KNEE

Version 3.1

Software User Guide

Revision 1.1
Copyright 2015, Brainlab AG Germany. All rights reserved.
TABLE OF CONTENTS

TABLE OF CONTENTS
GENERAL INFORMATION ...................................................................................................7
Contact Data and Legal Information ......................................................................................................7
Contact Details.............................................................................................................................................7
Legal Information .........................................................................................................................................8

Symbols .......................................................................................................................................................9
Symbols Used in This Guide ........................................................................................................................9

Intended Use .............................................................................................................................................10

Using the System .......................................................................................................................................10
Camera System .........................................................................................................................................12
Potential Side Effects .................................................................................................................................13

Compatibility with Medical Devices .....................................................................................................14

Brainlab Medical Instruments .....................................................................................................................14
Brainlab Medical Software..........................................................................................................................15
Non-Brainlab Medical Devices ...................................................................................................................16
Non-Brainlab Software ...............................................................................................................................17

Training and Documentation .................................................................................................................18

Training ......................................................................................................................................................18
Documentation...........................................................................................................................................19

SYSTEM SETUP ..........................................................................................................................21

Operating Room Setup ...........................................................................................................................21
Camera Setup............................................................................................................................................22
Camera ......................................................................................................................................................23
Optimal Positioning of Reference Arrays....................................................................................................25
Navigation Accuracy ..................................................................................................................................30
Navigation Instruments in Use ...................................................................................................................31

STARTING KNEE ........................................................................................................................33

Starting the Software and Selecting a Patient ...................................................................................33

KNEE WORKFLOWS ..............................................................................................................35

Introduction ...............................................................................................................................................35

General Navigation ..................................................................................................................................36

Knee3 Motion ............................................................................................................................................38

Implants, Treatment Side and Resection Presets.......................................................................................39

Software User Guide Rev. 1.1 Knee Ver. 3.1 3

TABLE OF CONTENTS

Registration................................................................................................................................................40
Navigation..................................................................................................................................................41
Planning.....................................................................................................................................................48
Joint Stability Graph ...................................................................................................................................49
Research and Recording ...........................................................................................................................52

Knee3 Universal .......................................................................................................................................54

Treatment Side Selection ...........................................................................................................................55
Registration................................................................................................................................................56
Navigation..................................................................................................................................................57

Knee3 Express ..........................................................................................................................................62

Treatment Side Selection ...........................................................................................................................64
Registration................................................................................................................................................66
Navigation..................................................................................................................................................67
Block Position Verification ..........................................................................................................................69
Cut Verification...........................................................................................................................................72

Knee3 Partial .............................................................................................................................................76

Treatment Side Selection ...........................................................................................................................77
Registration................................................................................................................................................78
Navigation..................................................................................................................................................79

REGISTRATION ...........................................................................................................................83
Registration Overview.............................................................................................................................83
Registration Workflows ..............................................................................................................................84
Point Acquisition ........................................................................................................................................87
Landmark Registration ...............................................................................................................................90
Axis Direction Registration .........................................................................................................................92
Surface Registration...................................................................................................................................93

Femur Registration ..................................................................................................................................94

Femor Head Center ...................................................................................................................................94
Distal Femur Axis Point..............................................................................................................................95
Medial and Lateral Epicondylar Points .......................................................................................................96
Anteroposterior Axis (Whiteside’s Line)......................................................................................................97
Medial and Lateral Condyles......................................................................................................................98
Medial and Lateral Distal Condyles ..........................................................................................................100
Anterior Cortex.........................................................................................................................................101

Tibia Registration ...................................................................................................................................102

Proximal Tibia Axis Point..........................................................................................................................102
Tibia Anterior-Posterior (A-P) Direction ....................................................................................................103
Medial and Lateral Plateau Points............................................................................................................104
Medial and Lateral Malleoli.......................................................................................................................105

Verification in Knee3 Express .............................................................................................................106

Femoral Mechanical Axis and A-P Direction ............................................................................................106
Tibial Mechanical Axis and A-P Direction .................................................................................................107

Additional Registration Functions .....................................................................................................108

Skipping Landmarks.................................................................................................................................108
Re-Registration ........................................................................................................................................109

4 Software User Guide Rev. 1.1 Knee Ver. 3.1

TABLE OF CONTENTS

PATIENT REPORT ................................................................................................................... 111

Creating a Patient Report ..................................................................................................................... 111

