0612 05 514 TMAttune PG ST

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Pin Guide System
TruMatch® Personalized Solutions
Surgical Technique with ATTUNE™ Knee
INTUITION™ Instruments

Pin Guide Surgical Technique

The following steps are an addendum to the
ATTUNE™ Knee INTUITION™ Instruments Surgical
Technique (Cat. No. 0612-09-512).
This surgical technique provides instructions on how to
incorporate the use of the TRUMATCH® Solutions Femoral
and Tibial Pin Guides into the broader ATTUNE Knee
INTUITION Surgical Technique. The surgeon must be familiar
with the proper use of the appropriate instruments that are
necessary to complete the operation
following the use of the TRUMATCH
Solutions Femoral and Tibial Pin Guides.
It is strongly recommended that the
surgeon carefully review the TRUMATCH
Solutions Patient Proposal prior to
proceeding with the surgical procedure.
The Patient Proposal is available through
the web-based, password protected,
TRUMATCH Personalized Solutions Web
Portal (www.depuysynthes.com/
trumatch). The Patient Proposal contains
in-depth information utilized in the design
of the patient specific guides including, as
necessary, surgeon requested plan
modifications that are listed in the Notes/
Comments section.
Note: Pin Guides are only cleared for use with
ATTUNE Knee and SIGMA Fixed Bearing Total
Knee Implants.

Basic TRUMATCH® Solutions
Pin Guide Surgical Steps
ATTUNE™ Knee System steps shown.

Tibial Preparation

Step 1: Insert Drill Guides and
twist clockwise to tighten

Step 2A: Tibial Guide placement

Step 2B: Tibial Guide alignment

Step 4: Placement of
Anterior Pins.

Step 5: Twist counterclockwise
and remove Drill Guide and Pin
Guide. Anterior Pins left in place

Step 6: Proximal tibial resection
using ATTUNE Knee Tibial
Cutting Block

Step 3: Use of Uprod Extension.
Verification of Varus/Valgus and
lateral alignment

Femoral Preparation

Step 1: Insert Drill Guides and
twist clockwise to tighten

Step 2: Femoral Guide
placement

Step 3: Drill anterior and distal
pin holes and remove Pin Guide

Step 4: Position the Distal
Femoral Cutting Block with
Anterior Reference Guide

Step 6: Distal femoral resection

Step 7: Use of Fixed Reference
Guide to position the 4-in-1
Cutting Block

Step 8: Use of Angel Wing to
verify anterior resection

Step 9: Fixation of 4-in-1
Cutting Block to complete
femoral resection

Step 5: Use of Angel Wing to
verify distal resection level

Surgical Technique  TRUMATCH® Solutions Pin Guides  DePuy Synthes Joint Reconstruction    3

Proximal Tibial Resection

The Tibial Pin Guide (in addition to the product packaging
label) will have patient specific identifiers: Patient Name, Lot
No., Size and Patient Anatomy (R/L). Verify the accuracy of
these identifiers prior to opening the sterile package (Figure 1).
Note: The size information was selected pre-operatively
based on the Patient Proposal. Final implant sizing may
change due to intra-operative evaluation of implant fit
and/or joint gap assessment.
Prior to use, insert the TRUMATCH Solutions Drill Guides
(Part Number (P/N) 2004-20-925) into the two anterior
openings of the plastic Tibial Pin Guide by twisting in a
clockwise direction until tightened (Figure 2).

Figure 1

Note: The TRUMATCH Solutions Drill Guides (P/N
2004-20-925) are reusable after sterilization. A
minimum of four (4) Drill Guides should be on hand for
a case. They are shipped separately from the
TRUMATCH Solutions Pin Guides.
For optimal handling and placement stability of the Tibial Pin
Guide, first insert the HP Extramedullary (EM) Tibial Uprod
(P/N 9505-01-228) into the anterior holes of the Tibial Pin
Guide. Then slide the Rod Extension (P/N 2004-20-923) over
the distal end of the Uprod. This will lengthen it to reach the
patient’s ankle. Then, grasp the Guide using the medial and
lateral finger pads (Figure 3A). Do not grasp the Uprod or the
area on which the metal Drill Guides are located. (Figure 3B).

Figure 2

Note: The ATTUNE Knee INTUITION Instrument set
does not include the HP EM Tibial Uprod and Rod
Extension. This will need to be ordered separately or
taken from an existing SIGMA HP Instrument Set.

