HİPOKRAT 2000

TOTAL KNEE SYSTEM

Material :

Femoral compenent :

The femoral implant compresing of 3 sliding

surfaces in contact with polyethelene, is a
Cr.Co alloy who’s reliability needs no further
proof. The patellar groove is deeply
hollowed and presents an anatomically
aligned outline. This feature serves for better
patellar guidance and relief of strain on the
knee extensor apparatus.
The femoral component is available in a
cemented and a non-cemented version. - Cr.Co.Mo alloy
A posterior stabilised version for more - Cemented and Uncemented options
stabilisation is also available. - Anatomıc patellofemoral track
- 7 degree anterior flange.

Tibial compenent :

Tibial İnsert :

The tibial insert of ‘‘ HİPOKRAT 2000 knee

prosthesis ’’ is an polyethelene high density
.This choice is motivated by the excelent
mechanical properties of this materials both
in its strength and its tribological ( low
friction) qualities.
This High density materials, proved for many
years in the most reliable hip and knee - Captured attachment screw .
prostheses, stil being unequalled today…it is - 5 Sizes, 5 thicknesses .
here meticulously machined on specific - Anatomıc radius .
dedicated machining centres, eliminating all - UHMWPE pollyethelene .
risks of contamination. The tibial insert is
available in 5 different heights of 8, 10, 12,
15 and 18 mm so that the joint
height can be restored depending on the
degree of tibial bone substance loss. An
ultracongruent and a posterior stabilised
version for more stabilisation are also
available.

Tibial Metal Back :

- Titanyum,Cr.Co.Mo alloy.
- Improved locking mechanism design.
The tibial plate has been designed in Tİ6AI4V
, due to the osteo-integration of this alloy, but also - Tibial augmentation blockes usable.
because of its suitability for forging, so increasing - Modular stem usable.
mechanical strength. - Porous option with four screw hole
Tibial Stem :

The Wedge and the tibial plate of ‘‘

HİPOKRAT 2000 knee prosthesis ’’ are
joined by a morse cone system, the most
reliable and the most used system in
orthopedics.
The morse cone is fixed by a locking screw
which completely locks the tibial insert and
ensures positive anchorage ( without the
slightest risk of the system being ejected).
We add a final security …. This locking
screw is itself fitted with a locking
mechanism.
- Titanyum alloy.
- Two different sizes .
- Winged – keel stem.
Patellar compenent :
The patella is an polyethelene with offers
the most ceratin contact and friction
behaviour with the Cr.Co trocchlea.
patellar implant is designed to help fill in lost
patellar bone, restoring the
patellofemoral joint space to its normal
height.
- Smooth anatomical design .
- UHMWPE pollyethelene .
- 3 different diameter.

Uncemented application :
İt is must be noted that the material chosen for ‘‘ HİPOKRAT 2000 knee prosthesis ’’ directly in
contact with the bone are given a porous coating ( Titanyum Chrome Cobalt deposit or by plasma
spraying ) providing better adhesion and exceptional bonding.
The pure titanium coating on the bone-facing surfaces of the non-cemented femoral and tibial
components is applied by the vacuum plasma spraying process, ensuring secure bonding to
the substrate. The very rough, highly porous surface of the coating provides the ideal basis for
effective osteointegration.

During their manufacture the different compenents of ‘‘ HİPOKRAT 2000 knee prosthesis ’’
must pass muliple probative tests by extremely accurate three dimensional measurement ;
surface finish examination , appearance inspection and cleaning before packing and sterilizing.
İndications :

Suitable patints for a total knee prosthesis are those where the shape and articular function are
deficient as well as where pain associated with the arthorosis process compromieses the qualıty
of life .İn general, any patient suitable for prosthesis must have a ligamental structure which
could be returned to normal functioning stability.

