Knee Primary Surgical Technique

Beijing Chunlizhengda Medical Instruments Co.,Ltd.
TOTAL KNEE JOINT REPLACEMENT

—XN KNEE SYSTEM
Surgical Technique

Contents
1. Products Introduction 01
2. Indication 03
3. Contraindication 03
4. Preoperative Preparation 04
5. Surgical Technique 05
6.Rehabilitation 30

Products Introduction
01
Femoral Design
1.Anatomic arc angle design,reduce the pressure for soft tissue.
2.The anterior condyle is thinner,is effective to avoid prepatellar pain.
3.Deeper trochlea and lengthier recess lowers loosen rate of lateral ligament and prevents patellar
tendinitis.
4.Column design, increase the stability of the prosthesis during high flexion.
5.The semi-open design of the intercondylar fossa reduces the wear of the tibial plateau.
6.Extending and shortening the posterior condyle design,high flexion allow rotation and keep the stability,
can reach 155 ° of high flexion.
02
Tibial Design(Symmetrical/Dissected/Rotated)
1.The keel wing design provides initial implantation stability.
2.5°of caster angle,prevent the frontal cortex from colliding.
3.Accurate and stable locking design reduces movement.
4.Can match with the insert of PS&CR.
5.The anatomical tibial plateau design, the tibial plateau was better covered,lower the subsidence of tibial
plateau.
03
Tibial Insert Design
1.The deep notch design of front of the platform pad,reduce the adverse effect on the patellar ligament
because of high flexion.
2.The column of tibial insert is moved 2mm from normal position,
the crossbeam of femoral condyle can contact with the column firstly in the flexion process,reducing the
impact force,preventing the column from breaking.
3.Aquiline nose - shaped column design reduces the risk of dislocation in the process of high flexion.
4.The double joint surface’s bonding mechanism between the column and the crossbeam, reduces the
pressure to the column, reduces the wear.
5.Two types,CR&PS.

Indication
1. Joint noninflammatory lesions,include OA,TA,FHN.

2. Inflammation of the joints
3. Correction of functional deformity
4. Other problems suitable for TKA treatment
Contraindication
1. Apparent infection
2. A distant infection of the lesion.
3. The disease develops rapidly, manifested by the obvious joint collapse or bone absorption under the
X-ray fluoroscopy.
4. Patients with immature skeletal structure.
5. Cases of insufficiency of neuromuscular function.

Preoperative preparation
1. Make the preoperative X-ray, the straight line between the center of the femoral medullary cavity and
the midpoint of the knee joint, is the anatomical axis of the femur;the connection between the center of
the femoral head and the midpoint of the knee joint, is the mechanical axis.The angle of these two lines is
valgus angle.
2. The valgus angle should be measured ,it is usually between 3°-8°,the valgus angle should be
confirmed well before the distal femur osteotomy ,generally,choose 5°-7°.
3. It should be confirmed the size of each component and the thickness of osteotomy by using prosthetic
template before operation.

Surgical Technique
1. Supine position.
2. Anterior midline incision.If there is a local old incision, use the original incision, or further extend the
old incision to reduce the risk of skin exfoliation.
3. The joint capsule was incised by the medial patellar approach.
Tibial Preparation
1.Confirm femoral force line.

Purpose.
Ensure that the osteotomy plane of the tibia is perpendicular to its mechanical axis.

Tibial extra-medullary location
 XN tibial cutting guide has L and R,two sizes,and

general cutting guide,aim to avoid soft tissue
collision.
 The extra-medullary tibial cutting guide is an
assembly including a ankle attaching device,
adjustable rod, alignment guide and tibial resection
block.
 Tibial resection block has two types,caster angle 3°
and 5°
 Tibial cutting guide is assembled and installed on the

tibia.Confirm direct tibial resection block,L or R.
 First stable the tip of the alignment guide which is two pins
in between the two tibial eminenc or one-third after
intercondylar ridge.

