0612 51 506r5 Sigma HP Revision Surgical Technique

2014-03-27

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SIGMA
REVISION
AND M.B.T.
REVISION
TRAY
®

SURGICAL TECHNIQUE

TABLE OF CONTENTS

Surgical Technique

Key Surgical Steps Summary

SIGMA® Revision/M.B.T. Revision Tray Knee Surgery

The SIGMA Revision System Overview

Incision and Exposure

Intra-operative Evaluation

Initial Preparation of the Tibia

Preparation of the Metaphyseal Bone – Tapered Reamer

Proximal Tibial Resection – Tapered Reamer

Preparation of the Metaphyseal Bone – Broach

Tibial Trial Assembly

Joint Space Assessment

Preparation of Femoral Diaphysis

Reaming the Medullary Canal

Preparation of the Metaphysis – Stem Use

Preparation of the Metaphysis – Sleeve Use

Femoral Preparation – Distal Resection

Femoral Preparation – A/P and Chamfer Cuts

Femoral Preparation – Notch Resection

Femoral Trial Assembly

Femoral Trial Assembly – Sleeve and Stem Use

Femoral Trial Assembly – Stem-Only Use

2 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

APPENDICES

Femoral Trial Assembly – Sleeve-Only Use

Final Preparation of the Tibia

Preparation of the Patella

Implant Assembly - Tibia

Tibial Implantation

Implant Assembly – SIGMA Femoral Adapter

Implant Assembly – SIGMA Femoral Augments

Implant Assembly – Sleeve and Stem Use

Implant Assembly – Stem-Only Use

Implant Assembly – Sleeve-Only Use

Final Trial with Implants

Key Surgical Steps Summary

Appendix 1: The Cemented Tibial Stem Extensions

Appendix 2: Step Wedge Preparation

Appendix 3: Thick Tray Preparation

Appendix 4: Femoral Revision and Tibial Insert Compatibility

Appendix 5: SIGMA Revision
Anteroposterior Chart (With Sleeve Use)

Instrument Glossary

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 3

KEY SURGICAL STEPS SUMMARY

Incision and Exposure

Tibial Medullary Canal Preparation

Tibial Resection

Femoral Medullary
Canal Preparation

Distal Femoral Resection

Femoral Preparation A/P and Chamfer Cuts

Final Trialing

Patella Preparation

Implantation

4 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Tibial Trial Assembly

Joint Space Assessment

Femoral Preparation
- Notch Resection

Femoral Trial Assembly

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 5

SIGMA® REVISION / M.B.T. REVISION TRAY
KNEE SURGERY*

Introduction
In total knee arthroplasty (TKA), failure may result
from many causes including: wear, aseptic loosening,
infection, osteolysis, ligamentous instability,
arthrofibrosis and patellofemoral complications. In
approaching revision procedures, the surgeon must
address such considerations as the planning of an
incision in a previously operated site, the condition of
the soft tissue, mobilization of the extensor mechanism,
extraction of the primary prosthesis and the attendant
conservation of bone stock. Among the goals of
successful revision arthroplasty are the restoration of
anatomical alignment and functional stability, fixation
of the revision implants and accurate re-establishment
of the joint line. Careful selection of the appropriate
prosthesis is of paramount importance. Ideally, the
revision knee replacement system will offer the options
of adjunctive stem fixation and variable stem positions,
femoral and tibial augmentation, sleeve, and various
levels of prosthetic constraint.
Pre-operative Planning
Revision total knee arthroplasty begins with thorough
clinical and roentgenographic evaluation. Physical
evaluation includes the examination of the soft
tissues, taking into account previous skin incisions,
range of motion, motor strength, the condition of all
neurovascular structures, ligamentous stability and
the integrity of the extensor mechanism. Biplanar
radiographic views are obtained, as are tangential views
of the patella and full-length standing bilateral extremity
views for the assessment of alignment and bone stock,
documentation of the joint line and evaluation of the
present implant fixation. Stress views are helpful in
evaluating ligamentous instability. CAT and MRI scans
may at times be of value in cases of massive bone loss
or substantial anatomic distortion from trauma and
metabolic bone disorders. Templates are employed to
establish replacement implant size and the alignment of
bone cuts, to indicate augmentation of skeletal deficits
and to confirm the anatomic joint line.
*The SIGMA Revision Knee System is intended for cemented use only.

6 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

THE SIGMA REVISION SYSTEM OVERVIEW

The M.B.T. Revision Knee System is comprised
of the following components:

The SIGMA Revision Knee System is comprised of
the following components:

·· Tibial Components are available in eight sizes

·· Stabilized Femoral Component is available
in seven sizes

·· Tibial Metaphyseal Sleeves are available in 29 mm, 37
mm, 45 mm, 53 mm and 61 mm sizes (M/L dimension)
·· Tibial Wedge Augmentation Components: Step Wedge
in 5, 10 and 15 mm thicknesses
·· 75, 115 and 150 mm Fluted Stem lengths in 10 to 24
mm diameters in 2 mm increments
·· 30 and 60 mm Cemented Stem lengths in 13 mm
diameters. 90, 120, 150 Cemented Tapered Stem
lengths in 13 mm diameters
·· Thick Trays are available in three different sizes (2, 3
and 4) and two different thicknesses
(+15 mm and +25 mm)
·· Accepts Rotating Platform inserts from LCS®
Complete™, SIGMA RP, LCS Complete Revision and
SIGMA TC3 RP inserts
·· Accepts rotating platform hinged insert, Universal
LPS Hinged insert, from the Orthogenesis LPS™ (Limb
Preservation System), which is compatible with the
S-ROM® NOILES™ Rotating Hinge (NRH) femoral
component and LPS femoral component

·· TC3 Femoral Component is available in six sizes
·· M
odular Femoral Stem, known as the SIGMA Femoral
Adapter, which allows the use of the Universal
Femoral Metaphyseal Sleeves and Universal Stems.
The SIGMA Femoral Adapter is available in 5 and 7
degree valgus angles
·· T he Universal Femoral Metaphyseal Sleeves are
available in
20 mm, 31 mm, 34 mm, 40 mm and 46 mm sizes
(M/L dimension), and can be used with or without a
stem
·· 4
mm, 8 mm, 12 mm and 16 mm Distal Femoral
Augmentations
·· 4 mm and 8 mm Posterior Femoral Augmentations
·· Three anteroposterior stem positions: 0 mm, +2 mm
and -2 mm
·· 7
5 mm, 115 mm and 150 mm Fluted Universal Stem
lengths in 10 mm to 24 mm diameters in 2 mm
increments
·· 3
0 mm and 60 mm Cemented Stem lengths in 13 mm
diameter
·· 3
0 mm and 60 mm Cemented Stem lengths in 15 mm
diameter (Must be used with a sleeve)
·· 9
0 mm, 120 mm, and 150 mm Tapered Cemented
Stem lengths in 13 mm diameter
·· 9
0 mm Tapered Cemented Stem length in 15 mm
diameter (Must be used with a sleeve)

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 7

INCISION AND EXPOSURE

Initial Incision
When possible, follow the scar from the primary
procedure (Figure 1). Where parallel incisions are
present, the more lateral is usually preferred, as
the blood supply to the extensor surface is medially
dominant. Where a transverse patellectomy scar is
present, the incision should transect it at 90 degrees.
Where there are multiple incision scars or substantial
cutaneous damage (burn cases, skin grafting, etc.), one
may wish to consult a plastic surgeon prior to surgery
to design the incision, determine the efficacy of preoperative soft tissue expansion and plan for appropriate
soft tissue coverage at closure.

Figure 1

Capsular Incision
The fascial incision extends from the rectus femoris
proximal margin to the distal margin of the tibial
tubercle following the patella’s medial border,
maintaining a 3-4 mm cuff for reapproximation of the
vastus medialis aponeurosis at closure (Figure 2). Where
mobilization of the extensor mechanism and patella
is problematic, extend the skin and capsular incisions
proximally.

Figure 2

8 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

INCISION AND EXPOSURE

Occasionally an early retinacular release is indicated to
assist with patellar eversion. Where eversion difficulties
persist, a quadriceps snip, a proximal inverted quadriceps
incision (modified V-Y) or a tibial-tubercle osteotomy
may be indicated. Perform appropriate ligamentous
release based upon pre-operative and intra-operative
evaluation. Release fibrous adhesions to re-establish
the suprapatellar pouch and medial and lateral gutters
(Figure 3).
In many revision cases, the posterior cruciate ligament
will be absent or non-functional; when this is the
situation, excise any residual portion. Exercise care when
everting the patella. Frequently, subluxing the patella
laterally is adequate. Doing so will help avoid patella
tendon avulsion.

Figure 3

Implant Extraction from the Primary Procedure
Take care to preserve as much bone as possible.
To this end, assemble a selection of tools, including
thin Osteotomes, an Oscillating Saw, a Gigli Saw, a
highspeed Burr and various extraction devices, but many
cases will require only the thin Osteotome. Carefully
disrupt the bone/cement or bone prosthesis interface
before attempting extraction (Figure 4).
Disengage the implanted components and extract
as gently as possible, in such manner as to avoid fracture
and unnecessary sacrifice of bone stock. Where the
entire prosthesis is to be replaced, it is advantageous to
remove the femoral component first, as this will enhance
access to the proximal tibia. Clear all residual methyl
methacrylate with hand (chisels) or power tools.

Figure 4

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 9

INTRA-OPERATIVE EVALUATION

The surgeon should establish two anatomic conditions
to facilitate revision arthroplasty: the level of the joint
line and the disparity in the flexion and extension gaps
(Figure 5).
Joint Line Evaluation
In an average knee in full extension, the true joint line
can be approximated in reference to several landmarks.
·· It lies 12–16 mm distal to the femoral PCL
attachment
·· It lies approximately 3 cm distal to the medial
epicondyle and 2.5 cm distal to the lateral
epicondyle
·· It lies distal to the inferior pole of the patella
(approximately one finger width)
·· Level with the old meniscal scar, if available
Additional pre-operative joint line assessment
tools include:
1) Review of original pre-operative radiograph
of the TKA
2) Review of radiograph of contralateral knee
if non-implanted

Figure 5

11 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

INITIAL PREPARATION OF THE TIBIA

The Tibial Alignment System
When pre-operative evaluation and radiographs indicate
that fluted stem extensions, metaphyseal sleeves or
Wedges are required, it is recommended that the
proximal tibia be prepared with reference to the position
of the IM Rod.

4 cm

Note: Where a Cemented Stem Extension is
indicated, see Appendix 1 (page 56).
Place the knee in maximal flexion with the patella
laterally retracted and the tibia distracted anteriorly and
stabilized. Release fibrosis around the tibial border or
excise as required to ensure complete visualization of its
periphery.
Approximate the location of the medullary canal with
reference to pre-operative anterior/posterior (A/P) and
lateral radiographs and to the medial third of the tibial
tubercle.
Introduce a 9 mm Drill into the canal to a depth of
2 to 4 cm. Avoid cortical contact (Figures 6 and 7).

2 cm

Figure 6

Figure 7

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 11

INITIAL PREPARATION OF THE TIBIA

Reaming the Medullary Canal
Assemble the straight reamer to the T-handle.
If power reaming, it will be necessary to attach the
modified Hudson Adapter to the straight reamer. The
shaft of the Reamer contains markings in 25.4 mm
(1 inch) increments. Each marking is numbered to
use as a reference when reaming to the appropriate
depth. Fluted stem lengths are available in 75, 115
and 150 mm. Determine the length and diameter of
the Prosthetic Stem Extension with Templates (Cat. No.
2178-30-100) applied to pre-operative Radiographs.
Use the Reamer Depth Chart (Figure 8) to determine
the appropriate mark on the reamer for canal reaming
depth. Another option to determine Reamer depth is to
measure the trial assembly against the Reamer and note
the corresponding depth mark for reaming. Sequentially
open the canal with progressively larger Reamers until
firm endosteal engagement is established (Figure 9).

