Surgical Technique Natural-Knee II Primary System .Knees Apollo® Knee System Classic condylar knee

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  • KneesApollo Knee System Classic condylar knee replacement systemDurasul Tribological System Highly crosslinked polyethylene that resists wear and agingNatural-Knee System Anatomic design for superior clinical resultsUniSpacerTM Knee System No bone cuts. No compromises.

    Severe Revision/Limb SalvageMOST OptionsTM System Modular knee and hip options for severe bone loss, trauma and revision

    HipsAlloclassic (ZweymllerTM ) Hip Classic proven design with superior clinical resultsAllofitTM Acetabular Cup System Unique Ridgelock surface designed for easy implantation and stabilityApollo Hip System Designed for optimal results with low-demand patientsAPR Anatomical Hip System The anatomic solution for patient matchingCLSTM (SpotornoTM ) Hip System The standard of proximal press-fit designConverge CSTi Porous Acetabular Cup System Where technology and experience meetDurasul Tribological System Highly crosslinked polyethylene that resists wear and agingFracSureTM Hip System A classic design for hip fracturesMetasul Metal-on-Metal Acetabular System Over 15 years of clinical results & 200,000 implantations worldwideMS-30TM Hip A highly polished cemented stemNatural-HipTM System A comprehensive system with a natural approachPrecedentTM Revision Hip System A better solution for revision hipsSL RevisionTM Hip System A stable revision design with extensive sizes

    Upper ExtremitiesAnatomicalTM Shoulder System Multiple adjustments of inclination & retroversion with the potential for precisely restored anatomyGSB Elbow System A nonconstrained design with 21 years of clinical resultsSelect Shoulder System TSA and fracture management with offset head options

    Centerpulse Orthopedics Inc.9900 Spectrum DriveAustin, Texas 78717

    512.432.9900877.768.7349fax: 512.432.9014www.centerpulseorthopedics.com

    Products are distributed in Europe by Centerpulse Orthopedics Ltd., Altgasse 44, CH-6340, Baar, Switzerland, 41 41 768 32 32; in Canada by Centerpulse Orthopedics Canada, 265 Bartley Drive, Toronto, Ontario, Canada M4A2N7, (416) 751-8787; in Australia by Centerpulse Australia Pty Ltd., Level 5, 384 Eastern Valley Way, Chatswood, NSW 2067, Australia, 011 (61) 2-9417-7922; and in Japan by Centerpulse Japan K.K., Itopia Eitai Bldg., 7F 1-3-7, Saga, Koto-Ku, Tokyo 135-0031, Japan, 011 (81) 3-3820-7477.

    1001-01-032 Rev 9/2003 2003 Centerpulse Orthopedics Inc. All rights reserved.

    Natural-Knee II Primary Systemwith Modular Cemented Baseplate OptionAnatomic design for superior clinical results

    Implanting trust.

    Surgical Technique

  • Centerpulse OrthopedicsAnatomic design for superior clinical results

    Centerpulse OrthopedicsAnatomic design for superior clinical results

    Since 1986 the Natural-Knee System has been used to successfully treat over 350,000 patients. Long-term clinicalresults have confirmed that the Natural-Knee systems designconsiderations have resulted in improved motion and stability,as well as normal alignment and stable fixation of the implant.The mean Modified Hospital for Special Surgery knee score improved from 59.113.2 preoperatively to 97.84.7 postoperatively at 10-to-14 years follow-up.1

    Specific Operative Techniques Anatomic posterior tibial slope resections provide ideal

    distribution of stress on the bone structure, maximizing theload carrying capacity of cancellous bone.

    Posterior-referencing femoral resection results in matched flexion and extension gaps, which help with natural rollback, natural ROM, and a reduced potential for polyethylene wear.

    Patellar measured resection followed by componentmedialization reduces the need for lateral retinacular releases, as well as prevents the surgeon from exceeding the patellar original thickness.

    Intraoperative use of bone slurry at the bone-implant interfaceis supported by postmortem studies and is shown to provide three times the amount of bone at the interface as compared to specimens implanted without bone slurry.1

    Device Design The Ultracongruent insert provides posterior stabilization

    without bone sacrifice.2 This innovative design provides continuous stabilization throughout the range of motion.

    The combination of the asymmetric tibial components increased coverage and the use of autograft bone slurry contribute to the excellent clinical success of porous tibial components.1

    A deepened trochlear groove prevents excessive load on thepatellar component while allowing good ROM.

    Material Technology Durasul highly crosslinked polyethylene is the material

    of choice for surgeons seeking wear-resistant implant systems. Durasuls improved resistance to oxidation and strong network of crosslinks directly addresses the problems of polyethylene delamination and wear in total knee arthroplasty.

