Stryker Triathlon Instruction Manual

Surgical
Protocol
Orthopaedics
TRIATHLON®
Single-Use Instruments

Triathlon®Knee System
Single-Use Instruments Surgical Protocol
Table of Contents
Indications .............................................................2
Exposure ...............................................................6
Tibial Preparation ......................................................6
Rotational Alignment ..................................................6
Varus/Valgus Alignment ...............................................7
Flexion/Extension Alignment ...........................................7
Establishing the Tibial Resection Level ...................................8
Final Tibial Resection ..................................................9
Femoral Preparation ................................................... 10
Femoral Intramedullary Alignment .....................................10
Distal Femoral Resection ..............................................14
Femoral A/P Sizing ...................................................15
Femoral Anterior, Posterior, and Chamfer Resections .....................18
PS Box Preparation ...................................................20
Femoral Trial Assessment..............................................21
Tibial Component Sizing ............................................... 24
Tibial Keel Punching ..................................................25
Patella Preparation .................................................... 26
Trial Assessment .....................................................27
Component Implantation .............................................. 28
PS or CR Femoral Component – Cemented/Cementless ...................28
Tibial Component Implantation – Cemented/Cementless ..................29
Tibial Insert Implantation .............................................30
Patellar Component – Cemented/Cementless ............................30
Closure............................................................... 31
Catalog............................................................... 32
1

Triathlon®Knee System
Single-Use Instruments Surgical Protocol
Indications
General Total Knee Arthroplasty (TKA) Indications include:
• Painful, disabling joint disease of the knee resulting from: noninammatory
degenerative joint disease (including osteoarthritis, traumatic arthritis, or avascular
necrosis), rheumatoid arthritis or post-traumatic arthritis.
• Post-traumatic loss of knee joint conguration and function.
• Moderate varus, valgus, or exion deformity in which the ligamentous structures
can be returned to adequate function and stability.
• Revision of previous unsuccessful knee replacement or other procedure.
• Fracture of the distal femur and/or proximal tibia that cannot be stabilized by
standard fracture management techniques.
Additional Indications for Posterior Stabilized (PS) Components:
• Ligamentous instability requiring implant bearing surface geometries with
increased constraint.
• Absent or non-functioning posterior cruciate ligament.
• Severe anteroposterior instability of the knee joint.
e Triathlon Total Knee System beaded and beaded with Peri-Apatite components
are intended for uncemented use only.
e Triathlon Tritanium Tibial Baseplate and Tritanium Metal-Backed Patella
components are indicated for both uncemented and cemented use.
e Triathlon All-Polyethylene tibial components are indicated for cemented use only.
2

Contraindications
• Any active or suspected latent infection in or about the knee joint.
• Distant foci of infection which may cause hematogenous spread to the implant site.
• Any mental or neuromuscular disorder which would create an unacceptable risk of
prosthesis instability, prosthesis xation failure, or complications in postoperative care.
• Bone stock compromised by disease, infection or prior implantation which cannot
provide adequate support and/or xation to the prosthesis.
• Skeletal immaturity.
• Severe instability of the knee joint secondary to the absence of collateral ligament
integrity and function.
e Triathlon Single-Use Instruments are intended for use in a single
Total Knee Arthroplasty.
See package insert for warnings, precautions, adverse eects and other essential
product information.
Patient Counseling
Surgeons should discuss all relevant contraindications, adverse eects and the need for
post-implantation protection with their patients.
3

Triathlon®Knee System
Single-Use Instruments Surgical Protocol
CR Tibial
Tibial Sizers Tibial Sizers
CR Femoral
4
Triathlon CR Single-Use Femoral Prep Kit
Part Numbers Size
5555-2201 1
5555-2202 2
5555-2203 3
5555-2204 4
5555-2205 5
5555-2206 6
5555-2207 7
5555-2208 8
Triathlon CR Single-Use Tibial Prep Kit
Part Numbers Size
5555-2321 1
5555-2322 2
5555-2323 3
5555-2324 4
5555-2325 5
5555-2326 6
5555-2327 7
5555-2328 8
Triathlon Single-Use Tibial Sizer Prep Kit
Part Number Sizes
5555-4600 1 – 8

