be necessary to re-cut the L-cut to achieve this component-to-component positioning which is most important in extension. If the trial has been successful, diathermy marks are made on the tibia against the alignment marks on the tibial trial (Figure 36).

The Femoral Fin SlotWith successful trialing complete, the leg is held in flexion with the tibial trial in place to stabilise the femoral trial. The femoral fin slot is cut in the distal femur using a reciprocating saw down both sides of the slot of the femoral trial (Figure 37). Because the femoral fin gets deeper posteriorly, the oscillating saw should cut deeper posteriorly, although care should be taken not to over resect.

FEMORAL FIN SLOT

Figure 36 Figure 37

Align the femoral trial over the centre of the tibial trial in flexion

and extension

For the mobile bearing, remove any excess bone from the tibial eminence to allow insertion of the polyethylene component.

Depth of femoral fin cut

Diathermy mark

22

The Femoral Peg HoleThe femoral drill guide is inserted into the femoral trial and the femoral component location hole is then drilled through the drill guide, using the peg drill to the depth marked on the drill (Figure 38). The drill handle is kept in line with the femur to provide correct flexion-extension.

Trial Femoral PegThe femoral peg trial is now used to ensure that the fin slot and peg hole have been formed to the correct depth (Figure 39). It is important to ensure that the femoral peg trial is fully inserted, as this component may become loose during impaction.

FEMORAL PEG

Figure 39

The slot must be cut before the peg trial is used

Figure 38

23

Diathermy mark

Figure 40

Tibial Keel PreparationThe tibial keel template that matches the selected tibial trial is inserted, using the system handle. This is aligned using the diathermy marks on the tibia. This is tapped into place and secured with a Specialist® 2 pin (Figure 40) or laminar spreader.

A keel groove is cut through the slot using the tibial keel osteotome (Figure 41). The groove can be carefully pre-cut using a oscillating saw. All resected bone must be removed from the joint. The tibial keel trial is inserted through the slot into the groove to check the correct depth of the keel has been prepared (Figure 42).

TIBIAL KEEL PREPARATION

Figure 42Figure 41

24

Component TrialThe definitive components can be trialed to ensure that the knee is placed in the appropriate position to facilitate implantation, prior to cementing. The tibial prosthesis is trialed first and gently impacted into place using the C-arm. The prosthesis and its keel should be fully seated on the tibia (Figure 43).

The femoral prosthesis is attached to the femoral introducer (Figure 44), introduced to the femur and gently pushed into place using the femoral impactor. The joint is checked for alignment and stability in flexion and extension with a trial tibial bearing. The components must be removed and thoroughly cleaned prior to final insertion.

COMPONENT TRIAL

Figure 44Figure 43

7 mm

Femoral introducer

C-arm

25

Cementing PreparationSmall holes can be drilled on the prepared tibial surface and in the keel slot in order to promote the penetration of cement.

The prepared tibial surface should be fully washed out using a pulse lavage, ensuring that no residual particles of bone are present in the joint space.

The surface should be fully dried using surgical swabs, ensuring the prepared tibia is as dry as possible prior to cementing.

A thin layer of cement can be applied to the prepared tibial surface and a small osteotome or the handle end of surgical forceps can be used to pressurise the cement into the bone.

A small cylindrical shaped piece of bone cement can also be inserted into the tibial keel slot and pressurised using the same technique (Figure 45).

A thin layer of cement can be applied to the prosthesis (Figure 46).

CEMENTING PREPARATION

Thin layer of cement

Figure 46Figure 45

26

Cementing the Tibial ComponentsThe tray can be positioned by applying pressure from the posterior to the anterior side. This will extrude the cement away anteriorly from the back of the joint (Figure 47). Ribbon gauze placed posteriorly around the implant can be used to prevent cement being displaced. Remove the gauze once the tray is impacted. Alternatively a bent arthroscopy probe can be used to remove posterior cement from the edge of the prosthesis. It is important to ensure complete removal of any bone cement extruded posteriorly from the tibial component.