Figure 3A

4    DePuy Synthes Joint Reconstruction  TRUMATCH® Solutions Pin Guides  Surgical Technique

Figure 3B

With the knee flexed at 90 degrees, place the Tibial Resection
Guide and Uprod Assembly onto the proximal anterior medial
aspect of the tibia and both plateaus. Avoid using excessive
force to seat the Guide. Apply most of the force anterior to
posterior while holding the Guide as described.
To assist in the medial/lateral positioning of the Tibial Pin
Guide, refer to the last page of the Patient Proposal which
contains a top view of the patient’s tibial surface. It is
recommended to visualize the red line shown in the Patient
Proposal to the patient’s bone and to check alignment with
the raised line on the lateral aspect of the Tibial Pin Guide
(Figure 4).
The planned Varus/Valgus (V/V) alignment can be confirmed
by verifying the alignment of the Rod to the patient’s tibial
crest and center of the ankle (Figure 5). The Rod is designed to
be parallel to the mechanical axis of the tibia regardless of the
planned tibial slope, when viewed laterally.
Note: The position of the line in the Patient’s Proposal is
intended to reference the medial one-third of the tibial
tubercle and not the middle of the tibial crest (Figure 4).

Figure 4

Pins include
tibial slope.

Rod is parallel
in all cases.

Note: It is recommended to clear extraneous tissue along
the anterior medial aspect of the tibia. Soft tissue
impingement can impact the fit of the guide and overall
alignment or slope. Visualization in assessing proper fit
observed from a sagittal or side view is helpful.
Figure 5

Note: To position the Guide, apply most of the pressure
to the anterior aspect and the remaining pressure to the
proximal aspect of the Guide. This will help assure
proper seating of the Guide at the appropriate resection
level. The correct position is found when there is
minimal or no toggling/rocking of the Tibial Pin Guide.
Once the Tibia Pin Guide and Uprod Assembly is in the
desired position, hold it in place, and secure it to the bone
by inserting two ATTUNE Threaded Headless Pins (ATTUNE
Knee INTUITION Single-Use Pin Pack; P/N 2544-00-111),
first through the lateral and then the medial, Drill Guide pin
holes (Figure 6).

1

2

0 degree Block should be used
as slope has been planned in
the Pin placement.
Figure 6

Surgical Technique  TRUMATCH® Solutions Pin Guides  DePuy Synthes Joint Reconstruction    5

Proximal Tibial Resection

After drilling the two Anterior Pins, the TRUMATCH Solutions
Drill Guides are removed by twisting in a counterclockwise
direction, while leaving the two Anterior Pins in place (Figure
7). Remove the Tibial Pin Guide by moving it up and pulling it
away from the Anterior Fixation Pins.
Slide the appropriate L/R 0 degree ATTUNE Proximal Tibial
Cutting Block over the Anterior Fixation Pins through the
“0” mm holes (Figure 8). If desired, confirm the cut
orientation with the Angel Wing. If necessary, the Block may
be shifted 2 mm proximally or distally by selecting the
appropriate offset holes adjacent to the “0”mm hole.
Perform the proximal resection with a 1.19 mm Whale Tail
Saw Blade.
Remove the ATTUNE Tibial Cutting Block and make sure bone
cuts are clean and void of any under-cut bone fragments.

Figure 7

Note: The arthritic disease process can cause adaptive
bone changes that result in hard, sclerotic bone in the
affected tibial condyle, thus making resection difficult.
A solution is to start the tibial cut on the “least affected”
or the side opposite to the more involved tibial condyle.
This will provide an easier entry cut in the intended
orientation and sets the path for the continued Saw
Blade sweep through the hard, sclerotic bone of the
involved plateau.
Proceed with the remaining surgical steps for distal femoral
and proximal tibial preparation, and trialing, as outlined by
the ATTUNE Knee INTUITION Instruments Surgical Technique.

Figure 8

6    DePuy Synthes Joint Reconstruction  TRUMATCH® Solutions Pin Guides  Surgical Technique

Distal Femoral Resection

The Femoral Pin Guide (in addition to the product packaging
label) will have patient specific identifiers: Patient Name, Lot
No., Size and Patient Anatomy (R/L). Verify the accuracy of
these identifiers prior to opening the sterile package (Figure 9).
Note: The size information was selected preoperatively
based on the Patient Proposal. Final implant sizing may
change due to intraoperative evaluation of implant fit
and/or joint gap assessment.
Prior to use, insert the TRUMATCH Solutions Drill Guides (P/N
2004-20-925) into the two anterior and two distal openings
of the plastic Femoral Pin Guide by twisting in a clockwise
direction until tightened (Figure 10).

