Smith & Nephew RT-PLUS Surgical Technique
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Smith & Nephew RT-PLUS Surgical Technique

Smith & Nephew RT-PLUS Surgical Technique

Rotating hinge knee system
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Intramedullary Procedure
Rotating Hinge Knee System
Sawblade Thickness: 1.00mm
Optional Thickness:
1.27mm
*smith&nephew
*smith&nephew
Rotating Hinged Knee
*smith&nephew
RT-PLUS™
Rotating Hinged
*smith&nephew
RT-PLUS™
Modular Rotating Hinged
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Summary of Contents for Smith & Nephew RT-PLUS

  • Page 1 *smith&nephew *smith&nephew Surgical Technique Intramedullary Procedure RT-PLUS™ Rotating Hinged Knee *smith&nephew Rotating Hinge Knee System RT-PLUS™ Rotating Hinged *smith&nephew RT-PLUS™ Modular Rotating Hinged Page 2 of 2 Sawblade Thickness: 1.00mm Optional Thickness: 1.27mm...

  • Page 3: Table Of Contents

    RT-PLUS™ IM Procedure Table of Contents Introduction ................2 General Warnings and Comments ........3 Concept/Description ............. 4 Indications ................8 Contraindications ..............8 Case Study ................9 Preoperative Planning ............10 Surgical Technique .............. 13 - Femoral Preparation ............17 - Tibial Preparation ............

  • Page 4: Introduction

    Introduction The RT-PLUS prosthesis, that is in clinical use since 1996 , is a valuable addition to bicondylar surface replacement. With the rising number of implantations we are increasingly being confronted by cases which are difficult to treat and which require the use of special prosthetic systems using a higher degree of coupling.

  • Page 5: General Warnings And Comments

    Surgical Techniques. Responsibility It is the responsibility of the user of the RT-PLUS knee systems to review all relevant information concerning the product before use. All the information provided in the Instructions for Use and in the Surgical Technique are to help the user in preparing for use of the product.

  • Page 6: Concept/Description

    TC-PLUS permits, if necessary, an intraoperative switchover from the resurfacing to the constrained rotating knee. The femoral and tibial components of RT-PLUS are identical to those of RT-PLUS Modular, with the exception of the additional option to connect stems and augmentation blocks.

  • Page 7: Product Description

    Product Description Femoral component The femoral component, which is asymmetrical, is manufactured using a CoCrMo alloy. The femoral patellar groove is deeply hollowed out and present a 6° oblique patella tracking. The joint mechanism is contained in a narrow box (only 25mm) that keep an anterior bone bridge and require minimum bone resection, thereby reducing the risk of femoral condyle fracture.
  • Page 8 While the tibial insert is in place, it is additionally secured by a clamp that is locked with a PE pin. The tibial inserts are identical to those in the RT-PLUS™ Modular portfolio. Tibial component The symmetrical tibial component is manufactured from CoCrMo alloy. In order to...
  • Page 9 Tibial blocks (PE) In order to compensate tibial bone defects, there are proximal tibial blocks available in height of 10mm. The tibial blocks are manufactured from UHMW PE and are cemented both side (on bone & tibial component). Before applying the cement on the tibial block, make sure that the component is clean of any fluid and particles.

  • Page 10: Indications

    Trauma induced femoral or tibial fractures • Important Due to the design, it is possible to switch with relatively little effort, even intraoperatively, from the TC-PLUS knee system to the RT-PLUS Modular knee system, since the resections and prosthesis sizes match. Contraindications Contraindications are: Acute or chronic local or systemic infections (or if a corresponding anamnesis occurs) •...

  • Page 11: Case Study

    Case Study Preoperative picture Patient presenting with severe joint instability (valgus gonarthrosis), with a valgus angle of 25° and medial joint destruction. Postoperative result Immediately postoperatively: functional and pain-free reconstruction with RT-PLUS™ knee.

  • Page 12: Preoperative Planning

    Preoperative Planning A full leg x-ray, with the patient in standing position, is recommended for preoperative planning purposes. If this is not possible, an x-ray of the thigh, including the femoral head, should be taken. X-ray images of the knee joint at three levels should be available for planning the surgery.
  • Page 13 Planning the Surgery Using the Radiograph The following procedure is recommended for the anterior-posterior whole leg imaging process: 1. Femoral axis “A” (anatomical axis) is drawn onto the radiograph. 2. A line is drawn from the femoral head to the centre of the knee (mechanical axis “D”) on the radiograph.