FLY-OUT MENU AND TOOL BAR .............................................................................113

Fly-out Menu ...........................................................................................................................................113

Tool Bar ....................................................................................................................................................115

SETTINGS .......................................................................................................................................117
Sound and Tools ....................................................................................................................................117

Screenshots ............................................................................................................................................118

INDEX ..................................................................................................................................................119

Software User Guide Rev. 1.1 Knee Ver. 3.1 5

TABLE OF CONTENTS

6 Software User Guide Rev. 1.1 Knee Ver. 3.1

GENERAL INFORMATION

1 GENERAL INFORMATION
1.1 Contact Data and Legal Information
1.1.1 Contact Details

Support
If you cannot find information you need in this guide, or if you have questions or problems, contact
Brainlab support:

Region Telephone and Fax Email

United States, Canada, Central and Tel: +1 (800) 597-5911

South America Fax: +1 (708) 409-1619 [email protected]
Brazil Tel: (0800) 892-1217
UK Tel: +44 1223 755 333
Spain Tel: +34 (900) 649 115
France and French-speaking regions Tel: +33 800 676 030
Tel: +49 89 991568-44 [email protected]
Africa, Asia, Australia, Europe
Fax: +49 89 991568-811
Tel: +81 3 3769 6900
Japan
Fax: +81 3 3769 6901

Expected Service Life

Unless specifically stated otherwise Brainlab provides five years of service for this product. During
this period of time, spare parts as well as field support are offered.

Feedback
Despite careful review, this manual may contain errors.
Please contact us at [email protected] if you have suggestions as to how we can
improve this manual.

Manufacturer
Brainlab AG
Kapellenstr. 12
85622 Feldkirchen
Germany

Software User Guide Rev. 1.1 Knee Ver. 3.1 7

Contact Data and Legal Information

1.1.2 Legal Information

Copyright
This guide contains proprietary information protected by copyright. No part of this guide may be
reproduced or translated without express written permission of Brainlab.

Non-Brainlab Trademarks

Microsoft® and Windows® are registered trademarks of Microsoft Corporation in the United States
and other countries.

Integrated 3rd-Party Software

• This software is based in part on the work of the Independent JPEG Group.
• Portions of this software are based in part on the CyberVrml97 package written by Satoshi
Konno.
• Other company and product names mentioned herein may be trademarks of these respective
companies.

CE Label

• The CE label shows that the Brainlab product complies with the essential re-
quirements of Council Directive 93/42/EEC (the “MDD”).
• According to the principles set out in the MDD, Knee software is a Class IIa
product.

NOTE: The validity of the CE label can only be confirmed for products manufactured by Brainlab.

Disposal Instructions
When a surgical instrument reaches the end of its functional life, clean the instrument of all
biomaterial/biohazards and safely dispose of the instrument in accordance with applicable laws
and regulations.

Only dispose of electrical and electronic equipment in accordance with statutory regu-
lations. For information regarding the WEEE (Waste Electrical and Electronic Equip-
ment) directive, visit:
http://www.brainlab.com/en/sustainability/

Sales in the US
U.S. federal law restricts this device to sale by or on the order of a physician.

8 Software User Guide Rev. 1.1 Knee Ver. 3.1

GENERAL INFORMATION

1.2 Symbols
1.2.1 Symbols Used in This Guide

Warnings

Warnings are indicated by triangular warning symbols. They contain safety-critical

information regarding possible injury, death or other serious consequences associated
with equipment misuse.

Cautions

Cautions are indicated by circular caution symbols. They contain safety-critical information
regarding possible problems with the device. Such problems include device malfunctions,
device failure, damage to device or damage to property.

Notes
NOTE: Notes are formatted in italic type and indicate additional useful hints.

Software User Guide Rev. 1.1 Knee Ver. 3.1 9

Intended Use

1.3 Intended Use

1.3.1 Using the System

Medical Purpose
Knee is an image guided surgery system for knee replacement, based on landmark-based
visualization of femur and tibia, functioning with different DePuy implants.

