Scorpio TS Single Axis Revision Knee System Scorpio... · 6633-9-421 21mm 6633-9-422 22mm 6633-9-423 23mm 2459_10_LSPK34_Rev2_Scorpio_Protocol_Text_012958 txt_.qxd 6/6/11 4:14 PM

Scorpio TS Femoral Component Specifications

Resected Box Intercondylar Condylar StemSize A/P-Med A/P-Lat M/L A/P Height Box Width Width Height*

(mm) (mm) (mm) (mm) (mm) (mm) (mm) (mm)

#3 52 54 56 35 20 17 20 42

#5 56 58 61 39 20 17 22 42

#7 60 62 66 44 23 19 24 46

#9 66 68 71 49 23 19 26 46

#11 72 72 76 53 25 21 28 48

#13 74 76 81 58 25 21 30 48

Tibial Baseplates**

77-4003 77-4005 77-4007 77-4009 77-4011

76-4103 72-4-03xx 72-4-05xx

76-4105 72-4-03xx 72-4-05xx 72-4-57xxCrossover



76-4111 72-4-19xx 72-4-11xxCrossover

76-4113 72-4-11xx

**Scorpio® PS Inserts may be used.

Femoral

Components

Scorpio TS Tibial Tray Specifications

*With end cap

Size A/P M/L Stem Boss(mm) (mm) Length* (mm)

3 40 61 35

5 44 66 35

7 47 71 37

9 51 77 37

11 54 82 43

13 58 88 43

Scorpio TS Tibial Insert Specifications

Post Post

Size A/P M/L Height Width(mm) (mm) (mm) (mm)

3 40 61 23 165 44 66 23 16

7F/5T 44 66 27 185F/7T 47 71 23 167 47 71 27 189 51 77 27 18

11F/9T 51 77 29 209F/11T 54 82 27 1811 54 82 29 20

Orthopaedics

Scorpio® TSSingle Axis Revision

Knee System

A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particularproduct when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons betrained in the use of any particular product before using it in surgery.

The information presented is intended to demonstrate the breadth of Stryker product offerings. A surgeon must alwaysrefer to the package insert, product label and/or instructions for use before using any Stryker product. Products may notbe available in all markets because product availability is subject to the regulatory and/or medical practices in individualmarkets. Please contact your Stryker representative if you have questions about the availability of Stryker products inyour area.

Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the followingtrademarks or service marks: Stryker. All other trademarks are trademarks of their respective owners or holders.

Literature Number: LSPK34 Rev. 2MS/GS 06/11

Copyright © Stryker 2011Printed in USA.

Scorpio TS Trial Cutting Guide SurgicalProtocol

325 Corporate DriveMahwah, NJ 07430t: 201 831 5000

www.stryker.com

Sizing InformationScorpio Trial Cutting Guide

*With end cap

2459_10_LSPK34_Rev2_Scorpio_Protocol_Cover_Back_012958 CVR.qxd 6/6/11 4:16 PM Page 1

AcknowledgementsStryker Orthopaedics would like to thankDr. Masini for his help in developing theScorpio Trial Cutting Guide.

Michael A. Masini, MDAnn Arbor Bone and Joint SurgerySt. Joseph Mercy HospitalAnn Arbor, MI

Clinical Instructor in Orthopaedic SurgeryUniversity of Michigan Ann Arbor, MI

IntroductionThis surgical protocol is a supplement to the Scorpio Total Stabilizer RevisionKnee System Surgical Protocol (Lit No. LSTS/ST).

The Scorpio Trial Cutting Guide is anintramedullary based instrumentationsystem focused on the restoration of thejoint line and proper flexion-extensiongap assessment.