Reamer Depth Chart
M.B.T. Revision Tray

Press Fit
Stems

Cemented
Stems

75 mm

115 mm

150 mm

30 mm

60 mm

90 mm

2.5

120 mm

3.5

150 mm

Figure 8

Note: Simple cortical contact should not be
construed as engagement.
The fixed relationship of the reamer to the cortices
ensures the secure fit of the appropriate reamer
and, subsequently, the corresponding fluted stem.
It is equally important to not over-ream osteopenic bone.
While reaming the proximal tibia, pay close attention
to the reamer to assure that it is somewhat centrally
located to the exposed proximal tibial surface. Eccentric
reaming can occur, which could lead to undersizing of
the tibial component.

Reamer Line Depth

T-handle

Straight
Reamer

The size of the final reamer indicates the diameter
of the implant stem. The fluted stems are available in
even sizes (10 through 24 mm). Perform final reaming
with an even-sized reamer. The final implant will have a
.4 mm press fit versus the reamer.
Note: Refer to Appendix 1 (page 56) for cemented
stem preparation.

Figure 9

11 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

PREPARATION OF THE METAPHYSEAL BONE
– TAPERED REAMER

For Diaphyseal Engaging Stem and
Metaphyseal Filling Sleeve
Attach the appropriately sized stem trial to the end of
the M.B.T. Revision Tapered Reamer.
Note: Assembly of the stem trial may be aided by
the pre-attachment of the T-handle to the M.B.T.
Revision Tapered Reamer.
Taper ream to the planned proximal tibial resection level
(Figure 10). When finished reaming, the notches on
the drill should line up with the planned proximal tibial
resection level.
Note: Use the “cemented” taper reamer when
requiring a cement mantle or when utilizing a
sleeve. Use the press-fit tapered reamer when lineto-line fit is desired and a sleeve will not be utilized
(Figure 10). Use End-Cutting Primary Reamer (Cat.
No. 2178-63-199) when a stem or sleeve will not be
used.

Tibial Resection Plane
Notches on the Drill

Note: To avoid stem trial disengagement, do not
reverse ream.
At this point, intra-operatively determine if a
metaphyseal sleeve will be used.
Note: Metaphyseal sleeves are ideal to provide
filling of Engh Type II or III defects in revision TKA.
The steps of the metaphyseal sleeve also provide
progressive loading of the bone with porous coating,
which enhances fixation.
If a metaphyseal sleeve is selected, see page 16 in order
to broach the metaphyseal bone.
If a metaphyseal sleeve will not be used, see the
following page to prepare for the proximal tibial
resection.

Figure 10

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 11

PROXIMAL TIBIAL RESECTION
– TAPERED REAMER

Attach the 2 degree Tibial Cutting Block to the I.M.
Tibial Referencing Device. Attach the I.M. Tibial
Referencing Device to the shaft of the tapered reamer.
Position the I.M. Tibial Referencing Device with the
pre-attached 2 Degree Cutting Block onto the shaft
and allow it to descend to the proximal tibial surface.
Since considerable bone stock may have been sacrificed
in the primary total knee arthroplasty, minimize the
amount resected: no more than 1-2 mm from the most
prominent condyle, managing residual defects of the
contralateral condyle with either prosthetic augment or
bone graft.
Resection is based on tibial deficiency and the level of
the joint line. Compensate deficiencies with sleeves,
wedges and/or bone grafts. Advance the cutting block
to the anterior tibial cortex and lock into position
by tightening the knurled knob on the outrigger.
Preliminary rotational alignment is based on the medial
third of the tibial tubercle. Secure the alignment device
to the reamer shaft with the lateral Setscrew (Figure 11).
Pin the Tibial Cutting Block so a minimal resection is
made from the proximal tibia. Utilize the stylus when
necessary (Figure 11).
Note: There is a slotted and non-slotted end to the
stylus. The difference between the two
is 5 mm.
Note: If a metaphyseal sleeve is to be used the tibial
resection will be performed using the Tibial Sleeve
Broach (see page 17, Figure 14).

11 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Pins

Figure 11

PROXIMAL TIBIAL RESECTION
– TAPERED REAMER

Remove the I.M. device while leaving the 2 degree
Cutting Block in place. Remove the tapered reamer and
resect the proximal tibia (Figure 12).
Note: At this point determine whether a Step Wedge
is necessary on either the medial or lateral side to
augment a defect, or both sides in order to restore
the joint line. If a wedge is necessary on one side,
it is recommended that the step wedge be prepared
after rotational position of both the femoral and
tibial components have been determined. For step
wedge preparation see Appendix 2 (page 59).

Figure 12

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 11

PREPARATION OF THE
METAPHYSEAL BONE – BROACH

For Sleeve Utilization Only
Note: The M.B.T. Revision Tibial Tray will accept
either a tibial metaphyseal sleeve or a tibial step
wedge. Only the 29 mm Sleeve is indicated for use
with a tibial step wedge.
Attach the M.B.T. Revision Broach Handle to the smallest
broach and then attach the appropriately sized Stem
Trial. The broaches are asymmetrical, position the “ANT”
engraving on the broach anteriorly. Impact the broach
into the tibia until the top surface of the broach is at the
desired proximal tibial resection level. When broaching
the proximal metaphysis, take care to assure the
appropriate rotation of the broach.
Note: The corresponding tibial sleeve implant
allows up to +/- 20 degrees of rotation from
the centerline of the M.B.T. Revision Tray.
Check for rotational stability of the broach. If the broach
(not the handle) moves in the canal, it is not rotationally
stable.

Tibial Resection Plane

If the broach is unstable or the defect is unfilled, repeat
with consecutively larger broaches until the desired
fit is achieved (Figure 13). Remove the broach handle,
leaving the last broach in place. Any defects remaining
can be filled with allograft or autologous bone placed in
intimate contact with the sleeve.
Two common tibial broaching techniques:
1) Chase the defect by rotating the broach to fill the
defect until reaching rotational stability of the broach.
If utilizing this technique the surgeon must be aware
that the sleeves are allowed to rotate +/-20 degrees
with respect to the M.B.T. Revision Tibial Tray.
2) Align the broach with the medial third of the tibial
tubercle and progressively broach until rotational
stability of the broach is attained.

Figure 13

11 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

PREPARATION OF THE
METAPHYSEAL BONE – BROACH

Resect the proximal tibia utilizing the top of the broach
as a guide (Figure 14). The top of the broach has a 2
degree slope built in. The proximal cut should be parallel
to the top of the broach.
Note: If a cutting guide is desired for resecting
the proximal tibia with the tibial broach in place,
assemble the SP2 0 degree Tibial Cutting Block
to the SP2 IM Tibial Guide and slide over the
Broach Adapter Outrigger (2178-01-108). Slide this
assembly onto the boss of the seated tibial broach,
pin the block, remove the outrigger, and resect
through the slot of the cutting block (Figure 15).
Slide the tibial view plate which best covers the proximal
tibial over the broach post. Note the view plate size as
it will dictate the size of the M.B.T. Revision Tibial Base
Trial that will be used. The tibial view plate is transparent
to help visualize tibial coverage (Figure 16). The template
matches the implant to aid in orienting the tibial sleeve
to the tibial base during assembly.

Figure 14

Figure 15

Figure 16

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 11

TIBIAL TRIAL ASSEMBLY

Assemble the tibial tray trial with the stem extension and
sleeve trial, if applicable (Figure 17). Position the tibial
trial construct into the prepared tibial canal (Figure 18).
Assess proximal tibial coverage and rotation of tibial
component. The base plate should be positioned to
provide the best coverage of the tibial condylar surface.
Note: The M.B.T. Revision Tibial Keel Punch with
the Universal Handle may be utilized to assist with
seating of tibial trial construct. Once the tibial trial
construct is seated the keel punch must be removed
in order to accommodate the use of the HP Revision
M.B.T. Spacer Blocks.
Leave the trial in place and proceed to femoral
preparation, final tibial preparation will occur after
femoral preparation is complete.
Note: A 14 mm or smaller size stem implant can be
pulled through the sleeve implant. If the stem is 16
mm or greater it will not pull through the sleeve.

Figure 17

Figure 18

11 SIGMA Revision and M.B.T. Revision Tray Surgical Technique
18

JOINT SPACE ASSESSMENT

After tibial preparation has been performed you may utilize
the HP Revision M.B.T. Spacer Blocks to assess the flexion
and extension gaps (Figures 19 and 20). For common
scenarios, potential solutions are explained below.
Where flexion gap >extension gap:
·· To decrease flexion gap without affecting extension gap,
apply a larger femoral component. This is particularly
important where an IM Stem Extension is indicated, as
the Stem Extension will determine the anteroposterior
positioning of the component and the consequent
flexion gap
·· Where stem positioning will not permit posterior
augmentation, translate the Femoral Adapter Trial on the
TC3 Box Trial to the +2 (Fem Pos) position. This will result
in translating the femoral component 2 mm posteriorly
(Refer to page 38 for further explanation)

Figure 19

Figure 20

·· Where there is insufficient stability, a cemented femoral
stem may be substituted, allowing the component to be
seated further posteriorly
·· Where the joint line is elevated, the preferred correction
is posterior femoral augmentation. The alternative–
additional distal femoral resection and use of a
thicker tibial insert to tighten the flexion gap–is not
recommended, as considerable bone stock has been
sacrificed in the primary procedure, and it is important
that additional resection of the distal femur be avoided.
The possible exception is where the joint line is not
elevated and minimal distal resection will increase the
extension gap toward equivalency with the flexion gap

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 11

JOINT SPACE ASSESSMENT

Where extension gap >flexion gap:
·· To decrease extension gap without affecting flexion
gap, augment the distal femur with bone graft or
prosthetic augmentation. It is important to note that
this will lower the joint line, which is usually desirable
as it is generally found to be elevated in revision cases.
This will lessen the incidence of post-operative
patella infera

Note: In the initial assessments of the joint space
the Extension Shim may be utilized to help evaluate
the flexion space. This will only be used to evaluate
gap differences. It is important to keep in mind
that the use of the Extension Shim in flexion will
be approximately 1 mm thicker than the final
flexion gap. If the Extension Shim is not used
here to evaluate flexion, the Spacer Block will be
approximately 4 mm thinner than the final
flexion gap.

Flexion/Extension Balancing

Tight Flexion

Loose Flexion

Loose Extension

Tight Extension

Stable Extension

Cause

Flexion and extension gaps are too
large.

Inadequate resection of the distal
femur (i.e. extension gap < flexion
gap).

Extension gap < flexion gap.
Can be tolerated to a small extent,
but verify stability.

Possible Solution

1. Recut distal femur.
2. Recut chamfers.

1. Increase tibial bearing thickness and
reset more distal femur.
2. Upsize femoral component.

Cause

1. Extension gap > flexion gap.
2. Posterior osteophytes.

Flexion and extension gaps are too
small.

Flexion gap is too small.

Possible Solution

1. C
heck for presence of
posterior femoral osteophytes.
2. Downsize femoral component.
3. Cut Posterior slope on the tibia
(not to exceed 10 degrees) and
increase tibial bearing thickness.

1. Thinner tibial component.
2. If the smallest PE is still too tight,
resect more tibia.

1. C
heck for posterior femoral
osteophytes.
2. E nsure that there is no soft
tissue impingement.
3. R
ecut the tibia with a posterior slope.
4. P ossibly downsize femoral component.

Cause

1. Extension gap > flexion gap.

Extension gaps are too small.

Excellent ligament balance.

Possible Solution

Upsize the tibial components. Might
be necessary to recut tibia with
biggerposterior slope (not to exceed
10 degrees) to obtain full range of
motion (ROM).

Recut the distal femur and chamfers.

You have already found it.

Possible Solution
Thicker tibial insert.

22 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Possible Solution

PREPARATION OF FEMORAL DIAPHYSIS

Intramedullary Femoral Alignment System
This technique is designed to flow in a logical sequence,
from reaming the diaphysis, to broaching the metaphysis
and cutting the bone. The length and diameter of the
stem extension is determined with templates applied to
pre-operative radiographs.
Begin the procedure with the preparation of the
medullary canal (Figures 21 and 22).
Enter the medullary canal with a 9 mm Drill to a depth
of 3-5 cm (Figure 23). Take care that the drill avoids the
cortices. It is helpful to palpate the distal femoral shaft
as the drill is advanced.