Indications for Use

Knee includes four different workflows:
• Knee3 Motion
• Knee3 Universal
• Knee3 Express
• Knee3 Partial
For Knee3 Motion, Knee3 Universal and Knee3 Express, the following indications apply:
Knee is intended to be an intraoperative image guided localization system to enable minimally
invasive surgery. It links a freehand probe, tracked by a passive marker sensor system to a virtual
computer image space on an individual 3D-model of the patient's bone, which is generated
through acquiring multiple landmarks on the bone surface. The system is indicated for any
medical condition in which the use of stereotactic surgery may be appropriate and where a
reference to a rigid anatomical structure, such as the skull, a long bone, or vertebra, can be
identified relative to a CT, X-ray, MR-based model of the anatomy. The system aids the surgeon to
accurately navigate a knee prosthesis to the intraoperatively planned position. Ligament balancing
and measurements of bone alignment are provided by Knee.
Example orthopedic surgical procedures include but are not limited to:
• Total Knee Replacement
• Ligament Balancing
• Range of Motion Analysis

Indications for Use - Knee3 Partial Only

For the Knee3 Partial workflow only, the following indications for use apply:
Knee is intended to be an intraoperative image guided localization system to enable minimally
invasive surgery. It links a freehand probe, tracked by a passive marker sensor system to a virtual
computer image space on an individual 3D-model of the patient's bone, which is generated
through acquiring multiple landmarks on the bone surface. The system is indicated for any
medical condition in which the use of stereotactic surgery may be appropriate and where a
reference to a rigid anatomical structure, such as the skull, a long bone, or vertebra, can be
identified relative to a CT, X-ray, MR-based model of the anatomy. The system aids the surgeon to
accurately navigate a knee prosthesis to the intraoperatively planned position. Ligament balancing
and measurements of bone alignment are provided by Knee.
Example orthopedic surgical procedures include but are not limited to:
• Unicondylar Knee Replacement
• Ligament Balancing
• Range of Motion Analysis

Intended User
Knee is to be used by trained orthopedic surgeons. The users should be experienced in
performing unsupervised knee replacement surgery and should fully understand knee kinematics
and anatomy.

10 Software User Guide Rev. 1.1 Knee Ver. 3.1

GENERAL INFORMATION

Place and Conditions of Use

Knee is an image guided surgery system that is used in operating rooms. The system consists of
parts that can be used multiple times, such as the software, tracking system, and computer
platform, and parts that are single-use items, such as reflective marker spheres for instruments.
Instruments and navigation disposables must be sterile during use. The computer platform and
tracking system may be mobile, according to platform specification.

Patient Population
Fully grown adults requiring a Total Knee Replacement. Contraindications for certain patient
populations are as follows:
• Patients that suffer from osteoporosis should not be treated using the implant based total knee
navigation procedure with the tibia and femur array. In this case, the fixated reference arrays
may become loose during navigation due to reduced bone density rendering navigation
inaccurate or not possible. For those patients, the pinless Alignment Verification procedure is
an alternative.
• Patients that suffer from dysplasia or other pelvic deformities should not be treated using knee
navigation software. In this case, it is not possible to register the center of rotation correctly.
Thus, the registration/navigation result could be inaccurate or navigation not possible.

Plausibility Review

Before patient treatment, review the plausibility of all information input to and output from
the system.

Software User Guide Rev. 1.1 Knee Ver. 3.1 11

Intended Use

1.3.2 Camera System

Camera Accuracy

Accuracy Measurement Value

Tracking 0.3 mm RMS (Root Mean Square)
Navigation Values +/- 1° (angles), +/- 1 mm (distances)

12 Software User Guide Rev. 1.1 Knee Ver. 3.1

GENERAL INFORMATION

1.3.3 Potential Side Effects

Additional Incisions
During Knee navigation, additional skin incisions or bone holes are needed on the tibia and femur
to securely fixate reference arrays using bone screws.
Alternatively, the femur and tibia reference arrays may be fixed directly inside the wound to avoid
an additional incision.

Software User Guide Rev. 1.1 Knee Ver. 3.1 13

Compatibility with Medical Devices

1.4 Compatibility with Medical Devices

1.4.1 Brainlab Medical Instruments

Compatible Brainlab Medical Instruments

Knee is compatible with:
• 4 in 1 Cutting Block Template
• Bone Fixator “1-Pin”, X-Press (Sizes S, M or L)
• Bone Fixator “2-Pin”, X-Press
• Knee Plane Tool
• Disposable Clip-On Remote Control
• Disposable Reflective Marker Spheres
• Femoral and Tibial Cutting Block Adapter “Universal”
• Fine-adjustable Cutting Block
• Pointer Angled
• Pointer Straight for Knee
• Reference Array, X-Press (Y-Geometry and T-Geometry)
NOTE: For more specific information, refer to the Hip and Knee Instrument User Guide.