1

Orthopaedics

Scorpio®TSSingle Axis Revision

Knee SystemScorpio TSTrial Cutting Guide Surgical Protocol

2459_10_LSPK34_Rev2_Scorpio_Protocol_Text_012958 txt_.qxd 6/6/11 4:14 PM Page 1

Tibial and Femoral Canal PreparationScorpio Trial Cutting Guide

Tibial Preparation Prepare the tibia following the ScorpioTotal Stabilizer Revision Knee SystemSurgical Protocol (Lit. No. LSTS/ST, pages1- 5). If an offset is needed, use the tibialoffset reamer to prepare for the tibialoffset. Insert the assembled trial into thetibia (Figure 1 and Figure 2).

Note: The Scorpio Trial CuttingGuide (TCG) is designed for usewith its own mating tibial inserttrial. The trial insert does not havea post to allow for more accurateassessment of the ligamentsduring surgery.

Femoral Canal PreparationPrepare the femoral canal to accept astem as described in the Scorpio TotalStabilizer Revision Knee System SurgicalProtocol (Lit. No. LSTS/ST, page 5). If anoffset is needed, use the femoral offsetreamer to prepare for the femoral offset(Lit. No. LSTS/ST, page 9) (Figure 3).

2

Figure 1 Tibial Canal Preparation Figure 2 Tibial Trial Assembly andInsertion

Figure 3 Femoral Canal Preparation

Command T-Handle6266-5-401

Tibial Boss/Offset Reamer8200-0015

Reamer Depth Stop8200-0047 80mm stem with offset8200-0048 155mm stem with offset

Femoral Offset Reamer8200-0095

IM Reamers6633-9-408 8mm6633-9-409 9mm6633-9-410 10mm6633-9-411 11mm6633-9-412 12mm6633-9-413 13mm6633-9-414 14mm6633-9-415 15mm6633-9-416 16mm6633-9-417 17mm6633-9-418 18mm6633-9-419 19mm6633-9-420 20mm6633-9-421 21mm6633-9-422 22mm6633-9-423 23mm


Femoral/Tibial Trial SelectionScorpio Trial Cutting Guide

Femoral/Tibial Trial SelectionSelect the appropriate size femoral trialcutting guide, offset adapter, andcorresponding tibial insert trial (Table 1).

Appropriate sizing can be achievedthrough the use of:• Previous operative notes• Size of the original implant removed• X-ray templates

The Scorpio Trial Cutting Guide (TCG)can be assembled for either a left or rightknee. Assemble the offset adapter into thehousing of the TCG so the offset adapteris pointing to the appropriate left or rightorientation (Figure 4).

3

Category SizesFemoral Cutting Guides 3, 5, 7, 9, 11, 13

Offset Adapter 0mm, 2mm, 4mm, 6mm, 8mm

Tibial Insert Trial Sizes 3, 5, 7, 9, 11, 13

Tibial Insert Trial Thickness 10mm, 12mm, 14mm, 16mm , 18mm, 21mm, 24mm

Table 1 Trial Cutting Guide Instrument Sizes

Femoral Cutting Guide

Figure 4 Trial Cutting Guide in “Right” Orientation

Trial Cutting Guide8200-50038200-50058200-50078200-50098200-50118200-5013


Femoral/Tibial Trial Selection (continued)Scorpio Trial Cutting Guide

AssemblyAssemble the trial cutting guide, offsetadapter, and appropriate size trial stem as shown (Figure 5).

A neutral offset adapter may be usedinitially to construct the trial cuttingguide assembly until the need for afemoral offset is determined.

First, assemble the trial stem to the offsetadapter, then assemble the offset adapterinto the Trial Cutting Guide housing andsecure the anterior set screw. Once “fingertight” pressure is achieved, rotatecounterclockwise 1/2 turn to allow theoffset adapter to rotate freely. The anteriorset screw will be fully secured after theappropriate offset and rotation isdetermined (Figure 6).

Note: Rotating counterclockwise1/2 turn will allow the offsetadapter to rotate freely withoutdisassembling from the TrialCutting Guide housing. Rotatingcounterclockwise more than 1/2turn will cause the offset adapterto fall out of the Trial Cutting Guidehousing.

