Surgical rotocol Acknowledgments Stryker Orthopaedics wishes to thank the global Triathlon Knee System Surgeon Panel for their dedication to the development of the Triathlon Knee System. Introduction The Triathlon Knee System Instrumentation has been developed based on Stryker’s 30-year orthopaedic history. The system combines the expertise of orthopaedic and human factors engineers with that of surgeons and OR staff worldwide.
Triathlon Knee System Surgical rotocol System Highlights Femoral Alignment & Femoral Alignment & Distal Resection Distal Resection Femoral Sizing Femoral Sizing Femoral Bone Resections Femoral Bone Resections PS Box Preparation PS Box Preparation Tibial EM Alignment & Tibial EM Alignment &...
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Tibial Sizing Tibial Sizing Tibial Keel Preparation Tibial Keel Preparation Patella Resection - Patella Resection - Patella Resection - Patella Resection - Bone Remaining Method Bone Removing Method Bone Removing Method Bone Remaining Method Trialing Trialing Component Implantation Component Implantation...
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Triathlon Knee System Surgical rotocol System Highlights System Highlights A Triathlon Knee System Instrumentation Highlights pullout has been included. This can be torn out and used as a quick reference wall chart in the OR to aid both the surgeon and the OR staff.
Assembly Instructions Many of the Triathlon Knee System Instruments have unique mechanisms incorporated to assist surgeons and OR staff, in a simplified, efficient surgical experience. Therefore, assembly instructions have been included in the first section of this surgical technique to assist with instruments that may be pre-assembled on the back table, as well as other instruments that need to be assembled.
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Triathlon Knee System Surgical rotocol Universal Alignment Handle, Distal Resection Guide and Universal Alignment Rod Assembly: > Insert the Universal Alignment Handle into the Distal Resection Guide as shown. Assembly 2A > Insert the Universal Alignment Rod as shown. Assembly 2B...
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Femoral Sizer, Femoral Stylus and Modular Handle Assembly: > Attach the Femoral Stylus to the appropriate lateral hole of the Femoral Sizer by squeezing the black tab and inserting into the hole. Release the tab to lock into place. > Press the black button on the Modular Handle and insert into the holes shown.
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Triathlon Knee System Surgical rotocol Femoral Impactor Extractor, Impaction Handle and Femoral Trial or Femoral Component Assembly: > Snap the Femoral Impactor Extractor into the Impaction Handle. > Ensure the hexagon on the Femoral Impactor Extractor is fully seated in the Impaction Handle.
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Tibial Alignment Ankle Clamp EM, Tibial Alignment Distal Assembly EM, Tibial Alignment Proximal Rod EM, Tibial Stylus, Tibial Resection Guide Modular Capture and Tibial Adjustment Housing Assembly: Note: The Tibial Adjustment Housing is available in 0° slope (posterior stabilized) and 3° slope (cruciate retaining): >...
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Triathlon Knee System Surgical rotocol > Ensure that the bronze lock on the Distal Assembly is unlocked prior to insertion. > Insert the Proximal Rod and Tibial Adjustment Housing assembly into the hole on the top of the Distal Assembly with the fixation pins on the superior portion of the Proximal Rod facing posteriorly.
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> Final Assembly Assembly 6G > Squeeze the bronze tab on the Tibial Resection Guide Modular Capture to attach it to the Tibial Resection Guide. Locate the posts on the bottom of the Tibial Resection Guide Modular Capture and the post holes on the top surface of the Tibial Resection Guide.
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Triathlon Knee System Surgical rotocol Universal Tibial Template, Alignment Handle and PS or CR Tibial Insert Trial Assembly: > Posterior hole and Channel of Universal Tibial Template (referenced in Assembly 7B). Assembly 7A > Depress and hold the lever on the anterior position of the Alignment Handle.
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Universal Tibial Template and Keel Punch Guide Assembly: > Ensure that the handle of the Keel Punch Guide is unlocked – pull back on the handle to unlock. > Assemble the Keel Punch Guide to the Universal Tibial Template by inserting the Keel Punch Guide (at a slight angle to the Universal Tibial Template) into the two locating slots towards the posterior portion of the Universal Tibial Template.
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Triathlon Knee System Surgical rotocol Patella Clamp, Patella Stylus and Patella Clamp Jaws Assembly (this may also be used to assemble the Patella Clamp Base, Patella Drill Template and Patella Cement Cap to the Patella Clamp): > Snap the Patella Clamp Jaws into the holes on the Patella Clamp.
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1/8" Hex Drive, Slip Torque Handle and Modular Femoral Distal Fixation Pegs Assembly: > Snap the 1/8 Hex Drive into the Slip Torque Handle. " Assembly 10A > Insert the tip of the 1/8 Hex Drive into the " Modular Femoral Distal Fixation Peg and turn the Slip Torque Handle to tighten.