Additional guidance fort he use of this product:

1- Arthrosis of thre knee.
2- Rheumatoid polyarthritis of the knee.
3- Degenerative or post-traumatic osteoarthritis
4- Avascular necrosis of the femoral condyles
5- Moderately abnormal varus, valgus or flexion postures
6- Repeat of previous surgical intervention, whether or not a knee prosthesis was applied.

Contra-İndications :

İn general, patient who are not suitable for this prosthesis are those where the quality of life has
not been compromised by dysfunction articular deformation or pain from arthrosis illness.
Further, patients where ligamentary lesions can not be treated to renew their normal functions
and stability can not benefit from this type of prosthesis.

Contra-İndications fort he use of this prosthesis are :

1- Acut intra or extra-articulatory infection of the knee.

2- Neuro-muscular disorders, whos undesirable effects on the function of the prosthesis,
are not compensated by the benefit achieved
3- Psychic problems which would compromise essential post operative care
4- A stable and painless arthrodesis in good position can be a contra-indication in relation
to the use of this method.

Undesirable effets

Dislocation of a prosthesis component can arise from inappropriate activity of the patient, from a
traumatism or for reasons of other biomechanical considerations.
Apremature mechanical defect can result from inadequate intinial fixing from an infection, from
premature loading of the prosthesis or from a traumatism.
Later failure can result from biological complications or from a traumatism with the ultimate
possibility of bone erosion or pain.
The patients intolerance to the metal after prosthesis, although rare, has been reported. The
reality and the effects of this intolerance need confirmation and clinical evaluation.

Use and İmplantation :

Trial prosthesis are used to determine the size, to effect trial positioning and also to evaluate the
mobility zone. This preserves the integrity of final implants and their sterile packing. X-ray
photographs are also available to help pre-operative assessment of the size of the compenent
parts.

Screws can be used if reinforcement of the fixing proves necessary.

İnstrumentation :

‘‘ HİPOKRAT 2000 knee prosthesis ’’ is endowed with a simple and efficient instrument kit to
avoid any ‘’false paths’’ by the sergun, letting him make precies cuts to an. Operating protocol
based on the principle of alignment.

To be noted is the wide range of sizes and the modular nature of the system :
- 2 types of wedge to adapt to the tibial plate .
- Adaption of a ‘’medium’’ femur to an ‘’ large’’ or ‘’ small’’ tibial tray maket the
‘‘ HİPOKRAT 2000 knee prosthesis ’’ a total, polyvalent prosthesis.
- To ensure satisfactory ligamental balance, the surgeon has available for examble,
5 heights of tibial insert and more then 5 femoral and tibial sizes and 3 sizes of
patella.
- Finally, in the case of tibial shortening the design of the prosthesis permis
comfortable deflection during and after the operatıon.
- By the design, its choice of material and manufacturing methods, by its minute
finish and its astute instrumentation, enabling any cut development, adjustment
and alterations in the theatre controlling the axes‘‘ HİPOKRAT 2000 knee
prosthesis ’’ offers one of the best Quality/Safty/Performance ratios on the
market.
Pre-Operative Planning

A full-leg X-ray with the patient in the standing

position is recommended for preoperative
planning purposes.
If this is not possible, an X-ray of the thigh, including
the femoral head,should be taken. X-ray images of
the knee joint at three levels should be available for
planning the surgery.
A patella tangential image, a frontal image and a
sagital to the leg axis image have to be taken.
There are, however, also X-ray templates available
for preoperative planning. The lateral view of the
condyles is decisive. If these are no longer
completely intact,
it is possible to switch to the condylar width. If in
doubt, select the smaller implant to prevent
prosthesis components from protruding. In normal
cases, the size determination and the correct
positioning of the prosthesis are controlled
intraoperatively by using the relevant instruments.
Intraoperative control during these procedures is
provided by corresponding alignment
and test guides.