4

Torx Screwdriver8200-5110

Tibial Insert TrialT72-7-XXYYXX = 03, 05, 07, 09, 11YY = 10, 12, 14, 16, 18, 21, 24

Offset Adapter8200-51008200-51028200-51048200-51068200-5108

Figure 6 Set Screw Assembly

TrialStem

Offset Adapter

TrialCutting Guide

Trial CuttingGuideHousing

SetScrew

Figure 5 Trial Cutting GuideAssembly


Trial Cutting Guide OrientationScorpio Trial Cutting Guide

Note: Femoral chamfer cuts cannotbe made with the TCG. However, ifbone loss is minimal and it isdetermined that chamfer cuts arerequired, the Scorpio TotalStabilizer (TS) All-In-One CuttingBlock may be used to makechamfer cuts (Lit. No. LSTS/ST,Page 8).

Joint Line RestorationInsert the TCG into the femoral canal(Figure 7) and align the TCG medialepicondyle (ME) scribe line reference markwith the medial epicondyle (Figure 8). TheME scribe line is 28mm from the distalsurface of the TCG. When the ME scribeline is in line with the medial epicondyle,the distal surface of the TCG will beapproximately located at the joint line.(The joint line can also be estimatedusing pre-operative radiographs andanatomic landmarks.)

Place an initial fixation pin in the middleof the medial slot on the TCG (Figure 9and Figure 10). Pinning the medial slotwill fix the proximal/distal position whileallowing for slight internal and externalrotation of the TCG.

5

Figure 7 TCG Femoral CanalInsertion

Figure 8 Joint Line Restoration toMedial Epicondyle

Figure 9 Initial Fixation Pin Insertion Figure 10 Initial Fixation Pin –Extension

Medial

ME Scribe

1/8" Headless Pins7650-1038

Joint Line Scale8200-0065


Trial Cutting Guide Orientation (continued)Scorpio Trial Cutting Guide

Femoral OffsettingThere are several ways to determine theproper femoral offset required.

1) Start with a neutral offset and measureor estimate the distance from theinferior surface of the anterior flangeof the TCG to the anterior femur(Figure 11) or,

2) Line up the femoral sizing “C” templateswith the trial stem and measure orestimate the distance from the anteriorfemur to the inferior surface of theanterior flange of the TCG.

Note: A 4mm offset is typical formany revision scenarios, and if anA/P offset is not necessary, theoffset adapter may be used todisplace the femur medially orlaterally.

Note: When adjusting the offset ofthe TCG, the entire offset adapterand stem construct will be rotating.

To adjust the offset, insert the hex driverinto the distal face of the offset adapterand rotate (Figure 12). After final offsetposition has been determined, tighten theanterior set screw to secure the offsetposition on the TCG (Figure 6, page 4).

If an offset is required, record the finalposition of the offset by reading thelocation of the hash mark on the offsetadapter relative to the clock face on theTCG. The clock recording will berequired when assembling the implant. Ifan offset is not required, use the 0 adapter(Figure 13).

Note: The numerical clock on theTCG is a mirror image of the clockface markings on the femoral trialand final implant (Figure 14 andFigure 14a).

6

Figure 11 Offset Measuring Figure 12 Trial Cutting GuideOffsetting

Figure 13 Offset Reading Figure 14 Trial Cutting Guide andImplant/Trial Clock Face

Figure 14A Enlarged View of ClockFace (0=Posterior Offset)

Anterior Set Screw

Femoral Sizing Template8200-0096 #3/58200-0097 #7/98200-0098 #11/13



Preliminary Trial AssessmentWith the joint line restored and theappropriate offset determined, apreliminary trial assessment should beconducted with the trial tibialcomponents in place (Figure 15).

Select the appropriate trial tibial insertand place it onto the trial tibia. Select theinsert that provides varus/valgus stabilityin full extension (Figure 16).