Other Brainlab Instruments

Additional instrumentation may become available after release of this manual. Contact Brainlab
support if you have any questions regarding instrument compatibility with Brainlab software.

Only use instruments and spare parts specified by Brainlab. Using unauthorized
instruments/spare parts may adversely affect safety and/or effectiveness of the medical
device and endanger safety of patient, user and/or environment.

14 Software User Guide Rev. 1.1 Knee Ver. 3.1

GENERAL INFORMATION

1.4.2 Brainlab Medical Software

Compatible Brainlab Medical Software

Knee is compatible with:
• Content Manager 2.2
• Patient Browser 4.1
• DICOM Viewer 2.2

Other Brainlab Software

If you are running software versions other than those specified above, contact Brainlab support for
clarification regarding compatibility with Brainlab devices.

Only Brainlab medical software specified by Brainlab may be installed and used with the
system.

Software User Guide Rev. 1.1 Knee Ver. 3.1 15

Compatibility with Medical Devices

1.4.3 Non-Brainlab Medical Devices

Compatible Non-Brainlab Medical Devices

Medical Device Manufacturer

Implants
NOTE: Knee is compatible with specified implants and toolsets
available from the listed manufacturers. For questions regarding
compatibility, contact Brainlab support.
DePuy
NOTE: For implant compatibility refer to the specifications of the im-
plant manufacturer. The information provided in the software are in-
dicative only.

Footswitch steute

Other Non-Brainlab Devices

Using medical device combinations which have not been authorized by Brainlab may
adversely affect safety and/or effectiveness of the devices and endanger safety of patient,
user and/or environment.

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GENERAL INFORMATION

1.4.4 Non-Brainlab Software

Compatible Non-Brainlab Software

Knee is compatible with:
• Windows 7
• Windows 8.1
NOTE: For information regarding compatible service packs please contact Brainlab support.

Other Non-Brainlab Software

Only non-Brainlab software applications specified by Brainlab may be installed and used
with the system.

Software User Guide Rev. 1.1 Knee Ver. 3.1 17

Training and Documentation

1.5 Training and Documentation

1.5.1 Training

Brainlab Training
To ensure safe and appropriate use, before using the system all users must participate in a
training program held by a Brainlab representative.

Supervised Support
Before using the system for surgical procedures where computer-aided navigation is considered
critical, perform a sufficient number of complete procedures with a Brainlab representative present
to provide guidance where necessary.

Responsibility

This system solely provides assistance to the surgeon and does not substitute or replace
the surgeon’s experience and/or responsibility during its use.

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GENERAL INFORMATION

1.5.2 Documentation

Reading User Guides

The user guides describe complex medical devices and surgical navigation software that must be
used with care.
It is important that all users of system, instruments and software:
• Read the user guides carefully before handling the equipment
• Have access to the user guides at all times

Available User Guides

User Guide Contents

• Overview of treatment planning and navigation
Software User Guides • Description of OR system setup
• Detailed software instructions
Instrument User Guides Detailed instructions on instrument handling
Cleaning, Disinfection and
Details on cleaning, disinfecting and sterilizing instruments
Sterilization Guide
System User Guides Comprehensive information on system setup
Detailed technical information on the system, including specifica-
Technical User Guide
tions and compliances

Software User Guide Rev. 1.1 Knee Ver. 3.1 19

Training and Documentation

20 Software User Guide Rev. 1.1 Knee Ver. 3.1

SYSTEM SETUP

2 SYSTEM SETUP
2.1 Operating Room Setup

Before You Begin

Ensure that:
• The camera and monitor do not restrict the work of the surgeon.
• The camera has a clear view of the reference arrays during all registration and navigation
procedures.

OR Setup Example

③ ④ ⑤ ⑥

⑧ ⑦

Figure 1
For optimum visibility, position the camera directly opposite the surgeon.

No. Component
① Navigation Monitor
② Camera Placement Angle (45 - 90 degrees)
③ Camera Field of View
④ Camera
⑤ Assistant
⑥ Anesthesiologist
⑦ Nurse
⑧ Surgeon

Software User Guide Rev. 1.1 Knee Ver. 3.1 21

Operating Room Setup

2.1.1 Camera Setup

How to Set Up the Camera

Steps
Position the camera in the required OR location.
The camera should be positioned:
1. • approximately 1.5 - 2 m (5 - 6.5 feet) from the surgical field for optimum viewing.
• opposite the surgeon.
• between 45 - 90 degrees from the foot of the patient.
Open Camera from the tool bar, see page 23.
2.
Verify the distance using the camera distance graph.
Adjust the camera until the lenses have an unobstructed view of all reference arrays in
the surgical field.
3. NOTE: You can verify reference array detection at any point within registration and navi-
gation.