Tibial Sizers Tibial Sizers
PS Tibial
PS Femoral
5
Triathlon PS Single-Use Femoral Prep Kit
Part Numbers Size
5555-2251 1
5555-2252 2
5555-2253 3
5555-2254 4
5555-2255 5
5555-2256 6
5555-2257 7
5555-2258 8
Triathlon PS Single-Use Tibial Prep Kit
Part Numbers Size
5555-2361 1
5555-2362 2
5555-2363 3
5555-2364 4
5555-2365 5
5555-2366 6
5555-2367 7
5555-2368 8
Triathlon Single-Use Tibial Sizer Prep Kit
Part Number Sizes
5555-4600 1 – 8

Figure 1
Exposure
>A standard anterior midline incision can be utilized.
Any previous incision can be used or incorporated
to decrease risk of skin slough.
>e capsule can be entered through a modied mid-
vastus approach, which makes a skin incision medial
to the patella from just above the tibial tubercle to
just above the patella.
>Use a so tissue approach that allows adequate
patella visualization and sucient knee exion.
6
Tibial
Preparation
Triathlon®Knee System
Single-Use Instruments Surgical Protocol
Figure 3
is surgical technique describes cutting the tibia rst,
followed by the femur and then patella. e sequence
may be varied based upon surgeon preference.
In some patients it may be dicult to cut the femur rst
and get proper rotation due to the tibia being in the way
of the placement of the femoral sizer. In these cases it
may be benecial to cut the distal femur, then tibia, and
then go back to size and nish the femoral cuts.
Tibial Preparation
>e tibia is prepared using the Triathlon
extramedullary alignment system. Retractors may be
placed medially, laterally, and posteriorly to expose
the tibial plateau for preparation. It is important to
remove all osteophytes, menisci and remaining so
tissues. Menisci can be removed before or aer the
bone cut. If the PCL has been retained, an optional
retractor is available to cradle the PCL for increased
exposure. e knee is exed anywhere from 45
degrees to more than 90 degrees of exion depending
on surgeon preference. e tibia may be subluxed or
dislocated as required.
>e tibial plateau referencing arm of the proximal
rod is placed on the proximal tibia just anterior to
the ACL insertion. A rongeur may remove any
osteophytes that prevent satisfactory positioning.
Rotational Alignment
>e assembly must be in the proper rotational
alignment. e most common landmark referenced
is the tibial tubercle. e assembly should be
aligned with the medial third of the tibial tubercle.
>Once the rotational alignment is determined, a
headless pin is placed through the posterior xation
hole in the proximal assembly to lock it in place.
Either the anterior or posterior xation holes may
be used to set the exion extension and rotational
alignment.
Figure 2
Headless
Pin
Locking
Switch
12

