Zimmer Biomet OSS Compress User manual

OSS™Orthopedic Salvage System
Compress®Device
Surgical Technique

Table of Contents
Quick Reference Guide ............................................................................................. 2
Device Description.................................................................................................... 3
Resection .................................................................................................................. 4
No Face Adapter Provisional Construct ................................................................... 4
Canal Preparation ..................................................................................................... 5
Anchor Plug............................................................................................................... 9
Instrumentation Assembly................................................................................... 9
Instrumentation Assembly Alignment................................................................ 13
Anchor Plug Implantation ................................................................................. 15
Transverse Pins....................................................................................................... 17
Transverse Pin Measurement............................................................................. 17
Transverse Pin Selection ................................................................................... 20
Transverse Pin Insertion .................................................................................... 23
Spindle .................................................................................................................... 28
Diameter Selection ........................................................................................... 28
Face Reaming Assembly.................................................................................... 31
Face Reaming.................................................................................................... 33
Centering Sleeve/Spindle Assembly...................................................................... 35
Spindle Implantation .............................................................................................. 37
Standard Distal Femoral Trialing ........................................................................ 40
Reduced Resection Distal Femoral Trialing ........................................................ 40
Realignment of Spindle...................................................................................... 42
Pin Drilling and Insertion ................................................................................... 42
Final Construct Assembly....................................................................................... 45
Without Locking Cap and Screw ....................................................................... 45
Optional Locking Cap and Screw Assembly ....................................................... 46
Screw Placement Guide.......................................................................................... 48
Utilizing Reduced Resection for a Segmental Distal Femur Replacement ........... 48
Utilizing Taper Adapter for a Distal Femoral Replacement .................................. 49
Utilizing Diaphyseal Segment and Taper Adapter
for a Distal Femoral Replacement .................................................................. 50
Utilizing Reduced Resection for a Proximal Femur Replacement ........................ 51
Utilizing Taper Adapter for a Proximal Femoral Replacement.............................. 52
Utilizing Short Spindle for a Proximal Femoral Replacement............................... 53
Utilizing Short Spindle for a Low Profile Proximal Femur Replacement ............... 54
Tibial Preparation ................................................................................................... 55
The Compress Device utilizes the OSS Orthopedic Salvage System.

2 | Compress Device Surgical Technique
Quick Reference Guide
Compress Resection Chart
Total
Construct
Length
Distal or Proximal
Femoral Component
(cm)
Standard, RS or
Reduced Resection
Segment(s)
Taper Adapter
5 cm
Spindle Collar
1 cm
3 cm 4 cm 5cm 7cm 9 cm 11 cm 13 cm 15 cm 17 cm
30 7 17 5 1
29.5 8.5 15 5 1
29 7 7 9 5 1
28.5 8.5 (7+7) 5 1
28 7 15 5 1
27.5 8.5 13 5 1
27 7 (7+7) 5 1
26.5 8.5 5 7 5 1
26 7 13 5 1
25.5 8.5 11 5 1
25 7 5 7 5 1
24.5 8.5 (5+5) 5 1
24 7 11 5 1
23.5 8.5 95 1
23 7 (5+5) 5 1
22.5 8.5 (4+4) 5 1
22 7 95 1
21.5 8.5 75 1
21 7 (4+4) 5 1
20.5 8.5 (3+3) 5 1
20 7 75 1
19.5 8.5 551
19 7 (3+3) 5 1
18.5 8.5 45 1
18 7 55 1
17.5 8.5 35 1
17 7 45 1
16 7 35 1
14.5 8.5 5 1
13 7 5 1
11 10 Reduced Resection 1
9.5 8.5 Reduced Resection 1
8 7 Reduced Resection 1

3 | Compress Device Surgical Technique
Device Description
The Compress Device was developed as an alternative
method for fixating a segmental construct to host
bone, while creating a stable bone-prosthesis
interface. Unlike a stemmed construct, the Compress
Device was designed to prevent bone resorption by
allowing stress sharing via the implant and bone while
providing a motion free environment suitable for
biologic fixation (Figure 1).
The system is available in two dierent anchor
plug/spindle options: the short Compress Device
requiring 45 mm of medullary placement (particularly
advantageous for bone loss) and the standard
Compress Device requiring 80 mm of medullary
placement (Figure 2). The following surgical technique
will focus on the standard 80 mm anchor plug/spindle
oering.
Note: Please reference the IFU for indications and
contraindications relating to the Compress Device
and OSS implants.
Note: While the 9 and 13 hole anchor plugs exist,
this technique focuses on 5 hole anchor plugs.
If using the 9 or 13 hole anchor plug, additional
instrumentation may be required.
Figure 1 Figure 2
Short Compress Spindle Standard Compress Spindle
Immediate Postoperative 12 Years Postoperative
X-rays compliments of:
James O. Johnston, M.D.
Kaiser Permanente Medical Center
Department of Orthopedic Surgery
South San Francisco, CA.