    Centerpulse Orthopedics' proprietary Cancellous-Structured Titanium (CSTi) allows a cobalt-chrome articulating surfaceto be combined with the biocompatibility of a titanium coating, resulting in stable fixation and outstanding clinical results.3,4 Postmortem studies support biocompatibility of CSTi and consistent skeletal attachment by bony ingrowth.1

    1 Hofmann A, Evanich D, Ferguson R, Camargo M. Ten to 14 year Clinical Followup of the Cementless Natural-Knee System. Clin Orthop. No.388, July 2001.

    2 Hofmann A, Tkach T, Evanich C, Camargo M. Posterior Stabilization in Total Knee Arthroplasty with the use of an Ultra Congruent Polyethylene Insert. J Arthroplasty. Vo. 15, No.5 2000.

    3 Bonding of Porous Ti to CoCr The SinterLock Process, Centerpulse Orthopedics Inc.

    4 Baldwin J, El-Saied R, Richard A. Uncemented Total Knee Arthroplasty: Report of 109 titanium knees with cancellous-structured porous coating. Orthopedics. 19(2) 123-130, February 1996.

  • Centerpulse OrthopedicsAnatomic design for superior clinical results

    Centerpulse OrthopedicsAnatomic design for superior clinical results

    Developed in conjunction with:

    Aaron A. Hofmann, MDProfessor of Orthopedic SurgeryUniversity of Utah Medical CenterSalt Lake City, Utah

    Kenneth A. Gustke, MDFlorida Orthopaedic InstituteClinical Professor of Orthopedic SurgeryUniversity of South FloridaCollege of MedicineTampa, Florida

    Modular Cemented BaseplateSurgeon Consultants:Kenneth Gustke, MDAaron Hofmann, MDWilliam Overdyke, MDBlake Stamper, DO

    Design Rationale 1 Restoration of Anatomy 1 Restoration of Normal Alignment 2 Increased Fixation 3Preoperative Planning 3Surgical Technique 4 Bone Cuts 4Surgical Technique Summary 5 Preparing the Femur 5 Preparing the Tibia 6 Preparing the Patella 7Patient Positioning 8Surgical Approach 8Locating the Medullary Canal 9Distal Femoral Cut 10Drill Distal Femoral Holes and Calibrate Femur 12Anterior/Posterior Cuts 13Chamfer Cuts 14Preparing the Proximal Tibia 15Extramedullary Tibial Technique 15Rotation 16Posterior Slope 17Level of Resection 17Proximal Tibia Sizing and Drilling 21 Stemmed/Resurfacing Baseplates 21 Modular Cemented Tibial Baseplates 22Patellar Preparation 25Trial Reduction 28Implanting the Components 30 Patella 30 Stemmed/Resurfacing Baseplates 30 Modular Cemented Tibial Baseplates 31 Tibial Insert 32 Femoral Component 32Postoperative Care 32Posterior Stabilization Option 33Intramedullary Tibial Option 35 Reference Hole 35 Rotation 36 Posterior Slope 37 Level of Resection 38 Tibial Spacer Option 39All-Poly Tibial Option 42 Tibial Preparation 42 Tibial Implantation 42Soft Tissue Balancing 43 Varus Deformity 43 Valgus Deformity 43Ultracongruent and Traditional PosteriorStabilized Component Indications 43Important Information for Surgeon 44Ordering Information 51

  • Centerpulse OrthopedicsAnatomic design for superior clinical results

    Centerpulse OrthopedicsAnatomic design for superior clinical results

    Design Rationale

    Restoration of AnatomyThe surgery is intended to permit a true resurfacing by referencingthe least-involved portion of the femoral condyle, the least-involved portion of the tibial plateau and the thickest portion of the medial facet of the patella. This restores bony anatomyand the anatomic joint line. Knee rotation testing and computermodeling have shown that the level of resection relative to theamount of bone replaced by the prosthesis on the distal femurplays an important role in knee kinematics and ligament balance.Resection of bone followed by an equal amount of prosthetic replacement will provide the knee with near normal varus-valgusand rotational stability throughout the full range of motion.

    The level of the trochlear groove on the femur is anatomically restored by a stepped anterior chamfer cut that allows thebone to be resected and replaced with a deeply grooved femoralcomponent. As a result, patellofemoral joint stability is achieved,making lateral release less frequent and, when required, less extensive. In addition, increased patellofemoral compressiveforces are avoided by maintaining the patellofemoral joint line.

    With the Natural-Knee II System, the tibial cut is made parallelto the joint line in the anterior/posterior plane. Since the normalposterior tilt of the tibia is not at a fixed angle (range 4 degreesto 12 degrees), this cut must be adjustable to reproduce eachindividuals normal posterior slope to avoid camming or laxity during extension and flexion.5 If the posterior slope is fixed or if the tibia is cut perpendicular to the tibial shaft axis, the normal kinematics of the knee will not be simulated.

    Furthermore, cutting the tibia parallel to the patients natural posterior slope greatly improves the load-carrying capacity of the supporting bone. A 40% improvement in ultimate compressive strength was noted when bone cuts were made parallel to the joint versus those made perpendicular to the tibial shaft axis.6 Clinically, anterior