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Smith & Nephew JOURNEY II BCS Manual

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Table of Contents

• Intended Use, Indications, Contraindications
• Indications for Use
• Design Rational/Surgical Planning Rational
• NAVIO Surgical System Overview
• Navio Instrument Trays
• Positioning the System
• System and Patient Setup
• Bone Tracking Hardware
• Surgical Preferences
• Registration
• Ligament Balancing
• Implant Planning
• Implant Planning - Soft Tissue Balancing
• Bone Cutting
• Trial Reduction
• Cement and Close
• Recovery Procedure Guidelines
• Manufacturer Contact Information

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• 1 Intended Use, Indications, Contraindications
• 2 Design Rational/Surgical Planning Rational
• 3 Navio Surgical System Overview
• 4 Manufacturer Contact Information
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Summary of Contents for Smith & Nephew JOURNEY II BCS

• Page 1 Surgical Technique for use with the JOURNEY™ II BCS and JOURNEY™ II CR...
• Page 2 NAVIO™ Surgical System Surgical Technique for use with the JOURNEY™ II BCS and JOURNEY™ II CR Smith & Nephew 500081, Rev B Issue Date: 2016-11-16 The following technique is for informational and educational purposes only. It is not intended to serve as medical advice. It is the responsibility of treating physicians to determine and utilize the appropriate products and techniques according to their own clinical judgment for each of their patients.
• Page 3 Introduction This procedure guide provides an overview of the recommended surgical technique for using the NAVIO™ surgical system technology with the JOUR- NEY™ II CR (Cruciate Retaining) and JOURNEY™ II BCS (Bi-Cruciate Stabilized) Knee System. Smith & Nephew recommends that users review this guide prior to performing total knee arthroplasty utilizing the NAVIO system.

Page 4: Table Of Contents

Page 5: intended use, indications, contraindications, page 6: design rational/surgical planning rational, page 7: navio surgical system overview, page 8: navio instrument trays, page 9: positioning the system, page 10: system and patient setup.

• Page 11 System and Patient Setup Upon making the incision, carefully debride and inspect the joint. If any prominent spurs or osteophytes are present, especially in the area of the superior posterior femoral condyle, remove them with an osteotome or rongeur, as they could inhibit the leg motion.

Page 12: Bone Tracking Hardware

• Page 13 Bone Tracking Hardware Slide the tracker clamp (with the clamp opening • oriented towards the camera) over the two bone screws until the bottom of the clamp is within 1 cm of the patient’s skin, taking care not to place the clamp where it is touching the patient's skin.

Page 14: Surgical Preferences

• Page 15 Surgical Preferences Rotational References The NAVIO™ Total Knee application allows the user to choose landmark collection preferences on the femur and the tibia in order to define rotational references, from which the implant component placement plan and ligament balancing information is calculated.
• Page 16 Surgical Preferences Joint Line Selection Preference The joint line selection is an optional selection, which allows the user to choose a landmark point on the femur and/or tibia and offset a line perpendicular to the mechanical axis from that point to a chosen distance (Figure 15, 16). This reference line is then displayed during the implant planning stage, to guide the component placement.

Page 17: Registration

• Page 18 Registration Ankle Center Using the point probe, input the locations of the medial and lateral malleoli points by identifying the most prominent portion (Figure 20). Ensure that the point probe is visible throughout the point collection. If the probe is not visible, check that the tracking spheres on the point probe array are not overlapping (in front, or behind) the tracking spheres on the tibia tracker array.
• Page 19 Registration Most Posterior Lateral Point • This point is used in conjunction with the anterior notch point and the most posterior medial point for initial sizing of the implant component. Figure 23. Anterior Notch Point • This point is used as a reference during prosthesis planning to prevent notching of the implant component.
• Page 20 Registration Femoral Condyle Rotational References Based on surgeon preference, there are three options on which the femur rotational reference frame can be defined . These rotational references are used during Implant Planning (Section 6) for component placement onto the patient anatomy. It is important to understand how these collections are taken on the patient’s bony anatomy so that they may be referenced properly during planning.
• Page 21 Registration Posterior Condylar Axis Collection • The femur posterior condyles selection for defining the femur rotational reference, uses the most medial and lateral posterior condyles collections, and allows the user to dial in the medial-lateral axis angle with respect to the two points collected. Figure 28.
• Page 22 Registration Medial Plateau Point • Take the singular low-point of cartilage wear on the medial side of the tibial plateau. Lateral Plateau Point • Attempt to access the lateral side of the tibial Figure 31. condyle by flexing the leg and internally rotating the tibia and manually distracting the joint.
• Page 23 Registration AP Axis Collection • While all of the other collections listed above are singular points referencing the tip of the point probe, this collection will reference the axis of the point probe. If the AP axis is selected for rotational reference collection, using the length of the pointer probe, collect the AP axis on the tibia, normal to the transepicondylar axis.
• Page 24 Registration Tibia Joint Line Reference [Optional- Based on Surgeon Preference] The tibia joint line reference allows the user to pick a landmark point on the bone surface and offset a line perpendicular to the mechanical axis from that point. Figure 37. Tibial Condyle Surface Mapping The Tibia Free Collection stage (Figure 38) offers a visualization of the tibial mechanical and rotational...

