THE P.F.C.® SIGMA™ PATHWAY SURGICAL TECHNIQUE FOR P.F.C.® SIGMA™ , P.F.C.

® SIGMA™ RP AND RP-F KNEE SYSTEMS

MANUAL APPROACH SURGICAL TECHNIQUE

Contents

Surgical Summary 1

Incision and Exposure 2

Patellar Resection 4

Tibial Jig Assembly 6

Lower Leg Alignment 6 Minimally Invasive CAS

Tibial Resection 8

Entering the Medullary Canal 9

Femoral Locating Device 10

Open CAS

Extension Gap Assessment 13

Femoral Sizing 14

Final Femoral Preparation 17

Trial Reduction 20 Manual Less Invasive

Tibial Preparation 23

M.B.T. Tray Preparation 24

Open Manual
M.B.T. DuoFix™ Tray Preparation 25

Final Component Implantation 26

Final Patella Preparation 27

Closure 29

Instruments and Ordering Information 30

Surgical Summary

Incision and exposure Patellar resection Align tibial jig Tibial resection Distal femoral location Distal femoral resection

Femoral sizing Anterior femoral resection Final femoral preparation Trial reduction Tibial preparation Final implantation

1
Incision and Exposure
Lateral
Figure 1
The Pathway instrumentation has been
designed for use with and without
Ci™ computer assisted surgery, for a
minimally invasive subvastus, midvastus
or open approach. The following technique
describes the use of these instruments in
a manual approach.
Medial
With the knee flexed, make a straight mid-
line skin incision from 2 to 4 cm above the
patella, passing over the patella, and
ending at the tibial tubercle (Figure 1).
With neutral alignment or with varus
deformity, make a medial parapatellar
incision through the retinaculum, capsule
and synovium (Figure 2).
2
Figure 2
In thin patients or patients with mild Should tension prevent adequate lateral
deformity a subvastus (“Southern”) displacement of the patella, detach the
approach may be used. If significant medial one-quarter of the patellar tendon
valgus deformity exists, a lateral parapatellar from the tibial tubercle.
deep incision may be preferred. Following
a medial parapatellar incision, luxate
the patella laterally to expose the entire
tibio-femoral joint (Figure 3).
 Figure 3 Figure 4

Elevate the tibial tubercle with an osteo-
periosteal flap if necessary for exposure.
Luxate the patella and periosteal
attachments laterally.
Excise hypertrophic synovium and a Evaluate the condition of the posterior
portion of the infrapatellar fat pad to cruciate ligament to determine the
allow access to the medial, lateral and appropriate tibial insert component to use.
intercondylar spaces. All osteophytes
should be removed at this stage
(Figure 4).

3
 Patellar Resection

9 mm

16 mm

25 mm

Patella stylus

Example (for a 38 mm size dome

or oval/dome patella): From a
patella 25 mm thick, resect 9 mm
of articular surface, leaving 16 mm
of residual bone to accommodate
the 9 mm thickness implant.

Figure 5 Figure 6 Figure 7

With the leg in extension the patella is The thickness of the patella is measured A patella stylus is selected that matches The leg is placed in extension with the

everted to an angle of approximately and the level of bone resection calculated the thickness of the implant to be used. patella cutting guide positioned with the

40 - 60 degrees. The synovial tissue (Figure 5). The thickness of the resurfaced The minimum depth of the patella resection stylus against the posterior cortex of the

and retinaculum are released from the patella should be the same as the natural should be no less than 10 mm (Figure 6). patella with the serrated jaws at the superior

periphery of the patella down to the patella. The minimum residual dimension and inferior margins of the articular surface.

plane of the quadriceps tendon. should be no less then 12 mm. The jaws should be closed to firmly

engage the patella (Figure 7).

4
 Saw capture

40°

Figure 8 Figure 9 Patella wafer

The patella is everted to 40˚ (Figure 8). Suitable saw blades are listed in the back A patella wafer can be hand placed on the

The stylus is removed and the resection of this Surgical Technique. resected surface if required to protect the

performed using an oscillating saw (with patella bone bed.

a 1.47 mm blade) through the saw capture

and flush to the cutting surface (Figure 9).

