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OsteoBridge IKA - · PDF file2 OsteoBridge® IKA 01. OsteoBridge® IKA Failed total knee arthroplasty Limb salvage Oncology surgery Any other condition where there is little soft tissue

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Text of OsteoBridge IKA - · PDF file2 OsteoBridge® IKA 01. OsteoBridge® IKA Failed total knee...

  • From the BioBall Company

    OsteoBridge IKAIntramedullary Knee Arthrodesis Fixation System

    OsteoBridge Family

    The modular system for the fixation of the knee joint

  • 2

    OsteoBridge IKA

    01. OsteoBridge IKA

    Failed total knee arthroplasty

    Limb salvage

    Oncology surgery

    Any other condition where there is little soft tissue or bony tissue available for support and arthrodesis is the treat-ment of choice

    Indications include:

    The OsteoBridge IKA serves as a custom implant to fixate the knee after failed primary

    knee arthroplasty. Based on the OsteoBridge IDSF system, the OsteoBridge IKA modu-

    lar segments are designed to be attached together to form a complete fixed knee implant

    using specially designed semicircular attachement shells that are clamped together to

    create a firm bridge at the joint.

    All components are manufactured from Ti-6Al-4V Titanium Alloy conforming to ASTM

    F-136. The intramedullary rods can be fixed with interlocking screws without or with bone

    cement.

    Nail without Collar

    Angled Spacer

    Clamping Screws

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    OsteoBridge IKA

    Merete Medical Inc. 49 Purchase Street Rye, New York 10580 USA Phone: (914)9671532 Fax: (914)9671542 Mail: [email protected] www.merete-medical.com

    Advantages and System Structure

    Interlocking Screws

    Clamping Screws

    Nail with Collar

    Cementless and cemented implantation possible

    Primary stability is achieved by pressfit

    Distal interlocking screws provide rotational stability

    Secondary stability is achieved with biological integration of the stems into the bone structure (osseointegration) stimulated by a brushed titanium surface

    By rotating the angled spacer, the surgeon may adjust both the extension/flexion and valgus/varus positioning of the joint

    Trial nails and a trial spacer for an intraoperative selection of implant components

    Hollow spacer shells can be used as a carrier of antibiotics as well as bone graft

    The custom modularity of the system enables intraoperative adaption to the bone defect by using variable nail diameters and lengths

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    OsteoBridge IKA

    02. Case Studies

    preoperative

    postoperative

    Axial knee replacement after meniscal resection with infection

    Fall resulting in patellectomy with arthrolysis

    Arthrodesis with chronic pain syndrome using OsteoBridge IKA

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    OsteoBridge IKA

    Merete Medical Inc. 49 Purchase Street Rye, New York 10580 USA Phone: (914)9671532 Fax: (914)9671542 Mail: [email protected] www.merete-medical.com

    preoperative postoperative

    Condition after failed TKR with infectionTemporary prosthesis

    Treatment with OsteoBridge IKA

    preoperative postoperative

    Merete Medical GmbH likes to thank Dr. med. I. Flesch, Berufsgenossenschaftliche Unfallklinik Tbingen, Germany; Prof. Dr. med. L. Rabenseifner, Stadt-klinik Baden-Baden, Germany and Prof. Dr. med. A. H. Tiemann, Bergmannstrost Berufsgenossenschaftliche Kliniken Halle, Germany for the kind supply of the x-ray images.

    Condition after infection

    Temporary prosthesis using a carbon fiber rod

    Treatment with OsteoBridge IKA

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    OsteoBridge IKA

    Prepare the intramedullary canal by opening it with

    the manual awl or by drilling with flexible or rigid

    reamers (not included) to the desired diameter.

    The diameter varies depending on nail form and

    the principle of anchoring.

    Most often after failed TKA the defect is trumpet

    shaped. In this case the nail with collar fits per-

    fectly into the bone. The reamer (GA90021) can

    be used to shape the bone. The line on the reamer

    indicates the correct depth.

    2

    Preparation of the Intramedullary Canal and Implant Selection

    1

    04. OsteoBridge IKA Surgical Technique

    Nail without Collar

    Nail Reamer Size

    CementedReamer SizeCementless

    14 mm 16 mm 12 mm

    16 mm 18 mm 14 mm

    18 mm 20 mm 16 mm

    Nail Reamer Size

    CementedReamer SizeCementless

    10 mm 14 mm 10 mm

    12 mm 16 mm 12 mm

    14 mm 18 mm 14 mm

    16 mm 20 mm 16 mm

    Nail with Collar

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    OsteoBridge IKA

    Merete Medical Inc. 49 Purchase Street Rye, New York 10580 USA Phone: (914)9671532 Fax: (914)9671542 Mail: [email protected] www.merete-medical.com

    Under fluoroscopy use the trial nails to check the

    adequate length and diameter. Different nails can be used for tibia and femur. For checking the total length, the trial spacer has to be assembled. The

    upper spacer half-shell is guided by two pins and fastened by two screws. Remove the trial compo-nents when the leg length is accurate.