Instrument Bar
7
Tibial
Preparation
Varus-Valgus Alignment
>Once the proximal portion of the assembly is xed, varus-valgus
alignment can be attained by adjusting the distal assembly to the proper
medial/lateral position. e position should be in the center of the talus,
not the center of the ankle. e center of the talus usually resides 5 to
10mm medial to the mid-point between the medial and lateral malleoli.
>Medial/lateral oset can be adjusted by pushing the bronze button on the
anterior portion of the distal assembly 1. Once alignment is achieved,
the bronze button is released and the assembly is xed in place.
>e proper tibial resection should be 0 degrees in the coronal plane of the
tibia.
Figure 4
Flexion-Extension Alignment
>Once rotational alignment is determined, the ankle clamp is placed just
proximal to the ankle at the level of the maleolus. e distal assembly
locking switch, located approximately halfway up the rod, is then
locked. Adjustments to the exion extension alignment can be made by
depressing the button located on the inferior le hand side of the distal
assembly 2.
>Flexion and extension alignment is proper when the long axis of the
assembly parallels the weight-bearing axis of the tibia in both the coronal
and sagittal planes. Usually, there is less space between the assembly
and the tibia proximally than there is distally. Alignment can be veried
using the universal alignment tower and universal alignment rod, which
can be assembled to the anterior inferior hole on the tibial adjustment
housing.
> e proper tibial resection should be 0 to 3 degrees of slope in the
sagittal plane, depending on surgeon preference and the type of implant
used.
Note: It is important that there is no anterior slope in the tibial resection.
6541-6-700
MIS Uncaptured Tibial Resection Guide-Right
6541-6-701
MIS Uncaptured Tibial Resection Guide-Le
6541-6-702
MIS Captured Tibial Resection Guide-Right
6541-6-703
MIS Captured Tibial Resection Guide-Le
6541-2-609
Tibial Alignment Ankle Clamp EM
6541-2-610
Tibial Alignment Distal Assembly EM
0º slope 6541-2-704
3º slope 6541-2-705
Tibial Adjustment Housing
6541-2-429
Tibial Stylus
6541-6-611
MIS Proximal Rod EM
1
2

8
Tibial
Preparation
Triathlon®Knee System
Single-Use Instruments Surgical Protocol
Figure 5
Figure 6
Establishing the Tibial Resection Level
>Once the tibial assembly is xed in place, the tibial
resection level must be established using the tibial
stylus. is attaches to the tibial resection guide
referencing either the lowest level of the aected
compartment or the highest level of the unaected
compartment. Typically, in a varus knee, the lateral
compartment is relatively unaected so placing the
“9” referencing end on the unaected lateral side
will insure at least a 9mm thickness for the tibial
component. If the surgeon desires a thicker tibial
component or if there is a defect on the medial side
of the tibia necessitating resection, further resection
can be made.
>To reference the lateral compartment, retraction of
the proximal rod arm is performed by pressing the
bronze button 1, and sliding the arm away from
the knee 2.
>Alternatively, by placing the tibial resection guide
with the “2” referencing end, the resection carried
out would be 2mm lower then the point chosen.
For a coarse gross adjustment, the bronze wheel can
be pressed and the assembly slid up or down. For
the nal ne adjustment, the bronze wheel is turned
to the right to move the assembly up the proximal
rod or turned le to move the assembly down the
proximal rod.
Tip: When using the stylus, it is important to make
sure the construct is under tension. is will help
ensure adequate resection levels.
>Once the nal position is chosen, two headless pins
are drilled into the “0” neutral holes securing the
level of the tibial resection guide. For additional
stability, the oblique “X” pinhole can be utilized.
Once the tibial resection guide is secured, all
alignment instruments are removed.
Referencing the medial
compartment
Referencing the lateral
compartment
1
2

Figure 7
Instrument Bar
9
Final Tibial Resection
>Once all alignment instruments are removed leaving
the tibial resection guide in place, the proximal tibia is
osteotomized using either the right or le captured or
uncaptured tibial resection guide. If the entire resection
cannot be completed, the guide is removed and the
resection completed free-hand. Care must always be
taken not to injure the patella tendon, neurovascular
structures, or collateral ligaments. Oen some bone is
le unresected near the posterior aspect of the lateral
tibial plateau and the anterior aspect of the lateral tibial
plateau near Gerdy’s tubercle. Once the resection guide
is removed, nal resection can be completed either with
an oscillating saw, bone le or a rongeur.
Note: Leaving the pins in place will allow for an additional
2mm or 4mm of tibial resection. e pins must be removed
prior to cutting the tibial keel.
Tibial
Preparation
6541-6-700
MIS Uncaptured Tibial Resection Guide-Right
6541-6-701
MIS Uncaptured Tibial Resection Guide-Le
6541-6-702
MIS Captured Tibial Resection Guide-Right
6541-6-703
MIS Captured Tibial Resection Guide-Le
6541-4-003
Headless Pins - 3”
6541-2-609
Tibial Alignment Ankle Clamp EM
6541-2-610
Tibial Alignment Distal Assembly EM
0º slope 6541-2-704
3º slope 6541-2-705
Tibial Adjustment Housing
6541-2-429
Tibial Stylus
6541-6-611
MIS Proximal Rod EM