5
 Tibial Jig Assembly Lower Leg Alignment
Tibial cutting blocks
(Left & Right handed)

Press down to
attach cutting block

Figure 10 Figure 11 Figure 12

Assemble the appropriate tibial resection Place the knee in 90˚ of flexion with the Align the centre of the uprod with the

block to the proximal alignment rod. Slide tibia translated anteriorly and stabilised. medial one third of the tibial tuberosity

the proximal alignment rod into the ankle Place the ankle clamp proximal to the (Figure 12).

clamp assembly (Figure 10). malleoli (Figure 11).

6

Figure 13
Establish rotational alignment by aligning
the device parallel to the transmalleolar
axis (Figure 13). Medial / lateral alignment
should be parallel to the tibial axis, but
as the lateral malleolus is more prominent,
bisecting the transmalleolar axis will place
the cut into varus. The midline of the tibia
is approximately 3 mm medial to the
transaxial midline. The lower assembly
is translated medially to the anterior crest
of the tibia (usually to the second vertical
mark). There are scribe marks at 3 mm
and 6 mm for reference aligning to the
middle of the talus.
7
Ankle clamp adjuster
Figure 14
Drill a central pin through the slot in the There are scribe marks at 1 cm (1 cm
cutting block. is approximately 2˚ posterior slope,
depending on the length of the tibia).
The angle of the tibial slope is set by turning
When using a posterior stabilised
the ankle clamp adjuster. This moves the
design 0˚ slope is recommended.
distal arm anteriorly or posteriorly until the
desired angle is reached (Figure 14).
Tibial Resection

Figure 15 Figure 16

Position the tibial stylus in the slot of the Set the stylus to 8 mm or 10 mm. After the height has been set, pin the block

tibial cutting block (Figure 15). It is placed If the stylus is placed on the more through the lower set of holes. Resect

into the cutting block using the open or involved condyle, 0 mm or 2 mm the tibia using a 1.47 mm saw blade

slotted foot. should be resected. (Figure 16) and remove the resected bone.

8
 Isthmus level

Entering the Medullary Canal

Note: Correct location of the medullary

canal is critical to avoid mal position of
the femoral component.

Figure 17 Figure 18 Figure 19

Enter the medullary canal at the midline The drill may be positioned anteromedially Attach the ‘T’ handle to the IM rod and slowly

of the trochlea, 7 mm to 10 mm anterior to allow unobstructed passage of the introduce the rod into the medullary canal,

to the origin of the PCL. Drill to a depth of IM rod (Figure 18). to the level of the isthmus (Figure 19).

approximately 5 mm to 7 mm. Take care

to avoid the cortices (Figure 17).

9
Femoral Locating Device

Figure 20 Figure 21

Pre operative X-rays are used to define the The T-handle is removed and the femoral

angle between the femoral, anatomical and locating device is placed on the IM rod

mechanical axis. The valgus angle (left or (Figure 21).

right - 0˚ to 9˚) on the femoral locating

device is set and locked in place (Figure 20).

10
 Outrigger

Distal femoral
cutting block

Fixation pin Fixation pin

Figure 22 Figure 23 Figure 24

The outrigger and distal femoral cutting Internal / external rotation of the locating The block should be pinned and secured At least 9 mm of distal femoral bone should

block are assembled and then lowered device is adjusted with reference to the to the femur through the holes marked with be resected from the most prominent

onto the locating device (Figure 22). trochlear groove. The outrigger legs a square. This will allow a +2 or -2 mm condyle.

should be set parallel to the whitesides adjustment to be made (Figure 24).

line. When rotation is correct, secure the

locating device by tapping the fixation

pins (Figure 23).

11
 Figure 25 Figure 26

The locating device and outrigger are The distal femoral resection is performed

removed, leaving the cutting block in using a 1.47 mm saw blade (Figure 26).

place (Figure 25).