  • Page 15: Surgical Technique

    Surgical Technique Positioning the patient for surgery Surgery is performed while the patient is supine. The operation can be performed with or without tourniquet. It is recommended to use a flexible cover for the leg which allows a stable positioning of the knee joint in 90° of flexion.
  • Page 16 Overview of the Resection Sequences for Primary Application It is important to have identical flexion and extension gaps. 1. Distal femoral resection. 2. A/P femoral resection. 3. Chamfer resections and cutting out the box. Remove residual posterior condyles if present. Important To avoid the risk of a condyle fracture, we recommend preparing the box after tibial...
  • Page 17 Overview of the Resection Sequences for Revision Application The bone resections are refreshed after extraction of the primary implants. 1. Distal femoral resection. 2. A/P femoral resection. 3. Chamfer resections and cutting out the box. Remove residual posterior condyles if present.
  • Page 18 Use of Speed-pins We also offer speed-pins as an alternative for fixing the instrument to the bone. The speed-pins are available in different lengths and types: Speed-Pins with Rim Ø 3.2 / 30 mm – 6x PAC (Art. No. 42000089) Speed-Pins with Rim Ø...

  • Page 19: Femoral Preparation

    Femoral Preparation Access: For initial access to the knee, refer to the relevant surgical textbooks. Important In addition to the bone resections, it is important to correct any ligament imbalance using appropriate soft tissue procedures. If necessary, a general release should be performed on the side of the contracture prior to the bone resections.
  • Page 20 Important To ensure optimal positioning of the femoral drill guide on the condyles, gently tap the M/L area – not the drill guide section of the instrument. Open the femoral IM canal as far as the stop, using the ∅ 8/14 mm IM stepped drill. The drill direction is along the femoral axis.
  • Page 21 Locating the distal femoral cutting block The 6° femoral bushing corresponds to the angle α that was determined in the preop- erative planning. The femoral bushing is inserted into the femoral suspension device, so that, depending on the operated leg, the mark L for “left knee”...
  • Page 22 After preliminary drilling with the ∅ 3.2 mm drill, set the femoral/tibial cutting block in place by inserting two bone pins (75 mm long) through the holes marked “0”. This position resects 9 mm from the distal femur – a distance corresponding to the distal thick- ness of the femoral prosthesis.
  • Page 23 Controlling the femoral size Recheck and definitively determine the femoral size. Important During medial/lateral (M/L) measurement, use the sizer external width as a reference. The side handles can be removed from the femoral/tibial cutting block and attached to the A/P femoral cutting block. Locating the A/P femoral cutting block Reinsert the reamer into the femoral IM canal and mount the A/P femoral cutting block on...
  • Page 24 A/P and chamfer resections Perform the anterior femoral resection through the closed saw slot with the 1 mm (or 1.27 mm option) saw blade (anterior slot with facet). Important If the M/L ligaments have not been resected, they must be protected during all resections. Perform the posterior femoral resection through the two open posterior saw slots (slots with facets).
  • Page 25 Preparing the femoral box (EM) Use the centring template to position the femoral box saw guide and femoral compo- nent mediolaterally. Insert the template through the anterior saw slot of the A/P femoral cutting block based on femoral size, to make a mark (e.g., using electrocautery or a pin) on the anterior cortical bone.
  • Page 26 Align the femoral box saw guide (guides for size 2 and sizes 4–10) with the anterior cortical bone marking, and set in place with bone pins. Important It is important that the box saw guide is flush with the resections. The side handles can be attached to the box saw guide.
  • Page 27 Excavate the femoral box along the outer limits marked and prepared with the saw blade, using a thin, straight osteotome and a Luer. (Using the osteotome, carefully extend the two lateral box cuts posteriorly.) From the anterior side, introduce the narrow saw blade (or an osteotome) into the IM canal hole in order to cut the posterior cortical box bone.
  • Page 28 Check box position and box depth, and finalize with the box rasp (rasps for size 2 and for sizes 4–10). Important Introduce the box rasp only in the longitudi- nal direction; do not jam or tilt it, since this can cause breakage of the femoral condyle. Controlling the femoral resections and anchorage Insert the femoral trial using the impactor.

