Movation e+ Knee - … · Movation Knee System Sizing ... Baseplates are left and right specific....

Movation™ e+ KneeSurgical Technique

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Table of Contents

Movation Knee System Sizing ....................................2Indications/Contraindications .....................................3Femoral Preparation ...................................................... 4Tibial Preparation............................................................. 6Gap Assessment ................................................................7Patella Preparation ......................................................... 8Trialing .................................................................................. 9Component Implantation .......................................... 10Short Tibial Stem Extensions .................................... 10

This brochure is presented to demonstrate the surgical technique utilized by the surgeon listed above. DJO Surgical, as the manufacturer of this device, does not practice medicine and cannot recommend this or any other surgical technique for use on a specific patient. The choice of the appropriate surgical technique is the responsibility of the surgeon performing the operation.

Surgical TechniqueMovation PS Knee

2

The Movation Knee SystemThe Movation Primary Knee originates from a long history of tradition and clinical success. The Movation Knee is used without a PCL. Implants were designed to allow for 10° hyper–extension, and accommodate up to 146° flexion.

Femoral ComponentThe Movation Femoral component is available in six AP sizes, left and right. Size 6 is also offered in a “Narrow” ML width, as it is a commonly used size for both males and females. Distal and posterior femoral condyles are 9mm thick.

Insert ComponentMovation Tibial Inserts are available in six sizes, and five thicknesses (9, 11, 13, 15, 18mm). The Tibial Inserts are labeled with the thickness of the total tibial construct (Baseplate and Insert combined), measured at the thinnest point.

Tibial Baseplate ComponentFor each Femoral Component, two Movation Tibial Baseplate options are available. Baseplates are left and right specific.

SizingImplant boxes and trials are color coded so that the correct sizes are used.

Patellar ComponentA Domed Patella is used with the Movation System. A Domed Patella will glide along the deep patellar groove of the femur, which was specifically designed to avoid patellar clunk.

SIZE AP (MM) ML (MM)

2 51 57

4 56.5 59.5

6N 62 63

6 62 68

8 67.5 71

10 71.5 74

12 76 78

SIZE AP MED (MM) AP LAT (MM) ML (MM)

2 41.5 38 64

4 44.8 41 69

6 48 44.5 74

8 51.5 47.5 79

10 54.8 50.5 84

12 58 54 89

FEMUR INSERT BASEPLATE COLOR

Size Match Downsize

2 2 2F-2T - Yellow

4 4 4F-4T 4F-2T Rust

6/6N 6 6F-6T 6F-4T Green

8 8 8F-8T 8F-6T Blue

10 10 10F-10T 10F-8T Gray

12 12 12F-12T 12F-10T Black

DOMED ALL-POLY RESURFACING

Size/Diameter Thickness Trial Color

26 8mm Yellow

29 8mm Rust

32 8mm Green

35 9mm Blue

38 9mm Black

DOMED ALL-POLY RECESSING

Size/Diameter Thickness Trial Color

26 10mm Lt. Purple

29 10mm Lt. Purple

32 10mm Lt. Purple

35 10mm Lt. Purple

38 10mm Lt. Purple

3Surgical TechniqueMovation Knee

IndicationsJoint replacement is indicated for patients suffering from disability due to:

• degenerative, post-traumatic or rheumatoid arthritis;• avascular necrosis of the femoral condyle;• post-traumatic loss of joint configuration, particularly

when there is patellofemoral erosion, dysfunction or prior patellectomy;

• moderate valgus, varus or flexion deformities;• treatment of fractures that are unmanageable using other

techniques.

This device may also be indicated in the salvage of previously failed surgical attempts. This system is to be used for cemented applications.

ContraindicationsJoint replacement is contraindicated where there is:

• infection (or a history of infection), acute or chronic, local or systemic;

• insufficient bone quality which may affect the stability of the implant;

• muscular, neurological or vascular deficiencies, which compromise the affected extremity;

• obesity;• alcoholism or other addictions;• materials sensitivity;• loss of ligamentous structures;• high levels of physical activity (e.g. competitive sports,

heavy physical labor).