Figure 21

Where impedance of the intramedullary canal is
anticipated, adjust the entry point accordingly.

Figure 22

Figure 23

Surgical
Technique SIGMA Revision and M.B.T. Revision Tray 22
21

REAMING THE MEDULLARY CANAL

Connect the Reamer Handle to a small diameter M.B.T.
Revision Reamer. If power reaming, it will be necessary
to attach the modified Hudson Adapter to the Straight
Reamer.
Note: The Reamer shaft contains markings in
25.4 mm increments to accommodate the various
Universal stem/sleeve length combinations (Figure
24).
Use the Reamer Depth Chart (Figure 25) to determine
reamer depth for each combination of components.
Another option to determine reamer depth is to measure
the trial assembly against the reamer and note the
corresponding depth mark for reaming.
You may also determine the length and diameter of
the prosthetic stem extension with templates (Cat. No.
2294-99-035: SIGMA Femoral Adapter Sleeve and Stem
Template) applied to pre-operative Radiographs.
The P.F.C.® SIGMA Femoral Component accepts:
·· Universal Fluted Stems available in lengths of 75, 115
and 150 mm in diameters of 10-24 mm
·· Cemented Stems available in lengths of 30 and 60 mm
lengths and diameters of 13 and 15 mm (15 mm with
sleeve use only)
·· Cemented Tapered Stems available in lengths of 90,
120, 150 mm (13 mm diameter) and also a 90 mm in
15 mm diameter (with sleeve use only)

Figure 24

22 SIGMA Revision and M.B.T. Revision Tray Surgical Technique
22

REAMING THE MEDULLARY CANAL

In 1 mm diameter increments, sequentially open
the medullary canal with M.B.T. Revision Reamers
of progressively greater size until firm endosteal
engagement is established.

PS Femur

Take care to ream the canal in line with the femoral axis
to avoid putting the implant in flexion.
Note: Do not reverse ream.
It is important that simple cortical contact of the tip not
be construed as engagement as it is the fixed
relationship of the reamer to the cortices that ensures
the secure fit of the appropriate sleeve and subsequently,
the corresponding fluted or cemented stem.

Cemented
Stems

Universal
Slotted
Stems

No
Sleeve

20 mm
31 mm
34 mm

40 mm
46 mm

30 mm

60 mm

90 mm

120 mm

150 mm

75 mm

115 mm

150 mm

No
Sleeve

20 mm
31 mm
34 mm

40 mm
46 mm

30 mm

60 mm

90 mm

120 mm

150 mm

75 mm

115 mm

150 mm

TC3 Femur

Cemented
Stems

Universal
Slotted
Stems

Figure 25

Surgical
Technique SIGMA Revision and M.B.T. Revision Tray 22
23

PREPARATION OF THE METAPHYSIS – STEM USE

Universal Fluted Stem Use:
As Fluted Stems are available in even sizes (10 through
24 mm diameters), perform final reaming with the
appropriate even-sized reamer.
Note: For stem-only applications, where a Fluted
Stem less than 16 mm in diameter is chosen, use the
Stem Reamer to clear the area around the adapter.
Attach the threaded shaft to the Stem Reamer and then
attach the appropriate Stem Trial to this assembly (Figure
26). Ream the canal (Figure 27).
Sink the Threaded Shaft, Stem Reamer, Stem Trial assembly
until the 20 mm, 31 mm, 34 mm mark corresponds with
the planned level of distal resection.
For trial and implant assembly with stem-only use, please
see page 41.

Stem Reamer

Cemented Stem Use:
Where a Cemented Stem Extension is indicated, perform
final reaming with a 15 mm Diameter Reamer for the
13 mm diameter stem extension; similarly, a 17 mm
Diameter Reamer is used to accommodate the 15 mm
diameter stem extension. This allows for creation of a
cement mantle.

Figure 27

Figure 26

22 SIGMA Revision and M.B.T. Revision Tray Surgical Technique
24

PREPARATION OF THE METAPHYSIS – SLEEVE USE

After reaming the intramedullary canal, attach the
threaded shaft to the broach reamer and then to the
appropriate Stem Trial as determined by straight reaming
(Figure 28).
Ream to the 20 mm, 31 mm, 34 mm etch mark on the
Threaded Shaft (Figure 29).
When using the broach reamer, the next smaller diameter
stem trial may be used to allow for easier reaming. The
broach reamer will be necessary when utilizing a 20
mm Sleeve and for the beginning of larger sequential
broaching when using a 31 mm or larger sleeve. After
broach reaming has been completed, attach the 31
mm broach to the broach handle (Figure 30). Attach the
appropriate stem trial to the broach as determined by
straight reaming. Give close attention to the medial
orientation of the broach.

Broach
Reamer

Note: The broach is asymmetrical; and the narrow
side of the broach must point medially (Figure 31).
Note: When prepping for a 20 mm Sleeve, leave the
broach reamer and threaded shaft in the canal and
perform the subsequent femoral cuts off the reamer.

Figure 29

Figure 28

Lateral Side

Medial Side

Figure 31

Figure 30

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 22

PREPARATION OF THE METAPHYSIS – SLEEVE USE

Sequentially broach to the desired TC3 or SIGMA CS
Line (Figure 32). When the appropriate etch mark on the
broach handle is at the planned distal resection level,
check the broach’s rotational stability. If the broach (not
the handle) moves in the canal, it is not rotationally
stable.
If the stability of the broach is unsatisfactory, move up
to the next broach size. The last broach used will be the
femoral sleeve size. The broach depth sets the extension
gap/joint line.
In patients with a large degree of distal femoral bow,
closely monitor the anterior progression of the broach
during impaction. Excessive anterior placement of the
broach may result in a loose flexion gap.

Planned Level of Distal Resection

Figure 32

22 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

PREPARATION OF THE METAPHYSIS – SLEEVE USE

After broaching is complete, remove the broach handle
from the broach. With the broach seated in the femur,
attach the threaded shaft to the broach (Figure 33), and
continue with the distal, 4-in-1, and notch cuts.

Figure 33

Surgical
Technique SIGMA Revision and M.B.T. Revision Tray 22
27

FEMORAL PREPARATION – DISTAL RESECTION

Distal Resection
Set the valgus angle to 5 degrees and Left/Right on the
Distal Femoral Alignment Guide by compressing the two
triggers and lock in place by rotating the blue locking
lever clockwise. Place the Femoral Alignment Guide on
the threaded shaft and seat against the distal femur
(Figure 34).
Rotate the knob on the Femoral Resection Guide
counterclockwise until the arrow is pointing to the
padlock symbol. Slide the femoral distal connector
into the Femoral Resection Guide. Rotate the knob
on the Femoral Resection Guide clockwise. Every
click moves the Revision Distal Cutting Block 1 mm
proximal or distal. Turn the knob clockwise from
15 all the way down to 0 (which is the padlock
symbol). This will set the block up for a 0 mm
resection (Figure 35).

Figure 34

Distal Femoral
Connector

Distal Femoral
Resection Guide

Slide the femoral Distal Cutting Block onto the Distal
Femoral Block attachment. The tang on the block
connector will slide into the 0 mm cutting slot on the
cutting block. The trigger should engage in the hole
behind the 0 mm slot (Figure 36).

Figure 35
Revision Distal
Cutting Block

Note: An open resection will resect 4 mm less
femur. When a 0 mm, open resection is desired, the
dial should be set to 4 mm.
Position the Resection Guide over the two legs of the
Distal Femoral Alignment Guide until the Distal Cutting
Block touches the anterior femur (Figure 37).
Note: The Revision Distal Block is equipped with 0,
4, and 8 mm saw slots. Please keep in mind that if
the resection level is not at 0 (the padlock symbol)
this will alter the resection. If the resection knob is
set at 2, for instance, the saw slots will perform 2, 6,
and 10 mm resections.

Figure 36

Figure 37

22 SIGMA Revision and M.B.T. Revision Tray Surgical Technique
28

FEMORAL PREPARATION – DISTAL RESECTION

Secure the cutting block to the femur with Non-Headed
HP Pins through the holes marked with a
.
Optional: A Convergent Pin can also be used to provide
better block stability/fixation (Figures 38 and 39).

0 mm
4 mm
8 mm

Figure 38

Figure 39

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 22

FEMORAL PREPARATION – DISTAL RESECTION

Once the pins are in place, unlock the Distal Cutting
Block from the distal block connector, using your thumb
and index finger to release the attachment. Slide the
Femoral Resection Guide upwards on the Alignment
Guide legs until the block connector disengages from
the cutting block and in one motion remove the Femoral
Alignment Guide by pulling the instruments distally over
the threaded shaft (Figure 40).

1. Slide femoral
resection guide
upwards

In many cases, little, if any, bone is removed from the
distal femur as the joint line is effectively elevated with
the removal of the primary femoral component. As the
level of resection is based on the preservation of bone
stock, each condyle is cut only to the level required to
establish a viable surface, with augmentation employed
to correct imbalance

Release
attachment

2. Remove femoral
alignment guide
towards the
T-handle

The resection is then performed through the slot
appropriate for each condyle, using a standard 1.19 mm
Thick Blade (Figure 41).
Note: If a ½ inch wide Standard Saw Blade is used
it can complete both medial and lateral distal
femoral cuts with the entire jig still in place.

Figure 40

An example of a medial
4 mm augment resection

Figure 41

33 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

FEMORAL PREPARATION – A/P AND CHAMFER CUTS

To size the femur, turn the femoral trial around so the
posterior condyles point away from the distal surface
(Figure 42). The M/L width of the trial should provide the
femoral size. Once the femoral size is determined, select
the appropriately sized Revision 4-in-1 Cutting Block.
Note: The Revision 4-in-1 Cutting Blocks may also
be used to assess the femoral size, as the block is
the same M/L width as the implant (See Figure 43).
If augment cuts were made during the distal resection,
assemble the appropriate distal spacer (4, 8, 12 or
16 mm) to the proximal side of the cutting block to
compensate for the condylar discrepancy. The distal
spacers slide in from the side using a dovetail connection
on the 4-in-1 Block (Figure 44).
Each distal spacer thickness is represented by a different
color (Figure 45).

Figure 42

Red = 4 mm
Black = 8 mm
Green = 12 mm

Width of femoral trial
matches 4-in-1 block

Blue = 16 mm

Figure 43

16 mm
12 mm

8 mm

4 mm
Figure 44

Figure 45

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 33

FEMORAL PREPARATION – A/P AND CHAMFER CUTS

The HP Revision 4-in-1 Cutting Block is fixed at a 5
degree angle. To change the block’s orientation for left
5 degrees or right 5 degrees, flip over the block’s knob
until the L is on top for Left or the R is on top for Right
Note: To assist in changing the Left or Right
orientation (L/R), the shaft of the Revision
Screwdriver may be placed lengthwise between the
two knobs of the L/R dial and rotated 180 degrees.
To set the block to the correct A/P starting position,
Insert the Revision Screwdriver into the hex head on the
block, PUSH and turn clockwise. (To change the setting,
the hex head must first be pushed in to shift the block)
(Figure 46).
Note: The block should be set up in the +2 position
(Fem Post) to begin. The lines on the side of the
knob should line up with the etched lines for the
desired position.

The Revision 4-in-1 Cutting Block

As the Screwdriver is turned
clockwise, the +2,0,-2 knob shifts
downwards

Once done, slide the block proximally onto the threaded
shaft with the appropriate Left/Right (L/R) orientation on
top (Figure 47).

To adjust A/P position:
1. Push Screwdriver into Hex Head
2. Rotate Screwdriver to adjust +2,0,-2 position

Figure 46

Figure 47

33 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

FEMORAL PREPARATION – A/P AND CHAMFER CUTS

Rotational positioning of the Revision 4-in-1 Cutting Block
is critical to the establishment of a symmetrical flexion gap
and patellofemoral alignment. The correct block rotation
should have the posterior surface of the cutting block
parallel to the resurfaced proximal tibia under tension.
Validate symmetry with the HP Revision M.B.T. Spacer
Blocks (Figure 48).
Note: The Revision M.B.T. Spacer Blocks are
designed to rest on top of the M.B.T. Revision Tray
Trial and underneath the posterior portion of the
4-in-1 Cutting Block, providing both the appropriate
tension and the correct insert thickness.
Optional: If desired, Alignment Rods may be introduced
through the handle of the spacer block. This may be
helpful in assessing alignment. Rods can be inserted
vertically (to assess the mechanical axis) and horizontally
(to assess tibial cut accuracy) (Figure 49).
Optional: Balanced Block Handles can be used to rotate
the block and to hold the block in place during final
resection.