All-Polyethylene Tibial BearingThe all-polyethylene tibial bearing is attached to the all-polyethylene tibial inserter and lowered onto the tibial resection, from posterior to anterior, forcing the cement away from the back of the joint (Figure 48).

The C-arm is used to maintain pressure until the cement has fully polymerised and fully set.

CEMENTING TIBIAL COMPONENTS ALL POLYETHYLENE

All-polyethylenetibial inserter

Figure 48Figure 47

Squeeze posterior to anterior

27

Modular Fixed BearingThe fixed bearing prosthesis tibial tray is inserted as per the all polyethylene tibial bearing technique.

The recommended method is to pre-assemble the insert and tray on the back table to ensure proper seating of the insert before the tray is cemented in the patient (Figure 49).

CEMENTING TIBIAL COMPONENTS FIXED BEARING

Figure 49

28

CEMENTING TIBIAL COMPONENTS MOBILE BEARING

Mobile BearingAn osteotome or nibbler should be used to remove anterior and posterior bone chamfers from the lateral side of the L-cut (Figure 50).

With the trial component in place, full anterior and posterior mobility of the mobile bearing should be assessed. The trials are removed and the final implant selected.

Cement is applied as per the all polyethylene and fixed bearing tray.

The mobile bearing tray Inserter/Impactor fits into the track of the mobile bearing tray. The tray is inserted into the joint and pressure is applied to seat the implant. Maintain pressure until the cement has fully polymerised and fully set (Figure 51).

Figure 50

To ensure that the bearing tracks correctly, anterior and posterior bone chamfers need to be removed.

Figure 51

Press trigger to grip implant

Chamfers

Femoral impactor

29

CEMENTING TIBIAL COMPONENTS MOBILE BEARING INSERTION

When the cement has fully set, the final bearing can be inserted onto the track.

The final mobile bearing component should be inserted into the track without any interference from the anterior tibial eminence (Figure 52). Again, full anterior and posterior mobility of the final mobile bearing must be checked.

If the bearing is positioned so that the joint space is opened up, the femoral prosthesis can enter more easily (Figure 53).

If the bearing is too posterior, it is impossible to insert the femoral component.

Figure 52 Figure 53

30

CEMENTING THE FEMORAL COMPONENT

Cementing the Femoral ComponentAn even layer of “doughy” viscosity cement is applied to the accessible cut surfaces of the femur, and digitally pressurised. A small amount of cement should be placed in the peg hole and fin slot to enhance fixation. A thin layer of cement can also be applied to the posterior condyle (Figure 54).

The femoral prosthesis is attached to the femoral introducer and inserted (Figure 55). The patella will need to be strongly retracted to facilitate femoral prosthesis insertion especially for a lateral approach, and the knee flexed at 90˚.

Even layer of cement

Thin layer of cement

Figure 54 Figure 55

Femoral introducer

31

The femoral prosthesis is tapped firmly onto the femur with the impactor and excess cement is removed (Figure 56).

The knee should now rest in varus (for a medial UKR) or valgus (for a lateral UKR) at about 20 - 30˚ of knee flexion. This position maintains even pressure on the tibial prosthesis. If the knee is flexed over 40˚ while the cement sets, pressure from the insert (fixed bearing / mobile bearing) on the posterior cut and posterior chamfer will cause undesirable distal and anterior femoral lift off (Figure 57).

At 20 - 30˚ of flexion, pressure from the insert on the posterior chamfer and distal cut is ideal (Figure 58).

Once the cement has polymerised and fully set, the joint is checked for range of movement, alignment and collateral ligament stability.

The wound is closed and the procedure is complete.

CEMENTING THE FEMORAL COMPONENT

Femoral impactor

Lift offGood even pressure

40˚ flexion and over 20˚ - 30˚ flexion.

Figure 56 Figure 57 Figure 58

32

POSSIBLE FLEXION AND EXTENSION GAP ADJUSTMENTS

1. Tight in Extension If the joint is tight in extension, the femoral trial is removed and the femoral distal cutting block is placed back in the joint with an appropriate sized tibial spacer to balance the

ligaments. A further 2 mm is cut from the distal femur using the Preservation™ Uni Saw Blade. The finishing block is then relocated on the distal femur using the existing pin holes. The chamfers are re-cut and the trial reduction is repeated.