Figure 8
Figure 9
Figure 10
Femoral Preparation
Femoral Intramedullary Alignment
>e Universal Driver allows for attachment of
all drills and pins. e Universal Driver may be
attached directly to a reamer, drill, or a Jacob’s
Chuck.
>Locate the IM drill hole; it is approximately 1cm
anterior to the femoral attachment of the posterior
cruciate ligament and slightly medial to the midline
of the distal femur.
>Identication of landmarks may be aided by
removal of osteophytes from the margins of the
intercondylar notch.
>Attach the 3
/ 8” IM Drill to the Universal Driver and
drill into the IM canal ensuring that the drill is
parallel to the sha of the femur. e rst diameter
will create a tight t around the IM Rod. If further
clearance is desired, continue to drill until the larger
step diameter opens the hole. is will allow the IM
canal to dictate the position of the rod avoiding the
need to “toggle” the drill to create clearance.
10
>Attach the T-Handle Driver to the 5 / 16” IM Rod.
Insert the IM Rod into the MIS Femoral Alignment
Guide. e MIS Femoral Alignment Guide is
designed for use on either the le or right knee and
may be set between 2° and 9° of valgus (Note: this is
typically set between 5° and 7°). Set the instrument
to the desired angle by pulling back on the black
knob of the MIS Femoral Alignment Guide and
placing it in the appropriate notch. Advance the
rod, with attached guide, slowly up the IM canal
until the desired depth is reached ensuring that the
alignment guide is ush against the most prominent
condyle.
>Snap the MIS Distal Resection Guide onto the MIS
Adjustment Block and insert the posts of the MIS
Adjustment Block into the two holes in the MIS
Femoral Alignment Guide.
>Place the MIS Femoral Alignment Guide in contact
with the more prominent distal femoral condyle and
align the guide in neutral I/E rotation. e guide
face is angled at 3° and has a tick mark to reference
Whiteside’s Line to set I/E rotation, if desired.
>Insert 1
/ 8” headless pins into the converging pinholes
on the MIS Femoral Alignment Guide to aid in
stabilization.
Femoral
Preparation
Triathlon®Knee System
Single-Use Instruments Surgical Protocol

Figure 11
Instrument Bar
11
>Position the leg in 45°-60° of exion.
>e MIS Adjustment Block allows for a 2mm through 12mm
resection level.
>Press the black button on the end of the MIS Adjustment Block
and push/pull the carrier to set the resection to the desired level.
Figure 12
>e Triathlon MIS Knee System Instruments allow for a clear
view of the bone that is being resected to ensure the appropriate
level is set.
>Slide the Adjustment Block Assembly posteriorly within the
Femoral Alignment Guide until the Distal Resection Guide
contacts the anterior surface of the femur.
Femoral
Preparation
6541-4-801
Universal Driver
6541-4-538
3/8” IM Drill
6541-4-800
T-Handle Driver
6541-4-516
5/16” IM Rod
6541-5-601
MIS Femoral Adjustment Block
6541-5-629
MIS Femoral Alignment Guide
6541-5-721
MIS Distal Resection Guide - Le
6541-5-722
MIS Distal Resection Guide - Right
6541-4-003
Headless Pins - 3”
Button

