TORNIER AEQUALIS REV II - wmtemedia.com

1 TORNIERAEQUALIS REV IIThreaded Post BaseplateSURGICAL TECHNIQUE ADDENDUM2 Overview/Intended Use ..4 Guide Pin Positioning ..4 Glenoid Depth Evaluation ..5 Reaming ..5 Central hole Drilling ..6 Depth Drill ..7 Tapping ..7 Introduction of the Baseplate ..8 Peripheral Screw Drilling ..9 Peripheral Screw Fixation ..10 Sphere Fixation ..10 Instrumentation ..113 Table of Contents: Guide Pin PositioningAll steps prior to the positioning of the guide pin should be followed as they are described in the AEQUALIS Reversed II surgical technique. The x 200 mm guide pin should be positioned as described in the AEQUALIS Reversed II surgical technique. (Figure 1) OverviewThis technique contains instructions for the use of the Threaded Post Baseplate, which is an expanded offering of the AEQUALIS Reversed II product family. The Threaded Post Baseplate is an alternative to the existing AEQUALIS Reversed II press-fit baseplate.

2 The surgeon has to evaluate the bone quality preoperatively in order to decide if he uses the Threaded Post Baseplate or the Press Fit Baseplate. Intended UsePlease refer to the AEQUALIS Reversed II surgical technique for a complete list of indications. Figure 1 Surgical Steps4 Note: It is recommended to stop drilling as soon as the far cortex is reached in order to produce an accurate depth measurement in the following step. Direct palpation of the guide pin tip is recommended to confirm the pin is exiting the anterior cortex and ensure the tip is barely protruding for an accurate length measurement in subsequent Depth EvaluationOnce the pin is in place, the length of the pin inside the scapula is evaluated using the pin gauge. The pin gauge is slid over the mm guide pin and the length of the pin inside the scapula is read using the end of the pin as a measurement marker to indicate the depth. (Figure 2) This evaluated length is an indication for the correct position of the pin.

3 The desired position is slightly anterior, so that the threaded post can exit with its tip through the anterior cortical wall to ensure cortical fixation is is recommended to reposition the pin anteriorly when the evaluated depth is significantly longer than 35 mm and repositioned posteriorly when it is significantly shorter than 25 mm. This will ensure that cortical fixation is achieved at the tip of the glenoid is then reamed over the guide wire with the corresponding baseplate reamer ( 25 mm or 29 mm) and peripheral reamer ( 36 mm or 42 mm) as described in the AEQUALIS Reversed II surgical technique. (Figure 3) Figure 3 Figure 25 Note: Standard baseplates are available in 30 and 35 mm post lengths. Baseplates with post lengths above or below these sizes are available upon request only. 6 Figure 7 Note: To ensure an accurate evaluation of the final implant length, make sure the tip of the depth gauge is contacting the glenoid surface.

4 Positioning the tip of the depth gauge inside hole will result in an incorrect : 4, 5 and 6 mm drill bits are available for gradual preparation of the central hole , if desired. (Figure 6) The first drill bit is used over the initial guide pin. Increasing diameter drills are used until the final mm drilling step is hole DrillingThe glenoid central hole is drilled over the guide wire using the cannulated mm drill bit. Laser marks can be used to help determine the final implant length. (Figure 4) Palpation of the drill bit tip can be performed to confirm the drill bit has exited the drilling is performed under power over the guide wire. The drill depth depends on the previously evaluated pin depth: (Figure 5) If the pin depth evaluation is 25 mm or shorter, the drilling should continue until the drill penetrates the cortical wall to ensure the 30 mm threaded post can be fully inserted. If the pin depth is between 25 mm and 30 mm, the drilling should advance to at least 30 mm or until the drill exits the cortex.

5 This will appropriately prepare the glenoid to receive the 30 mm length baseplate. If the pin depth is over 30 mm, the drilling should advance to at least 35 mm or until the drill exits the cortex. This will appropriately prepare the glenoid to receive the 35 mm length GaugeIf additional evaluation of the final implant length is required, the peripheral screw hole depth gauge can be used. (Figure 7) Figure 4 Figure 5 Figure 6253035404550 Counterbore DrillThe starter hole is expanded using the cannulated mm counterbore drill bit under power. (Figure 8) If the pin is removed during the previous step, the drill is centered on the previous hole and performed free-hand. This will prepare the bone for the coated post section of the implant. Drilling should progress until the positive stop reaches the glenoid surface. TappingAfter drilling the central hole , the guide pin is removed and the tap is used in order to prepare the threads of the final implant.

6 Similar to the drill bit, there are depth laser markings on the tap. The tapping depth should be chosen similar to the depth of the drilled central hole . A depth stop can be placed at the desired position in order to stop the tapping at the desired depth. (Figure 9)For post lengths 25, 30, 35 and 40 mm, stop at the level of the corresponding laser mark. For lengths 45 mm and 50 mm stop at the level of the step on the tap, shown on Figure 9. 7 Figure 9 Figure 8 Note: The tap stopper can be Clicked to the next position, so it is important to stop once the tap stop is flush with the glenoid surface. (Figure 10) The tap stopper is not needed for 45 and 50 mm : When tapping, it is important to maintain alignment to the axis of the previously drilled : Tapping has to be done manually using the AEQUALIS Reversed II handle (Do not use with power).Shown with depth stopShown without depth stop35403025303540 Figure 10 Note: Tapping is mandatory in order to prevent glenoid fracture.