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The Movation Knee System cuts can be completed independently per the surgeon’s preference. While the technique demonstrates a femur-first technique, surgery can also be performed tibia first, or extension gap first.

Femoral PreparationIntramedullary ExposureUsing the 8mm IM Femoral Drill, locate and drill a pilot hole into the intramedullary femoral canal. The inferior edge of this hole should be positioned approximately 1 to 2 mm anterior to the intercondylar notch. Make the hole larger by toggling the bit inside the canal. This reduces the risk of a fat embolism and allows the guide rod to seek the proper position in the canal. Irrigate and suction the canal to further decrease the risk of fat embolization.

Placement of the hole too anterior will result in a femoral component position that is in relative extension with respect to the long axis of the femur. In contrast, placement of the hole too posterior or close to the apex of the intercondylar notch will result in a femoral component position which is in relative flexion compared to the long axis of the femur.

Slowly insert the T-Handle IM Rod into the pilot hole created by the IM Femoral Drill until it passes through the isthmus of the femoral canal. Remove the T-Handle.

Establish Femoral AlignmentSelect the appropriate Femoral IM Bushing (5°, 6°, or 7°) based on the preoperative measurement of valgus for the distal cut. The bushings will magnetically secure into the Distal Femoral Cut Guide. The bushings indicate the proper setting for a left or right knee with appropriate “L” and “R” markings facing anteriorly.

Assemble the T-Handle IM Rod through the bushing and guide, and put the assembly into the femoral canal. Set the Distal Femoral Cutting Block at a 9mm resection by pushing it all the way against the guide and tightening the locking knob. More distal resection may be considered for knees with flexion contractures.

Distal Femoral ResectionFix the position of the Cutting block by drilling two pins through the “0” holes with self-drilling Smooth Pins. Holes placed in 2mm increments above the holes marked “0” allow for re-adjustment of the cutting block to remove more bone as determined necessary.

A general guideline for the distal femoral resection is to remove an amount of bone that results in the saw blade passing near or at the depth of the intercondylar notch. Remove the Distal Femoral Resection Guide and IM Rod. Once the cut depth is satisfactory, drill a pin through the cross-pin hole with the

Drill an intramedullary hole.

Make Block flush with “9mm” line for recommended cut.

+3mm cut slot

Assemble the Distal Femoral Guide, Cut Block, and IM Bushing.

Place the T Handle through the IM Bushing and insert the assembly into the IM canal. Pin the Cut block in place.

Remove the assembly, leaving the Cut Block pinned onto the anterior femur.


headed self-drilling Bone Pin for increased fixation. Using a saw blade that is 1.27mm thick and a sagittal saw, cut the distal femur. Remove the pins and cut block.

Femoral Sizing Seat the anterior referencing Femoral Sizer on the distal femur using the sizer feet to reference the posterior condyles. The small handle can be used to position the sizer. The Sizer can be pinned in place with Headed Bone Pins. Allow the anterior portion of the guide to “float” until the stylus tip is positioned on the lateral aspect of the anterior cortex of the femur. Keep in mind that the sawblade exit point will correspond to the stylus tip location. Read the measurement indicator to determine the appropriate size femoral component. Place the appropriate Femoral Peg Bushing (0°, 3°, or 5°) on the Sizer to set desired external rotation for either a left or right femur as indicated on each bushing. Drill two holes for the femoral pegs using the .19” drill marked “Femoral Peg”. Remove the assembly.

AP and Chamfer CutsPlace the appropriate size 4-in-1 Speed Block on the distal femur. The Speedblock Removal Tool can be used to help impact the block, or the block can be tapped into place by using a mallet on the flat surface.

Use the Angel Wing to assure the cuts are in the desired location and size is appropriate. A Femoral Shift Block is available to shift the Speedblock 2mm anterior or posterior. The block may be pinned in place using headed bone pins.

Make the anterior cut, posterior cut, and anterior and posterior chamfer cuts using a sagittal saw and a 1.27mm thick saw blade. Extract using the Slaphammer with the Speedblock Removal Attachment.

