Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 -...
Transcript of Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 -...
![Page 1: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/1.jpg)
CSAO Conference 46th Annual September 13th-15th, 2015
Oxford Microplasty Instrumentation
![Page 2: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/2.jpg)
Oxford Microplasty Instrumentation Proven, safe and reproducible results
![Page 3: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/3.jpg)
• Instrumenta*on – Set Overview
• Surgical Technique – Key Steps
• Highligh*ng Key Instruments
• Improvements vs Phase 3 technique
Topics
![Page 4: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/4.jpg)
Instrumentation
![Page 5: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/5.jpg)
Phase 1 1976 - 1988
Phase 2 1988 - 1998
Phase 3 1998 - 2011
Microplasty 2011 – Present…
• Problems with balancing due to femoral prep
• A lot of eyeballing
• Introduction of milling
• Improving reproducibility
• Improving milling technique
• Continued focus on reproducibility
• Focus on reproducibility
Instrumentation Overview
![Page 6: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/6.jpg)
Top Tray • Tibial Templates and Trials • Nails, drill bits, puller
Bo)om Tray • Tibial Impactor, Inserter
• Tibial Groove CuDers
• Slap Hammer • T-‐Handle
• Bearing Inserter/Extractor
Instrumentation: Set Overview Tibia 1
![Page 7: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/7.jpg)
Top Tray • Tibial Resec*on • IM Link
• IM Rod Pusher
Bo)om Tray • IM Rods
• Anterior Mill
• Impactor • Spigots
• Toffee Hammer
Instrumentation: Set Overview Tibia 2
• Drills • Bone Collar
Remover • 5mm Awl
![Page 8: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/8.jpg)
Specific for Femoral Size • Femoral Trials • Bearing Trials
• Femoral Drill Guide
• Femoral Resec*on Guide
• An*-‐Impingement Guide • Feeler Gauges
• Mill
Instrumentation: Set Overview Size Specific
![Page 9: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/9.jpg)
Overview of Size Specific Trays
XSM
XLG
MD
SM
LG
![Page 10: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/10.jpg)
highlights of Oxford Microplasty
Surgical steps
![Page 11: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/11.jpg)
• Design Goal: Simple, Easy, Accurate, Reproducible
• No change in indica*ons • Enhancement in *bial resec*on instruments • IM linked femoral prepara*on • An*-‐impingement instrumenta*on • Trial bearing inserts by hand
Oxford Microplasty
![Page 12: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/12.jpg)
12
• Antero-‐medial OA
• Intact ACL • Full Thickness Lateral • Correctable Varus • Fixed Flexion Deformity (FFD) less than 15°
• Patello-‐femoral Joint
• Obesity • Age • Ac*vity
Indications/Contraindications
Not Contraindica*on Indica*ons
12
1 in 4 OA Knees!
![Page 13: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/13.jpg)
Goals
• Minimize resec*on depth • Maximize surface area • Decrease re-‐cu^ng
– Offers shims for recu^ng in +/-‐ 2mm increments
• Appropriate slope
Tibial Preparation
![Page 14: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/14.jpg)
• Tibial Slope – Parallel to *bial crest – 7 degrees
• New ankle posi*oning – Helps avoid overslope
• Pinned to *bia – Single nail suffices
Tibial Preparation
![Page 15: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/15.jpg)
• Sizing spoon placed under posterior medial femoral condyle
• 1,2,3 mm spoons (1mm spoon is default)
• Ligament tension achieved
• Clamped to *bial guide with G-‐Clamp
Tibial Preparation
![Page 16: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/16.jpg)
![Page 17: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/17.jpg)
• Ver*cal cut important
• M/L posi*on – Adjacent to ACL footprint
• Rota*onal posi*on – ASIS/Flexion plane
• Depth – DON’T LIFT HAND
Tibial Preparation
![Page 18: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/18.jpg)
• “Curly Whirly” inserted – Protect the MCL
• Flat cut • SloDed guide available • Shim op*on
– Addi*onal 2mm
Tibial Preparation
![Page 19: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/19.jpg)
![Page 20: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/20.jpg)
• IM rod cannulated – Flexion/extension – Varus / valgus
• Star*ng posi*on cri*cal • Yellow pusher • Mark central third
Femoral Preparation
![Page 21: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/21.jpg)
• Femoral drill guide set
• Inserted and linked • Posi*on of link important
• Must be seated
• M/L posi*on confirmed
Femoral Preparation
![Page 22: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/22.jpg)
4mm
6mm
• “Flat arm” of link in IM hole
• Curved arm in femoral drill guide • Foot of guide against *bial resec*on – In contact with femur
• Central third confirmed
• Correct hole, not femoral drill – Link out of way of drill hole – Places drill holes 10° flexed, and 7° valgus
