Oxford® Partial Knee Surgical Demonstration Advanced Instructional Course Material intended solely for attendees. Not for distribution.

The Set-up Leg support (Biomet) - do not place in popliteal fossa Patient at edge of table, with hip flexed 40º and abducted Leg should hang with knee flexed 110º Full knee flexion possible

Indications Intact ACL Lateral PFJ Preparation Incision – From medial patella to medial tubercle Indications – Check ACL, Lateral Compartment and PFJ Osteophytes – remove from medial femoral condyle, notch, anterior tibia (esp roof notch & by ACL). Not from medial tibia Indications Intact ACL Lateral PFJ

Pre-op Sizing Height/gender1 Intraoperative confirmation with sizing spoon Intraoperative confirmation with tibial sizing Women Height Femur Matching Tibia <60” <153cm X-Small A or B 61-65” 153-165cm Small A, B, or C 66-69” 165-175cm Medium C or D >69” >175cm Large E Men Height Femur Matching Tibia <63” <160cm Small A, B, or C 63-67” 160-175cm Medium C or D 67-73” 170-185cm Large E or F >73” >185cm X-Large F Put in CM as well Reference added Determination of femoral component size in unicompartmental knee replacement. E Fawzy, H Pandit, C Jenkins, C A Dodd, D W Murray. Knee 2008, 15(5): 403-406. Based on presenter’s experience Fawzy et al. The Knee, 20081

Femoral Component Size Insert spoon of estimated femoral size Handle of spoon should be in line with femoral axis The inner surface of spoon is size of component Optimal size is 3mm to 5mm from eburnated bone

Tibial Resection Guide 1. Strap above ankle 2. Parallel to crest 3. Flexion plane/ASIS 4. Over patella tendon 5. Zero shim 6. 3 or 4 G-clamp 7. Pin in place

Vertical Cut Direction Flexion axis Between head and ASIS Position Just medial to apex of medial spine Not too deep Illustration does not show medial spine and pelvis. Flexion plane = flexion axis KRB edit - I like the red drawing, but I do not think we should say anything regarding the asis or femoral head.  Simply flexion plane.  I would recommend maybe a short 3-5 second video here to demonstrate how far lateral and the flexion plane, highlighting the differences between phase three and microplasty. Mauerhan edit - I agree with Keith on  slide 10. Demonstrate flexion axis. No one can see where head or asis is anyway, so let’s make it easy. I would get rid of the reference to 2-3 mm lateral to femoral codyle. It is confusing and may lead to cut too far medial. If we demonstrate proper cut next to the tibial spine at ACL footprint properly, we do not need this

MCL Retractor Need MP tibial resection guide w/ Z retractor Picture enlarges

Femoral Drill Guide Insert IM rod Insert guide set as for G-clamp Link for 10° flex Ensure 6mm hole (boss) central Avoid antero-medial overhang Watch for lateral movement of the guide KRB edit - highlight that the tendency is for the holes to migrate laterally, the guide wanst to go into the notch DRM edit - emphasize marking the middle of the femur after osteophyte removal, so one can look and see that you are centered.

Posterior resection guide

Third Milling Spigot referenced in two places If collar of bone removed reference at bottom of hole is not lost. To remove 1mm more bone use 1 size shorter spigot, but don’t hammer in

Cementing - Critical 2 stages initially Facilitates removal of cement Tibia Thin layer of cement on bone Extract soft tissue Insert feeler & pressurise at 45º Femur Cement in hole & in component Insert feeler & pressurize at 45° The Oxford Partial Knee is intended for use with bone cement Material intended solely for attendees. Not for distribution.

References Fawzy, Ernest, et al. "Determination of femoral component size in unicompartmental knee replacement." The Knee 15.5 (2008): 403-406.

THANK YOU. Zimmer Biomet, does not practice medicine. This perioperative plan is utilized by training surgeons. Each surgeon is responsible for determining the appropriate device, technique and overall treatment for each individual patient.  With respect to any pharmaceutical or other product, please consult the appropriate product labelling or other applicable sources. Please check for country product clearances and reference product specific instructions for use.   All trademarks herein are the property of Zimmer Biomet, or its affiliates unless otherwise indicated. This material is intended for attendees at the Zimmer Biomet Advanced Instructional Course.   It is not to be redistributed, duplicated or disclosed without the expressed written consent of Zimmer Biomet. The content herein is based on the personal experience of the presenters. The Oxford Partial Knee is intended for use in individuals with osteoarthritis or avascular necrosis limited to the medial compartment of the knee and is intended to be implanted with bone cement. The Oxford Knee is not indicated for use in the lateral compartment or for patients with ligament deficiency. Potential risks include, but are not limited to, loosening, dislocation, fracture, wear, and infection, any of which can require additional surgery. For complete product information, including indications, contraindications, warnings, precautions and potential adverse effects, see the package insert at www.biomet.com. Oxford Legal Manufacturer: Biomet UK Limited Waterton Industrial Estate Bridgend CF31 3XA United Kingdom Presenting surgeons have received financial remuneration from Biomet. This material is intended for health care professionals and Zimmer Biomet sales force attending a Zimmer Biomet Oxford Partial Knee training course. Distribution to any other recipient is prohibited.