12
Extension Gap Assessment

Figure 27 Figure 28

The knee is placed in full extension and Where the extension gap is trapezoidal,
lamina spreaders or spacer blocks are the bilateral soft tissue must be balanced
applied medially and laterally (Figure 27). (Figure 28).
The extension gap must be rectangular

in configuration.

13
Femoral Sizing (Anterior Down) Medial

Sizing indicator

Adjustment screw
Lateral

Intended exit Stylus sizing guide

point of femoral Drill guide scale
component

Upper pin holes

Locking screw

Lateral Medial

Figure 29 Figure 30
Posterior plate

The anterior sizing guide is placed on the
resected distal surface of the femur, with
the posterior condyles resting on the
posterior plate of the guide (Figure 29).
The stylus on the anterior sizing guide is
placed on the anterior femur with the tip
positioned at the intended exit point on
the anterior cortex - avoiding any potential
notching of the femur.
The locking screw is tightened and the
size is read from on top of the sizing
indicator. When properly set, the size
indicated on the stylus should match
the size on the guide.
Set the drill guide scale to match the size
on the sizing indicator and tighten the
adjustment screw (Figure 30).

14
 Base block

Figure 31 Figure 32

Pins are drilled through the upper medial Choose the appropriate left or right cutting
and lower lateral hole to set 3 degrees of block. Place the anterior cutting block
external femoral rotation (Figure 31). over the lateral pin. Rotate the block to

Remove the medial pin and the sizing locate the captured pin in the previously

guide leaving the lateral pin in place. drilled medial hole (Figure 32).

15
 Sizing guide

Lateral Medial

Figure 33 Figure 34 Figure 35

Use the sizing guide to adjust the resection A visualisation wing should be used to The anterior femoral resection guide is
height to match the femoral size indicated check the resection level (Figure 34). secured in place with at least one additional
previously (Figure 33). pin and the resection performed using a

1.47 mm saw blade (Figure 35).

16
Final Femoral Preparation

Block fixation pins

Fixation lug

Posterior femoral cut

Figure 36 Figure 37

The appropriate sized finishing block
(standard or P.F.C.® Sigma™ RP-F) is
selected and positioned on the resected
anterior and distal surfaces of the femur.
The fixation lugs on each side of the block
correspond exactly to the M/L dimension
of the final implant and are used to visually
place the instrument in the correct M/L
position (Figure 36).
The block is pinned in place through
the fixation pin holes with at least two pins
before any bone cuts are made.
Final resections are made using a 1.47 mm
saw blade in the following order:
Posterior femoral, chamfer cuts, box cut or
peg holes (depending on implant selection -
posterior stabilised or cruciate retaining)

(Figure 37). The use of a reciprocating saw

is recommended for all remaining resections.

17
 Figure 38 Figure 39

The chamfer cuts are made with the saw

flush to the angled plates on the cutting

block (Figures 38 & 39).

18
 Figure 40 Figure 41

The box cut is made using an oscillating

or reciprocating saw. An osteotome may

be used to clear any remaining bone

(Figures 40 & 41).

19
Trial Reduction
Figure 42
There are two options available to assess
the knee during trial reduction. One or
both may be used.
Trial reduction with trial bearing in
non-rotation mode
This option is useful when the tibial tray
component size is smaller than the
femoral size. Note: Mobile bearing tibial
insert size MUST match femoral
component size.
With equivalent sizes the bearing rotation
allowance is 8˚. For a tibial tray one size
smaller than the femoral component, this
bearing rotation allowance reduces to 5˚.
In this situation, finding the neutral position
with respect to the femur is therefore more
important in order to prevent bearing
overhang and soft tissue impingement.
20
Figure 43
Position the appropriate sized femoral trial
onto the femur. Position the lock-off
evaluation bullet into the cut-out of the
M.B.T. tibial tray trial (Figure 42).
Select the tibial insert trial that matches the
chosen femoral size and style, curved or
stabilised, and insert it onto the M.B.T. tray
trial (Figure 43). With the trial prosthesis in
place, extend the knee carefully, noting the
anterior / posterior stability, medial/lateral
stability and overall alignment in the
A/P and M/L plane. If there is any
indication of instability, substitute a tibial
insert trial with the next greater thickness
and repeat the reduction.