Triathlon Knee System Surgical rotocol Exposure > A standard anterior midline incision is utilized. Any previous incision can be used or incorporated to decrease the risk of skin slough. > The capsule is entered through a medial parapatellar approach approximately 1cm from the medial border of the patella.
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Instrument Bar 6541-4-801 Universal Driver 6541-4-538 3/8" IM Drill 6541-4-800 T-Handle Driver 6541-4-516 5/16" IM Rod Figure 4 6541-1-657 Femoral Alignment Guide > Snap the Distal Resection Guide onto the Adjustment Block and insert the posts of the Adjustment Block into the two holes in the Femoral Alignment Guide (See Assembly 1).
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Press the black button on the end of the Adjustment Block and pull to set the resection to the desired level. Figure 5 > The Triathlon Knee System Instruments allow for a clear view of the bone that is being resected to ensure the appropriate level is set. >...
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Instrument Bar 6541-1-600 Adjustment Block 6541-1-657 Femoral Alignment Guide 6541-1-721 Distal Resection Guide 6541-4-806 Universal Alignment Handle 6541-4-602 Universal Alignment Rods Figure 7 > Prior to pinning the Distal Resection Guide to the femur, an optional external alignment check may be performed. Attach the Universal Alignment Handle to the Distal Resection Guide and insert a Universal Alignment Rod into the handle (See Assembly 2).
Modular Capture - Distal Resection to insert into the Distal Resection Guide. > The Triathlon Knee System Instruments are designed to provide control of the saw blade during bone resections. When using Modular Captures or cutting through slots, a .050 (1.25mm) blade is used.
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Instrument Bar 6541-1-721 Distal Resection Guide 6541-4-003 Headless Pins - 3" 6541-4-809 Headless Pin Driver 6541-4-801 Universal Driver Figure 11 6541-4-400 Bladerunner > Remove the Headless Pins by placing the Headless Pin Extractor over the pin and place it flush on the Distal Resection Guide. Squeeze the handle approximately four times, ensuring that after each squeeze, the Headless Pin Extractor is placed flush with the 6541-1-723...
Triathlon Knee System Surgical rotocol Femoral Sizing > Assemble the Femoral Sizer with the Femoral Stylus in the appropriate lateral hole, setting the stylus length to an approximate size. Set the rotation to “LEFT” for a left leg and “RIGHT” for a right leg.
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Instrument Bar 6541-1-603 Femoral Sizer 6541-1-605 Femoral Stylus 6541-4-400 Bladerunner Figure 15 6541-4-003 Headless Pins - 3" > It is recommended that the anterior resection level be checked 6541-4-809 to further confirm the correct size by sliding a Bladerunner Headless Pin Driver through the sizing guide’s size-specific anterior slots and assessing the resection.
Triathlon Knee System Surgical rotocol > Remove the Headless Pins using the Headless Pin Extractor. > As a secondary sizing check, use the Bladerunner to check the M/L width of the Femoral component. > Line the Bladerunner up with the epicondyles and determine the component size.
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Triathlon Knee System Surgical rotocol > Complete the remaining four femoral bone resections. > The use of a .050 (1.25mm) thick saw blade is " recommended. > The order of bone resections is not critical; however, a recommended sequence for improved stability of the 4:1 Cutting Block is: >...
Triathlon Knee System Surgical rotocol > Remove the 4:1 Cutting Block. > If preparing for a Cruciate Retaining Knee where no PS box preparation is needed, proceed to Femoral Trial Assessment on page 32. PS Box Preparation > If it is determined that a PS component will be used, the box must be prepared on the distal femur.
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Triathlon Knee System Surgical rotocol > Attach the Slap Hammer to the Box Chisel. Remove the Box Chisel from the PS Box Cutting Guide and remove the bone. Figure 31 > If Modular Femoral Distal Fixation Pegs are to be...
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Triathlon Knee System Surgical rotocol > Remove the Femoral Impactor Extractor and Impaction Handle and assess the fit of the PS or CR Femoral Trial. Care must be taken to ensure that all of the osteophytes beyond the end of the posterior femoral condyles are removed.
Triathlon Knee System Surgical rotocol Option 1 – Extramedullary Referencing > The tibial resection assembly has five parts: the appropriate Tibial Resection Guide, the Ankle Clamp, the Distal Assembly, the Proximal Rod and the Tibial Adjustment Housing. These are assembled first (See Assembly 6).
Instrument Bar Right 6541-2-700 Left 6541-2-701 Tibial Resection Guide 6541-2-610 Tibial Alignment Distal Assembly EM 6541-2-609 Tibial Alignment Ankle Clamp EM Figure 42 6541-2-611 Tibial Alignment Proximal Rod EM Option 2 – Intramedullary Referencing > Attach the 3/8 IM Drill to the Universal Driver and create a hole "...