Planning of surgery using the

radiograph

The following procedure is recommended for the A/P

whole-leg imaging process:
1. The femur axis A (anatomical axis) is drawn onto
the radiograph.
2. A line is drawn from the head of the hip to the
center of the knee (mechanical axis D) on the
radiograph.
3. The angle measured between the anatomical and
mechanical axis (= ), determines the valgus angle.
4. The tibial axis B is drawn in and the tibial
resection plane E is determined to avoid too much
resection, especially where there are defects.
5. The component sizes and resection depths are
determined preoperatively using the radiograph
templates in anterior,
posterior and lateral planes.
6. The mechanical leg axis C should merge with the
lines D and B after correction.
Surgical Technique

Position of the patient for surgery

Surgery is performed whilst the patient is supine. It

is recommended that the blood supply be partially
blocked, but this is not absolutely necessary. The leg
must be covered, so as to allow movement, and
secured to the operating table so that the knee joint
is brought into a stable 90° flexion position. Most of
the surgical steps are performed in this position.

Surgical Incision
The surgeon may elect to use any standard
exposure method to perform the skin and
capsular incision.A long anterior skin incision and
medial parapatellar approach will allow the patella to
be everted far laterally.
In order to achieve good lateral position of the
patella,it may be necessary to completely detach the
oblique portion of the vastus medialis from the distal
one-third of the quadriceps tendon .
The vastus intermedius,lateralis,and rectus femoris
muscles are left in continuity with the patella so that
early quadriceps rehabilitation will be possible.
Synovium and fat proximal to the patellar groove
should be excised to allow proper function of the
anterior feeler gauge later in surgery.
For maxımum exposure,flex the knee as far as it will
go after opening, without endangering the patellar
tendon. Occasionally,the patella cannot be turned
laterally after routine exposure,and the tibial tubercle
may need to be osteotomized to achieve good
visibility of the posterior femoral condyles.If this is
necessary,the tibia tubercle should be left in
continuity with the periosteum laterally so that
reattchment will be simple and secure.
Ligement assessment and balancing is
recommended to be done after trials are in place and
osteophyts have been removed.
Preparation of the Femur

Proper insetion of the Femoral Intramedullary aligment rod requires a clear view of the
walls and roof of the intercondylar notch .
When the osteophyts and the ACL are removed with the rongeur , the typical femoral
entry hole location is thought to be slightly medial to the center of the intercondylar
notch, and approximately 5 to 7mm anterior to the anterior insertion of the PCL into the
femur.

Awl is used to mark the hole location, followed by the 8mm femoral intramedullary (IM)
drill to create an opening in the femoral canal.The drill is typically inserted to a depth of
approximately 100mm within the femoral canal.
Preparation of the F1 distal femoral cutting guide
(Intramedullary rod+angled guide+cutting guide)

1- Remove the attached screw.

2- Select the Intramedullary rod (Short / Long ) and

attached through the angled guide.

3- Fix the removed screw

through the hole of the
Intramedullary rod.
 4 - Slide the Distal Femural cutting block onto the
suspension device and engage at the 10 mm
marking.

Note
We recommend resection of 10 mm of the
Distal femur, although this may need
to be modified to take account of
special anatomic conditions.

5- Insert the bushing into the angled guide so that the ‘L’ (left
knee) or ‘R’ (right knee) marking is visible at the top,
depending on the side to be operated. Reinsert the IM rod
through the bushing hole into the prepared femoral
medullary space.
6- With the help of the sliding hummer push the prepared Distal femur
cutting guide until it makes contact with the condyles.

7- The Distal cutting block is secured to the bone by

placing fixation pins through the two holes marked
“0.” Prior to cutting the distal femur,additional fixation may be
achieved by oblıque pins in the medial and
lateral pin holes provided.

8– Remove the bushing from the uspension device, and

slide the device out the femur.
9 - Check the distal cut with cutting control guide. The +2 / -2 mm
Slot Option may also be selected for use if the surgeon
wishes to resect a 2mm greater or less thickness of
distal bone. If prior to making the initial distal cut it is
determined that more or less bone resection is required, the
distal femoral cutting block is removed and repositioned
over the holes marked +2 or -2.

