Smith & Nephew TC-PLUS Revision Surgical Technique
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Smith & Nephew TC-PLUS Revision Surgical Technique

Revision knee system
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Surgical Technique
*smith&nephew
Intramedullary Procedure
TC-PLUS™ REVISION
Revision Knee System
Complex Primary Knee System
Sawblade Thickness: 1.00 mm

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Summary of Contents for Smith & Nephew TC-PLUS Revision

  • Page 1 Surgical Technique *smith&nephew Intramedullary Procedure TC-PLUS™ REVISION Revision Knee System Complex Primary Knee System Sawblade Thickness: 1.00 mm...

  • Page 3: Table Of Contents

    For more information on the TC-PLUS Revision knee system, including its indications for use, contraindications, and product safety information, please refer to the product's label and the Instructions for Use packaged with the product.

  • Page 4: Introduction

    The TC-PLUS™ Revision knee prosthesis, with the posterior-stabilized version, has been developed to extend the indication range of the primary TC-PLUS knee system. The TC-PLUS Revision knee system use the same joint design (femur/insert) and resections as the TC-PLUS Primary knee system. Just additional stem connection and...
  • Page 5 Techniques. Responsibility It is the responsibility of the user of the TC-PLUS Revision knee system 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

    CoCrMo stems for cemented application. CoCrMo blocks are available to compensate femoral and tibial bone defects. All stems of the TC-PLUS Revision can be combined with the femoral and tibial components of the TC-PLUS Revision. The same applies for the femoral components of the TC-PLUS PS Revision.
  • Page 7 Patellar Component The all-poly ( UHMW-polyethylene ) patellar component has a symmetrical biconcave surface for better tracking. The patellar component are identical to those in the TC-PLUS™ portfolio. Tibial Inserts The tibial inserts present a snapping fixation and is additionally secured by a screw. The tibial inserts are identical to those used in the primary TC-PLUS knee portfolio, they are manufactured from UHMW-polyethylene and are available in six different...
  • Page 8 Tibial Component The symmetrical tibial component is manufactured from CoCrMo alloy. In order to minimize polyethylene wear inside the tibial component, the base plate is polished on the inside and the insert is completely enclosed along its entire circumference. The revision tibial component has a 3° slope connection that allows the use of different stems.
  • Page 9 Cemented Stem The femoral and tibial components can be intramedullary anchored in the bone by cemented conical stems, made of forged CoCrMo alloy. Available in lengths; 80 mm, 110 mm and 150 mm. Zementfreie Schäfte The femoral and tibial components can also be stabilised into the bone by using non-cemented cylindrical stems, made of forged Ti6Al4V alloy.

  • Page 10: Indications

    Indications The principal preoperative planning factor is the correct diagnosis. It has to be determined whether the bone and stability situation allow the implantation of an uncoupled prosthesis. The main indications for implantation of TC-PLUS™ Revision are : • Degenerative or posttraumatic arthrosis •...

  • Page 11: Contraindications

    Contraindications Contraindications are : • Acute or chronic, local or systemic infections ( or in the case of a corresponding anamnesis ) • Severe muscle, nerve or vascular diseases that endangers the affected extremity • Laking bone substance or inadequate bone quality that endangers a stable seating of the prothesis •...

  • Page 12: Case Study

    Case Study Preoperative situation Patient with varus displaced or implanted tibia, with a medial instability that must be revised because of pain and swelling.
  • Page 13 Postoperative Result Immediately postoperative; functional and pain-free reconstruction with TC-PLUS™ Revision knee.

  • Page 14: Preoperative Planning

    Preoperative Planning A full-leg X-ray with the patient in the 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. The X-ray images of the knee joint at three levels should be available for planning the surgery.
  • Page 15 Planning the surgery using the radiograph The following procedure is recommended for the anterior-posterior whole leg imaging process: 1. The femoral axis A (anatomical axis) is drawn onto the radiograph. 2. A line is drawn from the femoral head to the center of the knee (mechanical axis D) on the radiograph.