Figure 9

With the knee flexed to at least 90 degrees, place the
Femoral Pin Guide over on the anterior aspect of the femur
and position the “feet” of the Guide over the distal femoral
condyles (Figure 11A). Avoid using excessive force to seat the
Guide. Care should be taken to avoid squeezing the Guide
and causing the legs to deform while Pins are being placed
(Figure 11B).
The majority of the finger pressure (~75%) should be applied
on the anterior aspect of the Guide while applying light
pressure (~25%) over the distal aspect of the Guide.
Note: Soft tissue impingement may cause difficulty in
seating the Femoral Pin Guide on the femur and could
impact the overall alignment of the Guide. It is
recommended to clear extraneous soft tissue from the
anterior aspect of the femur to facilitate proper
placement of the Guide. Visualization for proper seating
may be enhanced when the guide is observed from a
sagittal or side view.

Figure 10

Figure 11A

Figure 11B

Surgical Technique  TRUMATCH® Solutions Pin Guides  DePuy Synthes Joint Reconstruction    7

Distal Femoral Resection

Evaluate the lack of toggling or rocking of the Femoral Pin
Guide to confirm the optimum placement of the Guide. It is
not uncommon to see a 1 to 2 mm gap around the periphery
of the Guide due to cartilage loss. Next drill two Anterior Pins
and two Distal Pins through the appropriate Drill Guides
(Figure 12).
Note: Pins should always be drilled and not
hammered in.
The anterior holes will be used to place the ATTUNE Distal
Femoral Cutting Block to perform the distal femoral cut. The
distal holes set the femoral rotation and match the Fixed
Reference Pin placement of the ATTUNE 4-in-1 Cutting Block.
Extract the two Anterior Pins and two Distal Pins and
remove Femoral Pin Guide by flexing the Guide from
posterior to anterior.
Note: The TRUMATCH Solutions Drill Guides are
reusable after sterilization. A minimum of four (4) Drill
Guides should be on hand for a case. They are shipped
separately from the TRUMATCH Solutions Pin Guides.

Figure 12

Attach the ATTUNE Impaction Handle (P/N 2544-01-017) to
the ATTUNE Anterior Reference Guide (P/N 2004-20-927) and
position the Guide’s spikes through the “0” mm holes in the
ATTUNE Distal Femoral Resection Block (Figure 13). Using the
Handle, place the ATTUNE Anterior Reference Guide spikes
now located through the ATTUNE Distal Femoral Resection
Block into the anterior holes.
Note: The ATTUNE Anterior Reference Guide (P/N 200420-927) and Fixed Reference Guide (P/N 2000-42-074) are
not included in the INTUITION Instrument sets. These
will need to be ordered separately.

Figure 13

8    DePuy Synthes Joint Reconstruction  TRUMATCH® Solutions Pin Guides  Surgical Technique

Evaluate the distal cut using the Reference Guide or Angel
Wing (Figure 14A). If needed, the Block may be shifted 2 mm
proximally or distally by selecting one of the appropriate
offset holes adjacent to the “0” mm hole.
For additional stability during the cut, an optional third
Fixation Pin can be placed through the Cutting Block in
either the lower medial or lateral holes. Perform the distal
femoral resection using a 1.19 mm Whale Tail Saw Blade
(Figure 14B).
Remove the Distal Femoral Cutting Block and confirm the
bone cuts are clean and without any under-cut bone
fragments.
Note: In order to address gap assessment and ligament
tension, it may be necessary to re-cut 2 or 4 mm of
additional bone from the distal femur or the proximal
tibia. The ATTUNE Spacer Block and Alignment Rod
are useful in assessing leg alignment and gap balance.
Figure 14A

Figure 14B

Surgical Technique  TRUMATCH® Solutions Pin Guides  DePuy Synthes Joint Reconstruction    9

Femoral Preparation:
A/P and Chamfer Cuts

Attach the ATTUNE Impaction Handle (P/N 2544-01-017) to
the ATTUNE Fixed Reference Guide (P/N 2000-42-074) and
position the Guide’s spikes through the “0” mm holes located
at the bottom of the ATTUNE Femoral Fixed Reference 4-in-1
Cutting Block without the Posterior Saw Capture (Figure 15).
Insert the construct spikes into the previously drilled holes
located on the distal femoral bone cut.
Note: The ATTUNE Anterior Reference Guide (P/N 200420-927) and Fixed Reference Guide (P/N 2000-42-074) are
not included in the INTUITION Instrument sets. These
will need to be ordered separately.
Evaluate the anterior cut with the Angel Wing (Figure 16). If
desired, the Block may be shifted 1.5 mm anteriorly or
posteriorly by selecting the appropriate offset holes adjacent
to the “0” mm hole. (See notes section on page 11 for
additional detail).
Secure the Block’s location by inserting Threaded Headed
Pins (ATTUNE Knee INTUITION Single-Use Pin Pack; P/N 254400-111) into the convergent pin holes on the medial and
lateral aspect of the 4-in-1 Cutting Block. Remove the
Handle/Fixed Reference Guide Assembly and perform the
femoral resections (Figure 17). After performing all cuts,
remove the Pins and Cutting Guide, making sure bone cuts
are clean and void of any under-cut bone fragments. If the
use of the Posterior Saw Capture is desired, it may be
inserted after removing the Handle/Fixed Reference Guide
Assembly and prior to performing the additional femoral
finishing cuts.