PS Box PreparationThe PCL should be excised if still present. Choose the appropriate PS Box Cutting Guide corresponding to the size of the femoral component to be used, and secure the jig on the distal femur. The distal portion of the box cut can be made with a reciprocating saw or a chisel. Place the PS Box Cutting Chisel into the anterior slot in the box cutting guide – the side engraved “Distal” should be facing away from the patient’s hip. Tap the chisel through the slot carefully. Leave the chisel in the bone to use as a depth guide for wall cuts if desired. Using the sides of the PS Box Cutter as a guide, cut the distal femur with a sagittal saw or a reciprocating saw. If not using the chisel, the depth of the box wall cuts should be carefully monitored by eying the anterior slot of the guide, which corresponds to the distal surface of the box. If used, remove the chisel and check cuts.

Pin the Speedblock in place for added fixation and make the femoral cuts.

A Femoral Shift Block re-sets the Speedblock lug hole location 2mm anterior or posterior.

Ensure “DISTAL” is facing distally.

Place the Sizing Guide on the distal femur with appropriate Femoral Peg Bushing.

The Stylus should touch the desired exit point of the Sawblade on the lateral cortex.


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Tibial PreparationExternal Alignment, Option 1Assemble the Ankle Cradle, EM Straight Rod, Proximal Spike piece (optional), and correct orientation Tibial cut block (left or right).

Clamp the Ankle Cradle around the patient’s ankle. Adjust the overall length of the EM Tibial Resection Guide to the appropriate tibial length. As a low level of slope is recommended with the Movation PS Knee, set the EM Straight Rod close to the Ankle Cradle. An optional EM Bridge (shown on page 11) can be assembled on the guide to get the Tibial Cut Block closer to the tibia. If using, lightly anchor the Proximal Spike piece onto the central tibial plateau by tapping in the tip of the long pin.

Align the EM Straight Rod to the tibia. Position the center of the Tibial Cut Block just medial to the tibial tubercle and the perpendicular center through the medial 1/3 of the ankle. With the foot in a neutral position, align the rod with the second metatarsal. This is accomplished by sliding the M/L adjustment at the ankle. When alignment is achieved, lock the rod in place.

Note that a low level of slope is recommended for the Movation tibia. No slope is built into the implant. If slope is desired, adjust the slope of the Cut Block by sliding the Straight EM Rod along the length of the Ankle Cradle until the desired slope is reached.

When alignment of the EM Guide is achieved, if using, fully sink the Proximal Spikes into the tibial plateau.

Internal Alignment, Option 2Using the Femoral IM Drill, locate and drill a pilot hole into the intramedullary tibial canal. The posterior edge of this hole should be positioned 3 to 5 mm anterior to the pinnacle of the proximal tibial spine and in line with the tibial tubercle.

Assemble the T-Handle Rod and the IM Tibial Resection Guide so the slope indicators on the guide face away from the patient when the guide is in position. Insert the assembly into the tibial canal.

Assemble the Tibial Cut Block to the IM Resection Guide with the desired amount of posterior slope: 0 or 3° options are available. Establish rotational alignment by positioning the center of the Tibial Cut Block just medial to the tibial tubercle and the perpendicular center through the medial 1/3 of the ankle.

External Alignment Assembly Anchor the optional Proximal Spike into the proximal tibia after setting alignment and slope.

Alignment Adjustment.

Internal Alignment Assembly

Slope Adjustment.

Insert the T-Handle through the IM Prong Guide and into the IM canal.


Use the Tibial Stylus to reference cut depth.

Assess the flexion and extension gaps prior to finishing bone preparation.

Slip the External Alignment Tower into the Cut Block slot.

Remove the assembly, leaving the Cut Block pinned onto the anterior femur.

Assess varus/valgus alignment.

Tibial CutPlace the Stylus on the Tibial Cut Block until the tip of the Stylus marked “9mm” touches the lowest point of the least involved compartment of the tibial plateau. Do not allow the Stylus to tip, or the measurement can be biased. Adjustment of the Rod height and Cutting Block position is made by pressing the blue button on the Rod.