  • Page 29: Tibial Preparation

    Tibial Preparation The leg is flexed and any remaining osteophytes, along with the intercondylar eminence, are removed. Opening the tibia Remove the intercondylar eminence. Open the tibial IM canal with the ∅ 8 mm drill or directly with the ∅ 8/14 mm stepped drill.
  • Page 30 Join the two tibial resection guide IM compo- nents by aligning arrow with arrow and pressing the button. Attach the femoral/tibial cutting block to the tibial resection guide IM with the small top grub screw and slide fully onto the reamer extension (∅...
  • Page 31 Checking alignment and tibial resection Recheck the alignment using the axial align- ment rod. The rod tip must point to the centre of the ankle joint. The tibial stylus can now be removed. Check the resection height using the resection stylus. After preliminary drilling with the ∅...
  • Page 32 Tibial resection Perform the tibial resection using a 1 mm (or 1.27 mm option) saw blade through the 0 saw slot (closed slot with facet). To lock the femoral/tibial cutting block securely, an additional pin can be inserted into the oblique holes marked “AUX”. Remove the pin after resection.
  • Page 33 Tibial size determination Assemble the tibial sizer trial and handle, and place on the resected bone surface. The tibial sizer trial should completely cover the cortex, without projecting beyond the tibia. In case of doubt, a lateral projection is preferred because a medial projection may cause irritation of the pes anserinus.
  • Page 34 Preparing the tibial IM canal Prepare the proximal tibial anchorage using the osteotome and rasp. Using the thin, narrow 10 mm chisel; prepare the tibial cavity initially along the internal sizer contour, thereby avoiding bone frac- tures especially if the bone quality is poor. Important If sclerotic bone is present, preparation of the fins is especially important! These can also...
  • Page 35 Trial reduction The purpose of the trial reduction is to check the radius of movement, the patellar tracking, and the tension of the soft tissue mecha- nism. Insert the tibial trial first, followed by the femoral trial using the impactor. Important If a 10 mm tibial augmentation block is used, appropriate block trials, which can then be...
  • Page 36 When the definitive implants have been selected, prepare the components for implantation (see instructions, starting page 37). Remove the trial components with the Knock In/Out instrument, starting with the femur.

  • Page 37: Patellar Preparation

    Patellar Preparation The leg should be extended. Soft tissue on the posterior surface of the patella is exposed, preserving the ligaments. If the posterior surface of the patella is not replaced, all osteophytes should be removed from the patella, which is then denerved. Positioning the patellar clamp and performing patella resection The patellar instruments permit the use of...
  • Page 38 Milling Mount the patellar bushing onto the patellar clamp with the ratchet. Select the patellar reamer that will match the patella size. Depending on the selected anchoring technique, mill briefly (“onlay” technique) or countersink by 3 to 5 mm (“inlay” technique). Milling down to the stop will produce a depth of 5 mm.

  • Page 39: Implanting The Components

    Modern cementing techniques, using a vacuum mixer and jet lavage, are recommended. The RT-PLUS™ knee is used with cement. Cement the tibial component first, followed by the femoral component. Filling the IM canals using a cement gun is recommended.
  • Page 40 Hammer in the femoral component (see page 44 ff) using the impactor. Here too, continu- ous pressure must be maintained and excess cement removed. Important Make sure the posterior femoral condyles do not come into contact with the tibial compo- nent when impacting the femoral component.
  • Page 41 Fixation of the tibial insert Place the impacting attachment on the plug inserter. In the extension position, fully insert the tibial insert clamp by hand, in an anterior to poste- rior direction, using the plug inserter with the impacting attachment fitted. It should end up flush against the tibial insert and the tibial component.
  • Page 42 Implanting the cemented patellar component If patellar replacement is indicated, the patellar component (see page 44 ff) of the TC-PLUS™ knee system is used since the geometry of the patellar groove is matched to this implant. Mount the patellar inserter on the patellar clamp with the ratchet.

  • Page 43: Postoperative Treatment

    Postoperative Treatment* Rehabilitation The operated leg is immobilized in a splint and the knee joint is cooled. Isometric con- traction exercises should be performed on the first postoperative day. Thrombosis prophylaxis is required until full load can be borne. On the second postoperative day, after removng the drains, assisted movement exercises and the use of a motorized splint (CPM) are started.