2. Tight in Flexion and Extension If the joint is tight in both flexion and extension, the tibial cutting block is replaced on the tibia. The two rows of pin holes in the jig are 2 mm apart. 2 mm more tibia should

be resected and the flexion and extension gaps re-checked. By repositioning the guide, up to 4 mm can be recut from the tibia. If more bone is to be resected, the tibial stylus should be re-employed.

3. Tight in Flexion If the joint is tight in flexion then there are two options:

Firstly, the femur can either be downsized using a smaller anterior cutting block. Secondly, the tibial slope can be adjusted. The tibial jig is placed on the tibia and aligned to the mechanical axis of the tibia. The saw blade is placed in the slot of the tibial cutting guide to reference the previous cut. The ankle clamp is adjusted to generate additional slope and the tibia is re-cut.

4. Loose in Flexion The gap has to be assessed by the surgeon and in some cases may be accepted as the knee will tolerate laxity in flexion much more than in extension. However if it has

to be corrected, then this is done by using a thicker insert and re-cutting the distal femur to adjust the extension gap.

5. Loose in Extension This must be corrected by adding a thicker insert. If this in turn produces a tight flexion gap, the tibial slope should be increased. Laxity in extension may lead to a poor

result.

6. Loose in Extension and Flexion Use a thicker tibial insert to correct this.

FlexionE

xten

sion

2

3

5 & 3

1

5

1 & 4

4

6

Tight

Normal

Loose

Tight Normal Loose

33

IMPLANT PRODUCT CODES

Preservation™ Cemented Femoral Components1498-01-001 Preservation™ Femoral Cemented Size 11498-01-002 Preservation™ Femoral Cemented Size 21498-01-003 Preservation™ Femoral Cemented Size 31498-01-004 Preservation™ Femoral Cemented Size 41498-01-005 Preservation™ Femoral Cemented Size 5

Preservation™ All Poly Tibias 1498-11-106 Preservation™ A/P Tibial RM/LL Size 1 7 mm1498-11-108 Preservation™ A/P Tibial RM/LL Size 1 9.5 mm1498-11-110 Preservation™ A/P Tibial RM/LL Size 1 11.5 mm1498-11-206 Preservation™ A/P Tibial RM/LL Size 2 7 mm1498-11-208 Preservation™ A/P Tibial RM/LL Size 2 9.5 mm1498-11-210 Preservation™ A/P Tibial RM/LL Size 2 11.5 mm1498-11-306 Preservation™ A/P Tibial RM/LL Size 3 7 mm1498-11-308 Preservation™ A/P Tibial RM/LL Size 3 9.5 mm1498-11-310 Preservation™ A/P Tibial RM/LL Size 3 11.5 mm1498-11-406 Preservation™ A/P Tibial RM/LL Size 4 7 mm1498-11-408 Preservation™ A/P Tibial RM/LL Size 4 9.5 mm1498-11-410 Preservation™ A/P Tibial RM/LL Size 4 11.5 mm1498-11-506 Preservation™ A/P Tibial RM/LL Size 5 7 mm1498-11-508 Preservation™ A/P Tibial RM/LL Size 5 9.5 mm1498-11-510 Preservation™ A/P Tibial RM/LL Size 5 11.5 mm1498-12-106 Preservation™ A/P Tibial LM/RL Size 1 7 mm1498-12-108 Preservation™ A/P Tibial LM/RL Size 1 9.5 mm1498-12-110 Preservation™ A/P Tibial LM/RL Size 1 11.5 mm1498-12-206 Preservation™ A/P Tibial LM/RL Size 2 7 mm1498-12-208 Preservation™ A/P Tibial LM/RL Size 2 9.5 mm1498-12-210 Preservation™ A/P Tibial LM/RL Size 2 11.5 mm1498-12-306 Preservation™ A/P Tibial LM/RL Size 3 7 mm1498-12-308 Preservation™ A/P Tibial LM/RL Size 3 9.5 mm1498-12-310 Preservation™ A/P Tibial LM/RL Size 3 11.5 mm1498-12-406 Preservation™ A/P Tibial LM/RL Size 4 7 mm1498-12-408 Preservation™ A/P Tibial LM/RL Size 4 9.5 mm1498-12-410 Preservation™ A/P Tibial LM/RL Size 4 11.5 mm1498-12-506 Preservation™ A/P Tibial LM/RL Size 5 7 mm1498-12-508 Preservation™ A/P Tibial LM/RL Size 5 9.5 mm1498-12-510 Preservation™ A/P Tibial LM/RL Size 5 11.5 mm