  • Page 17: Surgical Technique

    Surgical Technique Positioning of the patient for the surgery Surgery is performed whilst the patient is supine. It is recommended that the blood supply be partially blocked with the use of a tourniquet. But this is not absolutely necessary. The leg must be covered, so as to allow movement and secured to the operating table in such a way that the knee joint is brought into a stable 90°...
  • Page 18 Overview of the resections sequences for primary application It is important that the flexion and extension gaps are identical. 1. Distal femoral resection and optional distal augment resection 2. A/P femoral resections and optional posterior augment resection 3. Chamfer and trochlea resections and cutting out of the box if the PS version is required Remove residual posterior condyles if present...
  • Page 19 Overview of the resection sequences for revision application The bone resections are refreshed after extraction of the primary implants. 1. Distal femoral resection and optional distal augment resection 2. A/P femoral resections and optional posterior augment resection 3. Chamfer and trochlea resections and cutting out of the box if the PS version is required Remove residual posterior condyles if present...
  • Page 20 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 / 30mm – 6x PAC (Art. Nr. 42000089/75006487) Speed-Pins Ø 3.2 / 65mm –...

  • Page 21: Femoral Preparation

    Femoral Preparation Access: Please refer to the relevant surgical textbooks for the initial access to the knee. Important In addition to the bone resections, it is important to correct any ligament imbalance by appropriate soft-tissue procedures. If necessary, a general release should be performed on the side of the contracture.
  • Page 22 The Ø 8 mm IM rod is carefully inserted using the modular handle to approximately the isthmus of the femoral IM canal and removed again. It is important to work carefully to prevent excess pressure in the IM canal. The IM rod with the modular handle is now removed. The femoral IM canal is opened further with the Ø...
  • Page 23 Controlling the stem position An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in axial alignment and depth (the end of the reamer alignment guide corresponds to the tip of the reamer).
  • Page 24 Locating the distal femoral cutting block Select the femoral bushing, «4°», «6°» and «8°» bushings are available, in accordance with the angle measured in the preoperative planning. The femoral bushing is inserted into the femoral suspension device, so that depending on which side is the operation, the mark «L»...
  • Page 25 After preliminary drilling with the Ø 3.2 mm drill, the femoral / tibial revision cutting block is fixed with two bone pins ( 75 mm long ) through the holes marked «0». This position resects 9 mm from the distal femur, which corresponds to the distal thickness of the femoral prosthesis without femoral blocks.
  • Page 26 The distal resection is the reference for the following steps and has to be checked for accuracy. The femoral / tibial revision cutting block does not have to be removed yet because it will be used later (Depending the following chosen steps)! The side handles can be removed from the femoral / tibial revision cutting block and attached on the femoral A/P femoral cutting block revision.
  • Page 27 The rotation can be as well adjusted by applying anteriorly the femoral / tibial revision cutting block. After preliminary drilling with the Ø 3.2 mm drill, the A/P femoral cutting block revision is fixed with two bone oblique pins ( 38 mm with head ) through the lateral 45° oblique holes.
  • Page 28 The femoral chamfer resections are made through the corresponding slots ( slots with facet ). The A/P femoral cutting block revision is removed. Positioning the femoral reamer guide The chosen femoral reamer guide of the previously defined femoral size is positioned on the prepared bone and aligned intramedullary with the femoral valgus adapter ( «4°», «6°»...
  • Page 29 The posterior M/L dimension of the femoral reamer guide corresponds to the M/L implant dimension. The external contour of the femoral reamer guide corresponds to the anterior lateral femoral flange contour, the anterior laser markings to the anterior medial femoral flange contour. After preliminary drilling, the femoral reamer guide is fixed with bone pins ( 75 mm long or 38 mm with head ) through the anterior and lateral oblique holes.
  • Page 30 Removing the dorsal condyle residue Important: This must be checked in all cases! After having completed the femoral resections, use the curved osteotome to remove all osteophytes as well as protruding posterior condyles. At this point, a posterior contracture can also be released. This will improve flexion and prevent possible damage to the polyethylene insert by these bony projections.

