1
`
`S&N EXHIBIT 1032
`S&N v. BSI
`IPR2013-00629
`
`
`
`S&N EXHIBIT 1032
`S&N v. BSI
`IPR2013-00629
`
`
`
`LACEY CONDYLAR TOEAL KNEE
`SURGICAL PROCEDURE
`
`1.The extremity is prepped and draped in the usual
`manner. An anterior 5-6 inch midline incision is made
`with the knee flexed to 90 degrees. The knee is then
`placed in extension and dissection carried out in line
`with the skin incision down through the medial retinac-
`ulum. Subperiosteal flaps are developed medially and
`laterally about the metaphyseal flares. The patella is
`reflected laterally and the knee flexed to 90 degrees.
`The anterior portion of the menisci are excised and
`
`2. A drill hole is placed in the intercondylar region
`of the femurjust above the interspinous eminence of .
`the tibia. This is to anchor the proximal end of the tibial
`guide centered at the mid portion of the tibia.
`
`the anterior cruciate ligament incised.
`
`DOW CORN/NG e
`WRIGHT
`
`©DOW COFlNlNG WRIGHT
`Developed by:
`J . Allen Lacey, M.D.
`Jewett Orthopaedic Clinic
`Winter Park, Florida
`
`2
`
`.
`
`FORM No.Los5»o2o.:
`
`
`
`3. The tibial guide may be set at zero or three degrees
`of varus. The knee is placed at8O to 90 degrees offlexion
`and the distal portion of the tibial guide centered with
`the “Y" portion placed just proximal to the malleoli. The
`set screws are secured. Visually the amount of tibial
`plateau to be removed is located with the transverse
`portion of the guide and the set screw secured. it is
`important at this point to maintain the degree of flexion
`of the knee or the depth of cut may change.
`
`4. The tibial plateaus are osteotomized placing the
`oscillating saw flush against the transverse portion of
`the guide. The tibial cutting guide is removed. The
`osteotomies through the tibial plateaus are completed.
`
`3
`
`
`
`
`
`5.Two vertical cuts are made just medially and
`laterally to the interspinous eminence to protect the
`posterior cruciate ligament.
`
`_..r'* ‘'
`-"
`
`.
`
`incision
`6. The knee is placed in extension and a
`made in the synovial recess off the anterior femur. A
`plane is developed between the soft areolar tissue and
`the periosteum. Care should be taken not to strip the
`»
`periosteum from the anterior portion of the femur. The
`desired amount of valgus is selected in the femoral .
`guide. This can be either 5, 7, 9 or 11 degrees. Generally
`9 degree is used. This guide may be used on either
`the right or left femur.
`
`4
`
`
`
`7. The locator pin is inserted into the distal end of
`the femoral alignment guide which determines the
`correct amount of bone removed with the transverse
`valgus cut. The femoral guide is then inserted along
`the anterior shaft of the femur until the locator pin stops
`the femoral guide in the inter—condy|ar notch. The
`locator pin should be aligned perpendicular to a plane
`along the posterior femoral condyles. Generally, if
`there is no angular deformity, the locator pin will point
`down the shaft of the tibia. This may be checked by
`placing a straight edge transversely along the posterior
`femoral condyles to make sure the locator pin is per-
`pendicular to the condyle. This positioning determines
`the correct rotation of the femoral prosthesis. The
`femoral alignment guide is attached to the femur
`with the alignment clamp.
`
`
`
`8. The locator pin is removed and the distal femoral
`cutting guide is attached to the femoral alignment
`guide. The guide is positioned so that it rests along
`the anterior femoral condyles. The set screw is secured
`with the locator pin. An osteotomy saw is placed along
`the superior margins of the femoral guide and the
`transverse out is now performed.
`
`
`
`5
`
`5
`
`
`
`
`
`9. The distal femoral cutting guide is removed and
`the osteotomy is completed.
`
`10. Generally, the largest A-P cutting guide applicable
`to the individual patient should be selected so that the
`corresponding prosthesis will provide stability with the
`knee in flexlon. The A-P cutting guide is applied with
`the locator pin in the anterior hole to determine the
`first cut. This cut is made flush with the anterior shaft
`of the femur to displace the prosthesis as far poste-
`riorly as possible.
`
`6
`
`
`
`
`
`11. The second cut is made along the anterior bevel
`of the A-P cutting guide and the third out along the
`posterior margin of the guide.
`
`3 12: The post holes are drilled through the template
`using a 3/a" drill bit.
`
`7
`
`
`
`13. All the cuts using the femoral guide are now com-
`pleted and the guide and clamp are removed. The 45°
`posterior beveled osteotomies are made at the junc-
`tions of the posterior osteotomy sites.
`
`
`
`
`
`14. The patella is osteotomized with a thin out passing
`through the medial and lateral facets. A %" drill hole
`is placed in the center of the patella. The margins are
`slightly undercut with a small right angle curet.
`
`.
`
`
`
`8
`
`
`
`15. A Hohman retractor is placed posteriorly to
`the tibia and the proximal tibia displaced anteriorly.
`A Hohman retractor is also placed laterally to displace
`the extensor mechanism out of the wound. The re-
`maining interspinous eminence is removed except for
`the portion remaining with the insertion of the posterior
`cruciate ligament. The margins of the remaining inter-
`spinous eminence are trimmed with rongeurs.
`
`16. The anchor hole for the tibial stem is outlined
`with a small osteotomy saw and a punch used to impact
`the bone plug for better cement fixation.
`
`9
`
`
`
`17. Hohman retractors are again placed posteriorly
`and laterally and the tibia displaced ante-riorly. A tibial
`trial component is selected and inserted into the tibia.
`If there is any impingement, the trial is removed and
`the bone excised with rongeurs.
`
`18. After good seating of the tibial trial is obtained.
`a Hohman retractor is used to elevate the femur overthe
`dome of the tibial trial and the femoral trial inserted.
`
`10
`10
`
`
`
`11
`
`
`
`12
Accessing this document will incur an additional charge of $.
After purchase, you can access this document again without charge.
Accept $ Charge
Still Working On It
This document is taking longer than usual to download. This can happen if we need to contact the court directly to obtain the document and their servers are running slowly.
Give it another minute or two to complete, and then try the refresh button.
A few More Minutes ... Still Working
It can take up to 5 minutes for us to download a document if the court servers are running slowly.
Thank you for your continued patience.
This document could not be displayed.
We could not find this document within its docket. Please go back to the docket page and check the link. If that does not work, go back to the docket and refresh it to pull the newest information.
Your account does not support viewing this document.
You need a Paid Account to view this document. Click here to change your account type.
Your account does not support viewing this document.
Set your membership
status to view this document.
With a Docket Alarm membership, you'll
get a whole lot more, including:
- Up-to-date information for this case.
- Email alerts whenever there is an update.
- Full text search for other cases.
- Get email alerts whenever a new case matches your search.
One Moment Please
The filing “” is large (MB) and is being downloaded.
Please refresh this page in a few minutes to see if the filing has been downloaded. The filing will also be emailed to you when the download completes.
Your document is on its way!
If you do not receive the document in five minutes, contact support at support@docketalarm.com.
Sealed Document
We are unable to display this document, it may be under a court ordered seal.
If you have proper credentials to access the file, you may proceed directly to the court's system using your government issued username and password.
Access Government Site