Figure 48

Where asymmetry exists, additional soft-tissue balancing
may be indicated. Confirm positioning
by assuring parallel alignment of the cutting block with
the transepicondylar axis or the proximal tibia.
Introduce the Angel Wing into the anterior saw slot
to check the anterior resection and ensure femoral
notching does not occur.

Figure 49

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 33

FEMORAL PREPARATION – A/P AND CHAMFER CUTS

If the flexion gap is loose relative to the extension gap,
the next larger size femoral component can be used and
the posterior condyles augmented.
If the flexion gap is too tight relative to the extension
gap, the block can be moved from the +2 setting
(Femoral Posterior) to the 0 (Neutral) or -2 setting
(Femoral Anterior) (Figure 50).
Note: The block should not be shifted from one
setting to another with the spacer block, pins, or
any tensioning device in place.
With rotation and gap balancing confirmed, secure the
Cutting Block with HP Threaded Pins introduced through
the side Convergent Pin holes.
Note: If additional fixation is required use threaded
non-headed pins in the anterior pin holes. Use
caution when using headed threaded pins if a gap
exists between the distal spacers and the distal
bone.

Figure 50

The pins will pass through the block and then through
the Distal Spacer (if used), fixing the block in place
(Figure 51). Once locked in place perform the anterior,
posterior, and chamfer cuts.

Figure 51

33 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

FEMORAL PREPARATION – A/P AND CHAMFER CUTS

Anterior resection is performed through the
anterior slot using a 1.19 mm ½ inch wide Saw Blade
(Figure 52).
Note: The blocks feature an etched line on the side
of the block. This line on the block represents the
distal joint line of the femoral component.
Posterior resection is through the slot designated 0
or, where there is posterior condylar deficiency, use
the appropriate 4 or 8 mm slot to accommodate the
projected augmentation (Figure 53).

Etch Line Represents Joint Line
Figure 52

Once Anterior and Posterior resections are complete
proceed with the Anterior and Posterior chamfer cuts
(Figures 54 and 55).
Note: If pins were used in the straight anterior pin
holes for additional fixation, they must
be removed prior to making the anterior
chamfer cut.
Figure 53

Figure 54

Figure 55

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 33

FEMORAL PREPARATION – NOTCH RESECTION

Select the appropriate sized Revision Notch Guide, based
upon the size of the Revision 4-in-1 Block used. If distal
spacers were used for the 4-in-1 cuts, insert the same
distal spacers into the Notch Guide on the appropriate
side (Figure 56).
Select the appropriate Notch Guide Bushing. This
corresponds to the Right/Left Block knob position and
the 0 mm (Neutral), +2 mm (Fem Pos) or -2 mm (Fem Ant)
position that was used on the 4-in-1 Cutting Block.
Assemble it onto the Notch Guide with the appropriate
Right/Left and 0, +2 or -2 designation facing up and lock
into position by rotating the tabs anteriorly to the stop
(Figure 57).

Distal Spacer

Note: The width of the Notch Guide corresponds to
the final implant width (Figure 57).

Notch Guide Bushing
Figure 56

Final Implant Width

Figure 57

33 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

FEMORAL PREPARATION – NOTCH RESECTION

Assemble the Notch Guide onto the threaded shaft and
advance to the prepared distal surface (Figure 58).
If assistance is needed in re-establishing the rotation of
the Notch Guide, the HP Revision M.B.T. Spacer Block
may be used between the M.B.T. Revision Tibial Trial
and the posterior side of the Notch Guide to re-establish
desired rotation from the 4-in-1 Block.
Once desired rotation is set, use Non-Headed Pins in the
convergent pin holes to lock the Notch Guide in place.
The pins will go through both the Notch Guide and the
distal spacers (if used) (Figure 59).
If necessary, introduce Non-Headed Pins in the sequence
displayed (Figure 59):

Figure 58

1. Anterior

2. Contralateral distal
3. Anterior
4. Distal

Note: Care should be taken not to insert pins too far
into anterior bone.

Remove the notch bushing and the threaded shaft (if
used). Ensure the Notch Guide orientation does not
change and the Notch Guide is still rigidly fixed in place.
Note: The length of the intercondylar box differs
for the P.F.C. SIGMA Stabilized and TC3 femoral
components. Care should be taken to ensure that
the appropriate cut is made through the Notch
Guide.

Figure 59

The TC3 box cut is made through the proximal surface
of the anterior Notch Guide (through the slot) and
the Stabilized or PS box cut is made on top of the
slot (Figure 60). Perform the resection either with
an Oscillating Saw and a ½’inch wide blade or a
Reciprocating Saw (Figure 60).

TC3 and STAB markings

Figure 60

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 33

FEMORAL TRIAL ASSEMBLY

The Femoral Component Box Assembly

1) Place the two outrigger tabs of the box trial into
the recesses of the posterior condyles on the
corresponding size trial femoral component (Figure
61).
2) Insert the two anterior tabs into the recesses of the
anterior flange (Figure 62). If the anterior tabs won't
fit, take the box out, insert the Screwdriver into the
hex head and rotate counter clockwise, then reinsert.
3) Using the Screwdriver, adjust the hex screw at the
posterior of the box trial until a "click" is heard from
the Screwdriver (Figure 63).
4) Adjust the Femoral adapter position to the
corresponding position 0 (Neutral), +2 (Fem Post), or
-2 (Fem Ant and Right/Left (R/L)) from the Revision
4-in-1 Cutting Block and the notch guide bushing.
(Pull up then translate to desired position (Figure
64). This can be done by hand or with the Femoral
Adaptor Shift Tool. For further instructions, see Page
38 on how to adjust this positioning).
Note: Using the Screwdriver, tighten the hex screw
until a "click" is heard from the Screwdriver. This
will ensure secure assembly of the Box Trial to the
Femoral Trial. Do not overtighten the Screw or
attempt to remove the Screw from the Box Trial as
this will result in damage to the Box Trial
attachment.

Figure 61

Figure 62

Note: Do not over-loosen the Hex Screw when
disassembling the femoral trial construct. The
Screwdriver does not limit torque in the reverse
direction.

Figure 63

33 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Figure 64

FEMORAL TRIAL ASSEMBLY

If the box trial adapter orientation needs to be adjusted,
pull the adapter up and rotate 180 degrees to set the
orientation to left or right. The correct orientation
marking will be pointing towards the posterior condyles
of the trial femoral component and will be indicated by
an L for left and an R for right (Figure 65).
Ensure that the A/P positioning is correct. There are
indicators on the side of the box to indicate +2 (which
shifts the femoral component posteriorly/closes the
flexion space), 0 (neutral), and -2 (which shifts the
femoral component anteriorly/opens the flexion space)
(Figure 65). This positioning should match the A/P
setting established on the Revision 4-in-1 Block.
Note: To change the positioning, pull up on
the Adapter and move the Adapter forward or
backwards on the box until the desired +2, 0, or -2
location is reached. If this adjustment is difficult the
Femoral Adapter Shift Tool may be used to aid in
setting this adjustment (Figure 66).

To adjust the
L/R setting:
1. Pull up
2. Rotate Adapter
180 degrees

Figure 65

To adjust the setting:
1. Pull up
2. Translate posterior
or anterior

Figure 66

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 33

FEMORAL TRIAL ASSEMBLY
– SLEEVE AND STEM USE

Trial assembly order
(with sleeve and stem use, see Figure 67):
·· Assemble HP Revision TC3 Box Trial to the
corresponding size Femoral Trial
·· Assemble sleeve trial over adapter trial
·· Partially tighten HP Revision Sleeve Bolt Trial with the
Screwdriver to hold the construct in place
·· Add stem trial to trial assembly
·· Add posterior and distal augment trials, if needed
·· Seat trial assembly on femur

Step 3

·· Once sleeve trial has achieved proper orientation,
completely tighten with the Screwdriver until the
"click" is heard
After assembling the HP Revision TC3 Box Trial to the
femoral trial, set the femoral adapter on the box trial to
the correct side (Left or Right) and position (+2,0,-2 mm)
from the 4-in-1 Cutting Block and Notch Guide Bushing
(Figure 67 - Step 1). Assemble the femoral sleeve trial
corresponding in size to the final broach employed to
the TC3 femoral trial assembly (Figure 67 - Step 2) and
pass the HP Sleeve Bolt Trial through the hole in the box
of the distal femoral trial and partially tighten using the
Screwdriver (Figure 67 - Step 3). Make sure to properly
orient the sleeve trial with the narrow side facing
medially. Assemble the proper stem trial to the sleeve
trial (Figure 67 - Step 4).
Note: Trial bolt lengths are different for adapter/
sleeve use than for adapter/stem-only use, the bolt
trials are marked accordingly "SLEEVE BOLT" or
"STEM BOLT".
Note: Do not completely tighten down the bolt prior
to seating the trial construct into the canal. Leave
the sleeve slightly loose so that it finds its proper
rotation/orientation as it is being inserted into the
canal.

Step 1

Step 2

Step 4

Figure 67

44 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

FEMORAL TRIAL ASSEMBLY – SLEEVE AND STEM USE

The sleeve bolt mechanical connection to the sleeve trial/
adapter/femoral trial construct helps to ensure that the
parts do not disassociate during use.
Note: Please consult the anterior width chart on
page 64 (in the Appendix) to determine the sleeve/
femoral component compatibility and the distance
between the anterior chamfer and the anterior
aspect of the sleeve.
Where augmentation is employed, assemble the
appropriate trial distal and posterior augmentation
components to the trial femoral component
(Figure 68).
Remove the sleeve broach with the broach handle.
Seat the femoral trial in the femur. The sleeve trial will
achieve the rotation and orientation of final broach
used. After the femoral trial with sleeve is seated
securely in the metaphysis, tighten the sleeve bolt trial
with the screwdriver until the "click" is heard (Figure
69).

Figure 68

Figure 69

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 44

FEMORAL TRIAL ASSEMBLY – STEM-ONLY USE

Trial assembly order (with stem-only use, Figure 70):
·· Assemble HP Revision TC3 Box Trial to the
corresponding size femoral trial
·· Tighten HP Revision Stem Bolt Trial
with the Screwdriver
·· Add stem trial to trial assembly
·· Add posterior and distal augment trials, if needed
·· Seat trial assembly on femur
After assembling the HP Revision TC3 Box Trial to the
Femoral Trial, set the Femoral Adapter on the box trial to
the correct side (Left or Right) and position (+2,0,-2 mm)
from the Revision 4-in-1 Cutting Block and Notch Guide
Bushing (Figure 70 - Step 1). Pass the Stem Bolt Trial
through the hole in the box of the distal femoral trial
and tighten using the HP Revision Screwdriver (Figure 70
- Step 2). Assemble the proper stem trial to the box trial
(Figure 70 – Step 3).

Step 2

Note: Trial bolt lengths are different for adapter/
sleeve use than for adapter/stem-only use, the bolt
trials are marked accordingly "SLEEVE BOLT" or
"STEM BOLT".
The stem bolt mechanical connection to the Adapter/
Femoral Trial construct helps to ensure that the parts do
not translate during use.

Step 1

Where augmentation is employed, assemble the
appropriate trial distal and posterior augmentation
components to the trial femoral component.
Seat the femoral trial in the femur.
Note: The stem bolt must be used for a stem only
trial. Failure to use the stem bolt will result in an
inaccurate reading of varus/valgus stability during
trialing.