  • Page 31: Tibial Preparation

    Tibial Preparation The leg is flexed and any remaining osteophytes and the intercondylar eminence are removed. Tibial opening Open the tibial IM canal with the Ø 8 mm drill or directly with the Ø 8 / 14 mm stepped drill. Position the hole centrally M/L and one third from anterior.
  • Page 32 Preparing the tibial stem connection The stem connection recess is drilled with the Ø 10 / 20 mm stepped drill until the larger laser marking ( corresponding to the tibial resection with the smallest 9 mm tibial insert ). The engraved marking «Tibia»...
  • Page 33 Setting the resection height The tibial stylus is positioned on the tibial plateau. The tibial stylus can be used for both primary resections ( «11 mm» marking ) and for revisions resections ( «1 mm» marking ). Important In primary revision procedures, the «11 mm» tibial stylus is positioned on the lowest point of the less damaged condyle.
  • Page 34 After preliminary drilling with the Ø 3.2 mm drill, the femoral / tibial revision cutting block is fixed with two bone pins ( 75 mm or 100 mm long ) through the holes marked «0». Handles can be attached. The lock lever is set to «OPEN» and the tibial resection guide IM is removed from the femoral / tibial revision cutting block by unscrewing the top small grub screw.
  • Page 35 As guidance for the vertical tibial augmentation block cut, two bone pins (length 75 mm or 100 mm are inserted into the two proximal holes level with closed saw slot. The vertical cut is performed between the two pins to the depth of the augmentation block.
  • Page 36 Tibial size determination The chosen trial stem is attached to the extension for trial stem ( Ø 8 mm ) and with the modular handle carefully inserted into the tibial IM canal so the line marked with «MIN.» is approximately level to the distal bone resection. The modular handle is now removed.
  • Page 37 Then the tibia slope adapter «3°», the alignment bushing «8», the extension of the trial stem ( Ø 8 mm ) and the trial stem itself are removed. The tibial sizer is additionally fixed with two or four bone pins with heads (25 mm or 38 mm). The corresponding manipulation tibial insert, which had previously been defined with the joint gap spacer, is placed on the tibial sizer.
  • Page 38 Preparing the tibial medullary cavity The tibia rasp guide is positioned on the tibial sizer and fixed with the retaining screw. The proximal tibia marrow space is definitively prepared with the tibia rasp. The tibia rasp is tapped in to the stop. Important The small tibia rasp guide and tibia rasp are used for tibia sizes 2 and 4 («2, 4») , and the large for tibia sizes...

  • Page 39: Offset Stem Option

    Offset Stem Option Preparing the tibial anchorage for offset stems. Positioning the tibial sizer for offset stems When using tibia blocks, appropriate manipulation tibia blocks («5 mm», «10 mm» and «15 mm») are available. They are fixed laterally on the manipulation tibial component ( tibial sizer ).
  • Page 40 Fixing the stem transfer guide After insertion of the vertical bone pins with head, the transfer guide can be placed in the tibial component. The transfer guide takes the offset position by clamping the lever and acts as a guide for assembly of the manipulation prosthesis and later for assembly of the implant.
  • Page 41 Preparing the tibial trial The corresponding tibial sizer with the matching tibial anchorage connection and «OFFSET» stem holder are mounted as the manipulation tibial component. Important Assembly is carried out on the instrument table. The transfer guide (3.75 mm) is positioned based on the fins.
  • Page 42 Trial reduction ( femoral component ) The manipulation femoral component is screwed to the manipulation femoral adapter (corresponding to the preset valgus angle) and the trial stem (corresponding to the last reamer). Important There is a danger that the same trial stem will be needed on the femur and on the tibia.

  • Page 43: Posterior-Stabilized Option

    Posterior-Stabilized Option In the case of complete insufficiency of the posterior cruciate ligament or if it is cut during surgery, e.g. with bending contractures greater than 30°, dorsal instability in bending position is possible. A posterior-stabilized model (PS) for cemented application is available as compensation. It includes a revision femoral component which includes a box in the intercondylar region designed to accept a PS tibial insert with a higher pin.
  • Page 44 The box is prepared medially and laterally with the oscillating saw. Important The medial and lateral saw cuts are aligned at an inclination to make it easy to place the IM-guided femoral component (valgus) in the correct position. Preparing the femoral box According to the predetermined valgus angle, the corresponding femoral valgus adapter ( «4°», «6°»...
  • Page 45 An extramedullary reamer alignment guide, which is attached to the reamer, can be used to check the position of the stem in axial alignment and depth ( the end of the reamer alignment guide corresponds to the tip of the reamer ). Preparing the femoral stem connection The largest reamer bushing «20»...