4 | Compress Device Surgical Technique
Resection
Utilize the Compress Resection Chart on page 2 to
determine the correct implant components needed to
recreate the residual femur.
To achieve a proximal or distal femoral resection,
begin by making a resection mark and a rotational
alignment mark with a cautery device or methylene
blue (Figure 3). Using a freehand transverse cut, resect
the femur at the reference resection mark.
Figure 3 Figure 4 Figure 5
No Face Adapter Provisional
Construct
Following the transverse resection, it is recommended
that the no face adapter provisional be attached to
segmental provisionals in order to ascertain some
semblance of the construct length (Figures 4 and 5).
This is suggested at the onset of the surgery because
once the holes for the transverse pins are drilled
and the anchor plug is secure within the canal, no
additional bone may be resected without dramatically
altering the original replacement length.
Note: If preparing the bone for use with the
Compress reduced resection implants, utilize the
no face adapter provisional with the threaded
connection rather than the quick connect
(32- 4 81114).
For use with the Reduced Resection Implants
Part Number 32-481114
For use with the Standard or Short Implants

5 | Compress Device Surgical Technique
Canal Preparation
After a starter reamer has opened the canal, prepare
the femoral canal for implant insertion by using the
Compress triple reamers (Figure 6).
When used in conjunction with the modular planers,
the triple reamers are preset to the desired reaming
depth and prepare for both the anchor plug and
centering sleeve diameters (Figure 7). This allows the
femoral osteotomy site to be perpendicular to the
longitudinal axis of the femoral shaft.
Note: The triple reamer tips protrude past the
medullary placement to a depth of 65 mm on
the short reamers and 100 mm on the standard
reamers.
Figure 6 Figure 7

6 | Compress Device Surgical Technique
Canal Preparation (cont.)
Sequentially ream with gentle force against the
femoral osteotomy site until full circumferential
cortical contact at the osteotomy site and centering
sleeve location is achieved (Figure 8).
Figure 8

7 | Compress Device Surgical Technique
Centering Sleeve
“B” Diameter
Anchor Plug
“A” Diameter
Canal Preparation (cont.)
The “A” diameter of the final triple reamer will
determine the anchor plug size and the “B” diameter
will determine the centering sleeve size (Figure 9).
Figure 9

8 | Compress Device Surgical Technique
20 mm
Canal Preparation (cont.)
Note: If the triple reamer provides cortical contact
for the anchor plug, but not the centering sleeve,
reintroduce sequential triple reamers to a depth of
20 mm at the resection level until cortical contact
is achieved (Figure 10). Refer to the Triple Reamer
Table for the appropriate anchor plug and centering
sleeve diameters.
Figure 10
Triple Reamer Table
Size
Diameters Use Anchor
Plug
Diameter
Use
Centering
Sleeve
Diameter
“A” (mm) “B” (mm)
10–12 10 12 10 *
11–13 11 13 10 13
12–14 12 14 12 14
13–15 13 15 12 15
14–16 14 16 14 16
15–17 15 17 14 17
16–18 16 18 16 18
17-19 17 19 16 19
18–20 18 20 18 20
19–21 19 21 18 21
20–22 20 22 20 22
21–23 21 23 20 23
22–24 22 24 22 24
*The diameter of the spindle shaft is 12 mm, no centering sleeve necessary

9 | Compress Device Surgical Technique
A
B
13 mm only
Anchor Plug
Instrumentation Assembly
Important: There are two distinct anchor plug
holders in the Compress instrumentation. The first
(Figure 11A) is used without a centering sleeve
provisional when the final reamer at the resection
level is 12 mm. It is also used with centering sleeve
provisionals when the final reamer measures 14
mm through 28 mm.
The second anchor plug holder (Figure 11B) is used only
when the final reamer at the resection level measures
13 mm. This 13 mm anchor plug holder is used without
a centering sleeve provisional.
Slide the anchor plug holder through the cross bar
(Figure 12).
Figure 11 Figure 12

