NexGen LCCK内部培训资料

NexGen®

CompleteKneeSolutionRevision-Legacy®KneeCCKLegacyKneeCCKOutlineDefectClassification(AORI)BoneDefectAlgorithmFlexion-ExtensionAlgorithmLCCKSurgicalTechniqueCompetitiveInstrumentsDefectClassification(AORI)TypeIHealthycancellousbonewithanundamagedmetaphysealsegmentNoevidenceofcomponentsubsidenceNoevidenceofosteolysis1LuceyS,ScuderiG,KellyM,etal.APracticalApproachtoDealingWithBoneLossinRevisionTotalKneeArthroplasty..November.

2000,3-6.DefectClassification(AORI)TypeIIMayormaynothavehealthycancellousboneMetaphysealflareisshortenedMildtomoderateevidenceofsubsidenceandosteolysis1LuceyS,ScuderiG,KellyM,etal.APracticalApproachtoDealingWithBoneLossinRevisionTotalKneeArthroplasty..November.

2000,3-6.DefectClassification(AORI)TypeIIIDeficientmetaphysealsegmentatorabovelevelofepicondylesandatorbelowleveloftubercleConsiderablecomponentsubsidenceandosteolysis1LuceyS,ScuderiG,KellyM,etal.APracticalApproachtoDealingWithBoneLossinRevisionTotalKneeArthroplasty..November.

2000,3-6.BoneDefectAlgorithm1LuceyS,ScuderiG,KellyM,etal.APracticalApproachtoDealingWithBoneLossinRevisionTotalKneeArthroplasty..November.

2000,3-6.APracticalApproachtoTKA2

FemurFirst.AssessthetypeofdefectRecreationofthefemurSize,rotationandpositionthefemurRebuildtheflexionspaceCreateaflattibialsurface,balanceflexionspaceRebuildtheextensionspaceDefectreconstruction2VinceK,BoothR,InsallJ,ScuderiG.RevisionKneeArthroplasty:SurgicalGuidelines,

2ndEdition,1999;32-37.APracticalApproachtoTKA2

TibiaFirstAssessthetypeofdefectRe-establishthetibialplatformStabilizethekneeinflexionSizeandrotationofthefemoralcomponentEstablishjointlineheightStabilizethekneeinextensionDefectreconstruction2VinceK,BoothR,InsallJ,ScuderiG.RevisionKneeArthroplasty:SurgicalGuidelines,

2ndEdition,1999;18-31.Flexion-ExtensionAlgorithmTightinextension,tightinflexionUseathinnerpolyethylenearticularsurface,

orresectmoretibiaFlexion-ExtensionAlgorithmOKinextension,tightinflexionUseanoffsetstemtomovethefemoral

componentanteriorlyFlexion-ExtensionAlgorithmOKinextension,tightinflexionUseasmallerfemoralcomponentFlexion-ExtensionAlgorithmOKinextension,tightinflexionUseadistalfemoralaugmenttomovethefemoralcomponentdistallyanduseathinnerpolyethylenearticularsurfaceFlexion-ExtensionAlgorithmLooseinextension,tightinflexionUseanoffsetstemtomovethefemoral

componentanteriorlyanduseathicker

polyethylenearticularsurfaceFlexion-ExtensionAlgorithmLooseinextension,tightinflexionUseathickerpolyethylenearticularsurface

anduseasmallerfemoralcomponentFlexion-ExtensionAlgorithmTightinextension,OKinflexionResectadditionaldistalfemoralboneand

movethefemoralcomponentproximallyFlexion-ExtensionAlgorithmLooseinextension,OKinflexionUseadistalfemoralaugmentFlexion-ExtensionAlgorithmTightinextension,looseinflexionResectadditionaldistalfemoralboneandusean

offsetstemtomovethefemoralcomponentposteriorlyUseposteriorfemoralaugmentsFlexion-ExtensionAlgorithmTightinextension,looseinflexionResectadditionaldistalfemoralboneanduse

athickerpolyethylenearticularsurfaceFlexion-ExtensionAlgorithmTightinextension,looseinflexionResectadditionaldistalfemoralboneanduse

alargerfemoralcomponentUseposteriorfemoralaugmentsFlexion-ExtensionAlgorithmOKinextension,looseinflexionUseanoffsetstemtomovethefemoral

componentposteriorlyUseposteriorfemoralaugmentsFlexion-ExtensionAlgorithmOKinextension,looseinflexionResectadditionaldistalfemoralboneand

useathickerpolyethylenearticularsurfaceFlexion-ExtensionAlgorithmOKinextension,looseinflexionUsealargerfemoralcomponentUseposteriorfemoralaugmentsFlexion-ExtensionAlgorithmLooseinextension,looseinflexionUseathickerpolyethylenearticularsurfaceLCCKSurgicalTechnique

Step1:DetermineTibialPlatformReamtoappropriatediameterAttachappropriatetibialboomtoshaftAttachtibialcuttingguideandprepareforflattibialcutLCCKSurgicalTechnique

Step1:DetermineTibialPlatformChecktibialalignmentwithExtramedullaryAlignmentRodDeterminetibialdepthresectioncutwithDepthResectionGaugeBegincuttingthetibialplateauLCCKSurgicalTechnique