  • Page 46: Patellar Preparation

    Patellar Preparation The leg is 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, the patella is freed osteophytes and denerved. Positioning the patella clamp and patella resection The patellar instruments permit the use of the «...
  • Page 47 Milling Mount the patellar bushing onto the patellar clamp with the ratchet. Select the patellar reamer to match the corresponding patella size. Depending on the selected anchoraging technique, mill briefly ( « onlay » technique ) or countersink by 3 mm to 5 mm ( « inlay » technique ). Milling down to the stop results in a depth of 5 mm.

  • Page 48: Assembling The Implants-Components

    Assembling the Implants - Components The assembling block is essential for safe and gentle assembling of the implants. Important When assembling the implant component, always start with the stem first. Then the blocks can be fixed. Otherwise the block screw may come loose during impacting. Be aware;...
  • Page 49 Assembling by using offset stems The offset stem ( page 65 ) is inserted into the taper on the assembling block and set to the offset position with the aid of the transfer guide ( pre-assembled with the centering rings and straight surface on the elbow on the stem must be flush with the straight internal surface of the transfer guide ).
  • Page 50 Assembling the tibial blocks There are blocks with a thickness of 5 mm, 10 mm and 15 mm available for the tibial component ( page 63 ). To enable tibial block assembly the required PE pegs must first be removed. Important The tibial blocks can be inserted either medially or laterally ( excepted tibial blocks size 15 mm ).
  • Page 51 Fixing the stem ( cemented / non-cemented ) to the femoral component The stem ( page 64 and 65 ) is inserted into the taper. Important Pay attention that the tapered connection is undamaged, clean and dry before mounting and by using non- cemented stems that a pocket is anterior, not a rib.
  • Page 52 Securing the stem The stem is additionally secured with the stem retaining screw. The retaining screw must be tightened with the screwdriver with torque. The required torque is reached when the line reaches the Stem/Block position ( 4.5 Nm ). Important The stem retaining screw for retaining the stem is packaged with the femoral component.

  • Page 53: Implanting The Components

    Implanting the Components Mix the bone cement according to the respective manufacturer's instructions. Clean, wash and dry the bone bed sufficiently. Modern cementing techniques using a vacuum mixer and jet lavage are recommended. The TC-PLUS™ Revision knee is used with cement, with the exception of non- cemented stems.
  • Page 54 Last controlling Prior to definitive assembly of the tibial insert it is possible to use the tibial insert trial for a final trial reduction. Before the cement has set, the excess cement must be removed in extension. Insertion of the tibial insert The ultracongruent tibial insert ( or PS tibial insert ) is slid onto the tibial component and positioned bent at 90°.
  • Page 55 After manual placement of the PE retaining screw into the tibial insert, the PE retaining screw is tightened with the screwdriver with torque. The required torque is reached when the line reaches the PE position ( 2.5 Nm ). Important The screwdriver with torque is maintenance-free.

  • Page 56: Postoperative Treatment

    Wound closure The wound must again be rinsed out thoroughly after implantation. Close the wound in layers, inserting two intra-articular and one subcutaneous Redon drain. Postoperative Treatment Rehabilitation The operated leg is immobilized in a splint and the knee joint is cooled. Isometric contraction exercises should be performed on the first postoperative day.

  • Page 57: Sterilization

    Sterilization Implants All the implants described in this Surgical Technique are sterile when they are delivered Resterilization is not allowed. by the manufacturer. Instruments System components and 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 59: Implants