Triathlon Knee System Surgical rotocol Rotational Alignment > With the body of the Tibial Alignment Jig IM resting on the proximal tibia, proper rotational alignment is achieved by rotating the instrument about the 5/16 " IM Rod so that the vertical mounting bar is over the medial 1/3 of the tibial tubercle.
Instrument Bar 6541-2-600 Tibial Alignment Jig IM 6541-4-800 T-Handle Driver 6541-4-516 5/16" IM Rod 6541-4-003 Figure 46 Headless Drill-Pins - 3" 6541-4-809 Headless Pin Driver [The following applies to both extramedullary and intramedullary alignment.] Establish Tibial Resection Level 6541-4-801 > The Tibial Stylus attaches to the Tibial Resection Guide with the “9”...
Triathlon Knee System Surgical rotocol > Remove all alignment instruments leaving only the Tibial Resection Guide in place. • If Option 1 EM Alignment was used: The Ankle Clamp, Distal Assembly, Proximal Rod and Tibial Adjustment Housing are removed. To remove the...
Instrument Bar Right 6541-2-702 Left 6541-2-703 Tibial Resection Guide Modular Capture 6541-4-610 Adjustable Spacer Block 6541-4-602 Universal Alignment Rods Figure 50 See Catalog PS Femoral Trial Tibial Component Sizing > Place the PS or CR Femoral Trial on the femur. >...
Triathlon Knee System Surgical rotocol Tibial Trial Assessment > For an optional tibial alignment check, insert a Universal Alignment Rod into the most anterior hole of the Alignment Handle and check alignment. Figure 51 > Place the knee in full extension and assess overall alignment in the A/P and M/L planes.
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Instrument Bar 6541-4-602 Universal Alignment Rods 6541-4-003 Headless Drill-Pins - 3" 6541-4-809 Headless Pin Driver 6541-4-801 Universal Driver 3170-0000 Figure 53 1/8" Drill > There are two options to secure the Universal Tibial Template to the tibia: • Option 1: Once satisfactory alignment and tibial component orientation are achieved, remove the PS or CR Femoral Trial.
Triathlon Knee System Surgical rotocol > If additional fixation is required after either Option 1 or 2 is used, place up to four Headed Nails in the holes on the Universal Tibial Template into the tibial plateau. > Trials may be reassembled to the pinned template for any subsequent trial reductions.
Triathlon Knee System Surgical rotocol Patella Preparation > Determine the total thickness of the patella by using the Patella Caliper. > There are two options for the patella preparation: Bone Removing Method and Bone Remaining Method. Figure 58 Option 1 –...
Instrument Bar 6541-3-602 Patella Caliper 6541-3-702 Small Patella Clamp Jaw Right 6541-3-703 Small Patella Clamp Jaw Left Figure 60 6541-3-704 Large Patella Clamp Jaw Right Option 2 – Bone Remaining Method 6541-3-705 Large Patella Clamp Jaw Left > Assemble Patella Clamp Jaws to the Patella Clamp. Attach the Patella Stylus to the hex shaped hole on the bottom side of either jaw by squeezing the gold tab See Assembly 9).
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Triathlon Knee System Surgical rotocol > Ensure that the Patella Stylus is touching the desired point(s) on the patella tendon. > Make resection through one of the resection slots. Figure 61 (The following applies to both Bone Removing Method and Bone Remaining Method) >...
Triathlon Knee System Surgical rotocol Component Implantation > If needed, prepare the resected bone surfaces using the Bone File, which is attached to the Impaction Handle. Figure 66 PS or CR Femoral Component - Cemented/Cementless > Attach the Femoral Impactor Extractor to the Impaction Handle and attach to the appropriate size and side Femoral Component (See Assembly 5).
Triathlon Knee System Surgical rotocol > To further seat the baseplate, attach the Tibial Baseplate Impactor to the Impaction Handle. > Place the Tibial Baseplate Impactor on to the Primary Tibial Baseplate straddling the central island. Ensure the Tibial Baseplate Impactor sits flat on the top surface of the Primary Tibial Baseplate.
Instrument Bar 6541-4-810 Impaction Handle 6541-4-812 Tibial Baseplate Impactor 6541-4-813 Tibial Insert Impactor Figure 73 See Catalog > Assess the joint in flexion and extension. PS Tibial Insert Closure For Cemented Components > After cement polymerization and removal of all residual cement, See Catalog thoroughly irrigate the joint.
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Triathlon Knee System Surgical rotocol Warnings and Precautions • Wear of polyethylene components has occurred and literature reports have associated its occurrence with Indications bone resorption, loosening and infection. General Total Knee Arthroplasty (TKR) Indications • Metal sensitivity reactions have been reported include: following joint replacement.
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