If it is necessary to spare bone, an alternative method is to adjust the Block until the tip of the stylus marked “1” touches the lowest point of the most involved compartment of the tibial plateau. If using this method, ensure that a 1mm cut will remove enough bone necessary for the joint space to accommodate implant components.

Secure the position of the Cut Block into the tibia using self-drilling Smooth Pins through the holes marked “0.” These are highlighted with a laser mark. Holes placed in 2mm increments above the holes marked “0” allow for re-adjustment of the Cut Block to remove more bone as determined necessary.

After the Cut Block is pinned, remove the remainder of the Tibial EM Assembly. Remove the Proximal Spike (if used) from the tibia using the Slaphammer hook and collapse the EM Straight Rod below and through the Cut Block by depressing the blue button on the Rod.

For removal of the Internal Alignment Guide, simply lift the Assembly upward, and out of the cut block. If you used the 3° slope option, you may need to lift the T-handle out of the assembly first.

The External Alignment Tower can be used to assess alignment prior to making the tibial cut. When using the Alignment Tower, proper alignment is indicated by the Alignment Rod pointing at the second metatarsal and medial 1/3 of the ankle.

A cross pin hole allows for more stable fixation. If using a cross-pin, always use a headed pin. Use a sagittal saw and a 1.27mm saw blade to complete the tibial resection.

Gap AssessmentSpacer Blocks are available to evaluate proper bone removal and balancing of the joint space. Spacer Blocks are used with no trials in place, and the thickness represents the total thickness of the baseplate, insert, and femoral component. Using the “9mm” Block will represent the overall implant thickness when using a “9mm” insert in both extension and flexion.

If gaps are not adequate, soft tissue releases or bone cuts can balance the gaps and make space for the implants.


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Finish the TibiaSelect the appropriate size Baseplate Trial options from the instrument tray. There are two sizes available for each femoral size: one matching, and one for a smaller tibia (down-sized). The baseplates have color dots that correspond to the appropriate sizing family. Select the one that most accurately matches the periphery of the tibial plateau. The Small Modular Handle can be used to hold the baseplate in place, and using the Alignment Rod with the Handle allows for alignment verification. Once appropriately aligned, secure the trial in place with two Headed Tibial Bone Pins.

Tibial Keel PreparationThe Tibial Tower must be adjusted to the correct size setting prior to use. The Tower should be set to the same size category of the Tibial Baseplate Trial you are using. For example, both sizes 6F-6T and 8F-6T will be set to size 6. The Tower can then reside within the “crows foot” area of the Baseplate Trial, with the hinged “door” facing anteriorly. When fully seated, ream through the tower until a positive stop is reached. Finally, broach through the tower until a positive stop is reached. Release the broach by hitting the EJECT tab with a mallet.

The Tibial Baseplate Trial, once oriented correctly, is pinned in place.

Posterior View - Adjust keel size by depressing the “Press” button. This view will sit into the baseplate trial facing posteriorly.

Impact the Broach until a positive stop can be felt.

Make an osteotomy on the patella.

Open the hinged “door” and insert the Broach as shown.

The Small Modular Handle will help to place and align the Baseplate Trial.

After seating the Tower on the Baseplate Trial, insert the Reamer through the hole in the top of the Tower and ream.

Hit the “Eject” button with a mallet to release the seal on the broach and remove the assembly from the Baseplate Trial.

Drill for the patellar pegs.

Patella PreparationResurfacingMeasure the overall patellar thickness using Calipers. Place the Patella Osteotomy Guide on the patella and set the stylus toindicate an amount of bone equal to the thickness of the patellar component to be used. It is recommended that at least 13mm of bone be remaining following the osteotomy. Using a 1mm thick saw blade, resect the patella.

Position the Patellar Sizer on the resected patella. Press the sharp pin on the Patellar/Sizer/Drill Guide into the resected patella and drill for the patella pegs using the Patella Peg Stop Drill.