    Implants TC-PLUS™ Revision implants for cemented application Femoral components left Femoral components right SAP No. Art. No. Size SAP No. Art. No. Size 22462 75005148 22482 75005143 75005149 22484 75005144 22464 75005150 22486 75005145 22466 75005151 22488 75005146 22468 75005152 22490 75005147 22470...
  • Page 60 Tibial inserts ultracongruent SAP No. Art. No. Size Height 75006065 25416 9 mm 75006066 25417 11 mm 75006067 25418 13 mm 75006059 25400 15 mm 75006069 25421 17 mm 75006068 25420 19 mm 75006070 25426 9 mm 75006071 25427 11 mm 75006072 25428 13 mm...
  • Page 61 Femoral blocks distal / lateral SAP No. Art. No. Size Height 75005091 22228 5 mm 75005092 22229 10 mm 75005093 22230 15 mm 75005094 22231 5 mm 75005095 22232 10 mm 75005096 22233 15 mm 75005097 22234 5 mm 75005098 22235 10 mm 75005099...
  • Page 62 Femoral blocks distal / medial right SAP No. Art. No. Size Height 75005121 22270 5 mm 75005123 22271 10 mm 75005124 22272 15 mm 75005125 22273 5 mm 75005126 22274 10 mm 75005127 22275 15 mm 75005128 22276 5 mm 75005129 22277 10 mm...
  • Page 63 Tibial blocks SAP No. Art. No. Size Height 75005153 22512 5 mm 75005154 22513 10 mm 75005163 22532 15 mm R-lat/L-med 75005164 22533 15 mm L-lat/R-med 75005155 22514 5 mm 75005156 22515 10 mm 75005165 22534 15 mm R-lat/L-med 75005166 22535 15 mm L-lat/R-med 75005157...
  • Page 64 Cemented Stems ( conical ) [CoCrMo] SAP No. Art. No. Height 75007325 61000 80 mm 75007327 61002 110 mm 75007326 61001 150 mm Non-cemented stems – straight [Ti6Al4V] SAP No. Art. No. Size Height Ø 10 mm 75007329 61100 80 mm Ø...
  • Page 65 Non-cemented stems – 2° valgus [Ti6Al4V] ( for femoral component only ) SAP No. Art. No. Size Height Ø 10 mm 75007346 61120 80 mm Ø 12 mm 75007347 61121 80 mm Ø 14 mm 75007348 61122 80 mm Ø 16 mm 75007349 61123 80 mm...
  • Page 66 Posterior-Stabilised Version TC-PLUS™ PS Revision implants for cemented application Femoral components left Femoral components right SAP No. Art. No. Size SAP No. Art. No. Size 75007315 60102 75007320 60122 75007316 60104 75007321 60124 75007317 60106 75007322 60126 75007318 60108 75007323 60128 75007319 60110...
  • Page 67 Tibial inserts PS ( on request ) Size Heigh SAP No. Art. No. 75005179 22616 21 mm 75005187 22626 21 mm 75005195 22636 21 mm 75005203 22646 21 mm 75005211 22656 21 mm Set of spare screws and PE pins SAP No.