7

Figure 15 Preliminary Trial Assessment

Figure 16 Varus/Valgus Stability Check at Full Extension



RotationWith the knee flexed at 90°, appropriateexternal rotation can be set bypositioning the TCG on the tibial trialinsert so that it is seated with novarus/valgus tilt. The transepicondylaraxis or Whiteside’s axis can be used toestimate rotation as well.

A second headless fixation pin shouldthen be placed in the TCG’s anterior pinhole to fix the TCG position oncerotation has been established (Figure 17).Place as many pins as necessary tosecurely fix the TCG on the distal femur.

Note: Headless pins may now bereplaced with short headed fixationpins to facilitate joint reduction.

Note: The TCG trial inserts do nothave a post. This allows for a moreaccurate assessment of theligaments during trialing.

8

Figure 17 Second Fixation Pin – Rotation

Headed Fixation Pin7650-1136 1” Headed Pin7650-1137 3” Headed Pin



Trial AssessmentOnce the TCG is fixed to the femur, atrial reduction may be conducted. Reducethe extensor mechanism and patella. Theinferior pole of the patella should restapproximately 14mm above the joint linewith the knee in 90° of flexion unlesspatella baja or patella alta was presentpre-operatively. Tracking of the patellacan then be assessed (Figure 18).

Note: A suture or towel clip may beused to facilitate reduction andtrial assessment (Figure 19).

It should be noted that the flexion gapoften feels “too loose” in the revisionsituation even when the appropriatelysized femoral implant is positioned at thejoint line. Using the TCG gives thesurgeon the unique opportunity to upsizethe femoral component and offset thenext size femur to selectively fill theflexion gap that feels “too loose.”However, if upsizing results in poortracking and “overstuffing of the joint”,the surgeon need only return to theprevious size TCG and offset.

Note: A full evaluation of stabilityand range of motion can beperformed before making anyresections on the distal femur.Adjustment of the implant positionand size is possible before makingany femoral bone cuts.

9

Figure 18 Preliminary Trial Reduction

Figure 19 Preliminary Trial Reduction With Suture

Suture


Femoral bone CutsScorpio Trial Cutting Guide

Note: A Stryker 152 saw blade(narrow-thick) or a reciprocatingsaw blade are recommended foraugment cuts and the box cut.

Augment CutsWith the TCG properly positioned,visually determine the appropriateposterior and distal resections required(Figure 20 and Figure 21). A bladerunner may be used to assess the level ofresection if necessary. The appropriate cutis selected by resting the blade on thesurface of the TCG apertures that willprovide a clean up cut.

Note: If an augment cannoteffectively “fill the gap,” i.e.,deficiencies greater than 15mmdistally or 10mm posteriorly, abone graft may be required (Figure 22).

Box CutWhen making the box cut, cut along theouter sides of the box guide and cutcompletely through the femur (Figure 23and Figure 24). The posterior portion ofthe proximal box cannot be completeddue to the presence of the stem. Completethe proximal posterior box cut after theTCG has been removed using the initialresection as the guide.

Note: The sides of the box may becompleted with a distal approach(Figure 25) in addition to theanterior approach.

10

Figure 20 Posterior Femoral Cuts Figure 21 Distal Femoral Cuts

Figure 22 Bone Graft Figure 23 Box Cut – Side Walls

Figure 25 Box Cut – Distal ApproachFigure 24 Box Cut – Proximal Wall


Final Trial AssessmentScorpio Trial Cutting Guide

A final trial assessment should beconducted with the Scorpio TS trialfemoral components to verify theaccuracy of the cuts and that the offsethas been properly recreated (Figure 26).

See the Scorpio Total Revision KneeSystem Surgical Protocol (Lit. No.LSTS/ST, page 10) for details on trialassembly and trial reduction.