Figure 44
Select the insert which gives the greatest
stability in flexion and extension whilst still
allowing full extension. Rotational alignment
of the tibial tray is adjusted with the knee in
full extension, using the alignment handle
to rotate the tray and trial insert into
congruency with the femoral trial. The
rotation of the tibial tray is usually centred
on the junction between the medial and
electrocautery marks
central one-third of the tibial tubercle.
The appropriate position is marked with
electrocautery on the anterior tibial cortex.
Overall alignment can be confirmed using
the two part alignment rod, attaching it to
the tibial alignment handle.
Fully flex the knee, and remove the trial
components. Replace the M.B.T. tray trial
back on the proximal tibia, and align the
21
Note: Excessive mal-rotation of
the tibial tray relative to the
femoral component can result in
excessive bearing overhang and
impingement with soft tissues.
handle with the electrocautery marks
(Figure 44). Assessment can be made
of the overall tibial coverage.
Figure 45
Trial reduction with trial bearing free
to rotate
This trial reduction can be done instead
or in addition to the one described before.
Position the appropriate sized femoral trial
onto the femur, and place the appropriate
sized M.B.T. trial tray onto the resected
tibial surface.

Figure 46
Assess the position of the tray to achieve
maximal tibial coverage (align the handle
with the electrocautery marks if procedure
described in 1 has been followed). The
rotation of the tibial tray is usually centred
on the junction between the medial and
central one-third of the tibial tubercle.
Position the pinned evaluation bullet into
the cut-out of the M.B.T. tibial tray trial, and
(cruciate retaining)
tap down lightly to secure the tray to the
proximal tibia (Figures 45).
Select the tibial insert trial that matches
the chosen femoral size and style, curved
or stabilised, and insert it onto the M.B.T.
tray trial (Figures 46).
Carefully remove the tibial alignment
handle, and, with the trial prosthesis in
place, extend the knee carefully, noting
22
(cruciate substituting)
Figure 47
the anteroposterior stability, medial/lateral
stability and overall alignment in the A/P
and M/L plane (Figures 47). Assessment
of the bearing rotation and patello femoral
tracking can also be achieved. Overall
alignment can be confirmed using the two
part alignment rod, attaching it to the tibial
alignment handle.
If there is any indication of instability,
substitute a tibial insert trial with the next
greater thickness and repeat reduction.
Select the insert which gives the greatest
stability in flexion and extension whilst still
allowing full extension. Confirm tray rotation
and position, and mark with electrocautery
if this has not already been done.
Tibial Preparation Drill
stop holes
Lines 4-7
Lift the catch to engage or
4-7 2-3
disengage the reamer tower
from the tray 2-3 1-1.5
1-1.5

Tibial screws
engagement
button

engagement
button slot

Figure 48 Figure 49 Figure 50

Position the tibial trial to fit the tibia for lifting the catch and rotating the tower until Tray Drill Stop Cement
The tibia is reamed to the appropriate

maximum femoral coverage. Rotation the button engages in the tray (Figure 49). Size Seating Mantle depth (Figure 50).

should be aligned with the medial one The tower is locked in place when the 1-1.5 2-3 0.5 mm per side
4 mm distal
third of the tibial tuberosity. Pin the trial catch is released. The tibial reaming depth
2-3 4-7 0.5 mm per side
with 2 pins. The tray trial allows for is controlled by setting the collars to match 4 mm distal
standard, M.B.T., keeled and DuoFix™ the size of the tibial tray. See table for 4-7 drill ‘bottoms out’ 0.5 mm per side
on tray trial 4 mm distal
4 peg tray (Figure 48). The MI reamer appropriate size.

tower is attached to the tray trial by

23
M.B.T. Tray Preparation

Tibial screws

Figure 51 Figure 52 Figure 53

Keeled Tray Option Non-Keeled Tray Option

If a keeled M.B.T. tray is to be employed, The universal handle is assembled to the The assembly is impacted into the The RP adaptor is inserted into the punch

and the bone of the medial or lateral appropriately sized M.B.T. keel punch and cancellous bone until the shoulder of the bushing (Figure 53).

plateau is sclerotic, it is helpful to initially inserted into the M.B.T. punch bushing, punch is in even contact with the M.B.T.

prepare the keel slot with an oscillating taking care to avoid malrotation. punch bushing (Figures 51 & 52).

saw or high speed burr.