  • Page 68: Instruments

    Instruments TC-PLUS™ Revision Instrument Set Instrument Set: SAP No. 75200232 Art. No. 0944030 Basic Instruments Case Set: SAP No. 75200215 Art. No. 0944012 Description Size Quantity SAP No. Art. No. 75006024 253309 Case Basic Instrument, Empty – 75007661 990019 Case Lid –...
  • Page 69 Optional Drill with AO Connection ( on request ) Set: SAP No. 75200233 Art. No. 0944031 SAP No. Art. No. Description Size Quantity Drill (AO) Ø 3.2 mm 75005672 251096 IM Drill with Starter Tip (AO) Ø 8 mm 75005673 251097 Drill with Stop (AO) Ø...
  • Page 70 Trial Stems & Reamers Case Set: SAP No. 75200216 Art. No. 0944013 Size Quantity SAP No. Art. No. Description 253302 Trial Stems Case, Empty 75006017 – Case Lid 75007661 990019 – Trial Stem Ø 10 / 40 mm 75007113 600132 Trial Stem Ø...
  • Page 71 Optional Cemented Trial Stems ( on request ) Case Set: SAP No. 75200281 Art. No. 0944094 Size Quantity SAP No. Art. No. Description ¹ Trial Stem 75007111 600130 80 mm Trial Stem 75007110 600129 110 mm Trial Stem 75007112 600131 150 mm ¹...
  • Page 72 Femoral Instruments Case Set: SAP No. 75200217 Art. No. 0944014 SAP No. Art. No. Description Size Quantity Case Femoral Trials, Empty 75006015 253300 – Case Lid 75007661 990019 – Femoral Drill Guide IM, Adjustable 75006001 253275 – Femoral Distal Spacer Revision 75007144 600183 7 mm...
  • Page 74 Femoral Trials Case Set: SAP No. 75200218 Art. No. 0944015 Art. No. Description SAP No. Size Quantity Femoral Trial Case, Empty 75006018 253303 – Case Lid 75007661 990019 – Femoral Trial Left 75007223 600381 Femoral Trial Left 75007224 600382 Femoral Trial Left 75007225 600383 Femoral Trial Left...
  • Page 76 Tibial Instruments Case Set No.: SAP No. 75200219 Art. No. 0944016 Size Quantity Art. No. Description SAP No. Case Tibial Instruments, empty 75006019 253304 – Case Lid 75007661 990019 – Tibial Sizer / Trial 75006025 253311 Tibial Sizer / Trial 75006026 253312 Tibial Sizer / Trial...
  • Page 77 Tibial Instruments ( next ) Case Set No.: SAP No. 75200219 Art. No. 0944016 Art. No. Description SAP No. Size Quantity Tibial Rasp 75007247 600413 2–4 Tibial Rasp 75007248 600414 6–10 Tibial Rasp Guide 75007132 600165 2–4 Tibial Rasp Guide 75007133 600166 6–10...
  • Page 78 Tibial Insert Trials CS Case Set No.: SAP No. 75200220 Art. No. 0944017 Art. No. Description SAP No. Size Quantity Case Tibial Insert Trials CS, empty 75006020 253305 – Case Lid 75007661 990019 – Tibial Insert Trials CS (ultracongruent) 75005600 250400 2 / 9 mm Tibial Insert Trials CS (ultracongruent)
  • Page 80 Assembly Instruments Case Set No.: SAP No. 75200221 Art. No. 0944018 SAP No. Art. No. Description Size Quantity Case Assembly Instruments, empty – 75006021 253306 Case Lid – 75007661 990019 – Slap Hammer 75007142 600181 Adapter for Slap Hammer Flat 75007143 600182 Adapter for Slap Hammer...
  • Page 81 ¸ µ ¹...
  • Page 82 Posterior-Stabilised Version TC-PLUS™ PS Revision Instrument Set Instrument Set: SAP No. 75200277 Art. No. 0944090 Femoral Instruments PS Case Set: SAP No. 75200278 Art. No. 0944091 SAP No. Art. No. Description Size Quantity Case Femoral Instrument PS, empty 75006023 253308 –...
  • Page 84 Tibial Insert Trials PS Case Set: SAP No. 75200279 Art. No. 0944092 Description Quantity Size Art. No. SAP No. Case Tibial Insert Trials PS, empty 75006022 253307 – Case Lid 75007661 990019 – Tibial Insert Trials PS 75005930 253140 2 / 9 mm Tibial Insert Trials PS 75005931 253141...
  • Page 86 Patellar Instruments Case Set: SAP No. 75200207 Art. No. 0944003 SAP No. Art. No. Description Size Quantity Case Patellar Instrument, Empty 75018088 22000451 – Case Lid 75007661 990019 – Patellar Clamp 75005702 251204 – Patellar Clamp Cutting Guide ( 1 mm ) 75005881 252203 –...
  • Page 87 ¸ µ...

  • Page 89: Product Overview ( Combination Tables )

    15873-en (1357) Product information X-ray templates "TC-PLUS™ Revision" (1.15:1) 1354-A1-A2-A3-B X-ray templates "TC-PLUS PS Revision" (1.15:1) 1355-A1-A2-A3-B X-ray templates "TC-PLUS Revision" (1:1) 1511-A1-A2-A3-B X-ray templates "TC-PLUS PS Revision" (1:1) 1512-A1-A2-A3-B Product overview "TC-PLUS Revision" 1358 Product overview "TC-PLUS PS Revision"...
  • Page 95 Note...
  • Page 96 Note...
  • Page 97 Note...
  • Page 98 Manufacturer For further information please contact Smith & Nephew Orthopaedics AG Oberneuhofstrasse 10d our local sales office. 6340 Baar www.smith-nephew.com Switzerland 0 1 2 3 ™ Trademark of Smith & Nephew 15801-en V1 (1402) 10/18...

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