Figure 15

Figure 16

Figure 17

11    DePuy Synthes Joint Reconstruction  TRUMATCH® Solutions Pin Guides  Surgical Technique

Note: If the ATTUNE Fixed Reference Guide (P/N 200042-074) is unavailable, two Fixation Pins can be
inserted in the previously drilled distal femoral holes
and used to set the location of the ATTUNE Femoral
4-in-1 Cutting Block. The TRUMATCH Solutions
Femoral Pin Guide is designed to position the pin holes
posteriorly on the femur which maintains the ability to
move the Block to resect 1.5 mm more bone anterior or
1.5 mm more bone posterior with the same size Block
regardless if the surgeon preference is anterior down or
posterior up. However, if it is necessary to downsize the
femoral component, the Pin placement references a
posterior up preference and the smaller Femoral Block
can be inserted over the posterior placed Pins. The
posterior femoral resection will remain unchanged and
additional anterior femoral bone will be taken. In order
to address an anterior down preference and the ability
to downsize the component, drill two Fixation Pins
through the anterior “0” mm holes with the planned
Femoral Block. Remove the Femoral Block and use
these anterior placed Pins with the smaller Block when
downsizing. The anterior femoral resection will remain
unchanged and additional posterior femoral condylar
bone will be taken.

Surgical Technique  TRUMATCH® Solutions Pin Guides  DePuy Synthes Joint Reconstruction    11

Surgical Tips and Pearls

Pre-operative Considerations
Order Submission

Patient Proposal

Order Form

Date of Consult:
Patient Name:
Gender:

D.O.B.:

Male

Patient Profile:

Female
Varus

Height:
Valgus

Weight:

Flexion Contracture:

Yes

No

Affected Side:

HEALTHY BONE

Estimated Joint Space Loss:

Left

Right

BONE-ON-BONE

0% Medial

25% Medial

50% Medial

75% Medial

100% Medial

0% Lateral

25% Lateral

50% Lateral

75% Lateral

100% Lateral

OPTIONAL: COMPLETE IF USING DIFFERENT IMPLANTS FROM STATED SURGEON PREFERENCES

Femoral Comp. Type:
Poly Comp. Type:

0612-03-510

Evaluate the M/L Joint Space Loss by utilizing weight-bearing
knee joint radiographs and provide the values with the order
submission. These values are an important part of the
algorithm used to determine the cartilage offset for proper
positioning of the guides. For ease of assessment, it is
sufficient to use “0”, “50” or “100” % joint space loss
when estimating the affected side. The optional Order Form
(Figure 18) can be utilized to collect all the necessary
information required to submit the TRUMATCH Solutions
order online.

®

CR
Curved

PS
Curved+

Tibial Comp. Type:
Stabilized

Stabilized+

Special Comments:

a.	Review the entire document in detail prior to the surgery.

Figure 18

b.	Review the Notes/Comments section for important
information from the TRUMATCH Solutions Design Team
regarding the design of the Guides.
c.	 Print in Color! All Notes/Comments will be shown
in red.
d.	 For intra-operative reference, display the wall chart
summary page (Figure 19) at an easy to read location in
the OR, such as the light box or back wall.
Intra-operative Check-List
Review the Wall Chart Summary (last page), which contains
implant sizing bone resection information and the tibial guide
orientation line.
The bone resection information can be used to verify if bone
cuts within 2 mm of the planned values shown. In particular,
the relationship between the medial and lateral cuts should be
noted. If both cut measurements are proportionally similar (i.e.
deviate by a similar amount), then the Varus/Valgus alignment
is preserved. Otherwise, it is an indication that the guide
placement and/ or bone resection(s) should be re-visited.
For clarity, the tibial resection thickness, shown for each
condyle, is measured from the lowest point on the middle
third of the respective condyle.