10 - Slide the saw capture onto the cutting block. A sharp, 050’’ thick saw blade with unset teeth is
used for the resection . Remove the cutting block and pins.

Note
To avoid overheating of the bone, perform all resections under cooling with physiological saline
solution.
Extramedullary Tibial Resection :

- Mount the tibial cutting block on the external tibial resection guide . The surgeon may select
from the options : left or right, 5 slope.
- With the knee flexed, place the ankle clamp around the distal tibia just above the malleoli using
the spring.
- The tibial resection block is then placed against the proximal tibia, Adjust the resection guide
until the tubular body is parallel with the shaft of the tibia, by adjusting the ankle clamp button
lock.
- The cutting elevation may be determined by inserting the Tibial Stylus in the resection slot.
Use the angled end of the stylus to reference the deepest portion of the unaffected medial
tibial condyle . Centralise the distal part of the tibial alignment guide on the ankle joint by
depressing the knob and positioning the guide in the correct position
- Once the elevation is chosen, the pıns are placed in the '0' hole option of the Cutting block.
Starting with the most lateral hole, Additional oblıque Pins may also be used to secure the
Cutting block.
- Remove the stylus from the resector and resect the tibia through the slot in the head with a
.050" sawblade, with the resector assembly attached to the head, taking care not to cut the
posterior cruciate ligament inadvertently.

NOTE : Prior to resection, if the surgeon wishes to increase or decrease the tibial resection thickness,
the +2 or -2 hole locations may be utilized to re-position the Cutting block.
 Femural Size determination

Instrument setup :

Attach the posterıor condyle rotatıon feet to the A/P femoral

sizing instrument.The feet are availble in 0°, 3° left or 3° right, and
will rotate the femoral compenent 0° or 3°.If a 3° external rotation is
required, place the lef tor right feet into the sizer
depending on the operative leg.
In additional hands may be attached to both
sides of the sizing instrument for additional
stability.

Place the femoral sizing instrument on the resected distal femur. Care should be taken to position the
two posterior feet of the Femoral Sizing Guide in contact with the posterior femoral condyles.Place the
stylus slightly lateral on the anterıor cortex and read the size of the femoral component off the calibrated
scale on the front of the sizing instrument.If the size rests on a line between sizes, use the larger of the
tow. While keeping the posterior condyle feet in contact with the posterior condyles, place two pın into
the chosen size holes.
 A/P and chamfer resection

- Choosen the slotted femoral contour guide which matches the selected size on the distal
femoral sizing instrument, and place into the pin holes into the distal femur with the help of
sliding hummer .Under request may you can attach the handles into the sides of the contour
block and make sure the contour guides is sitting flush against the flat area of the distal femur.
- A feeler blade can be used to determine the amount of anterior bone resection .
- Resect the anterior and posterior bone, and anterior and posterior chamfers with .050’’
sawblade

It is important to remove the sclerotic trochlear bone on the anterıor chamfer. Failure to do so may leave
a high spot which could cause the femoral compenent to rock in a M/L direction.The cuts should be
checked for flatness by passing a flat instrument over the resected surfaces.

Note : The same amount of posterior condyls will be removed each time. Since the posterior condyles of
each compenent correespond to this dimension, the joint line restored.

Tibial Plateau Sizing and rotational aligment preparation

The knee is placed in maximum flexion and the tibia is subluxed

anteriorly. Attach the tibial tray trial to the tibial tray trial handle. The
tibial tray is selected that provides the greatest amount of
coverage both in the M/L and A/P plane
Rotation can be achieved through one of two methodes

1- To allow for self aligment, place the femoral trial and the tibial trial into the joint space. Insert the
appropriate trial bearing onto the tibial plate. Take the knee through range of motion and establish
plate rotation along with soft tissue tension.When tibial rotation has been confirmed with the trial in
place, extend the lines on the anterior bone can be marked with electrocautery to serve as rotational
reference points during tibial preparation. The trials are then removed and the tibial template is
replaced in the resected tibia, aligned with the two anterior markes and stabilized using short fixation
pins .