Preservation™ Fixed Bearing Inserts 1498-13-108 Preservation™ Fixed Bearing Insert RM/LL Size 1 9.5 mm1498-13-110 Preservation™ Fixed Bearing Insert RM/LL Size 1 11.5 mm1498-13-112 Preservation™ Fixed Bearing Insert RM/LL Size 1 13.5 mm1498-13-208 Preservation™ Fixed Bearing Insert RM/LL Size 2 9.5 mm1498-13-210 Preservation™ Fixed Bearing Insert RM/LL Size 2 11.5 mm1498-13-212 Preservation™ Fixed Bearing Insert RM/LL Size 2 13.5 mm1498-13-308 Preservation™ Fixed Bearing Insert RM/LL Size 3 9.5 mm1498-13-310 Preservation™ Fixed Bearing Insert RM/LL Size 3 11.5 mm1498-13-312 Preservation™ Fixed Bearing Insert RM/LL Size 3 13.5 mm1498-13-408 Preservation™ Fixed Bearing Insert RM/LL Size 4 9.5 mm1498-13-410 Preservation™ Fixed Bearing Insert RM/LL Size 4 11.5 mm1498-13-412 Preservation™ Fixed Bearing Insert RM/LL Size 4 13.5 mm1498-13-508 Preservation™ Fixed Bearing Insert RM/LL Size 5 9.5 mm1498-13-510 Preservation™ Fixed Bearing Insert RM/LL Size 5 11.5 mm1498-13-512 Preservation™ Fixed Bearing Insert RM/LL Size 5 13.5 mm1498-14-108 Preservation™ Fixed Bearing Insert LM/RL Size 1 9.5 mm1498-14-110 Preservation™ Fixed Bearing Insert LM/RL Size 1 11.5 mm1498-14-112 Preservation™ Fixed Bearing Insert LM/RL Size 1 13.5 mm1498-14-208 Preservation™ Fixed Bearing Insert LM/RL Size 2 9.5 mm1498-14-210 Preservation™ Fixed Bearing Insert LM/RL Size 2 11.5 mm1498-14-212 Preservation™ Fixed Bearing Insert LM/RL Size 2 13.5 mm1498-14-308 Preservation™ Fixed Bearing Insert LM/RL Size 3 9.5 mm1498-14-310 Preservation™ Fixed Bearing Insert LM/RL Size 3 11.5 mm1498-14-312 Preservation™ Fixed Bearing Insert LM/RL Size 3 13.5 mm1498-14-408 Preservation™ Fixed Bearing Insert LM/RL Size 4 9.5 mm1498-14-410 Preservation™ Fixed Bearing Insert LM/RL Size 4 11.5 mm1498-14-412 Preservation™ Fixed Bearing Insert LM/RL Size 4 13.5 mm

1498-14-508 Preservation™ Fixed Bearing Insert LM/RL Size 5 9.5 mm1498-14-510 Preservation™ Fixed Bearing Insert LM/RL Size 5 11.5 mm1498-14-512 Preservation™ Fixed Bearing Insert LM/RL Size 5 13.5 mm