7 8 Note: The baseplate should be seated completely onto the prepared glenoid surface. Use three finger tightening technique to avoid over-tightening or excessive advancement of the baseplate into the subchondral bone. Gaps between the baseplate and glenoid surface should also be avoided. Introduction of the BaseplateThe final baseplate is chosen according to the prepared hole (30 or 35 mm for standard implant) and the reamed glenoid surface ( 25 mm or 29 mm). The glenoid baseplate is attached to the baseplate holder through its central hole using a screw in the central shaft of the handle. Care should be taken to ensure that the two pegs on the impactor seat properly into their respective holes on the implant baseplate. (Figure 11) The baseplate is carefully threaded into the prepared hole . It is important to continuously check the orientation of the baseplate relative to the prepared hole and reamed surface to ensure accurate implantation of the baseplate.

8 (Figure 12) Once the baseplate is seated flush on the glenoid surface (Figure 13), the baseplate holder is detached from the 11 Figure 12 Figure 13+/-20 Note: It is important to avoid angling the drill guide and drill too close to the post in order to avoid any damage to the post and compromising fixation. The screw length is read directly on the drill guide by locating the laser mark on the drill through the window on the drill guide. (Figure 16) If desired, a standard depth gauge is Screw DrillingOnce the baseplate is implanted, the 4 peripheral holes are prepared using the 3 mm drill bit and the locking screw drill guide from the Reversed II instrumentation. (Figure 14a) All 4 holes of the threaded post baseplate are multidirectional locking screws and can be angled up to 20 away from the central post and 0 toward the post. The screws can also be angled +/-20 parallel to the post. (Figure 14b) The direction of the drill axis is chosen by free orientation of the drill guide.

9 The 3 mm drill bit is passed through the guide and the hole is drilled bicortically. (Figure 15)It is desirable to have the superior screw in the base of the Coracoid and the inferior screw in the pillar of the Scapula, where the best bone fixation of the screws can be achieved. Figure 14aFigure 14bFigure 1550454035302520 Figure 1610 Peripheral Screw Fixation After drilling each hole , the measured screws are inserted into the drilled hole and fully tightened with the mm screwdriver. (Figure 17) The baseplate implantation is finalized once all screws are seated. (Figure 18)Sphere FixationAfter implantation of the baseplate and screws, the sphere is impacted and screwed into the threaded post baseplate using the same technique described in the AEQUALIS Reversed II surgical technique. (Figure 19) All AEQUALIS Reversed II spheres are compatible with the threaded post 17 Figure 19 Figure 18 Note: The threaded post baseplate contains 2 mm of lateral offset, therefore, there is always a gap of 2 mm between the sphere and the glenoid ImplantsReferenceDescriptionQuantityDWE7 30 25 x 30 mm1 DWE735 25 x 35 mm1 DWE830 29 x 30 mm1 DWE835 29 x 35 mm1 Single UseReferenceDescriptionQuantityDWD063** mm Alignment Pin L200 mm (Sterile)**MWF715* mm Modified Guide Pin (Non-sterile)* *Upon request only**Included in Rev II Single Use InstrumentsSpecial Order Implants*ReferenceDescriptionQuantityDWE 725* 25 x 25 mm1 DWE740* 25 x 40 mm1 DWE825* 29 x 25 mm1 DWE840* 29 x 40 mm1 DWE845* 29 x 45 mm1*Upon request onlyInstrumentationThreaded Post Baseplate Implants12 ReferenceDescriptionQuantityMWF713 Pin Gauge1 MWF711 Drill Bit Dia.

10 Bit Dia. p1 MWF716 Tap Depth Stop1 MWF717 Drill Bit Dia. 4 mm1 MWF718 Drill Bit Dia. 5 mm1 MWF719 Drill Bit Dia. 6 mm1 MWF710 Baseplate Holder1 Ref: YKAD98713 Cobalt ChromeReferenceDescriptionQuantityDWH901 33 mm - 10 Tilted Glenoid Sphere 25 mmDWH902 33 mm Lateralized +6 mm -DWH903 33 mm Lateralized +8 Glenoid SphereDWD180 36 mm Centered Glenoid Sphere DWD181 36 mm 10 Tilted Glenoid SphereDWD182 36 mm Eccentric + 2 mm Glenoid SphereDWH904 39 mm Centered Glenoid SphereDWH905 39 mm 10 Tilted Glenoid SphereDWH906 39 mm Eccentric + 2 mm Glenoid SphereDWD183 42 mm Centered Glenoid SphereDWD184 42 mm 10 Tilted Glenoid SphereDWD185 42 mm Eccentric + 2 mm Glenoid SphereDWD190 or DWB935 36 mm Centered Glenoid Sphere 29 mmDWD191 36 mm 10 Tilted Glenoid SphereDWD192 36 mm Eccentric + 2 mm Glenoid SphereDWH907 39 mm Centered Glenoid SphereDWH908 39 mm 10 Tilted Glenoid SphereDWH909 39 mm Eccentric + 2 mm Glenoid SphereDWD193 or DWB936 42 mm Centered Glenoid SphereDWD194 42 mm 10 Tilted Glenoid SphereDWD195 42 mm Eccentric + 2 mm Glenoid