10 | Compress Device Surgical Technique
Anchor Plug (cont.)
Slide the centering sleeve provisional (based on the
final reamer diameter B in the “Canal Preparation”
step) onto the anchor plug holder. Be sure to align the
exposed metal nub inside the provisional with the
female keyway located on the holder. When the
provisional meets the cross bar, lock into place with a
clockwise turning motion (Figures 13 and 14). Confirm
that the centering sleeve provisional fits snugly within
the canal at the osteotomy site.
Figure 13 Figure 14

11 | Compress Device Surgical Technique
Anchor Plug (cont.)
Slide the anchor plug implant (based on the final
reamer diameter A in the “Canal Preparation” step)
into the anchor plug holder. Be sure the male tab of the
holder fits into the female tab of the anchor plug head
(Figure 15). Tighten into position with a clockwise
motion of the anchor plug holder knob (Figure 16).
Figure 15 Figure 16

12 | Compress Device Surgical Technique
Anchor Plug (cont.)
Choose the appropriate drill guide to match the
selected anchor plug (Figure 17).
Place the cross bar through the drill guide (Figure 18).
Figure 17 Figure 18
The small drill guide is used with
the 10 mm-12 mm anchor plugs.
The large drill guide is used with
14 mm-24 mm anchor plugs.

13 | Compress Device Surgical Technique
Anchor Plug (cont.)
Instrumentation Assembly Alignment
Note: All three drill bits and the pin inserter are
packaged with each anchor plug.
Align the drill guide with the anchor plug by placing
one of the short drill bits through the far upper right
hole of both the anchor plug and the drill guide
(Figure 19).
Figure 19 Figure 20
Place the other short drill bit through the far upper left
hole of both the anchor plug and drill guide (Figure 20).

14 | Compress Device Surgical Technique
Figure 21
Anchor Plug (cont.)
The long drill bit is positioned through either of the
two lower holes in the anchor plug and drill guide
(Figure 21).
Once the drill bits are in place, minimize the lateral
distance between the drill guide and the anchor plug
to optimize targeting once the anchor plug is inserted
into the bone (Figure 22). Alternate tightening of both
adjustment knobs located on top with a clockwise
motion until snug (Figure 23).
Figure 22
Figure 23

15 | Compress Device Surgical Technique
Firm Contact
Figure 24 Figure 25
Anchor Plug Implantation
With the drill guide properly aligned with the anchor
plug, remove the three drill bits and position the
anchor plug into the femoral canal. Make certain
that the cross bar is in firm and even contact with
the femoral osteotomy site and that the centering
sleeve provisional is snug within the canal (Figure 25).
Placement of the anchor plug within the medullary
canal is non-directional; location is typically dictated
by the best exposure and ease of access to the drill
guide.
Anchor Plug (cont.)
When the knobs are tight, all three drill bits should
slide freely through the alignment holes (Figure 24).
Note: If the drill bits do not slide freely, loosen the
top two adjustment knobs and begin the tightening
process again.

16 | Compress Device Surgical Technique
Hole #1 Hole #5
Hold the cross bar and drill guide securely and, without
power, run a short drill bit through hole #1 of the drill
guide until contacting the bone. At full power drill
through both cortices (Figure 26). Leave the short drill
bit in place.
Figure 26 Figure 27
Repeat this procedure with the second short drill bit
through hole #5, leaving the short drill bit in place
(Figure 27).

17 | Compress Device Surgical Technique
Anchor Plug (cont.)
Using the long drill bit, sequentially drill each of the
remaining three placement holes. Remove the long
drill bit when finished (Figure 28).
Transverse Pins
Transverse Pin Measurement
The hook depth gauge is used to measure the bi-
cortical distance for determining the transverse pin
length (Figure 29).
Start by loosening knobs 1 and 2 and collapsing the
sleeves together.
Figure 28 Figure 29

18 | Compress Device Surgical Technique
Transverse Pins (cont.)
Tighten knob 2 (Figure 30). Push the hook through a pre-drilled hole and engage
the outer aspect of the far cortex (Figure 31).
Figure 30 Figure 31