Flexion and extension alignment

 Be sure the alignment guide should be parallel to the tibia,
and center of ankle attaching device should be towards
the middle of ankle joint, then loosen the knob nut at the
distal end of the cutting guide for adjusting posterior
slope.
 When the long axis of the proximal end of the
extramedullary positioning rod is parallel to the coronal
plane of the tibia, the correct anterior-posterior alignment
is achieved.
Internal and external inversion alignment

 Loosening the distal knob of the ankle attaching device,
the distal component can slide on and out to adjust the
internal and external inversion alignment line until the
tibial center is aligned with the extramedullary positioning
rod.
 When the long axis of the proximal end of the
extramedullary positioning rod is parallel to the coronal
plane of the tibia, the correct anterior-posterior alignment
is achieved.
 After obtaining the triaxial alignment, tighten the knob on

the ankle attaching device.

Tibial posterior angle adjustment

 Remark:If the long axis of the proximal end of the extramedullary
positioning rod is parallel to the tibia,confirm the caster angle
according to tibial resection block.The posterior angle can be 3 °
and 5 ° .If the tibial resection block is 0 ° of posterior angle,the
posterior angle of osteotomy is 0°，3° is same.
Pull the rod by back and forth,can adjust posterior angle.
Internal and external rotation alignment

 Rotate the assembly to confirm that the base is aligned to the
center of the ankle. In general, the center of the ankle is aligned
with the second metatarsal. It is best to mark the second
metatarsal, the midline of the tibia, and the tubercle of the tibia to
ensure the correct force line.
2. Tibial Preparation
Purpose.
Proper osteotomy of tibial for implanting prosthesis

Measure tibial osteotomy

 With the tibial resection gauge, the surgeon can decide how
much of the thickness of proximal tibia will be cut simply
putting the gauge in the slot of tibia resection cutting block.
The resection gauge provides either 2mm or 10mm resection
choices.
 2mm gauge:if not severe medial plateau chondrosis, simply put
the tip of the 2mm gauge on the lowest point of the medial
plateau.
 10mm gauge:if severe cartilage loss on one plateau, we suggest
a 10mm gauge be on the less damaged plateau.
 Confirm osteotomy with measuring guide,locking the nuts below

the tibial resection block, fix the resection block with two pins on
the holes marked with “0”

Tibial posterior angle adjustment

 Installation of frame of measuring force line on tibial resection
block.Using rod of force line to check the alignment again to be
sure it is correct.
 Remove the alignment guide with only resection block left in

place.
 Confirm osteotomy with measuring guide again,(if need,can

adjust osteotomy by adjusting holes,implant one toenail to fix
resection block.

 Use the saw of 1.2mm to finish osteotomy.
 Remove toenail and resection block,keep 2 long screw.
 Use the saw to repair the tibial surface. The resection of

tibia is completed.

Femoral Preparation
Femoral intramedullary localization

Purpose
The osteotomy plane of the distal femur was determined at
the correct the angle of valgus.
 Opening the femoral canal: locate the entry portal of

femoral canal at a point about 0.8cm-1.5cm anterior to the
femoral insertion of PCL.
 Use the 8mm of provided drill to open the canal.

 The Rod of Femoral Medullary Guide have two

types.Suggest:choose the long rod in order to correct
anatomical axis. According to the interpretation of preoperative
radiographs, adjust the guide knob, select the appropriate
valgus angle (note check "R" "L" position is correct, usually
choose 5-7 degrees) femoral medullary guide plug in medullary
cavity slowly until fully fitted to the distal femoral surface.
 Impact the fixed screw of femoral medullary guide.
Resection of distal femur

Purpose
Cutting distal femur at the correct the angle of valgus.
 Insert Distal Femur Cutting Guide into the Femoral Medullary

Guide,then lock the bolt of Distal Femur Cutting Guide.