Femoral Preparation
![Page 23: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/23.jpg)
![Page 24: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/24.jpg)
• New curved sloDed posterior cu^ng guide
• Suitable for Oxford oscilla*ng sawblade
• Allows blade to be flexed and for saw throw
• Goal: to prevent over/under resec*on
Femoral Preparation
![Page 25: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/25.jpg)
![Page 26: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/26.jpg)
• Milling – Curve off femur with 0 spigot
Femoral Preparation
![Page 27: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/27.jpg)
• Use single peg femoral trial to balance
• New tapered feeler gauges • Less som *ssues interference • Gaps determined • Standard milling to balance • 1,2,3 mm plas*c feeler gauges
Gap Assessment
![Page 28: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/28.jpg)
• Decreases early and late complica*ons
• Replaces tradi*onal “Freehand technique” • New instruments help guide bone removal
Anti-Impingement
![Page 29: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/29.jpg)
• Anterior mill
• Size specific • Similar to a calcar reamer • Spring loaded plunger • Extend the knee • Care to watch *bia…
Anti-Impingement
![Page 30: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/30.jpg)
• Insert *bial tray trial and single peg femoral trial
• Trial bearing inserted by hand
• BeDer “feel” of tension • Assess tracking • Check impingement
Final Trialing
![Page 31: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/31.jpg)
Trial Bearing Removal
![Page 32: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/32.jpg)
• Cemen*ng technique follows current Phase 3 Oxford Knee surgical technique
• Two staged 1. Tibia
• Small amount on *bia
• Use *bial impactor
• Compress at 45 deg with trial femur
2. Femur • Cement into large hole
• Concave surface of femoral component
• Impact at 45 deg to the long axis
• Compress at 45 deg with feeler gauge
Cementing the Components
![Page 33: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/33.jpg)
Differences vs Cemented
Cementless
![Page 34: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/34.jpg)
Use cementless tooth brush saw through *bial template
Cemented Use cemented *bial groove cuDer
Cementless Op*on to use the cementless *bial groove cuDer
Keel Preparation
![Page 35: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/35.jpg)
• Use cementless *bial inserter
• Two inser*on tabs on cementless *bia
• Bring in at an angle, and lightly tap home
Implant
![Page 36: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/36.jpg)
Conclusion
![Page 37: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/37.jpg)
• 219 Ph3 v 196 OXMP • Concluded that OXMP
delivered: – A more accurate alignment of the
femoral implants – A more accurate alignment of the
*bial implants – A more accurate resec*on, with a
greater number of thinner 3mm and 4mm bearings
Oxford Microplasty Proven to deliver more accurate and reproducible results
![Page 38: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/38.jpg)
• Cementless Microplasty surgical video • Cemented Microplasty surgical video
• Printed and digital surgical technique for Cementless and Cemented Microplasty
• Cemented Microplasty surgical technique anima*on
• Phase 3 vs Microplasty instrumenta*on anima*on
Support Materials Currently available on myBiomet
![Page 39: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/39.jpg)
• Oxford Microplasty Instruments enhance – Tibial prep, resec*on depth (femoral size)
– Femoral prep, component alignment precision
– Impingement avoidance
• Oxford Microplasty Instruments are more accurate with less outliers than Phase 3 instrumenta*on
Summary
![Page 40: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/40.jpg)
This publica,on and all content, artwork, photographs, names, logos and marks contained in it are protected by copyright, trademarks and other intellectual property rights owned by or licensed to Zimmer, Biomet or its affiliates, unless otherwise indicated. This publica,on must not be used, copied or reproduced in whole or in part for any purposes other than marke,ng by Zimmer, Biomet or its authorised representa,ves. Use for any other purposes is prohibited.
Zimmer and Biomet do not prac,ce medicine and do not recommend any par,cular orthopaedic implant or surgical technique and is not responsible for use on a specific pa,ent. The surgeon who performs any implant procedure is responsible for determining and u,lizing the appropriate techniques for implan,ng prosthesis in each individual pa,ent.
Disclaimer
![Page 41: Oxford Microplasty Instrumentation - MDRAO · 2018-05-26 · Phase 1 1976 - 1988 Phase 2 1988 - 1998 Phase 3 1998 - 2011 Microplasty 2011 – Present… • Problems with balancing](https://reader033.fdocuments.us/reader033/viewer/2022042914/5f4ea31577686e4cfe7d959f/html5/thumbnails/41.jpg)