Figure 14
Optional Check
>Prior to pinning the Distal Resection Guide to the
femur, an optional external alignment check may
be performed. Attach the Femoral EM Alignment
Tower to the MIS Femoral Adjustment Block and
insert a Universal Alignment Rod into the handle.
>Alignment is correct when the rod intersects the
center of the femoral head and roughly parallels the
axis of the femur in the lateral view.
>Once satisfactory alignment is achieved, remove the
Femoral EM Alignment Tower and the Universal
Alignment Rod.
12
>Pin the Distal Resection Guide to the anterior
femur using Headless Pins. Insert the pins into
the Headless Pin Driver (which is inserted into the
Universal Driver) and drill through the set of holes
marked “0” on the Distal Resection Guide. e pins
are automatically released from the driver as it is
pulled back.
Note: Ensure that 1/2” of the pin is protruding from all
guides aer insertion. is will aid in pin removal.
Figure 13
Femoral
Preparation
Triathlon®Knee System
Single-Use Instruments Surgical Protocol

Figure 15
Instrument Bar
13
>Pinning through the “X” pin hole will aid in further
securing the guide.
>Aer the Distal Resection Guide is pinned in place,
remove headless pins from the Femoral Alignment
Guide and remove the IM rod. e Femoral
Alignment Guide and the Adjustment Block may be
removed by pressing the black button on top of the
Adjustment Block.
Femoral
Preparation
6541-5-601
MIS Femoral Adjustment Block
6541-7-808
MIS Femoral EM Alignment Tower
6541-4-801
Universal Driver
6541-4-602
Universal Alignment Rod
6541-4-809
Headless Pin Driver
6541-5-721
MIS Distal Resection Guide - Le
6541-5-722
MIS Distal Resection Guide - Right
6541-5-629
MIS Femoral Alignment Guide
“X”
Pin-hole

Figure 16
Figure 17
Distal Femoral Resection
>e distal resection level may be altered by
repositioning the Distal Resection Guide in the 2
holes. is will remove an additional 2mm of bone.
>Once the nal resection level is determined, the
distal femoral resection is made. An optional
Modular Capture can be attached to the Distal
Resection Guide.
>e Triathlon MIS Knee System Instruments are
designed to provide control of the saw blade during
bone resections. When using captures or cutting
through slots, a .050” (1.25mm) thick blade is used.
14
>Remove the modular capture and check the
resection for atness.
>Remove the Headless Pins in the Distal Resection
Guide using the Pin Puller.
>Remove the Distal Resection Guide and check the
resection for atness.
Note: If the “X” pin hole is used, the pin must be
removed prior to repositioning or removing the Distal
Resection Guide.
Femoral
Preparation
Triathlon®Knee System
Single-Use Instruments Surgical Protocol

Figure 18
Instrument Bar
15
Femoral A/P Sizing
>Pre-assemble the MIS Femoral Sizer Body (Le
or Right) onto the MIS Femoral Sizer Adjustment
Housing
>Place the MIS Femoral Sizer Assembly onto the
resected distal femur, sliding the feet of the Sizer
under the posterior condyles.
>External rotation (0-6° Le or Right) is set by
depressing the black button on the top of the
Femoral A/P Sizer and rotating mediolateral.
For mechanical alignment set rotation in order to
cut parallel to the epicondylar axis.
>Assemble the MIS Femoral Stylus to the MIS
Femoral Sizer and extend the stylus over the lateral
ange to rest on the anterior cortex of the femur at
the desired run-out point of the anterior resection.
Note: e MIS Femoral Stylus uses two sizing
references. First, read the A/P scale by viewing the
position of the indicator lip of the femoral stylus
against the A/P scale on the medial side of the A/P
sizer. Second, adjust the superior/inferior position of
the stylus to match the rst A/P scale reading. Check to
verify the two sizing references match. If the A/P scale
reading then changes, reset the S/I stylus position to
the newly indicated reading. Repeat steps until the two
readings converge.
Femoral
Preparation
6541-5-721
MIS Distal Resection Guide - Le
6541-5-722
MIS Distal Resection Guide - Right
6541-5-723
MIS Modular Distal Capture
6541-4-003
Headless Pins - 3”
6633-7-605
Pin Puller
6541-5-500
MIS AP Sizer Adjustment Housing
6541-5-508
MIS AP Sizer Body - Le
6541-5-509
MIS AP Sizer Body - Right
6541-5-510
MIS Femoral Stylus
A/P
Scale
Rotation
Adjustment
A/P Translation
Adjustment
“EPI”
Line
Indicator