Preservation™ Mobile Bearing Tibial Inserts1498-15-108 Preservation™ Mobile Bearing Insert Size 1 9.5 mm1498-15-110 Preservation™ Mobile Bearing Insert Size 1 11.5 mm1498-15-112 Preservation™ Mobile Bearing Insert Size 1 13.5 mm1498-15-208 Preservation™ Mobile Bearing Insert Size 2 9.5 mm1498-15-210 Preservation™ Mobile Bearing Insert Size 2 11.5 mm1498-15-212 Preservation™ Mobile Bearing Insert Size 2 13.5 mm1498-15-308 Preservation™ Mobile Bearing Insert Size 3 9.5 mm1498-15-310 Preservation™ Mobile Bearing Insert Size 3 11.5 mm1498-15-312 Preservation™ Mobile Bearing Insert Size 3 13.5 mm1498-15-408 Preservation™ Mobile Bearing Insert Size 4 9.5 mm1498-15-410 Preservation™ Mobile Bearing Insert Size 4 11.5 mm1498-15-412 Preservation™ Mobile Bearing Insert Size 4 13.5 mm1498-15-508 Preservation™ Mobile Bearing Insert Size 5 9.5 mm1498-15-510 Preservation™ Mobile Bearing Insert Size 5 11.5 mm1498-15-512 Preservation™ Mobile Bearing Insert Size 5 13.5 mm

Preservation™ Fixed Tibial Tray - Cemented 1498-23-001 Preservation™ Fixed Tibial Tray RM/LL Cemented Size 1 1498-23-002 Preservation™ Fixed Tibial Tray RM/LL Cemented Size 21498-23-003 Preservation™ Fixed Tibial Tray RM/LL Cemented Size 31498-23-004 Preservation™ Fixed Tibial Tray RM/LL Cemented Size 41498-23-005 Preservation™ Fixed Tibial Tray RM/LL Cemented Size 5 1498-24-001 Preservation™ Fixed Tibial Tray LM/RL Cemented Size 1 1498-24-002 Preservation™ Fixed Tibial Tray LM/RL Cemented Size 21498-24-003 Preservation™ Fixed Tibial Tray LM/RL Cemented Size 31498-24-004 Preservation™ Fixed Tibial Tray LM/RL Cemented Size 41498-24-005 Preservation™ Fixed Tibial Tray LM/RL Cemented Size 5

Preservation™ Mobile Bearing Tibial Tray - Cemented 1498-25-001 Preservation™ Mobile Bearing Tibial Tray RM/LL Cemented Size 11498-25-002 Preservation™ Mobile Bearing Tibial Tray RM/LL Cemented Size 21498-25-003 Preservation™ Mobile Bearing Tibial Tray RM/LL Cemented Size 31498-25-004 Preservation™ Mobile Bearing Tibial Tray RM/LL Cemented Size 41498-25-005 Preservation™ Mobile Bearing Tibial Tray RM/LL Cemented Size 5 1498-26-001 Preservation™ Mobile Bearing Tibial Tray LM/RL Cemented Size 11498-26-002 Preservation™ Mobile Bearing Tibial Tray LM/RL Cemented Size 21498-26-003 Preservation™ Mobile Bearing Tibial Tray LM/RL Cemented Size 31498-26-004 Preservation™ Mobile Bearing Tibial Tray LM/RL Cemented Size 41498-26-005 Preservation™ Mobile Bearing Tibial Tray LM/RL Cemented Size 5

Preservation™ Femoral Trials2498-01-001 Preservation™ Uni Femoral Trial Size 12498-01-002 Preservation™ Uni Femoral Trial Size 22498-01-003 Preservation™ Uni Femoral Trial Size 32498-01-004 Preservation™ Uni Femoral Trial Size 42498-01-005 Preservation™ Uni Femoral Trial Size 52498-61-021 Preservation™ Peg Trial Femur Size 12498-61-022 Preservation™ Peg Trial Femur Size 22498-61-023 Preservation™ Peg Trial Femur Size 32498-61-024 Preservation™ Peg Trial Femur Size 42498-61-025 Preservation™ Peg Trial Femur Size 5