Step 3

Figure 70

44 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

FEMORAL TRIAL ASSEMBLY – SLEEVE-ONLY USE

Trial assembly order (with Sleeve-only use, Figure 71):
·· Assemble HP Revision TC3 Box Trial to the
corresponding size Femoral Trial
·· Assemble sleeve trial over adapter trial
·· Partially tighten HP Revision Sleeve Bolt Trial
with the Screwdriver to hold the construct in place
·· Add posterior and distal augment trials, if needed
·· Seat trial assembly on femur
·· Once sleeve trial has achieved proper orientation,
completely tighten with the Screwdriver until the
"click" is heard
After assembling the HP Revision TC3 Box Trial to the
femoral trial, set the femoral adapter on the box trial to
the correct side (Left or Right) and position (+2,0,
-2 mm) from the Revision 4-in-1 Cutting Block and
Notch Guide Bushing (Figure 71 - Step 1). Assemble the
femoral sleeve trial corresponding in size to the final
broach employed to the TC3 Femoral Trial assembly
(Figure 71 - Step 2) and pass the HP Revision Sleeve Bolt
Trial through the hole in the box of the distal femoral
trial and partially tighten using the Screwdriver (Figure
71 - Step 3). Make sure to properly orient the sleeve trial
with the narrow side facing medially. Do not completely
tighten down the bolt. Leave the sleeve trial slightly
loose so that it find its proper rotation/orientation as it is
being inserted into the canal.

Step 3

Step 1

Note: Trial bolt lengths are different for adapter/
sleeve use than for adapter/stem-only use, the bolt
trials are marked accordingly "SLEEVE BOLT" or
"STEM BOLT".
Step 2

Figure 71

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 44

FEMORAL TRIAL ASSEMBLY – SLEEVE-ONLY USE

The sleeve bolt mechanical connection to the adapter/
femoral trial construct helps to ensure that the parts do
not disassociate during use.
Note: Please consult the anterior width chart
on page 64 (in the Appendix) to determine the
sleeve/femoral component compatibility and the
distance between the anterior chamfer and the
anterior aspect of the sleeve.
Where augmentation is employed, assemble the
appropriate trial distal and posterior augmentation
components to the trial femoral component. Remove
the sleeve broach with the broach handle. Seat the
femoral trial in the femur. The sleeve trial will achieve
the rotation and orientation of final broach used. After
the sleeve trial is seated securely in the metaphysis,
tighten the sleeve bolt trial with the screwdriver until the
"click" is heard.

44 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

FINAL PREPARATION OF THE TIBIA

Assess proximal tibial coverage and rotation of tibial
component. Impact the appropriate Keel Punch (utilize
the cemented Keel Punch if a cement mantle is desired
or the press-fit Keel Punch if line-to-line contact is
desired) (Figure 72). The base plate should be positioned
to provide the best coverage of the tibial condylar
surface.
Leave the Keel Punch in place for trial reduction and
insert the polyethylene Trial (Figure 73).
Note: PS or CR M.B.T. Insert Trials may be used at
this point to assess construct stability. Using these
trials will allow easier insertion onto the keel and
will provide a better idea on how well the gaps are
balanced.

Figure 72

Figure 73

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 44

PREPARATION OF THE PATELLA

Where replacement of the patellar component is
indicated, it is important that the anteroposterior
dimension be maintained and that adequate bone
stock be preserved. Problems arise from inadequate,
excessive or uneven resection resulting in abnormal
anteroposterior dimension to the complex, subsequent
patellar tilt and implant wear.
Free sufficient soft tissue at the prepatellar bursa to
position Calipers at the anterior cortex.
Where residual bone stock is adequate, implantation of
the replacement prosthesis is essentially routine. Where
inadequate, patelloplasty may be indicated.
Note: The normal anteroposterior patellar
dimension is 22–24 mm in the female, 24–26 mm in
the male (Figure 74).

Figure 74

44 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

PREPARATION OF THE PATELLA

Meticulous disruption of the bone/prosthesis interface
is essential. It is performed with thin Osteotomes and
thin Oscillating Saw Blades. Avoid excessive leverage to
minimize possible fracturing.
Position the Patellar Template that most adequately
covers the prepared surface along the horizontal axis
of the patella and firmly engage. Fashion the three
holes for the fixation pegs of the component with the
appropriate drill (Figure 75). Depth is governed by the
collar.
Implanting the Patellar Component
Perform patellar implantation when convenient.
Cleanse the site with pulsatile lavage, dry, and apply
methyl methacrylate cement. Insert the component into
the prepared holes and position thePatellar Clamp.
The clamp is designed to fully seat and stabilize the
implant. Position it with the silicone O-ring centered
over the articular surface of the implant and the metal
backing plate against the anterior patellar cortex,
avoiding skin entrapment. When snug, the handles are
closed and held by the ratchet until polymerization is
complete (Figure 76). Avoid excessive compression as
it can fracture osteopenic bone. Remove all extruded
cement with a Curette.

Figure 75

Figure 76

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 44

IMPLANT ASSEMBLY - TIBIA

Tibial Sleeve Assembly
Note: It is imperative to assemble the sleeve prior to
stem attachment.
Note: Sleeves and step wedges can only be used
together if using a 29 mm Sleeve.
Remove trial component in one piece (use as guide for
assembly of implants).
Place the M.B.T. Revision Tray on a firm, stable, padded
surface. Set the tibial sleeve in an orientation that
matches the prepared canal. Matching the orientation of
the tray/sleeve trial is helpful in determining appropriate
rotation of the final tibial tray/sleeve implant (Figure 77).
The sleeve can rotate 20 degrees internally or externally.
Using the Sleeve Impactor and a mallet, impact the
sleeve onto the M.B.T. Revision Tray. Deliver several
strikes to engage the two components (Figure 78).
Stem Component Assembly
Attach the stem extension to the prosthetic tray using
the two appropriate wrenches to ensure full
engagement (Figure 79).

Figure 77

Figure 78

Figure 79

44 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

TIBIAL IMPLANTATION

Implanting the Tibial Component
Thoroughly cleanse the site with pulsatile lavage.
Perforate with small drill holes on the prepared tibial
surface to facilitate penetration of methyl methacrylate
cement (Figure 80). Pack residual small cavitary bone
defects with cancellous autograft, if available, or
allograft.
Apply methyl methacrylate cement to the proximal tibial
surface (Figure 81) or directly to the underside of the
tibial tray component.
When a fluted stem or a fluted stem with a metaphyseal
sleeve is used, ensure the medullary canal remains free
of cement. Clear all extruded cement with a curette.
Seat the tibial implant construct into the prepared tibia
by impacting the RP Tray Impactor and Universal Handle
assembly (Figure 82).

Figure 80

Figure 81

Figure 82

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 44

IMPLANT ASSEMBLY – SIGMA FEMORAL ADAPTER

Remove the assembled femoral trial components and
clean the site thoroughly using pulse lavage before
implantation. Before prostheses implantation proceeds,
attach all augments, sleeves and modular stems to the
femoral component.
Pass the appropriate P.F.C. SIGMA Femoral Adapter
Bolt, neutral or +/-2 mm, corresponding to the position
selected for the Revision 4-in-1 Cutting Block and the
bushing for the notch guide through the hole of the
distal femoral component and into the P.F.C. SIGMA
Femoral Adapter (Figure 83).

Figure 83

Arrow Indicator

+2 mm

0 mm

-2 mm

55 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Box Trial

Final Implant

IMPLANT ASSEMBLY – SIGMA FEMORAL ADAPTER

Tighten the construct until the base of the adapter is
flush with the femoral box. The three A/P etch marks
on the base of the adapter implant should face laterally.
From the posterior view of the assembly, the angle
(5 degrees) and orientation (L or R) will be legible
(Figure 84).
Attach the P.F.C. SIGMA Femoral Adapter holding
clamp to the femoral implant and tighten it. The clamp
provides the second moment arm needed to assemble
the parts. Place the torque wrench over the P.F.C. SIGMA
Femoral Adapter implant and move it clockwise to
tighten the adapter to the femoral implant
(Figure 84). The torque wrench has a deflection beam,
which indicates when sufficient torque has been applied
(Figure 85).
Note: Torque the assembly to the 270 in. lb mark on
the torque wrench to ensure proper assembly torque
(Figure 85).

Figure 84

Figure 85

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 55

IMPLANT ASSEMBLY – SIGMA FEMORAL AUGMENTS

Attach the femoral augments using the wobble bits
included in the augment package. Attach the femoral
augments to the femoral component using the augment
T-handle provided (Figures 86 and 87).It may be
necessary to use the T-handle extension in conjunction
with the T-handle to attach the augments.
Fully seat the augments on the component before
tightening the screw thread mechanism. Carefully
tighten with the large T-handle Torque Driver until an
audible "click" is discerned.
The augment assembly sequence is shown below. For
implant assembly: sleeve and stem proceed to page 51,
stem-only proceed to page 53, and sleeve-only proceed
to page 54.
Assembly Rules for Femoral Augmentation
1. For Size 1.5 Femoral Components
·· Distal augmentation component augments in
4, 8 and 12 mm thicknesses
·· Assemble last

Figure 86

2. For Size 4n PS Femoral Components
·· Use size 2 distal and posterior augments
3. For 4 mm/8 mm Augments
·· They are fully interchangeable
·· If using 4 mm or 8 mm distal with posterior augment,
install distal first
4. For 12 mm/16 mm Distal Augment
·· Use 16 mm distal augment with TC3 femoral only
·· Femoral stem is indicated
·· On size 2, 2.5 and 3 femoral component, use
4 mm posterior only
·· On size 4, 5 femoral component, may use 4
or 8 mm posterior
(Note: No size 6 augments available - use size 5
distal augments and size 3 posterior augments
with size 6 femoral component)
·· If using with posterior augment, install posterior
augment first
Figure 87

55 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

IMPLANT ASSEMBLY – SLEEVE AND STEM USE

Implant Assembly - Sleeve and Stem Use
Implant assembly order (with sleeve and stem use):
·· Femoral adapter-to-femoral component
·· Add posterior and distal augments, if necessary
·· Sleeve-to-stem
·· Sleeve construct-to-femoral adapter construct
To attach the Universal Stem to the universal femoral
sleeve, thread the stem onto the sleeve. Grasp the sleeve
with the tibial sleeve clamp and use the stem Extension
Wrench to grasp the Universal Stem and tighten
(Figure 88).
Apply sufficient force to both wrenches to ensure that
the stem is secure.
Place the femoral component with the femoral adapter
on a firm, stable surface. Place the appropriate sleeve
and stem construct on top of the femoral adapter
assembly (Figure 89).

Figure 88

Use the sleeve and femoral trial construct trial to help
set the final sleeve and femoral component implant
rotation.

Figure 89

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 55

IMPLANT ASSEMBLY – SLEEVE AND STEM USE

Slide the femoral stem/sleeve impactor on top of the
stem and forcefully apply three strikes with a mallet to
engage the two component assemblies (Figure 90).
Note: The femoral stem/sleeve Impactor has two
uses, one end for use of a sleeve without a stem
extension and one end for a sleeve and stem
combination.
The definitive components are implanted in the
following order:
·· Tibial tray (with stem, sleeve and/or wedges)
·· Femoral component (with stem, sleeve and/or
augments)
·· SIGMA Rotating Platform PS or TC3 inserts
Implant the femoral component using the Femoral
Impactor (Figure 91).

Figure 90

Figure 91

55 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

IMPLANT ASSEMBLY – STEM-ONLY USE

Implant Assembly - Stem Only
Implant assembly order (with Stem-only use):
·· Femoral adapter-to-femoral component
·· Add posterior and distal augments, if necessary
·· Stem-to-femoral adapter
To attach the Universal Stem to the P.F.C. SIGMA
Femoral Adapter, thread the stem onto the adapter.
With the P.F.C. SIGMA Femoral Adapter holding clamp
in place, use the Stem Extension Wrench to grasp the
Universal Stem and tighten (Figure 92). Apply sufficient
force to both the P.F.C. SIGMA Femoral Adapter holding
clamp and Stem Extension Wrench to ensure that stem
is secure.
The definitive components are implanted in
the following order:
·· Tibial Tray (with stem, sleeve and/or wedges)
·· Femoral component (with stem and/or augments)

Figure 92

·· SIGMA Rotating Platform PS or TC3 inserts
Implant the femoral component using the Femoral
Impactor (Figure 93).