Figure 19
Figure 20
Figure 21
>It is important that the Femoral Stylus point rests
on bone and not so tissue or an osteophyte. In an
MIS procedure this may be hard to see.
16
>e Femoral Sizer can be pinned in place through
the holes marked “X” with Headed Pins.
Note: If the femoral stylus reads in-between sizes, an
optional A/P translation feature may be used. Simply
use the Hex Driver found on the reverse side of the
Femoral Flexion Impactor to translate the
A/P Femoral Sizer up or down 1.5mm. (Triathlon
Primary prosthesis grows in the anterior direction
approximately 3mm between sizes.)
>A tertiary check to verify external rotation is to
assess A/P axis with the Blade Runner through the
slot in the top of the guide.
Femoral
Preparation
Triathlon®Knee System
Single-Use Instruments Surgical Protocol
“X” Holes “X” Holes

Figure 22
Instrument Bar
17
>Once size conrmation is complete, attach the 1/8” Peg Drill to the
Universal Driver and create xation pin holes (for the 4:1 Cutting
Block) through the holes on the face of the Femoral Sizer marked
“EPI”.
>Remove the Headed Pins using the Headed Pin Extractor.
Note: With the use of the Single-Use 4:1 Cutting Block there is the
potential for debris generation. It is recommended that the saw blade be
fully inserted into the slot prior to initiating oscillation. Additionally, it is
recommended that an irrigation system be available and that the joint be
thoroughly irrigated aer use of the block.
Femoral
Preparation
6541-5-500
MIS AP Sizer Adjustment Housing
6541-5-508
MIS AP Sizer Body - Le
6541-5-509
MIS AP Sizer Body - Right
6541-5-510
MIS Femoral Stylus
6541-4-802
1/8” Hex Drive
6541-4-518
1/8” Peg Drill
6541-4-801
Universal Driver
6541-4-300
Headed Pin Impactor Extractor
6541-4-515
Headed Nails - 1 1/2”
Figure 23
>Locate the xation pegs of the appropriate size Single-Use 4:1 Cutting
Block into the pin holes created on the distal femur.
See Catalog
Triathlon Single-Use Instruments
Femoral Prep Kit
Single-Use 4:1 Cutting Block

Figure 24
Figure 25
Figure 26
>Impact the Single-Use 4:1 Cutting Block ush
against the distal bone using a Femoral Impactor
or by directly impacting on to the surface of the
Cutting Block.
18
>Stabilize the 4:1 cutting block by placing headless
pins in the medial and lateral angled pin holes.
Verify stability.
Note: To conrm appropriate
femoral size, check run-out of
the anterior cut. If not ush with
anterior cortex, consider selecting
the next smaller size Single-Use
4:1 Cutting Block. As a secondary
check, femoral M/L width sizing
can be veried by utilizing the
width of the Single-Use 4:1
Cutting Block as marked on the
backside of the block.
Femoral Anterior, Posterior and
Chamfer Resections
>Complete the remaining four femoral bone
resections. e use of a .050” (1.25mm) thick saw
blade is recommended.
>e order of bone resections is not critical; however,
a recommended sequence for improved stability of
the 4:1 Cutting Block is:
1. Anterior cortex.
2. Posterior condyles.
3. Posterior chamfer.
4. Anterior chamfer.
Note: Fully insert blade into the cutting slot of
the Single-Use 4:1 Cutting Block before initiating
oscillation of saw blade. Cutting the anterior chamfer
last helps to stabilize the Single-Use 4:1 Cutting Block.
Femoral
Preparation
Triathlon®Knee System
Single-Use Instruments Surgical Protocol