24
M.B.T. DuoFix™ Tray Preparation

Figure 54 Figure 55

To finalise the rotational position, the four Pin the tibial template, and drill the four

peg holes must be prepared. Remove the peg holes (Figure 55).

insert trial, femoral trial and APG or RP

adaptor. Attach the tibial alignment guide

handle, and verify that orientation of the

tibial trial corresponds to the markings

on the tibia (Figure 54).

25
Final Component Implantation
The components are implanted in the
following order.
Tibial Implantation
The entire site should be thoroughly
cleansed using pulsatile lavage. Bone
cement is prepared and applied by syringe
or with digital pressure in its low viscous
state to assure maximal penetration into
the trabecular bone.
(cruciate retaining)
Figure 56
The universal handle is attached to the tray
inserter. The tibial tray is carefully inserted,
avoiding malrotation. When fully inserted,
several mallet blows may be delivered to
the top of the universal handle. All extruded
cement is removed using a curette.
26
(cruciate substituting)
Polyethylene Implantation
Loose fragments or particulates must
be removed from the permanent tibial
tray. The appropriate permanent tibial
insert can be inserted.
Femoral Implantation
The entire site should be thoroughly
cleansed using pulsatile lavage.
Bone cement is prepared and applied to
the femur. The femur is hyperflexed and
the tibia is subluxed forward. The implant
is attached to the femoral inserter and
inserted onto the femur.
Final Patella Preparation

Figure 57 Figure 58

The knee is extended to approximately 90˚
for final impaction. The inserter is released
and any extruded cement is cleared using
a curette (Figure 56).
A template is selected that most The template is firmly engaged to the
adequately covers the resected surface resected surface and the holes made with
without overhang (Figure 57). If used, the the appropriate drill bit (Figure 58).
patella wafer is removed from the patella.
The template handle is positioned on the
medial side of the everted patella.

27
 Locking
switch

Figure 59 Figure 60

The patellar implant may now be cemented. The patellar clamp is designed to fully When snug, the handles are closed and The clamp is released by unlocking the

The cut surface is thoroughly cleansed seat and stabilise the implant as the held by the ratchet until polymerisation is locking switch and squeezing the handles

with pulsatile lavage. Cement is applied to cement polymerises. It is positioned complete. All extruded cement is removed together (Figure 59). The patella is reduced

the surface and the component is inserted. with the silicon O-ring, centred over the with a curette. and the patella implant is evaluated. An

articular surface of the implant and the unrestricted range of motion, free bearing

metal backing plate against the anterior movement and proper patellar tracking

cortex, avoiding skin entrapment. should be evident (Figure 60).

28
Closure

Figure 61

The tourniquet is released and bleeding The knee is put through a range of motion The final flexion against gravity is noted for

controlled by electrocautery. A closed- from full extension to full flexion to confirm postoperative rehabilitation. Subcutaneous

wound suction drain is placed in the patellar tracking and the integrity of the tissue is reapproximated and the skin

suprapatellar pouch and brought out capsular closing (Figure 61). closed with sutures or staples.

through the lateral retinaculum. The fat

pad, quadriceps mechanism, patella

tendon, and medial retinaculum are

reapproximated with interrupted sutures.

