Surgical Technique for use with the
JOURNEY™ II BCS and JOURNEY™ II CR
2
NAVIO™ Surgical System
Surgical Technique for use with the JOURNEY™ II BCS and JOURNEY™ II CR
Smith & Nephew
The following technique is for informational and educational purposes only. It is not intended
the appropriate products and techniques according to their own clinical judgment for each of
the Instructions for Use packaged with the product.
3
Introduction
recommended surgical technique for using the
NAVIO™ surgical system technology with the JOUR
NEY™ II CR (Cruciate Retaining) and JOURNEY™ II
the NAVIO system.
the NAVIO surgical system. Additional information
on the JOURNEY II CR (Cruciate Retaining) and BCS
& Nephew.
4
Contents
........ 5
Design Rational/Surgical Planning Rational........... 6
......................... 7
.......................................... 8
Positioning the System .......................................... 9
1. System and Patient Setup .................................. 10
2. Bone Tracking Hardware ................................... 12
3. Surgical Preferences .......................................... 14
4. Registration ....................................................... 17
5. Ligament Balancing ........................................... 25
6. Implant Planning ................................................ 26
.......... 32
8. Bone Cutting ..................................................... 36
9. Trial Reduction ................................................... 44
10. Cement and Close .......................................... 45
............................ 46
Notes ..................................................................... 47
........................ 48
5
Intended Use
The NAVIO surgical system is intended to assist the surgeon in
reference information to anatomical structures during orthopedic
procedures.
Indications for Use
The NAVIO™ surgical system is indicated for use in surgical knee
The NAVIO surgical system is indicated for use with cemented
implants only.
Contraindications
knee replacement surgery.
Warning:
instructions for use and recommendations for the
6
through the unique features of the JOURNEY
unicompartmental replacement. This system is
designed for use in patients in primary total knee
posterior cruciate ligaments are incompetent and
the collateral ligaments remain intact.
compartment than other total knee systems.
whether additional implant constraint is more
appropriate.
Surgical Planning Rationale
Co
Surgical Technique for more details on the
surgical planning rationale for the implant
components.
Figure 1
7
The optical tracking camera communicates the
the handpiece (Figure 2).
placement plan.
guide is separated into sequential sections:
1. System and Patient Setup
2. Bone Tracking Hardware
3. Surgical Preferences
4. Registration
5. Ligament Balancing
6. Implant Planning
8. Bone Cutting
9. Trial Reduction
10. Cementing Final Components & Closing
Preferences section (Section 3) of this guide.
Figure 2
8
NAVIO™ Instrument tray
or dropped tool.
Femur Cut Adapter
JOURNEY™
Figure 3b.
Handpiece Tracker Frame
Tracker Clamps (2)
Anspach Surgical Drill
Rasp
Femur Tracker Frame
Tissue Protector
Handpiece
Long Attachment
Figure 3a.
tray that contains the required instrumentation
surfaces (Figure 3a).
9
Positioning the System
Position the NAVIO™ computer cart so that the
surgeon can clearly see and easily operate the
graphical user interface at all times. The computer
the laser pointer integrated into the faceplate of the
during the operation to meet the needs of the
center.
the Camera Orientation Adjustment screen of the
Once the system is positioned and the patient has
drape manufacturer (Figure 5). An additional
Left-knee OR Setup (above)
Right-knee OR Setup (above)
Figure 4a.
Additional Notes
to the entire tracker frame.
Figure 4b.
10
Preparing the System and Tool
NAVIO™ Surgical System for Total Knee Arthroplasty
User’s Manual)
consists of the following:
• 5 mm Spherical Bur
•
touchscreen monitor with a sterile drape. This will
allow the surgeon to manipulate the touchscreen
included instructions for use for how to properly
apply to the monitor).
Patient Setup
patient registration.
Figure 6.
Figure 5.
1 System and Patient Setup
11
and inspect the joint. If any prominent spurs or
the leg motion.
typically found on the lateral aspect of the medial
•
interfere with the collateral ligaments and capsule. In
•
patellar osteophytes.
•
•
component implantation.
•
arthroplasty.
•
instructions for use and product documentation.
1 System and Patient Setup
12
Figure 8.
Placing Tracking Hardware
towards the optical tracking camera so the markers
•
9.)
•
• Use the tissue protector to mark the position of the
the tissue protector to ensure the pins are placed
parallel to each other.
•
to place the clamp touching the skin.
•
(Figure 9). Orient the spheres towards the camera
and slide the array away from the incision site.
Femur Tracker Array Placement
•
in the center of the femur (Figure 9).
•
•
pins are placed parallel to each other.
Figure 7.
Figure 9.
2 Bone Tracking Hardware
Femur Tracker Frame
13
• Slide the tracker clamp (with the clamp opening
clamp where it is touching the patient's skin.
• Clamp the femur tracker frame
. Place the smaller side
of the tracker frame
Orient the spheres towards the camera and slide
the array away from the incision site.
Prior to registering the leg with the NAVIO™
of the optical tracking camera and tracker frames
registration and cutting processes.
following two positions:
•
•
Both
(Figure 11).
Figure 10.
Figure 11.
2 Bone Tracking Hardware
14
performed.
Femur First
1.
2. Femur Component Placement
3.
4.
5.
Tibia First
1.
Section 6)
2.
Section 8)
3.
Section 5)
4. Femur Component Placement
Section 6)
5.
Section 7)
6. Femur Bone Preparation
Section 8)
Figure 13.
Figure 12.
3 Surgical Preferences
15
Rotational References
to choose landmark collection preferences on the
is calculated.
the component on the femur (Figure 14a):
1.
2.
3. Posterior Condylar
1.
2.
3.
4.
Based on the chosen preference for rotational
registration of the patient anatomy. Further details
Figure 14a.
Figure 14b.
3 Surgical Preferences
16
Joint Line Selection Preference
which allows the user to choose a landmark
This reference line is then displayed during the
placement.
Checkpoint Pins
stages throughout the procedure to determine if
Figure 16.
3 Surgical Preferences
Figure 15.
Figure 17.
Warning: Ensure that the checkpoint pins
dislocating the checkpoint pins.
17
and kinematics. The user may choose to
the included NAVIO system footpedal or the
touchscreen controls. Any collected point
Femur Neutral Position
right footpedal to collect the position (Figure
Hip Center
The Hip Center Calculation stage will follow
the femoral tracker array through circular
error.
wide circle. Slowly rotate the leg at the hip until
(Figure 19).
Figure 18.
Figure 19.
4 Registration
18
Figure 20.
Ankle Center
the most prominent portion (Figure 20). Ensure
Femoral Condyle
There are four femoral landmark points to collect.
during Implant Planning (Section 6). It is important
to take care to understand where these points
• Knee Center
• Most Posterior Medial Point
This point is used in conjunction with the anterior
notch point and the most posterior lateral point for
Figure 22.
Figure 21.
4 Registration
19
Figure 23.
Figure 24.
Figure 25.
• Most Posterior Lateral Point
This point is used in conjunction with the anterior
notch point and the most posterior medial point for
• Anterior Notch Point
This point is used as a reference during
of the implant component.
• Femoral Condyle Surface Mapping
well as the four discrete femur landmark points
down the footpedal. The user must input enough
information into the system to appropriately
map input in 3D.
4 Registration
20
Femoral Condyle Rotational References
options on which the femur rotational reference
are used during Implant Planning (Section 6) for
component placement onto the patient anatomy. It
is important to understand how these collections
• Transepicondylar Axis Collection
If the epicondyles are selected as the preference
stage.
• Femoral AP Axis Collection
Figure 26.
Figure 27.
4 Registration
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