11

Figure 26 Final Trial Assessment


12

1. TibialCanal

Preparation

2.FemoralCanal

Preparation

3.TrialCuttingGuide

Assembly

4.TCG

FemoralCanal

Insertion

5.Joint LineRestorationto MedialEpicondyle

6.Initial

Fixation PinInsertion

Quick Pictorial Surgical Technique ReferenceScorpio Trial Cutting Guide

TrialStemOffsetAdapter

TrialCuttingGuide

SetScrew


1413

7.Trial

CuttingGuide

Offsetting

8.Preliminary

TrialAssessment

9.2nd

Fixation Pin –ExternalRotationAlignment

10.Preliminary

TrialReduction

11.Posterior

Femoral Cuts

12.Distal

Femoral Cuts

13.Box Cut

14.Final TrialAssessment

Quick Pictorial Surgical Technique ReferenceScorpio® Trial Cutting Guide


1413

7.Trial

CuttingGuide

Offsetting

8.Preliminary

TrialAssessment

9.2nd

Fixation Pin –ExternalRotationAlignment

10.Preliminary

TrialReduction

11.Posterior

Femoral Cuts

12.Distal

Femoral Cuts

13.Box Cut

14.Final TrialAssessment

Quick Pictorial Surgical Technique ReferenceScorpio® Trial Cutting Guide





#3 52 54 56 35 20 17 20 42

#5 56 58 61 39 20 17 22 42

#7 60 62 66 44 23 19 24 46

#9 66 68 71 49 23 19 26 46

#11 72 72 76 53 25 21 28 48

#13 74 76 81 58 25 21 30 48

Tibial Baseplates**

77-4003 77-4005 77-4007 77-4009 77-4011

76-4103 72-4-03xx 72-4-05xx




76-4111 72-4-19xx 72-4-11xxCrossover

76-4113 72-4-11xx


Femoral

Components


*With end cap


3 40 61 35

5 44 66 35

7 47 71 37

9 51 77 37

11 54 82 43

13 58 88 43


Post Post


3 40 61 23 165 44 66 23 16

7F/5T 44 66 27 185F/7T 47 71 23 167 47 71 27 189 51 77 27 18

11F/9T 51 77 29 209F/11T 54 82 27 1811 54 82 29 20

Orthopaedics


Knee System



Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the followingtrademarks or service marks: Stryker. All other trademarks are trademarks of their respective owners or holders.





www.stryker.com


*With end cap





#3 52 54 56 35 20 17 20 42

#5 56 58 61 39 20 17 22 42

#7 60 62 66 44 23 19 24 46

#9 66 68 71 49 23 19 26 46

#11 72 72 76 53 25 21 28 48

#13 74 76 81 58 25 21 30 48

Tibial Baseplates**

77-4003 77-4005 77-4007 77-4009 77-4011

76-4103 72-4-03xx 72-4-05xx




76-4111 72-4-19xx 72-4-11xxCrossover

76-4113 72-4-11xx


Femoral

Components


*With end cap


3 40 61 35

5 44 66 35

7 47 71 37

9 51 77 37

11 54 82 43

13 58 88 43


Post Post


3 40 61 23 165 44 66 23 16

7F/5T 44 66 27 185F/7T 47 71 23 167 47 71 27 189 51 77 27 18

11F/9T 51 77 29 209F/11T 54 82 27 1811 54 82 29 20

Orthopaedics


Knee System



Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the followingtrademarks or service marks: Scorpio, Stryker. All other trademarks are trademarks of their respective owners or holders.





www.stryker.com


*With end cap

2459_10_LSPK34_Rev2_Scorpio_Protocol_Cover_Back_012958 CVR.qxd 6/7/11 10:19 AM Page 1

Documents

Scorpio TS Single Axis Revision Knee System Scorpio... · 6633-9-421 21mm 6633-9-422 22mm 6633-9-423 23mm 2459_10_LSPK34_Rev2_Scorpio_Protocol_Text_012958 txt_.qxd 6/6/11 4:14 PM