34

IMPLANT PRODUCT CODES

Preservation™ Fixed Bearing Tibial Trials2498-13-106 Preservation™ Fixed Bearing Tibial Trial Size 1 7 mm2498-13-108 Preservation™ Fixed Bearing Tibial Trial Size 1 9.5 mm2498-13-110 Preservation™ Fixed Bearing Tibial Trial Size 1 11.5 mm2498-13-112 Preservation™ Fixed Bearing Tibial Trial Size 1 13.5 mm2498-13-206 Preservation™ Fixed Bearing Tibial Trial Size 2 7 mm2498-13-208 Preservation™ Fixed Bearing Tibial Trial Size 2 9.5 mm2498-13-210 Preservation™ Fixed Bearing Tibial Trial Size 2 11.5 mm2498-13-212 Preservation™ Fixed Bearing Tibial Trial Size 2 13.5 mm2498-13-306 Preservation™ Fixed Bearing Tibial Trial Size 3 7 mm2498-13-308 Preservation™ Fixed Bearing Tibial Trial Size 3 9.5 mm2498-13-310 Preservation™ Fixed Bearing Tibial Trial Size 3 11.5 mm2498-13-312 Preservation™ Fixed Bearing Tibial Trial Size 3 13.5 mm2498-13-406 Preservation™ Fixed Bearing Tibial Trial Size 4 7 mm2498-13-408 Preservation™ Fixed Bearing Tibial Trial Size 4 9.5 mm2498-13-410 Preservation™ Fixed Bearing Tibial Trial Size 4 11.5 mm2498-13-412 Preservation™ Fixed Bearing Tibial Trial Size 4 13.5 mm2498-13-506 Preservation™ Fixed Bearing Tibial Trial Size 5 7 mm2498-13-508 Preservation™ Fixed Bearing Tibial Trial Size 5 9.5 mm2498-13-510 Preservation™ Fixed Bearing Tibial Trial Size 5 11.5 mm2498-13-512 Preservation™ Fixed Bearing Tibial Trial Size 5 13.5 mm

Preservation™ Mobile Bearing Tibial Trials2498-25-001 Preservation™ Mobile Bearing Tibial Trial RM/LL Size 12498-25-002 Preservation™ Mobile Bearing Tibial Trial RM/LL Size 22498-25-003 Preservation™ Mobile Bearing Tibial Trial RM/LL Size 32498-25-004 Preservation™ Mobile Bearing Tibial Trial RM/LL Size 42498-25-005 Preservation™ Mobile Bearing Tibial Trial RM/LL Size 52498-26-001 Preservation™ Mobile Bearing Tibial Trial LM/RL Size 12498-26-002 Preservation™ Mobile Bearing Tibial Trial LM/RL Size 22498-26-003 Preservation™ Mobile Bearing Tibial Trial LM/RL Size 32498-26-004 Preservation™ Mobile Bearing Tibial Trial LM/RL Size 42498-26-005 Preservation™ Mobile Bearing Tibial Trial LM/RL Size 5

Preservation™ Mobile Bearing Insert Trials2498-15-108 Preservation™ Mobile Bearing Insert Trial Size 1 9.5 mm2498-15-110 Preservation™ Mobile Bearing Insert Trial Size 1 11.5 mm2498-15-112 Preservation™ Mobile Bearing Insert Trial Size 1 13.5 mm2498-15-208 Preservation™ Mobile Bearing Insert Trial Size 2 9.5 mm2498-15-210 Preservation™ Mobile Bearing Insert Trial Size 2 11.5 mm2498-15-212 Preservation™ Mobile Bearing Insert Trial Size 2 13.5 mm2498-15-308 Preservation™ Mobile Bearing Insert Trial Size 3 9.5 mm2498-15-310 Preservation™ Mobile Bearing Insert Trial Size 3 11.5 mm2498-15-312 Preservation™ Mobile Bearing Insert Trial Size 3 13.5 mm2498-15-408 Preservation™ Mobile Bearing Insert Trial Size 4 9.5 mm2498-15-410 Preservation™ Mobile Bearing Insert Trial Size 4 11.5 mm2498-15-412 Preservation™ Mobile Bearing Insert Trial Size 4 13.5 mm2498-15-508 Preservation™ Mobile Bearing Insert Trial Size 5 9.5 mm2498-15-510 Preservation™ Mobile Bearing Insert Trial Size 5 11.5 mm2498-15-512 Preservation™ Mobile Bearing Insert Trial Size 5 13.5 mm