Figure 93

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 55

IMPLANT ASSEMBLY – SLEEVE-ONLY USE

Implant Assembly - Sleeve Only
Implant assembly order (with sleeve-only use):
·· Femoral adapter-to-femoral component
·· Add posterior and distal augments, if necessary
·· Sleeve-to-femoral adapter
Slide the femoral stem/sleeve Impactor on top of
the sleeve and forcefully apply three strikes with a Mallet
to engage the two components (Figure 94).
Note: The femoral stem/sleeve impactor has
two uses, one end for the sleeve without a stem
extension and one end for a sleeve and stem
combination.
The definitive components are implanted in
the following order:
·· Tibial tray (with stem, sleeve and/or wedges)
·· Femoral component (with sleeve and/or augments)
·· SIGMA Rotating Platform PS or TC3 inserts
Implant the femoral component using the femoral
impactor.
Figure 94

55 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

FINAL TRIAL WITH IMPLANTS

Place the Revision Trial Post into the cone of the M.B.T.
Revision implant. Seat the appropriate trial insert in the
trial post/tray (Figure 95).

Revision Trial Post

Assemble the appropriate femoral implant construct
(see pages 51-54), apply the appropriate cementation
technique and impact the femoral implant construct into
the prepared femur.
Fully extend the knee to maintain pressure as the cement
polymerizes (Figure 96).
Note: With constrained femoral and tibial
components in trial reduction, it may be
appropriate to cement the tibial tray implant and
the femoral implant using the insert trial. This will
allow visibility of final rotation.
Note: PS or CR M.B.T. Insert Trials may be used in
the place of TC3 insert trials during this step. Using
these trials will allow easier insertion onto the keel
and will provide a better idea on how well the gaps
are balanced.

Figure 95

Figure 96

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 55

APPENDIX 1: THE CEMENTED TIBIAL
STEM EXTENSIONS

Cemented Stem Reamer
Align the tibial tray and secure with two Fixation Pins
inserted through the holes designated (Figure 1).
Seat the M.B.T. Revision Drill Bushing onto the tibia trial.
Place in the posterior holes.
Place the cemented drill bushing into the M.B.T. Revision
Drill Bushing (Figure 2).
Use the “cemented” reamer to ream to the
predetermined selected depths for tray only or the tray
with a 30 or 60 mm cemented stem.
Remove the reamer and “cemented” bushing, leaving
the tray trial and M.B.T. Revision Drill Bushing in place
(Figure 3).
Note: Only a 13 mm diameter cemented stem should
be used in conjunction with the M.B.T. Revision Tray
to avoid a step off at the stem/tray junction.
Figure 1

Cemented
Drill Bushing

M.B.T. Revision
Drill Bushing

Figure 2

55 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Figure 3

APPENDIX 1: THE CEMENTED TIBIAL
STEM EXTENSIONS

Tapered Reamer
Assemble the revision reamer adapter onto the
cemented tapered reamer.
Next, attach the modified Hudson Adapter to the
tapered reamer, if power reaming.

Modified Hudson Adapter

Attach the appropriately sized cemented stem trial
(13 x 30 mm or 13 x 60 mm) to the tapered reamer, if
utilizing a cemented stem extension (Figure 4). Ream
until the revision reamer adapter is flush with the M.B.T.
Revision Drill Bushing (Figure 5).
Note: To avoid stem trial disengagement,
do not reverse ream.

Revision Reamer Adapter

Figure 4

Figure 5

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 55

APPENDIX 1: THE CEMENTED
TIBIAL STEM EXTENSIONS

Tapered Cemented Stems
Note: Tapered cemented stem sizes 13 x 90/120/150
mm are compatible with M.B.T. Revision Trays.
Ream the canal with a reamer two sizes larger than the
stem. Ream the medullary canal with a 15 mm reamer
to implant a 13 mm tapered cemented stem, which
allows for a 1 mm circumferential cement mantle at the
proximal end of the stem. The cement mantle will be
greater around the distal end of the cemented tapered
stem (3 mm per side).
This provides the following benefits:
·· Thicker cement mantle distally helps assure that a
circumferential mantle is present and reduces the
possibility of thin or non-existent cement coverage of
the stem distally
·· Stresses are greatest at the tip of the stem. A larger
cement mantle is advantageous in dissipating these
stresses. Thinner cement mantles are more prone to
breakdown when exposed to higher stresses
Tibial Keel Preparation
Place the knee in full extension and determine
appropriate rotation of the tibial tray. Mark the
appropriate rotation with electrocautery on the anterior
tibial cortex at the center and sides of the alignment
handle.
Assemble the appropriate stem trial to the M.B.T.
Revision Tray Trial and seat in the prepared bone bed.
Impact the cemented keel punch (Figure 6).
Disconnect the Universal Handle leaving the Keel Punch
in place for trial reduction (if appropriate).
It is recommended that a Cement Restrictor be placed at
the appropriate level prior to cementing the component.
Use a Cement Gun to fill the canal with methyl
methacrylate.

66 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Figure 6

APPENDIX 2: STEP WEDGE PREPARATION

Step Wedge Augmentation
Resection for supplementary tibial augmentation
may be based on the established position of the
trial tray. Remove the femoral trial to provide greater
access. Confirm rotational alignment of the Tibial Tray
Stem Trial. Secure the tray with two Fixation Pins.
Attach the tray trial wedge cutting attachment with the
Step Wedge Cutting Guide to the trial tray. The Step
Wedge Cutting Block allows for a 5, 10, or 15 mm step
wedge preparation, as necessary. Slide the block forward
to the anterior proximal tibia and secure in place with
two Steinmann Pins through the holes marked with
(Figure 1).
Unlock the block and slide the assembly out of the
block. Disconnect the handle from the trial tray
(Figure 2).
Figure 1

Figure 2

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 66

APPENDIX 2: STEP WEDGE PREPARATION

Trim the tibia accordingly with an Oscillating Saw so the
cut does not extend beyond the central riser (Figure 3).
Remove the block and pins.
Assemble the trial wedge to the appropriate tibial tray
trial (Figure 4) and introduce into the prepared site.
Perform minimal correction with a Bone File where
indicated to ensure maximal contact.

Step Wedge
Cutting Block

Figure 3

Figure 4

66 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

APPENDIX 2: STEP WEDGE PREPARATION

Confirm positioning, alignment and security of the tray
assembly. If there is old cement or sclerotic bone, remove
this first with a saw blade or burr prior to punching.
Position the M.B.T. Revision Tibial Keel Punch at the tray
and cancellous bone interface and impact into the keel
configuration (Figure 5). Leave the punch in place and
perform a final trial reduction if necessary.
Note: Utilize the “cemented” keel punch when a
cement mantle is desired.
Alternative Step Wedge Preparation
This is a “free-hand” resection. Assemble the wedge
trial and stem trial to the tibial tray trial. Position the
device slightly proximal to the planned resection level.
Make a conservative “free-hand” wedge resection and
then check cuts with the trials (Figure 6).
Wedge Implant Assembly
Note: To aid wedge implant assembly, attach wedge
prior to stem attachment.
Assemble the designated wedge to the tray and secure
using the appropriate screw. Carefully tighten with the
large T-handle torque driver until an audible "click" is
discerned, ensuring a full and permanent interlock
(Figure 7).

Figure 5

Figure 6

Figure 7

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 66

APPENDIX 3: THICK TRAY PREPARATION

After impacting the cement or press-fit keel punch,
remove the keel punch. Insert the M.B.T. Thick Tray Trial
Adapter (15 or 25 mm) onto the tibial tray trial (Figures
1 and 2).
Note: The tibial tray trial must be used with the
thick tray adapters as the two pieces equal the
appropriate sizing – 15 or 25 mm.
Perform the final trial reductions utilizing the same
technique as the standard M.B.T. Revision Tray. Implant
assembly and implantation is also the same as with the
standard M.B.T. Revision Tray. If utilizing a wedge, refer
to the step wedge preparation in Appendix 2.
Note: A tibial wedge can be used with all thick tray
sizes, except for size 2. Sleeves may be used with all
thick trays.
Note: Due to the taper, trial with appropriate tray
trial size. For example, a size 4 thick tray tapers
down to a size 2. Use the size 2 tray trial with the
size 4 thick tray adapter. The size 3 thick tray
tapers down to a size 1. And the size 2 thick tray
tapers down to a size 0. The size 0 tray trial can be
found in the M.B.T. thick tray instrument set.

Figure 1

Figure 2

66 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

APPENDIX 4: FEMORAL REVISION AND
MBT REVISION TRAY COMPATIBILITY

FEMORAL COMPONENTS
Size 1.5

Size 2

Size 2.5

Size 3

Size 4N

Size 4

Size 5

Size 6

53AP/57ML

56AP/60ML

59AP/63ML

61AP/66ML

65AP/66ML

65AP/71ML

69AP/73ML

74AP/78ML

TC3

M.B.T
REVISION TRAYS
Size 1
39AP/59ML

Size 1.5
41AP/62ML

Size 2
43AP/65ML

Size 2.5
44AP/67ML

Size 3
46AP/70ML

Size 4
49AP/75ML

Size 5
53AP/81ML

Size 6
57AP/87ML
**TC3 FEMURS ARE NOT AVAILABLE IN SIZE 4N OR 6

Note: RP insert must match femur size for size.

M.B.T. Revision Thick Tray Sizing Chart

Note: For a size 4N femur, use a size 4 RP insert.
Size 2

Size Three

Size Four

Proximal

size two

size three

size four

Distal

size zero
(38ap/54ml)

size one

size two

M.B.T. Revision Trays
·· Made of Cobalt Chrome
·· Tray thickness is 4.8 mm
M.B.T. Revision Thick Trays
·· Made of Cobalt Chrome
·· Tray thickness is 15 mm and 25 mm
·· All thick trays taper distally by two sizes
to match tibial anatomy.

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 66

APPENDIX 5: SIGMA REVISION
ANTEROPOSTERIOR CHART (WITH SLEEVE USE)

The following chart shows the distance (mm) between
the anterior flange of a femoral component and the
sleeve, based on the size of the component and the
anteroposterior option chosen. Fields with an X denote
that the sleeve, femoral component and offset option is
not possible.

Size of sleeve (M/L)

Femoral Size and A/P Position
1.5
Ant

1.5
Neut

1.5
Post

2
Ant

2
Neut

2
Post

2.5
Ant

2.5
Neut

2.5
Post

3
Ant

3
Neut

3
Post

20 mm

0.9

2.7

4.7

1.8

3.8

5.8

2.6

4.6

6.6

3.2

5.2

7.2

31 mm

2.1

4.5

5.8

2.7

5.0

7.0

3.8

5.8

7.8

4.6

6.7

8.6

34 mm

3.4

4.6

2.1

4.4

5.9

3.2

5.2

7.0

3.6

5.7

7.6

40 mm

2.4

3.9

1.2

3.2

5.6

2.0

3.9

6.0

2.7

4.6

6.5

46 mm

2.6

3.6

2.6

4.8

1.5

3.6

5.5

2.4

4.6

6.4

Size of sleeve (M/L)

Femoral Size and A/P Position
4
Ant

4
Neut

4
Post

5
Ant

5
Neut

5
Post

6
Ant

6
Neut

6
Post

20 mm

4.9

6.9

8.9

6.4

8.4

10.4

8.5

10.5

12.5

31 mm

6.3

8.3

10.2

7.8

9.7

11.8

9.9

11.9

13.9

34 mm

5.3

7.3

9.3

6.8

8.9

10.8

8.8

10.9

13.0

40 mm

4.2

6.1

8.1

5.6

7.6

9.6

7.8

9.9

11.8

46 mm

4.3

6.2

8.2

5.7

7.6

9.6

7.9

9.9

11.7

66 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

SIGMA HP REVISION FEMORAL PREP INSTRUMENT
CASE CAT. NO. 2011-03-049

Top Tray

Description

Cat. No.