11    DePuy Synthes Joint Reconstruction  TRUMATCH® Solutions Pin Guides  Surgical Technique

Figure 19

Fixed Bearing

Rotating Platform

Intra-operative Considerations
Fixation Pins and Saw Blades
a.	The ATTUNE Threaded Headless Sterile Pins (ATTUNE Knee
INTUITION Single-Use Pin Pack; P/N 2544-00-111),
combined with the HP Driver (P/N 9505-02-071) are
recommended for firmly securing the Guides, especially
for the Tibial Guide when used in soft bone.
b.	 For efficient resection of large bones, select the longest
Saw blade possible, with a 12.7 mm (0.5 in) wide x 1.19
mm (.05 in) thick dimensions.

Femoral Resection Guide
a.	The Femoral Guide’s primary reference surface is the
anterior cortex of the femur (Figure 20). The most upper
portion of the Guide should clear the anterior femoral
flange and sit flush on the cortical surface. It may be
necessary to remove the thin soft tissue to expose the
underlying bone.
b.	Distally, a gap may be seen between the Guide and the
femoral condyles. If the Guide is securely positioned
anteriorly, do not force the Guide’s arms to sit flush on the
femoral condyles.

Figure 20

If the Femoral Pin Guide does not fit, verify the following:
1.	 Was the tissue in the anterior surface of the femur
removed and is the proximal portion of the Guide sitting
on bone?
2.	Did the upper Guide portion clear the anterior femoral
flange and is it sitting on the anterior cortex?
3.	Is the incision preventing the placement of the Guide on
the bone? The incision must be large enough to provide a
clear view of the Guide fit to bone.

Surgical Technique  TRUMATCH® Solutions Pin Guides  DePuy Synthes Joint Reconstruction    11

Surgical Tips and Pearls

Intra-operative Considerations
Tibial Resection Guide
a.	The Tibial Guide’s primary reference surface is the
anterior/medial aspect of the tibia. This area, roughly
triangular in shape, matches the Guide’s largest surface
contact area (Figure 21). When positioning the Guide,
apply most of the pressure (~75%) against the anterior
aspect of the tibia. It may be necessary to remove the thin
soft tissue to expose the underlying bone.
b.	If the Guide is securely positioned anteriorly, do not force
the Guide’s arms to sit flush on the tibial plateau. While
applying force anteriorly, apply light downward force
(~25%) on the Guide’s proximal arms to hold the Guide
stable while drilling the Anterior Pins.
If the Tibial Guide does not fit, verify the following:
1.	Is the incision preventing placement of the Guide on the
bone? The incision must provide a clear view of the Guide
fit on the bone.
2.	Check for interference of the lateral aspect of the Guide
with the patellar ligament.
3.	Confirm that both of the Guide’s proximal arms are not
impinging by tissue close to the tibial spine.
4.	Check the Patient Proposal; was the Joint Space Loss
reported to be 100% for either of the condyles and the
actual patient has little to no joint space loss? If so, scrape
the condyle where full joint loss was requested.

11    DePuy Synthes Joint Reconstruction  TRUMATCH® Solutions Pin Guides  Surgical Technique

Figure 21

Indications For Use:
The TRUMATCH Patient Specific Instruments are intended to be used as patient-specific surgical instrumentation to assist in the positioning of a joint replacement component intraoperatively and in guiding the marking of bone before cutting.
The anatomical landmarks necessary for the creation of the TRUMATCH Patient Specific Instruments must be present and identifiable on CT.
The TRUMATCH Patient Specific Instruments are intended for use with SIGMA® Total Knee Implants and ATTUNE™ Total Knee Implants and their cleared indications for use.
The TruMatch Patient Specific Instruments are intended for single use only.

Exclusion Criteria:
The following conditions are not compatible with TRUMATCH Personalized Solutions:
•	 Previous knee replacement of the same knee.
•	 Femoral nails and bone plates that extend into the knee, or 8 cm from the joint line.
•	Any metal device that will cause scatter in the CT through the knee.
•	Angular deformities greater than 15 degrees of fixed varus, valgus, flexion, or tibial slope exceeding 15 degrees.
•	Moderate to severe bony deformities, charcot knees, or patients with severe patella tendon calcification that may prevent patella eversion.

Limited Warranty and Disclaimer: DePuy Synthes Joint Reconstruction products are sold with a limited warranty to the original purchaser against defects
in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.
WARNING: In the USA, this product has labeling limitations. See package insert for complete information.
CAUTION: USA Law restricts these devices to sale by or on the order of a physician.
Not all products are currently available in all markets.

DePuy Orthopaedics, Inc.
700 Orthopaedic Drive
Warsaw, IN 46582
T. +1 (800) 366-8143
www.depuysynthes.com/trumatch
© DePuy Synthes Joint Reconstruction, a division of DOI 2013
0612-05-514 07/13



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