Page 25: Ligament Balancing

Page 26: implant planning.

• Page 27 Implant Planning 1. Using the cross section mode, in the transverse and coronal view, confirm that the component size provides adequate coverage on the digitized femur bone surface (Figure 41). Drag vertically on this view screen to visualize the superior-most part of the implant component on the bone (Figure 42).
• Page 28 Implant Planning 5. The implant components for JOURNEY II knee system are posterior referenced. Therefore, in order to have greater resection on the posterior bone, and to increase posterior gap, the component may be downsized, without any change to the anterior transition of the component on to the bone.
• Page 29 Implant Planning 1. Confirm the implant size using the transverse viewscreen (bottom left) and the tibia size up/ down button arrows in the right-hand control panel on the right side of the screen underneath the Tibia Size button. 2. Confirm the posterior slope, utilizing the sagittal view (upper right), NAVIO software will display the posterior slope within this viewscreen, which reflects the slope of the tibial implant component...
• Page 30 Implant Planning Button Mapping Femur While the NAVIO™ System for Total Knee Arthroplasty User’s Manual details each button on this screen, the following five buttons (Figure 46) are particularly critical to understand. - The Checkpoint Verification button is used to manually force a check of the checkpoints in the femur and tibia.
• Page 31 Implant Planning Button Mapping Tibia While the NAVIO™ System for Total Knee Arthroplasty User’s Manual details each button on this screen, the following five buttons (Figure 47) are particularly critical to understand. - The Checkpoint Verification button is used to manually force a check of the safety checkpoints in the femur and tibia.

Page 32: Implant Planning - Soft Tissue Balancing

• Page 33 Implant Planning - Soft Tissue Balancing Gap Balancing The goal of this stage is to have balanced extension and flexion gaps, with no overlap in either condyle, (i.e, medial or lateral). The extension gap will likely look unbalanced when comparing the medial and lateral space if no ligament release has been performed for a deformed knee.
• Page 34 Implant Planning - Soft Tissue Balancing Ligament Balancing Manipulations SCENARIO MANIPULATION Balance is tight Move tibial component inferior and/or in extension reduce thickness and flexion Balance Move tibial component superior and/or is loose in increase poly thickness extension and flexion Balance is tight Move femoral component superior.
• Page 35 Implant Planning - Soft Tissue Balancing Ligament Balancing Manipulations SCENARIO MANIPULATION Balance is loose in the Internally rotate the femur implant to medial compartment in balance gap in the medial and lateral flexion compartments Balance is tight in the Externally rotate the femur implant medial compartment in to balance gap in medial and lateral flexion...

Page 36: Bone Cutting

• Page 37 Bone Cutting Cut Guide Placement Prior to preparation of the locking features for cut guides on to the patient bone surface using the NAVIO™ handpiece in speed control, the user is presented with a cut guide placement screen, where the goal is to size the appropriate cut guide for the operation.
• Page 38 Bone Cutting The user has the ability to move the cut guide anterior and posterior, as well as rotate it in the cut plane. Confirm that the cut slot portion of the guide is not impinging on the bone surface by referencing the cross section view, as well as the 3D view (See Figure 58).
• Page 39 Bone Cutting Screen Overview Figure 60 shows a typical cutting screen with the following icons/buttons called out: - Checkpoint Verification button, used to activate a confirmation of the safety checkpoints on femur and tibia. - Change Bur button, used when the user switches bur size to tell the system about the change.
• Page 40 Bone Cutting Bone Preparation Warning: The NAVIO™ system does not prohibit cutting of soft tissue, which may be in the surgical area. Always use retractors to protect ligaments and other capsular structures. Use steady movement to minimize potential for ligament damage. Warning: NAVIO control modes do not establish “no-cut”...
• Page 41 Bone Cutting Cut Femur The handpiece is used to prepare four cylindrical features in the patient’s bone in order to lock the NAVIO™ femur cut guide onto the bone surface. 1. Align the handpiece tool, under speed control on the cut zone (areas color-coded purple, blue and green on the monitor), by utilizing the cross-hair visualization, and the tool’s eye view.
• Page 42 Bone Cutting 10. Ensure that the dial on the block is set to the zero mark, and tighten the dial using the Smith & Nephew JOURNEY 3.5 mm hex driver. Using the recommended saw, prepare the five planar femur cuts, as recommended by the implant manufacturer in the JOURNEY II Total knee surgical technique.
• Page 43 Bone Cutting Using the handpiece, prepare four features in the patient’s bone in order to lock the NAVIO™ tibia cut guide onto the bone surface. Make sure to uncover the tibia tracker array if it was covered for protection while burring the femur. 1.

Page 44: Trial Reduction

Page 45: cement and close, page 46: recovery procedure guidelines, page 47: notes, page 48: manufacturer contact information, this manual is also suitable for:, rename the bookmark, delete bookmark, delete from my manuals, upload manual.