MIU Instruments2498-16-112 Femoral Rotation Guide Spacer Block 5 mm2498-60-002 Preservation™ Tibial Cutting Block RM/LL2498-60-004 Preservation™ Tibial Cutting Block LM/RL2498-60-008 Preservation™ Tibial Stylus2498-60-010 Preservation™ L-Cut Guide 2498-60-040 Preservation™ Alignment Guide 2498-15-064 Preservation™ Femoral Spacer Block - 1 mm Defect2498-16-110 Preservation™ Femoral Spacer Block - 2 mm Defect2498-15-065 Preservation™ Femoral Spacer Block - 3 mm Defect 2498-60-048 Preservation™ Tibial Spacer Block 9.5 mm2498-60-050 Preservation™ Tibial Spacer Block 11.5 mm

2498-60-052 Preservation™ Tibial Spacer Block 13.5 mm 2498-16-108 Preservation™ Femoral Distal Cutting Block2498-60-058 Preservation™ System Handle2498-61-001 Preservation™ Femoral Rotation and Sizing Guide Size 12498-61-002 Preservation™ Femoral Rotation and Sizing Guide Size 22498-61-003 Preservation™ Femoral Rotation and Sizing Guide Size 32498-61-004 Preservation™ Femoral Rotation and Sizing Guide Size 42498-61-005 Preservation™ Femoral Rotation and Sizing Guide Size 52498-61-011 Preservation™ Femoral Finishing Guide Size 12498-61-012 Preservation™ Femoral Finishing Guide Size 22498-61-013 Preservation™ Femoral Finishing Guide Size 32498-61-014 Preservation™ Femoral Finishing Guide Size 42498-61-015 Preservation™ Femoral Finishing Guide Size 52498-61-030 Preservation™ Femoral Peg Drill2498-61-032 Preservation™ Femoral Peg Drill Guide2498-60-021 Preservation™ Tibial Keel Template Size 12498-60-022 Preservation™ Tibial Keel Template Size 22498-60-023 Preservation™ Tibial Keel Template Size 32498-60-024 Preservation™ Tibial Keel Template Size 42498-60-025 Preservation™ Tibial Keel Template Size 52498-60-030 Preservation™ Trial Keel Size 12498-14-108 Preservation™ Trial Keel Size 22498-14-110 Preservation™ Trial Keel Size 32498-14-112 Preservation™ Trial Keel Size 42498-14-208 Preservation™ Trial Keel Size 52498-15-094 Preservation™ MB Tray Inserter/Impactor2498-60-032 Preservation™ Tibial Keel Osteotome Fixed2498-61-040 Preservation™ Femoral Introducer2498-61-041 Preservation™ Fixed Bearing Tibial Impactor Size 12498-61-042 Preservation™ Fixed Bearing Tibial Impactor Size 22498-61-043 Preservation™ Fixed Bearing Tibial Impactor Size 32498-61-044 Preservation™ Fixed Bearing Tibial Impactor Size 42498-61-045 Preservation™ Fixed Bearing Tibial Impactor Size 52498-61-060 Preservation™ Tibial Pressure Arm (C-Arm)2474-85-000 Preservation™ Femoral Impactor9910-16 Specialist® Alignment Rod8679-08 All-polyethylene Tibial Inserter8691-17 3 inch (ø3.2 mm) Headless Steinmann Drill Pins9665-05 Specialist® 2 Steinmann Pin Inserter1801-18-000 3.2 mm Drill (127 mm long)9665-15 Specialist® 2 Pin Remover9663-10 Specialist® 2 Ankle Clamp9665-30 Specialist® 2 Resection Guide

Preservation™ Sawblades5627-86-000 Uni Blade - Old Stryker 70 x 9.5 x 1.27 mm5627-87-000 Uni Blade - New Stryker 70 x 9.5 x 1.27 mm5627-88-000 Uni Blade - Old Zimmer 70 x 9.5 x 1.27 mm5627-89-000 Uni Blade - New Zimmer 70 x 9.5 x 1.27 mm5627-90-000 Uni Blade - AO/Sod 70 x 9.5 x 1.27 mm5627-91-000 Uni Blade - 3M 70 x 9.5 x 1.27 mm