 Measure the bone resection with the resection guide , the

position of resection is “ 0 ” ,so the thickness of planned
resection bone will be 8mm (if adjust the bone resection, we
can adjust by the hole position of “±2”, “ ±4”).
 Impact two toenails to fix.
 Be sure the correct alignment: Installar the line corrector,insert

the alignment rod , should be through the center of femoral
head and center of the knee joint.

 Loosen the bolt of Distal Femur Cutting Guide,using the

impactor to pull out the Femoral Medullary Guide.
 Finish the osteotomy of distal femur.Confirm the osteotomy

with measuring guide again.(if adjust the bone resection, we
can adjust by the hole position of “±2”, “ ±4”),fix the
resection block with toenail,use 1.2mm-1.5mm of saw to cut
bone.
 Remove the cutting guide,keep the 2 screw in the bone.
 Measure the extension space with the spacer block(10#, 12#,

14#, 16#, 18#), if the thinness one 10# can not be put in the
space then recut should be done either on the distal femur or
proximal tibia.

Measurement of femur size and osteotomy
Purpose
Determine the size of the femoral prosthesis, perform anterior,
posterior and oblique osteotomy to achieve the shape for the
installation of the femoral prosthesis specimen.
 Use electrotome mark Insall line and whiteside line.

 Refer to Insall line and whiteside line to confirm femur external
rotation angle.Choose the correct external rotation angle,(0°，
3°，5°，L/R) usually select 3°.
 The femora dimension measuring device was attached to the

distal femur osteotomy and the pterygoid was attached to the
posterior femoral condyle.
 Move the probe mounted on the measuring device and adjust
the length of the slide probe until it reaches the highest point of
the anterior femoral cortex.
 Reading the figure(show the size) of Measuring Femoral Sizing
Guide.
 Remove femora dimension measuring device.

 Assemble the chosen 4 in 1 resection block , the size is same

with measuring size, then measure the anterior condyle
osteotomy with the resection guide. Avoid the NOTCHING. Fix
the 4 in 1 resection block with two cap screws or toenail.
 Start to cutting femur,in order:Anterior condyle-Posterior

condyle-Posterior chamfer-Anterior chamfer
1 2
3 4

Intercondylar resection
Purpose:
If confirm use PS prosthesis, it is necessary to make
Intercondylar resection.
 Select the intercondylar resection block according to the

size of 4 in 1 cutting plate. Put and then hammer the block
gently onto the cut distal femur with its two pegs into the two
drilled holes from the previous step. Stable the block with
additional 4 long pins.
 Insert osteotomy into cutting grove by hammer which located

in the above of resection block.

 Use reciprocating saw blade attach the inside edge of resection

block to cut bone, then remove out osteotome by hammer.
 Clean the intercondylar remaining bone by osteotome or

rongeur forceps, then impact and shape the cancellous bone in
the intercondylar region by box osteotomy impactor.
 With a limiting bit drill holes on the intercondylar guide.
 Remove fixed screw and intercondylar resection block.

 Put the femoral trial condyle in place, check the contact

condition between trail condyle and bone cutting surface.
Tibial Preparation
Dimension choice and place confirmation of of tibial prothesis
Purpose
Choose right tibial tray, and place into right position.
 Assemble trail condyle by femoral condyle holder, use tibial trail

tray as the same size of femoral trail condyel(make size
adjustment according to the tibial coverage of trail tray) and
corresponding tibial trail insert, flex and extend the knee with
the provisionals in place, to test the balance, the matching, and
the stability.
 Check the alignment of the tibial resection, use electrotome
mark two sides of the handle, to help confirm the position of
the prothesis.

 Check the alignment of the tibial resection, use electrotome

mark two sides of the handle, to help confirm the position of
the prothesis.
 Remove tibial trail tray and femoral trail condyle.
Shape tibial
Purpose
Prepare tibial base

 Place tibial trail platform according to previous

tibial mark, assemble alignment rod to check
tibial resection, use pins to fix onto tibial base.
 Assemble appropriate guide of tibial medullary
drill on the tibial trail platform, insert drill into
tibial medullary cavity.
 Remove drill, use corresponding tibial medullary

rasp to shape the medullary cavity.
 Remove rasp and tibial trail platform, clean tibial

medullary cavity.
 Make exposure and washing.