29
Instruments and Ordering Information

MI 8200 Base Kit MI CAS

950501543 MITKR CAS Tibial / Femoral Jig 250025000 M.B.T. Modular Depth Stop Ring
950501545 MITKR CAS 0 Degree 55 mm Cutting Block 217830121 M.B.T. Plateau Trial Post
217830137 M.B.T. RP Trial Button
MI 8300 P.F.C.® Sigma™ Femoral MI CAS
965383 M.B.T. tray impactor
950501541 MITKR CAS Anterior Jig Sigma™ Assembly
950501528 MITKR CAS Femoral 3-in-1 Sigma™ Size 2 MI 8600 P.F.C.® Sigma™ RP-F MI CAS
950501529 MITKR CAS Femoral 3-in-1 Sigma™ Size 2.5 950501552 MITKR CAS Femoral 3-in-1 RP-F Size 2
950501530 MITKR CAS Femoral 3-in-1 Sigma™ Size 3 950501553 MITKR CAS Femoral 3-in-1 RP-F Size 2.5
950501531 MITKR CAS Femoral 3-in-1 Sigma™ Size 4 950501554 MITKR CAS Femoral 3-in-1 RP-F Size 3
950501532 MITKR CAS Femoral 3-in-1 Sigma™ Size 5 950501555 MITKR CAS Femoral 3-in-1 RP-F Size 4
950501556 MITKR CAS Femoral 3-in-1 RP-F Size 5
MI 8400 M.B.T. MI CAS
954120 RP-F Tibial Insert Trial 10 mm Size 2
950501502 MITKR CAS Tibial Template Size 2
954121 RP-F Tibial Insert Trial 12.5 mm Size 2
950501503 MITKR CAS Tibial Template Size 2.5
954122 RP-F Tibial Insert Trial 15 mm Size 2
950501504 MITKR CAS Tibial Template Size 3
954123 RP-F Tibial Insert Trial 17.5 mm Size 2
950501506 MITKR CAS Tibial Template Size 4
954125 RP-F Tibial Insert Trial 10 mm Size 2.5
950501508 MITKR CAS Tibial Template Size 5
954126 RP-F Tibial Insert Trial 12.5 mm Size 2.5
950501511 MITKR CAS Bayonet Tower Assembly
954127 RP-F Tibial Insert Trial 15 mm Size 2.5
950501512 MITKR CAS Bushing Extractor
954128 RP-F Tibial Insert Trial 17.5 mm Size 2.5
950501514 MITKR CAS KL Punch Bushing Size 2-3
954130 RP-F Tibial Insert Trial 10 mm Size 3
950501515 MITKR CAS KL Punch Bushing Size 4-7
954131 RP-F Tibial Insert Trial 12.5 mm Size 3
950501516 MITKR CAS M.B.T. Bullet WO Pegs Size 1-3
954132 RP-F Tibial Insert Trial 15 mm Size 3
950501517 MITKR CAS M.B.T. Bullet WO Pegs Size 4-7
954133 RP-F Tibial Insert Trial 17.5 mm Size 3
950501518 MITKR CAS M.B.T. Evaluation Bullet Size 1-3
954140 RP-F Tibial Insert Trial 10 mm Size 4
950501519 MITKR CAS M.B.T. Evaluation Bullet Size 4-7
954141 RP-F Tibial Insert Trial 12.5 mm Size 4
950501523 MITKR CAS RP Tibial Bullet Size 2-3.5
954142 RP-F Tibial Insert Trial 15 mm Size 4
950501524 MITKR CAS RP Tibial Bullet Size 4-7
954143 RP-F Tibial Insert Trial 17.5 mm Size 4
966520 Universal Handle
954150 RP-F Tibial Insert Trial 10 mm Size 5
217830118 M.B.T. Central Drill
954151 RP-F Tibial Insert Trial 12.5 mm Size 5
217830119 M.B.T. Central Stem Punch