RecessingMeasure the overall patellar thickness using calipers. Place the Patella Osteotomy Guide on the patella and set the stylus to indicate an amount of bone equal to 2mm less than the thickness of the patellar component to be used (i.e.; if a 10mm Domed Patella is to be used, resect 8mm of bone). Using a sagittal saw and a 1mm thick saw blade, resect the patella. It is recommended that at least 15mm of bone be remaining following this osteotomy.

Size the patella using the Patellar Sizer. The center of the appropriate size patella should be positioned medially so that the highest point of the normal patella is replaced by the highest point of the patellar dome. To ensure sufficient rim following countersinking, size the patella such that 2mm of bone will remain beyond the periphery of the patellar diameter.

Based on the size of patella chosen, assemble the appropriate Patellar Bushing into the Patellar Clamp and position the Clamp over the resected surface of the patella. Care should be taken to position the center of the bushing medially so that the highest point of the patellar component will be correctly positioned. Using the corresponding Patella Reamer, countersink the patella 2mm by reaming the patella until the top surface of the reamer meets the first engraved line on the inside of the patellar bushing. To facilitate reaming, initiate power to the Reamer fully before engaging bone. Apply gentle, uniform pressure to the patellar surface while reaming. This should prevent over reaming and provide a concentric inset cavity for the patellar component.

After reaming, and without removing the Patellar Clamp, place the appropriate Patellar Drill Guide into the Patellar Bushing. Using the appropriate PatellaPeg Stop Drill, drill the three peg holes.

TrialingLeave the Baseplate Trial pinned in place. Impact the Femoral Trial onto the prepared femur. Insert the preferred thickness of Insert Trial and assess motion. The trial can be removed with the hook end of the Slaphammer.

Ream out 2mm of bone to recess the patella.

Impact the Femoral Trial onto the femur. Take care not to impact into a flexion position.

Drill for the patellar pegs.Ensure at least 2mm of bone remains around the periphery of the resurfacing Patella.

With the Femoral and Baseplate Trials in place, place the Insert Trial onto the Baseplate Trial.

Assess implant fit, alignment, and balance with all Trials in place.


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Component ImplantationPlace cement on the under-side of the Tibial Baseplate and impact it into place using the Baseplate Impactor Head and Universal Handle. Remove excess cement.

After ensuring that the tray is completely clean, place the Insert into the Baseplate. Engage the insert into the capture of the posterior portion of the Baseplate and impact it with the Insert Impactor. The anterior Insert tangs will engage behind the anterior lip of the Baseplate.

Place cement on the underside of the Femoral Component and the femoral bone. Impact the Femoral Component into place using the Femoral Impactor. Remove excess cement.

If preferred, the Femoral Component can be cemented onto the femur prior to Insert implantation. Be sure to protect the femoral surface.

Place a layer of bone cement on the underside of the patellar component and on the prepared patella surface.Using the appropriate size Patella Inserter in the Patella Clamp, secure the Patellar Component in position and tighten the Clamp. You may leave the Clamp in the secured position until the cement is hard but this is not always necessary. While the cement cures remove any excess cement from around the Patella.

Assess implant fit, alignment, and balance with all Trials in place.

Cement the Patella and use the Clamp to secure.


Optional Tibial Instrumentation

A Fixed Tibial Stylus is available if a fixed version is preferred over the magnetic Stylus. The Fixed Stylus slides into the cut slot.

A Tibial EM Bridge can be assembled to the EM Straight Rod. The Bridge gets the Tibial Cut Block closer to the Tibia if desired.


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Notes

©2014 Encore Medical, L.P.

DJO, LLC I A DJO Global CompanyT 800.336.6569 D 760.727.1280 F 800.936.6569

1430 Decision Street I Vista, CA 92081-8553 I U.S.A.DJOglobal.com

CAUTION: Federal Law (USA) restricts this device to sale by

or on the order of a physician.

See package insert for a complete listing of indications,

contraindications, warnings, and precautions.

0010311-001 Rev A 03/14

Movation e+ Knee - … · Movation Knee System Sizing ... Baseplates are left and right specific....

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