Patella prepartion
Patella osteotomy
Purpose
Check the thickness of patella osteotomy
 Use same thickness of patella after cut patella
 Use patella measurement clamp to measure thickness of patella.
 Assemble osteotomy guide on the clamp, hold patella, confirm the osteotomy thickness by
adjust the guide.
 Use measurement template to confirm the diameter of patella prothesis, the avaiable sizes
are 26, 29, 32, 35mm.
 Choose proper template and insert into clamp, use patella drill to drill out three fixed holes.
Trail patella estimate
Purpose
Estimate movement locus of patella
 Clean remaining cartilage, and washing. Insert proper size of patella prothesis on the bony
patellar.
 Estimate patella locus through flex and extend in the full range of activity. The patella locus
should be keep proper motion in the whole activity, to avoid incline and lateral subluxation.

Assemble prothesis
Prepare prothesis
Assemble prothesis
 First cement the tibial tray: fill cement in the prepared

medullary canal, with the impacter hammer the tibial
tray in position then remove the excess cement
 Pre-fill the cement on the femoral implant and be sure

the posterior condyles of implant should be covered by
cement, impact the femoral implant into position and
remove all the excess cement. Do the ROM of knee for
one or two times, keep the knee in extension until
cement solidified.

 Put the insert trial, in position then test the soft tissue
balance and still can do some more release if
necessary. Then put in the true insert.
 After solidification of cement, lavage and clean the
joint thoroughly, then close the incision according to
different layers.
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Beijing Chunlizhengda Medical Instruments Co.,Ltd.

TOTAL KNEE JOINT REPLACEMENT

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

1. Joint noninflammatory lesions,include OA,TA,FHN.

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

1.Confirm femoral force line.

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Tibial extra-medullary location

 XN tibial cutting guide has L and R,two sizes,and

 Tibial cutting guide is assembled and installed on the

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Flexion and extension alignment

Internal and external inversion alignment

 After obtaining the triaxial alignment, tighten the knob on

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Tibial posterior angle adjustment

Internal and external rotation alignment

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Measure tibial osteotomy

 Confirm osteotomy with measuring guide,locking the nuts below

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Tibial posterior angle adjustment

 Remove the alignment guide with only resection block left in

 Confirm osteotomy with measuring guide again,(if need,can

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

 Use the saw of 1.2mm to finish osteotomy.

 Remove toenail and resection block,keep 2 long screw.

 Use the saw to repair the tibial surface. The resection of

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Femoral intramedullary localization

 Opening the femoral canal: locate the entry portal of

 Use the 8mm of provided drill to open the canal.

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

 The Rod of Femoral Medullary Guide have two

Resection of distal femur

 Insert Distal Femur Cutting Guide into the Femoral Medullary

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

 Measure the bone resection with the resection guide , the

 Impact two toenails to fix.

 Be sure the correct alignment: Installar the line corrector,insert

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

 Loosen the bolt of Distal Femur Cutting Guide,using the

 Finish the osteotomy of distal femur.Confirm the osteotomy

 Remove the cutting guide,keep the 2 screw in the bone.

 Measure the extension space with the spacer block(10#, 12#,

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

Measurement of femur size and osteotomy

Determine the size of the femoral prosthesis, perform anterior,

posterior and oblique osteotomy to achieve the shape for the

installation of the femoral prosthesis specimen.

 Use electrotome mark Insall line and whiteside line.

 The femora dimension measuring device was attached to the

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

 Assemble the chosen 4 in 1 resection block , the size is same

 Start to cutting femur,in order:Anterior condyle-Posterior

Beijing Chunlizhengda Medical Instruments Co.,Ltd.

If confirm use PS prosthesis, it is necessary to make