30
954152 RP-F Tibial Insert Trial 15 mm Size 5 966564 Cruciform Keel Punch Sterile Tray Insert
954153 RP-F Tibial Insert Trial 17.5 mm Size 5
SP 2715 Specialist® 2 Modular Cemented Punch Instruments
954212 RP-F Trial Femur Size 2 Left
966360 Modular Tibial Cemented Punch Guide Size 1.5-3
954213 RP-F Trial Femur Size 2.5 Left
966361 Modular Tibial Cemented Punch Guide Size 4-6
954214 RP-F Trial Femur Size 3 Left
966370 Modular Tibial Cemented Punch Size 1.5-3
954215 RP-F Trial Femur Size 4 Left
966371 Modular Tibial Cemented Punch Size 4-5
954216 RP-F Trial Femur Size 5 Left
966376 Specialist® 2 Modular Tibial Drill Bush Cemented Size 1.5-3 (13 mm)
954222 RP-F Trial Femur Size 2 Right
966378 Specialist® 2 Modular Tibial Cemented Drill Bush Size 4-5 (15 mm)
954223 RP-F Trial Femur Size 2.5 Right
966380 Modular Tibial Drill Size 1.5-3 13 mm Cemented
954224 RP-F Trial Femur Size 3 Right
966381 Modular Tibial Drill Size 4-6 15 mm Cemented
954225 RP-F Trial Femur Size 4 Right
966566 Cemented Modular Punch
954226 RP-F Trial Femur Size 5 Right
MI 8800 Demo MI CAS (International Only)
MI 7400 P.F.C.® Sigma™ Fixed Bearing MI CAS
950501504 MITKR CAS Tibial Template Size 3
966554 Base Tibial Instruments
950501511 MITKR CAS Bayonet Tower Assembly
966341 Tibial Tray Trials Size 2
950501512 MITKR CAS Bush Extractor
966343 Tibial Tray Trials Size 3
950501514 MITKR CAS Keel Punch Bush Size 2-3
966344 Tibial Tray Trials Size 4
950501516 MITKR CAS M.B.T. Bullet WO Pegs Size 1-3
966345 Tibial Tray Trials Size 5
950501518 MITKR CAS M.B.T. EVAL Bullet Size 1-3
860590 Trial Tray Fixation Pins (pack of 4)
950501521 MITKR CAS DuoFix™ Tibial Reamer
966430 Tibial Trial Insert Remover
950501523 MITKR CAS RP Tibial Bullet Size 2-3.5
966520 Universal Handle
950501541 MITKR CAS Anterior Jig Sigma™ Assembly
966342 Tibial Tray Trial Size 2.5
950501542 MITKR CAS Anterior Jig LCS® Assembly
SP 2714 Specialist® 2 Standard Tibial 950501530 MITKR CAS Femoral 3-in-1 Sigma™ Size 3
966350 Standard Tibial Punch Guide Size 1.54 950501537 MITKR CAS Femoral 4-in-1 LCS® Standard
966351 Standard Tibial Punch Guide Size 5 & 6 950501554 MITKR CAS Femoral 3-in-1 RP-F Size 3
966355 Standard Non Cemented Tibial Punch Size 1.52 950501543 MITKR CAS Tibial/Femoral Jig
966356 Standard Non Cemented Tibial Punch Size 2.54 950501545 MITKR CAS 0 Degree 55 mm Cutting Block
966357 Standard Non Cemented Tibial Punch Size 56 950501547 MITKR CAS 15 Degree 55 mm Cutting Block
966358 Standard Cemented Tibial Punch Size 1.52
966359 Standard Cemented Tibial Punch Size 2.56