    The leg should be shortened to facilitate walking.

    3

    Check the position of the nails inside the spacer.

    The nails have to be flush with the window in the

    upper half-shell.

    For a better recognition of the trial components

    and implants, the trial nails are labeled with dia-

    grams of dice indicating the diameter of the nail.

    The diagram with the corresponding number of the

    dice can also be found on the product label.

    To remove the trial nails use the extractor and slot-

    ted hammer. Insert the extractor into the proximal

    thread of the nail.5

    4

    6

    10 mm 18 mm 12 mm 14 mm 16 mm

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    OsteoBridge IKA

    Insertion of the Nails

    When using interlocking screws the drill holes in

    the nail have to be positioned in the frontal plane,

    for medial insertion of the screws. To insert the nail

    correctly into the bone, the nail guiding/impacting

    instrument has to be fitted into the slot and the

    locking screw screwed down until the nail is tigh-

    tened to the nail guiding/impacting instrument.

    3

    1

    20 mm

    Attention: Clamping length of 20 mm minimumIf the surgeon prefers to not use interlocking

    screws, the nails may be inserted and pressfit into

    the bone with the impactor. At least 20 mm clam-ping range has to remain outside the bone.

    For cemented indications, cover sleeves must be

    placed over the nails before starting to insert the

    nail. The sleeves are removed once the insertion of

    the nails has been completed. The diameter of the intramedullary canal should be 4 mm larger than for cementless insertion (refer to the table on page 6). If the nail guiding/impacting instrument is not used, the covers GA90002 must be used when ce-

    menting the nails.

    2Locking Non-locking

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    OsteoBridge IKA

    Merete Medical Inc. 49 Purchase Street Rye, New York 10580 USA Phone: (914)9671532 Fax: (914)9671542 Mail: [email protected] www.merete-medical.com

    Use the 4.5 mm drill bit to drill the interlocking hole. Then remove the drill sleeve. The depth gauge must be positioned to the bone through the protection sleeve. Push the small depth gauge

    measuring hook through the bone and hook the

    opposite cortical bone. Now the required length

    of the interlocking screw can be determined at the

    end of the depth gauge. Always measure up to the

    next available screw size.

    5

    Insert the interlocking screw through the pro-

    tection sleeve and tighten with the Merete

    screwdriver. All nails are provided with two drill

    holes for double interlocking. After inserting

    the screws remove the nail guiding/impacting

    instrument. Do not start locking the second nail

    until the first nail has been completely locked into

    position.

    Additional Information: To achieve dynamic com-

    pression of the nail postoperatively, the surgeon

    may remove the static interlocking screw after

    a few weeks. Please contact Merete for surgical

    guidance when the indication requires dynamic

    screw compression postoperatively.

    6

    Dynamic interlocking

    Static interlocking

    Interlocking the nails: The length of the nail and corresponding drill hole alignment is indicated on

    the side of the nail guiding/impacting instrument.

    The protection sleeve must be inserted into the

    corresponding drill hole of the guiding/impacting

    instrument, indicating the same length as the nail.

    The trocar peak center-punches a percutaneous

    drill hole. The trocar is removed and the drill sleeve

    inserted.

    4

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    OsteoBridge IKA

    Position the lower half-shell carefully underneath

    the nails. Distract the leg to allow enough space to

    insert and position the spacer. A minimal clamping length of 20 mm must be maintained! The colored area must be entirely positioned inside the spacer.

    4 guiding pins are then inserted into the four out-

    side holes. Guided by the pins the upper half-shell

    can correctly be adjusted onto the lower half-shell.

    Support the knee bend to facilitate the correct po-sitioning of the spacer.

    Between the spacer and each collared nail a dis-tance holder is inserted. The distance holder de-

    fines the minimal distance needed for secure im-

    plantation. The dot on the distance holder must face the end of the nail, away from the spacer. Clamping screws must be screwed into the four

    vacant threaded holes, but not entirely tightened.

    The half-shells must always have the same dis-tance to each other on both sides.

    1

    2

    Inserting and Fastening the Spacer

    20 mm

    Dot

    Parallel alignm