Step2:FinishtheTibiaSelectappropriatetibialsizingplatePositionthetibialsizingplatetothetibialstemlocationwiththeStraightBushingIfnotoptimal,re-position

thetibialsizingplatewith

theOffsetBushingLCCKSurgicalTechnique

Step2:FinishtheTibiaPreparefortibialaugmentation

byapplyingtheappropriateTibial

OffsetBoomApplytheappropriatetibialaugmentationcuttingguideBegincuttingforaugmentationLCCKSurgicalTechnique

Step2:FinishtheTibiaDrillfortibialstembase10mmbelowengravedlineApplytheappropriatetibialbroachandimpactAssembletheappropriatetibialprovisionalsLCCKSurgicalTechnique

Step3:PrepareFemoralCanal(w/possibleDistalCut)Reamtoappropriatediameter.Remembertoreamatleast18mm

indiameterandthelengthofthe

stembaseandLCCKstemextensionshoulder(6cm)Apply6°valgusangleandpreparedistalfemoralcutwiththeRevisionIMGuideLCCKSurgicalTechnique

Step3:PrepareFemoralCanal(w/possibleDistalCut)Preparedistalfemoralclean-upcutLCCKSurgicalTechnique

Step4:EvaluateFemoralSizeFemoralsizingcanbeestimatedbyfemoralsizetemplates,thepreviousprosthesisortheepicondylarwidthLCCKSurgicalTechnique

Step5:EstablishFemoralRotation/A/PCutsWiththeFemoralStemBaseCuttingBlock,theStraightBushingandEpicondylarAlignmentGuide,externalrotationtothetransepicondylaraxisorparalleltotibialcutcanbeachievedIftheA/Pand/orM/Lpositionofthefemoralcomponentisnotoptimized,positioningforanOffsetStemcanbeachievedwiththeFemoralOffsetBushing.Rotationcanbeappliedoff

thetransepicondylaraxisorparallel

tothetibialcutLCCKSurgicalTechnique

Step5:EstablishFemoralRotation/A/PCutsPreparefemoralstemwiththeFemoralStemDrill.Drill10mmpasttheLCCKengravedlineCleanupcutsontheanteriorandposteriorcondylescanbemadewiththeFemoralStemBase/CuttingBlockLCCKSurgicalTechnique

Step5:EstablishFemoralRotation/A/PCutsAssembletheappropriatefemoralprovisionalsLCCKSurgicalTechnique

Step6:EstablishFlexionGapandStabilityAssessflexiongap

andstability

LCCKSurgicalTechnique

Step7:EstablishExtensionGapandStabilityAssessjointlinewiththeaidofthePatellaJointLineGauge.BalancesofttissuesifnecessaryAssessextensiongapandstabilityLCCKSurgicalTechnique

Step8:PrepareFemoralAugmentCutsMakeanynecessaryposterioraugmentcutsMakeanynecessarydistalaugmentcutsLCCKSurgicalTechnique

Step9:PrepareLCCKBoxAssembleStemExtensionintotheStemExtensionBushingRemovetheLCCKfemoralprovisionalsInsertStemExtensionBushingandnecessaryaugmentprovisionalsintotheLCCKNotch/ChamferGuideLCCKSurgicalTechnique

Step9:PrepareLCCKBoxCutanteriorandposteriorchamfers,

ifnecessaryCutsidesandbaseoftheLCCKboxLCCKSurgicalTechnique

Step10:PreparethePatellaIfpossibleornecessary,preparethepatellaLCCKSurgicalTechnique

Step11:PerformTrialReductionAssembletheStemExtensionProvisional

andaugmentprovisionals

totheLCCKFemoralProvisional/CuttingGuideAttachappropriateModularBoxProvisionalontotheLCCKFemoralProvisional/CuttingGuideLCCKSurgicalTechnique

Step11:PerformTrialReductionCheckrangeofmotionandjointstabilityinflexionInsertlockingscrewthroughthearticularsurfaceprovisionalandtightenCheckrangeofmotionandjointstabilityinextensionLCCKSurgicalTechnique

Step12:ComponentImplantationFemoralcomponentassemblyLCCKSurgicalTechnique

Step12:ComponentImplantationIntra-operativetibialcomponentassembly“Backtable”tibialcomponentassemblyRevision-LegacyKneeCCKMonogramI/MRevisionIntrumentsStryker/Howmedica/

Osteonics-MonogramI/MRevisionInstrumentSurgicalTechniquewithOffsettingInstrumentsMonogramI/MRevisionInstrumentsFemoralCanalPrepDistalFemoralResectionPrepDistalFemoralResectionTibialCanalPrepTibialPlateauCutFlexion/Extension

GapAssessmentMonogramI/MRevisionInstrumentsFemoralSizingFemoralResectionFemoralRotationMonogramI/MRevisionInstrumentsFemoralBoxCutTibialSizingandPositioningTibialOffsetStemPositioningMonogramI/MRevisionInstrumentsTibialAugmentPrep(optional)TibialFinishingTrialReductionMonogramI/MRevisionInstrumentsBiometMaximConstrainedSystemInstrumentSurgicalTechniqueMaximConstrained

SystemInstrumentsFemoralIMDrillDistalFemoralPrepDistalFemoralCutMaximConstrained

SystemInstrumentsFemoralAP&ChamferCutsFemoralBoxand/orPosteriorAugm