2- Another mothod of establishing tibial rotation is to place the tibial template on the plateau and insert
the external alignment rod through the tibial templates handle. The rod should align along the tibial
spine or secound metatarsal. When proper aligment is achieved, the templates is stabilized using
short fixation pins .
Tibial Stem Punch

The punch guide is assembled to the tibial template with the anterior thumb screw. The selected
reamer (47 / 100 ) is introduced to provide an initial hole into the tibia before the stem punch is used.
The reamer should be fully engaged in the punch guide before power is started.
Carefully drive the chosen stem punch into the punch guide until it mechanically stops (a mechanical
stop ensures the correct punching depth).
Patellar Resection

The patella is everted and the osteophytes and peripatellar tissues are removed down to the level of
the tendinous insertions of the quadriceps and patellar tendons.
The patella resection clamp is used to achieve a flat cut and is set for the amount of bone that will
remain after resection. After placing the patella between the jaws of the clamp, tighten the clamp nuts
to hold the patella firmly . Using a saw blade, a flat resection is made .

The single peg patellar drill guide is used to locate the placement of the central peg.
The central hole is drilled using the patellar peg drill. A trial patellar component is selected to optimize
coverage without increasing patellar thickness beyond pre-resection height.
Trial Reduction

With all bony surfaces prepared and soft tissue debrided, a trial reduction may be completed with the
trial components. The trial femoral component is placed over the distal femur .
Drill the holes in the distal condyles of the femoral trial.

The trial tibial tray is placed onto the tibial surface, The trial inserts are sequentially selected to
determine the appropriate thickness. When the trial components are in place, the range-of-motion
and stability of the knee are checked .If tightness is found medial/laterally, in flexion or
extension,appropriate soft tissue release must be performed.
Implantation

Tibial compenent preparation :

- To assemble the modular tibial component, choose the

appropriate stem (most primary cases will require a
47mm stem).The stem is seated using the tibial insert impactor

Place the appropriate polyethylene bearing insert on the tibial metalback and push posteriorly as far
as possible using finger and hand back pressure . The polyethylene bearing must be flat on the
metalback in all directions.Finaly the screw is tightened into the spiralock threads in the stem with the
hex screwdriver for added stem and insert fixation ( The locking screw for the stem is included in the
stem’s package)
All resected surfaces must be thoroughly cleaned with a pressurized lavage and dried. It is advisable
to use a suctioning device to remove the debris and liquid trapped in the chambers of the trabecular
bone.
Low viscosity cement in a semi-liquid state is first applied to the tibial surface.The cement is forced
into the chambers of the trabeculae of the resected tibia. To ensure good penetration, digitation can
be used to pack the cement over the entire surface. With the cement curing on the tibia, cement can
be applied to the patella. Again, the cement is forced into the surface with the gun and digitation.
Prepare the distal femur using the same application technique, with cement placed on the inner
surface of the component prior to its placement.

- To impact the Tibial metal back, it is recommended to carefully introduce and align the
stem of the implant into the prepared stem hole. The implant positioned by hand. Once the Tibial
Metal back is advanced sufficiently, the Tibal Metal back Impactor may then be used to complete
seating of the implant.

- To impact the Femoral compenent, the Femoral Impactor - extractor is assembled onto the
Femoral Implant. Carefully align the femoral implant with the distal femur to assure correct
advancement and seating of the implant. The universal fremoral Impactor may also be used for
seating if desired.
- The appropriate patellar component is placed into the patella and pushed into position with finger
pressure so the peg engages the prepared hole. Extruded cement is removed with a curette.
The patellar clamp is positioned onto the component and the cap screwed down until it contacts the
component. The ratchet handle is then tightened to compress the implant. As the clamp is tightened,
extruded
Kemalpasa Mah 407/6 No.10.
35060 Pınarbası - İzmir / TURKEY
Tel : +90 232 479 11 09
Fax : +90 232 479 84 71
CE 1014