31
MI 8000 LCS® Mobile Bearing MI CAS Instruments
1/8 950501572 MITKR CAS Prefixation Screw
180118000 Inch Drill Bit
228769000 Calliper 950501579 MITKR CAS Patella Trial - Sigma™ 25 mm
217856025 ®
LCS Completion Femoral Impactor/Extractor 950501580 MITKR CAS Patella Trial - Sigma™ 28 mm
864348 Bone File 950501581 MITKR CAS Patella Trial - Sigma™ 32 mm
966515 ®
Specialist 2 Pin Puller 950501582 MITKR CAS Patella Trial - Sigma™ 35 mm
966520 Universal Handle 950501583 MITKR CAS Patella Trial - Sigma™ 38 mm
869189 ®
P.F.C. J&J Tibial Retractor 950501584 MITKR CAS Patella Trial - Sigma™ 41 mm
217842005 Completion™ QDrill Driver 950501585 Tibial Impactor
217842010 Completion™ QDrill Pin Pack 950501586 Femoral Introducer
228748000 Femoral Lug Drill 950501587 Femoral Anterior Bow Yoke
258919000 Visualisation Wing 950501608 Tibial/Femoral RM/LL x 15 Degree Cutting Block
966180 Modular Femoral Impactor Head 950501609 MITKR CAS Patellar Wafer
950501610 MITKR CAS/Specialist® 2 Tibial Adapter
Individual Codes
950501611 Quick Drill Pin - MI
950501500 MITKR CAS Tibial Template Size 1
950501612 MI - Patella Resection Guide - P.F.C.®
950501501 MITKR CAS Tibial Template Size 1.5
950501505 MITKR CAS Tibial Template Size 3.5 129901061 Tibial Screws
950501507 MITKR CAS Tibial Template Size 4.5 129901030 Manual Driver
950501509 MITKR CAS Tibial Template Size 6 950501606 Tibial/Femoral LM/RL x 15 Degree Cutting Block
950501510 MITKR CAS Tibial Template Size 7 217842005 Completion Qdrill Driver
950501513 MITKR CAS Keel Punch Bush Size 1-1.5 217842010 Completion Qdrill Pin Pack
950501522 MITKR CAS RP Tibial Bullet Size 1-1.5 950501544 MITKR CAS 0 Degree 45 mm Cutting Block
950501527 MITKR CAS Femoral 3-in-1 Sigma™ Size 1.5 950501546 MITKR CAS 15 Degree 45 mm Cutting Block
950501533 MITKR CAS Femoral 3-in-1 Sigma™ Size 6 950501604 Tibial/Femoral 65 mm x 15 Degree Cutting Block
950501565 MITKR CAS Patella Track Assembly 950501550 MITKR CAS Femoral 3-in-1 RP-F Size 1
950501567 MITKR CAS System Screw 950501551 MITKR CAS Femoral 3-in-1 RP-F Size 1
950501568 MI CAS NC Keel Punch Bush Size 1-1.5 5950501557 MITKR CAS Femoral 3-in-1 RP-F Size 6
950501569 MI CAS NC Keel Punch Bush Size 2-3 950501603 Tibial/Femoral 65 mm x 0 Degree Cutting Block
950501570 MI CAS NC Keel Punch Bush Size 4-7 950501605 Tibial/Femoral LM/RL x 0 Degree Cutting Block
950501571 MITKR CAS System Screw 950501607 Tibial/Femoral RM/LL x 0 Degree Cutting Block

32
950501549 MITKR CAS Tibial/Femoral Jig Clamp
129901052 CAS Ligament Tensor Size 2 (12 Kg)
129901053 CAS Ligament Tensor Size 4 (12 Kg)
129901054 CAS Ligament Tensor Handle
129901055 CAS Tensor Spacer 5 mm
129901056 CAS Tensor Spacer 10 mm
CAS Ligament Tensor Size 2 (18 Kg)
CAS Ligament Tensor Size 4 (18 Kg)
CAS Ligament Tensor Size 2 (24 Kg)
CAS Ligament Tensor Size 4 (24 Kg)

Saw Blades
950501591 MITKR CAS Saw Blade - Old Stryker
950501592 MITKR CAS Saw Blade - New Stryker
950501593 MITKR CAS Saw Blade - Old Zimmer
950501594 MITKR CAS Saw Blade - New Zimmer
950501595 MITKR CAS Saw Blade - AO/Sod
950501596 MITKR CAS Saw Blade - 3M
229910000 MITKR CAS Double Side Recip Stryker
229910001 MITKR CAS Double Side Recip Zimmer
229910002 MITKR CAS Double Side Recip Hall

33
This publication is not intended for distribution in the USA

Completion™, DuoFix™ and Sigma™ are trademarks and LCS®, P.F.C.®, and Specialist® are registered trademarks of DePuy Orthopaedics, Inc.

© 2005 DePuy International Limited. All rights reserved.

Cat No: 9095-40-000 Version 1

DePuy International Ltd

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Leeds LS11 8DT
England
Tel: +44 (113) 387 7800
Fax: +44 (113) 387 7890 Issued: 08/05