Preservation™ Sterilisation Tray2498-61-064 Preservation™ Sterilisation Tray

Preservation™ X-Ray Templates2498-61-062 Preservation™ Mobile Bearing X-ray Template2498-60-042 Preservation™ Tibial Resection X-ray Template2498-61-063 Preservation™ Femur and Fixed Bearing Template

35

INSTRUMENT PRODUCT CODES

Instruments2498-16-112 Preservation™ Femoral Rotation Guide Spacer Block 5 mm

2498-60-002, 004 Preservation™ Tibial Cutting Block

2498-60-008 Preservation™ Tibial Stylus

2498-60-010 Preservation™ L-Cut Guide

2498-60-040 Preservation™ Alignment Guide

2498-15-064, 2498-16-110, 2498-15-065 Preservation™ Femoral Spacer Block - 1 mm, 2 mm, 3 mm Defect

2498-60-048, 050, 052 Preservation™ Tibial Spacer Block 9.5 mm, 11.5 mm, 13.5 mm

2498-16-108 Preservation™ Femoral Distal Cutting Block

2498-01-001, 002, 003, 004, 005 Preservation™ Femoral Trial

2498-60-058 Preservation™ System Handle

2498-61-001, 002, 003, 004, 005 Preservation™ Femoral Rotation and Sizing Guide Size 1, 2, 3, 4, 5

2498-61-011, 012, 013, 014, 015 Preservation™ Femoral Finishing Guide Size 1, 2, 3, 4, 5

2498-61-032 Preservation™ Femoral Peg Drill Guide

2498-60-021, 022, 023, 024, 025 Preservation™ Tibial Keel Template Size 1, 2, 3, 4, 5

2498-60-030, 2498-14-108, 110, 112, 208 Preservation™ Trial Keel Size 1, 2, 3, 4, 5

2498-60-032 Preservation™ Tibial Keel Osteotome Fixed

2498-61-040 Preservation™ Femoral Introducer

2498-61-021, 022, 023, 024, 025 Preservation™ Peg Trial Femur

36

INSTRUMENT PRODUCT CODES

2498-61-041, 042, 043, 044, 045Preservation™ Fixed Bearing Tibial Impactor Size 1, 2, 3, 4, 5

2498-61-060 Preservation™ Tibial Pressure Arm (C-Arm)

2498-15-094 Preservation™ Mobile Bearing Tray Inserter/Impactor

9910-16 Specialist® 2 Alignment Rod

8679-08 All-polyethylene Tibial Inserter

9665-05 Specialist® 2 Steinmann Pin Inserter

9665-15 Specialist® 2 Pin Remover

9663-10 Specialist® 2 Ankle Clamp

9665-30 Specialist® 2 Resection Guide

2474-85-000 Preservation™ Femoral Impactor

Preservation™ Sawblades5627-86-000 Uni Blade - Old Stryker 70 x 9.5 x 1.27 mm

5627-87-000 Uni Blade - New Stryker 70 x 9.5 x 1.27 mm

5627-88-000 Uni Blade - Old Zimmer 70 x 9.5 x 1.27 mm

5627-89-000 Uni Blade - New Zimmer 70 x 9.5 x 1.27 mm

5627-90-000 Uni Blade - AO/Sod 70 x 9.5 x 1.27 mm

5627-91-000 Uni Blade - 3M 70 x 9.5 x 1.27 mm

DePuy International LtdSt Anthony’s RoadLeeds LS11 8DTEnglandTel:+44 (113) 387 7800Fax:+44 (113) 387 7890

This publication is not intended for distribution in the USA.

Preservation™ is a trademark of DePuy Orthopaedics, Inc. Specialist® is a registered trademark of Johnson & Johnson. © 2007 DePuy International Ltd. All rights reserved.

Cat No: 9068-90-005 version 2

Issued: 06/07