SIGMA HP Revision 4-in-1 Cutting Block Size 2

2011-03-000

SIGMA HP Revision 4-in-1 Cutting Block Size 2.5

2011-03-001

SIGMA HP Revision 4-in-1 Cutting Block Size 3

2011-03-002

SIGMA HP Revision 4-in-1 Cutting Block Size 4

2011-03-003

SIGMA HP Revision 4-in-1 Cutting Block Size 5

2011-03-004

SIGMA HP Revision Notch Guide Size 2

2011-03-005

SIGMA HP Revision Notch Guide Size 2.5

2011-03-006

SIGMA HP Revision Notch Guide Size 3

2011-03-007

SIGMA HP Revision Notch Guide Size 4

2011-03-008

SIGMA HP Revision Notch Guide Size 5

2011-03-009

SP2 Femoral Notch Guide Bushing 5 degree +2L/-2R

96-6531

SP2 Femoral Notch Guide Bushing 5 degree 0 mm offset

96-6532

SP2 Femoral Notch Guide Bushing 5 degree +2R/-2L

96-6533

SP2 Removable Handles

96-6147

Pin Caddy

SIGMA HP Power Pin Driver

Distal Spacer Caddy

SIGMA HP Revision Distal Spacer 4 mm

2011-03-021

SIGMA HP Revision Distal Spacer 8 mm

2011-03-022

SIGMA HP Revision Distal Spacer 12 mm

2011-03-023

SIGMA HP Revision Distal Spacer 16 mm

2011-03-024

9505-02-071

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 66

SIGMA HP REVISION FEMORAL PREP INSTRUMENT
CASE CAT. NO. 2011-03-049

Bottom Tray

H
B

Description

Cat. No.

Visualization Wing

96-6530

Completion Revision Femoral Tapered Reamer

2178-60-030

Universal Revision Femoral Broach Reamer

96-1671

Universal Revision Femoral Broach 31 mm

96-1683

Universal Revision Femoral Broach 34 mm

96-1684

Universal Revision Femoral Broach 40 mm

96-1685

Universal Revision Femoral Broach 46 mm

96-1686

SIGMA HP Revision Adapter Removable Shaft

2011-03-029

SIGMA HP Distal Femoral Resection Guide

9505-01-235

SIGMA HP Distal Femoral Connector

9505-01-238

SIGMA HP Revision Distal Femoral Block

9505-01-239

SIGMA HP Distal Femoral Alignment Guide

9505-01-234

Universal Revision Femoral Broach Handle

96-1682

66 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

SIGMA HP REVISION FEMORAL TRIAL INSTRUMENT
CASE CAT. NO. 2011-03-050

Top Tray

E
F

O
P

Q
R

S
L
T

Description

Cat. No.

LCS/SIGMA Revision Femoral Sleeve Trial 20 mm

2294-53-100

LCS/SIGMA Revision Femoral Sleeve Trial 31 mm

2294-53-110

LCS/SIGMA Revision Femoral Sleeve Trial 34 mm

2294-53-120

LCS/SIGMA Revision Femoral Sleeve Trial 40 mm

2294-53-130

LCS/SIGMA Revision Femoral Sleeve Trial 46 mm

2294-53-140

Modular Plus Torque Driver

86-0284

SIGMA HP Revision TC3 Box Trial Size 2

2011-03-011

SIGMA HP Revision TC3 Box Trial Size 2.5

2011-03-012

SIGMA HP Revision TC3 Box Trial Size 3

2011-03-013

SIGMA HP Revision TC3 Box Trial Size 4

2011-03-014

SIGMA HP Revision TC3 Box Trial Size 5

2011-03-015

SIGMA HP Revision Femoral Adapter Shift Tool

2011-03-057

SIGMA Femoral Adapter Sleeve Bolt Trial Neutral

2011-03-052

SIGMA Femoral Adapter Stem Bolt Trial Neutral

2011-03-051

Femoral Augment Plug Puller

86-5151

SP2 Torque Driver Handle Extension

96-6301

Large Fragment Screwdriver Shank

8242-19-000

2.0 Nm Torque-limiting Screwdriver

2141-18-001

Femoral Adapter Torque Wrench

96-1673

Femoral Adapter Holding Clamp

96-1674

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 66

SIGMA HP REVISION FEMORAL TRIAL INSTRUMENT
CASE CAT. NO. 2011-03-050

Bottom Tray

J
G

Description

Cat. No

PFC SIGMA C/R Femoral Left Size 2 Trial

96-1002

PFC SIGMA C/R Femoral Right Size 2 Trial

96-1012

Size 2 Femoral Augment Trial Caddy

PFC SIGMA Distal Femoral Augment Trial 4 mm Size 2

96-1820

PFC SIGMA Distal Femoral Augment Trial 8 mm Size 2

96-1822

PFC SIGMA Posterior Femoral Augment Trial 4 mm Size 2

96-1826

PFC SIGMA Posterior Femoral Augment Trial 8 mm Size 2

96-1828

PFC SIGMA Distal Femoral Augment Trial 12 mm Size 2

96-1830

PFC SIGMA Distal Femoral Augment Trial 16 mm Size 2

96-1832

PFC SIGMA C/R Femoral Left Size 2.5 Trial

96-1008

PFC SIGMA C/R Femoral Right Size 2.5 Trial

96-1018

Size 2.5 Femoral Augment Trial Caddy

PFC SIGMA Distal Femoral Augment Trial 4 mm Size 2.5

96-1840

PFC SIGMA Distal Femoral Augment Trial 8 mm Size 2.5

96-1842

PFC SIGMA Posterior Femoral Augment Trial 4 mm Size 2.5

96-1846

PFC SIGMA Posterior Femoral Augment Trial 8 mm Size 2.5

96-1848

PFC SIGMA Distal Femoral Augment Trial 12 mm Size 2.5

96-1850

PFC SIGMA Distal Femoral Augment Trial 16 mm Size 2.5

96-1852

PFC SIGMA C/R Femoral Left Size 3 Trial

96-1003

PFC SIGMA C/R Femoral Right Size 3 Trial

96-1013

77 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

SIGMA HP REVISION FEMORAL TRIAL CASE
CAT. NO. 2011-03-050

Bottom Tray

J
G

Description

Cat. No

Size 3 Femoral Augment Trial Caddy

PFC SIGMA Distal Femoral Augment Trial 4 mm Size 3

96-1860

PFC SIGMA Distal Femoral Augment Trial 8 mm Size 3

96-1862

PFC SIGMA Posterior Femoral Augment Trial 4 mm Size 3

96-1866

PFC SIGMA Posterior Femoral Augment Trial 8 mm Size 3

96-1868

PFC SIGMA Distal Femoral Augment Trial 12 mm Size 3

96-1870

PFC SIGMA Distal Femoral Augment Trial 16 mm Size 3

96-1872

PFC SIGMA C/R Femoral Left Size 4 Trial

96-1004

PFC SIGMA C/R Femoral Right Size 4 Trial

96-1014

Size 4 Femoral Augment Trial Caddy

PFC SIGMA Distal Femoral Augment Trial 4 mm Size 4

96-1880

PFC SIGMA Distal Femoral Augment Trial 8 mm Size 4

96-1882

PFC SIGMA Posterior Femoral Augment Trial 4 mm Size 4

96-1886

PFC SIGMA Posterior Femoral Augment Trial 8 mm Size 4

96-1888

PFC SIGMA Distal Femoral Augment Trial 12 mm Size 4

96-1890

PFC SIGMA Distal Femoral Augment Trial 16 mm Size 4

96-1892

PFC*SIGMA C/R Femoral Left Size 5 Trial

96-1005

PFC SIGMA C/R Femoral Right Size 5 Trial

96-1015

Size 5 Femoral Augment Trial Caddy

PFC SIGMA Distal Femoral Augment Trial 4 mm Size 5

96-1900

PFC SIGMA Distal Femoral Augment Trial 8 mm Size 5

96-1902

PFC SIGMA Posterior Femoral Augment Trial 4 mm Size 5

96-1906

PFC SIGMA Posterior Femoral Augment Trial 8 mm Size 5

96-1908

PFC SIGMA Distal Femoral Augment Trial 12 mm Size 5

96-1910

PFC SIGMA Distal Femoral Augment Trial 16 mm Size 5

96-1912

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 77

SIGMA HP REVISION TC3 RP INSERT TRIAL
AND SPACER BLOCK CASE CAT. NO. 2011-03-070

Top Tray

Description

Cat. No.

TC3 RP Tibial Insert Trial Size 2 10

96-3321

TC3 RP Tibial Insert Trial Size 2 12.5

96-3322

TC3 RP Tibial Insert Trial Size 2 15

96-3323

TC3 RP Tibial Insert Trial Size 2 17.5

96-3324

TC3 RP Tibial Insert Trial Size 2 20

96-3325

TC3 RP Tibial Insert Trial Size 2.5 10

96-3331

TC3 RP Tibial Insert Trial Size 2.5 12.5

96-3332

TC3 RP Tibial Insert Trial Size 2.5 15

96-3333

TC3 RP Tibial Insert Trial Size 2.5 17.5

96-3334

TC3 RP Tibial Insert Trial Size 2.5 20

96-3335

TC3 RP Tibial Insert Trial Size 3 10

96-3341

TC3 RP Tibial Insert Trial Size 3 12.5

96-3342

TC3 RP Tibial Insert Trial Size 3 15

96-3343

TC3 RP Tibial Insert Trial Size 3 17.5

96-3344

TC3 RP Tibial Insert Trial Size 3 20

96-3345

TC3 RP Tibial Insert Trial Size 4 10

96-3351

TC3 RP Tibial Insert Trial Size 4 12.5

96-3352

TC3 RP Tibial Insert Trial Size 4 15

96-3353

TC3 RP Tibial Insert Trial Size 4 17.5

96-3354

TC3 RP Tibial Insert Trial Size 4 20

96-3355

TC3 RP Tibial Insert Trial Size 5 10

96-3361

TC3 RP Tibial Insert Trial Size 5 12.5

96-3362

TC3 RP Tibial Insert Trial Size 5 15

96-3363

TC3 RP Tibial Insert Trial Size 5 17.5

96-3364

TC3 RP Tibial Insert Trial Size 5 20

96-3365

77 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

SIGMA HP REVISION TC3 RP INSERT TRIAL
AND SPACER BLOCK CASE CAT. NO. 2011-03-070

Bottom Tray
F

G
A

Description

Cat. No.

TC3 RP Tibial Insert Trial Size 2 22.5

96-3326

TC3 RP Tibial Insert Trial Size 2 25

96-3327

TC3 RP Tibial Insert Trial Size 2 30

96-3328

TC3 RP Tibial Insert Trial Size 2.5 22.5

96-3336

TC3 RP Tibial Insert Trial Size 2.5 25

96-3337

TC3 RP Tibial Insert Trial Size 2.5 30

96-3338

TC3 RP Tibial Insert Trial Size 3 22.5

96-3346

TC3 RP Tibial Insert Trial Size 3 25

96-3347

TC3 RP Tibial Insert Trial Size 3 30

96-3348

TC3 RP Tibial Insert Trial Size 4 22.5

96-3356

TC3 RP Tibial Insert Trial Size 4 25

96-3357

TC3 RP Tibial Insert Trial Size 4 30

96-3358

TC3 RP Tibial Insert Trial Size 5 22.5

96-3366

TC3 RP Tibial Insert Trial Size 5 25

96-3367

TC3 RP Tibial Insert Trial Size 5 30

96-3368

HP Alignment Rod

9505-01-207

SIGMA HP Revision M.B.T. Spacer Block 10/12.5

2011-03-017

SIGMA HP Revision M.B.T. Spacer Block 15/17.5

2011-03-018

SIGMA HP Revision M.B.T. Spacer Block 20/22.5

2011-03-019

SIGMA HP Revision M.B.T. Spacer Block 25/30

2011-03-020

SIGMA HP Revision Extension Shim

2011-03-061

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 77

M.B.T. REVISION PREPARATION CASE
CAT. NO. 2178-64-100

Top Tray
A

B
D

H
G
I

L
K

Description

Cat. No.