  • Page 44: Sterilization

    Sterilization Implants All the implants described in this Surgical Technique are sterile when they are delivered by Implants must never be re-sterilized. the manufacturer. Instruments Instruments are not sterile when they are delivered. Before use they must be cleaned by the usual methods in accordance with internal hospital regulations and sterilized in an autoclave in accordance with the legal regulations and guidelines applicable in the relevant country.

  • Page 46: Implants

    Implants RT-PLUS™ Implants for cemented procedure Femoral components left right Set SAP No. 75300186 SAP No. Art. No. Size SAP No. Art. No. Size 75005499 24122 75005494 24102 75005500 24124 75005495 24104 75005501 24126 75005496 24106 75005502 24128 75005497 24108...
  • Page 47 SAP No. Art. No. Size Height 75005509 24151 10 mm 75005510 24153 10 mm 75005511 24155 10 mm 75005512 24157 10 mm 75005513 24159 10 mm The tibial inserts are the same as those of the RT-PLUS™ Modular knee system.

  • Page 48: Instruments

    Instruments RT-PLUS™ Instrument Set (1mm) Instrument Set: SAP No. 75210206 Art. No. 0944260 Femoral Instruments Case Set: SAP No. 7521023 Art. No. 0944270 SAP No. Art. No. Description Size Quantity 75005069 22000403 Case Femoral Instruments, Empty – 75007661 990019 Case lid –...
  • Page 49      9 ...
  • Page 50 Femoral Trials Case Set: SAP No. 75210233 Art. No. 0944272 SAP No. Art. No. Description Size Quantity 75005070 22000404 Case Femoral Trials, Empty – 75007661 990019 Case lid – 1 75005327 240051 Femoral Trial Left 75005314 240023 Femoral Trial Left 75005315 240024 Femoral Trial Left...
  • Page 52 Tibial Instruments Case Set: SAP No. 75210235 Art. No. 0944274 SAP No. Art. No. Description Size Quantity 75005071 22000405 Case Tibial Instruments, Empty – 75007661 990019 Case lid – 1 75023718 22000514 Holder Tibial Resection Guide IM – 2 75023727 22000523 Support Tibial Resection Guide IM ±...
  • Page 53   ...
  • Page 54 Tibial Trials Case Set: SAP No. 75210236 Art. No. 0944275 SAP No. Art. No. Description Size Quantity 75100392 22000569 Case Tibial Trials, Empty – 75007661 990019 Case Lid – 1 75005331 240055 Tibial Trial 75005317 240026 Tibial Trial 75005318 240027 Tibial Trial 75005319 240028...
  • Page 55 ...
  • Page 56 Patellar Instruments Case Set: SAP No. 75200207 Art. No. 0944003 SAP No. Art. No. Description Size Quantity 75018088 22000451 Case Patellar Instrument, Empty – 75007661 990019 Case Lid – 1 75005702 251204 Patellar Clamp – 2 75005881 252203 Patellar Clamp Cutting Guide 1 mm ...
  • Page 57  ...
  • Page 58 Documents Important The following documents are available for your assistance. Product-accompanying Documents Description Lit. No. Sawblade Portfolio 01218 Surgical Technique Intramedullary Procedure 15901 (1740) Product Information 15902 (1070) X-Ray Templates (1.15:1) 1069-A-B X-Ray Templates (1:1) 1585-A-B Product Overview 1345 System Specification Guide & Product Catalog 04805...

  • Page 59: Product Overview (Combination Tables)

    Product overview (combination table) RT-PLUS™...
  • Page 60 Notes...
  • Page 61 Notes...
  • Page 62 Notes...
  • Page 64 Reference: 1. Malzer U, Schuler P. 5 years results with the RT-PLUS Solution constrained total knee (Poster), 7th EFORT Congress, Lisbon, Portugal, June 4-7, 2005 2. Müller C, Basad E, Melzer C. Mid-term result with a new rotating hinge TKA (Poster), AAOS Annual Meeting, San Francisco, USA, March 5-9, 2008 3. NJR-UK, Summary report knee primary (KP) femoral RT-PLUS, August 15, 2016 4.

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