M.B.T. Revision Cemented Stem Reamer, 13 mm

2178-63-185

Tibial Cutting Block, 2 Degree

2178-40-086

M.B.T Revision Reamer Adapter

2178-63-128

M.B.T. Revision Press-fit Tibial Punch

2178-63-118

M.B.T. Revision Cemented Tibial Punch

2178-63-120

Pin Driver

2490-94-000

M.B.T. Revision Drill Bushing

2178-63-100

Pin Puller

96-6515

SP2 IM Rod, 400 mm

96-6120

SP2 IM Rod Handle

99-2011

M.B.T. Revision Cemented Bushing, 13 mm

2178-63-196

M.B.T. Revision Tapered Press-fit Reamer

2178-63-104

M.B.T. Revision Tapered Cemented Reamer

2178-63-106

Steinman Pins (Package of 10)

86-9117

77 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

M.B.T. REVISION PREPARATION CASE
CAT. NO. 2178-64-100

Bottom Tray

E
A

C
F

Description

Cat. No.

M.B.T. Revision 2-Degree Tibial Broaches 29 mm

2178-63-109

M.B.T. Revision 2-Degree Tibial Broaches 37 mm

2178-63-111

M.B.T. Revision 2-Degree Tibial Broaches 45 mm

2178-63-113

M.B.T. Revision 2-Degree Tibial Broaches 53 mm

2178-63-115

M.B.T. Revision 2-Degree Tibial Broaches 61 mm

2178-63-117

M.B.T. Tray Sleeve Trials 29 mm

2294-54-000

M.B.T. Tray Sleeve Trials 37 mm

2294-54-100

M.B.T. Tray Sleeve Trials 45 mm

2294-54-110

M.B.T. Tray Sleeve Trials 53 mm

2294-54-120

M.B.T. Tray Sleeve Trials 61 mm

2294-54-130

LCS Completion Tibial Stylus

2178-40-045

M.B.T. Revision Tibial Broach Handle

96-6521

Revision Sleeve Impactor

2178-63-124

Revision Femoral Sleeve/Stem Impactor

2178-63-126

SP2 Universal Handle

96-6520

SP2 IM Tibial Alignment Device

96-6315

M.B.T. Tibial Impactor

9505-01-558

M.B.T. Revision Tibial View Plate, Size 1

2178-65-110

M.B.T. Revision Tibial View Plate, Size 1.5

2178-65-115

M.B.T. Revision Tibial View Plate, Size 2

2178-65-120

M.B.T. Revision Tibial View Plate, Size 2.5

2178-65-125

M.B.T. Revision Tibial View Plate, Size 3

2178-65-130

M.B.T. Revision Tibial View Plate, Size 4

2178-65-140

M.B.T. Revision Tibial View Plate, Size 5

2178-65-150

M.B.T. Revision Tibial View Plate, Size 6

2178-65-160
Surgical Technique SIGMA Revision and M.B.T. Revision Tray 77

M.B.T. REVISION STEM TRIALS AND INSTRUMENTS
CASE CAT. NO. 2178-64-110
Top Tray

Description

Cat. No.

Revision Femoral/Tibial Sleeve Clamp

2178-63-134

SIGMA Tibial Cemented Stem Trial, Sizes 2-3, 13 x 60 mm

86-6502

SIGMA Tibial Cemented Stem Trial, Sizes 1.5-3, 13 x 30 mm

86-6501

Stem Trial Extractor

86-5226

Fluted Tibial Stem Trials – 75 mm

75 x 10 mm

86-6874

75 x 12 mm

86-6875

75 x 14 mm

86-6876

75 x 16 mm

86-6877

75 x 18 mm

86-6878

75 x 20 mm

86-6879

75 x 22 mm

86-6880

75 x 24 mm

86-6881

77 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

M.B.T. REVISION STEM TRIALS AND INSTRUMENTS
CASE CAT. NO. 2178-64-110

Top Tray

Description

Fluted Tibial Stem Trials – 115 mm

Cat. No.

115 x 10 mm

86-6882

115 x 12 mm

86-6883

115 x 14 mm

86-6884

115 x 16 mm

86-6885

115 x 18 mm

86-6886

115 x 20 mm

86-6887

115 x 22 mm

86-6888

115 x 24 mm

86-6889

Fluted Tibial Stem Trials – 150 mm

150 x 10 mm

86-6890

150 x 12 mm

86-6891

150 x 14 mm

86-6892

150 x 16 mm

86-6893

150 x 18 mm

86-6894

150 x 20 mm

86-6895

150 x 22 mm

86-6896

150 x 24 mm

86-6897

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 77

M.B.T. REVISION STEM TRIALS AND INSTRUMENTS
CASE CAT. NO. 2178-64-110

Bottom Tray

A
B

Description

Cat. No.

Press-fit Rod Wrench

86-5189

SIGMA Tibial Cemented Stem Trial, Sizes 2-3, 13 x 60 mm

86-6502

SIGMA Tibial Cemented Stem Trial, Sizes 1.5-3, 13 x 30 mm

86-6501

Fluted Tibial Stem Trials – 75 mm

75 x 10 mm

86-6874

75 x 12 mm

86-6875

75 x 14 mm

86-6876

75 x 16 mm

86-6877

75 x 18 mm

86-6878

75 x 20 mm

86-6879

75 x 22 mm

86-6880

75 x 24 mm

86-6881

77 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

M.B.T. REVISION STEM TRIALS AND INSTRUMENTS
CASE CAT. NO. 2178-64-110

Bottom Tray

A
B

Description

Cat. No.

Fluted Tibial Stem Trials – 115 mm

115 x 10 mm

86-6882

115 x 12 mm

86-6883

115 x 14 mm

86-6884

115 x 16 mm

86-6885

115 x 18 mm

86-6886

115 x 20 mm

86-6887

115 x 22 mm

86-6888

115 x 24 mm

86-6889

Fluted Tibial Stem Trials – 150 mm

150 x 10 mm

86-6890

150 x 12 mm

86-6891

150 x 14 mm

86-6892

150 x 16 mm

86-6893

150 x 18 mm

86-6894

150 x 20 mm

86-6895

150 x 22 mm

86-6896

150 x 24 mm

86-6897

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 77

M.B.T. REVISION REAMERS CASE
CAT. NO. 2178-64-105

Top Tray

D
F

Description

Cat. No.

Press-fit Rod Wrench

86-5189

IM Rod Sleeve Guide, 12 mm

2178-63-187

IM Rod Sleeve Guide, 14 mm

2178-63-188

LCS Reamer Depth Scale

2178-63-102

Revision Femoral/Tibial/Sleeve Clamp

2178-63-134

I.M. Reamer, 9 mm

2178-56-045

M.B.T. Revision Reamers

M.B.T. Revision Reamer, 10 mm

2178-63-170

M.B.T. Revision Reamer, 11 mm

2178-63-171

M.B.T. Revision Reamer, 12 mm

2178-63-172

M.B.T. Revision Reamer, 13 mm

2178-63-173

M.B.T. Revision Reamer, 14 mm

2178-63-174

M.B.T. Revision Reamer, 15 mm

2178-63-175

88 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

M.B.T. REVISION REAMERS CASE
CAT. NO. 2178-64-105

Bottom Tray

I
A

B
C
F

Description

M.B.T. Revision Reamers

Cat. No.

M.B.T. Revision Reamer, 16 mm

2178-63-176

M.B.T. Revision Reamer, 17 mm

2178-63-177

M.B.T. Revision Reamer, 18 mm

2178-63-178

M.B.T. Revision Reamer, 19 mm

2178-63-179

M.B.T. Revision Reamer, 20 mm

2178-63-180

M.B.T. Revision Reamer, 21 mm

2178-63-181

M.B.T. Revision Reamer, 22 mm

2178-63-182

M.B.T. Revision Reamer, 23 mm

2178-63-183

M.B.T. Revision Reamer, 24 mm

2178-63-184

IM Rod Sleeve Guide, 16 mm

2178-63-189

IM Rod Sleeve Guide, 18 mm

2178-63-190

IM Rod Sleeve Guide, 20 mm

2178-63-

IM Rod Sleeve Guide, 22 mm

2178-63-192

IM Rod Sleeve Guide, 24 mm

2178-63-193

IM Rod Sleeve Guide, 26 mm

2178-63-194

M.B.T. Revision T-Handle

2178-63-137

Modified Hudson Adapter

2178-63-136

191

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 88

M.B.T. REVISION WEDGE TRIALS AND INSTRUMENTS
CAT. NO. 2178-64-115

Top Tray
Size 1

Size 1.5

Size 2

Size 2.5

Size 3

Size 4

Size 5

Size 6/8
5 mm

10 mm
15 mm

5 mm
10 mm
15 mm

Description

Cat. No.

Size 1, 5 mm

2294-56-110

Size 1, 10 mm

2294-56-111

Size 1, 15 mm

2294-56-112

Size 1.5, 5 mm

2294-56-115

Size 1.5, 10 mm

2294-56-116

Size 1.5, 15 mm

2294-56-117

Size 2, 5 mm

2294-56-120

Size 2, 10 mm

2294-56-121

Size 2, 15 mm

2294-56-122

Size 2.5, 5 mm

2294-56-125

Size 2.5, 10 mm

2294-56-126

Size 2.5, 15 mm

2294-56-127

Size 3, 5 mm

2294-56-130

Size 3, 10 mm

2294-56-131

Size 3, 15 mm

2294-56-132

Size 4, 5 mm

2294-56-135

Size 4, 10 mm

2294-56-136

Size 4, 15 mm

2294-56-137

Size 5, 5 mm

2294-56-140

Size 5, 10 mm

2294-56-141

Size 5, 15 mm

2294-56-142

Size 6/7, 5 mm

2294-56-145

Size 6/7, 10 mm

2294-56-146

Size 6/7, 15 mm

2294-56-147

88 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

M.B.T. REVISION WEDGE TRIALS AND INSTRUMENTS
CAT. NO. 2178-64-115

Bottom Tray

F
J

A
H

L
K
M

Description

Cat. No.

M.B.T. Revision Tray Trial, Size 1

2294-36-110

M.B.T. Revision Tray Trial, Size 1.5

2294-36-115

M.B.T. Revision Tray Trial, Size 2

2294-36-120

M.B.T. Revision Tray Trial, Size 2.5

2294-36-125

M.B.T. Revision Tray Trial, Size 3

2294-36-130

M.B.T. Revision Tray Trial, Size 4

2294-36-140

M.B.T. Revision Tray Trial, Size 5

2294-36-150

M.B.T. Revision Tray Trial, Size 6

2294-36-160

M.B.T. Revision Tray Trial with Stem, Size 1

2294-35-110

M.B.T. Revision Tray Trial with Stem, Size 1.5

2294-35-115

M.B.T. Revision Tray Trial with Stem, Size 2

2294-35-120

M.B.T. Revision Tray Trial with Stem, Size 2.5

2294-35-125

M.B.T. Revision Cutting Block

2178-63-122

Tibial Wedge Trial Screwdriver

86-0277

M.B.T. Wedge Cutting Attachment

2178-63-130

SP2 Alignment Rods

99-1016

Tibial Trial Alignment Handle

96-6330

M.B.T. Revision Trial Post

2178-63-132

Modular Plus Torque Driver

86-0284

M.B.T. Tray Trial Fixation Pins

2178-30-123

M.B.T. Revision Tray Trial with Stem, Size 3

2294-35-130

M.B.T. Revision Tray Trial with Stem, Size 4

2294-35-140

M.B.T. Revision Tray Trial with Stem, Size 5

2294-35-150

M.B.T. Revision Tray Trial with Stem, Size 6

2294-35-160
Surgical Technique SIGMA Revision and M.B.T. Revision Tray 88

88 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 88

88 SIGMA Revision and M.B.T. Revision Tray Surgical Technique

Surgical Technique SIGMA Revision and M.B.T. Revision Tray 88

DePuy Orthopaedics, Inc.
700 Orthopaedic Drive
Warsaw, IN 46582
T. +1 (800) 366-8143

www.depuysynthes.com
0612-51-506 (Rev. 5) 3M 10/13

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0612 51 506r5 Sigma HP Revision Surgical Technique

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