The camera lenses must have an unobstructed view of the reflective marker spheres on
patient reference arrays and active instruments at all times during registration and
navigation.

The camera has a 2-10 minute warm up phase after it is connected to the system. A dialog
opens and the tracking system is unavailable during this time.

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SYSTEM SETUP

2.1.2 Camera

General Information
For registration and navigation, the camera must have an unobstructed view of the instruments.
The camera gives you real-time feedback about the visibility of instruments to the camera and can
be accessed at any time.

Camera Display

① ②

⑤
Figure 2

No. Component Explanation

Displays the distance of the instruments and/or reference arrays
in relation to the camera.
① Tracking corridor
For optimum visibility and accuracy, all tracking spheres shall be
inside the blue corridor.
Displays the camera motor control positioning buttons.
② Camera controls NOTE: This feature is only available on Curve 1.1.

Used to center the camera.

Camera centering Centering the camera takes up to 5 seconds. A second click de-
③ activates the centering feature.
button
NOTE: This feature is only available on Curve 1.1.

The marker sphere from an instrument and/or array is marked red

④ Marker sphere
when invisible to the camera.
Displays the position of the instruments and/or reference arrays in
⑤ Camera field of view
relation to the camera.

How to Access the Camera

Steps
1. Select an icon from the tool bar ③ or the fly-out menu (see page 113).

Software User Guide Rev. 1.1 Knee Ver. 3.1 23

Operating Room Setup

Steps
2. View status.
3. Press Back to return to knee navigation.

Visibility Status

Screen Status Visibility

Full 3D display of instrument or array with blue marker spheres Full visibility
Outline of instrument or array Partial visibility
Red marker spheres Not visible

24 Software User Guide Rev. 1.1 Knee Ver. 3.1

SYSTEM SETUP

2.1.3 Optimal Positioning of Reference Arrays

Reference Array Geometry

To enable registration and navigation, you must attach reference arrays to the femur and tibia of
the leg to be operated upon.
The software identifies the bone by the geometry of the attached reference array:

Figure 3

No. Geometry Bone Tracked

① Reference Array Y-Geometry Femur
② Reference Array T-Geometry Tibia

How to Position Reference Arrays

Steps
Ensure that the femoral and tibial reference arrays are positioned side by side from the
1.
camera’s perspective, so that neither blocks the camera’s view of the other.
2. Adjust the camera to ensure reference array visibility at all times during the procedure.
3. Make sure that the reference array geometries do not overlap.

Ensure you attach the Y-geometry reference array to the femur and the T-geometry
reference array to the tibia. Consider the leg movement during the procedure when
attaching the reference arrays to the bone.

Software User Guide Rev. 1.1 Knee Ver. 3.1 25

Operating Room Setup

Position the camera so that reference arrays within the surgical field are seen by the
camera. Make sure that reference arrays are visible in both flexion and extension. The
reference array must be visible to the camera at all times during navigation, otherwise
tracking is not possible.

Ensure the center of the Y-reference array is positioned anterior of the femur mechanical
axis.

Femoral Fixation

Figure 4

Steps
Using 3.2 mm or 4 mm Schanz pins, place the first pin 1 cm proximal and 1 cm anterior of
1.
the medial epicondyle.
From a horizontal position, angle the pin 45° toward the lateral posterior cortex.
2. NOTE: If a posterior stabilized implant is used, angle the pin 30° in the proximal direction
to ensure box cut clearance.

Slide the bone fixator over the pins with the array attachment point directed away from the
3. joint, leaving enough room between the skin and the bone fixator. Tighten in place with
the thumb screw.

26 Software User Guide Rev. 1.1 Knee Ver. 3.1

SYSTEM SETUP

Tibial Fixation

Figure 5

Steps
Place the first pin distal to the joint line, avoiding any keel or punch used by the specific
implant system.
1.
Consider using extra-medullary alignment guides/conventional instruments when placing
the pins (inside or outside the wound).
2. Perform a small stab incision and clear the underlying soft tissue.
Place the pins perpendicular to the bone surface, placing the second parallel and distal to
3.
the first, using the same alignment technique as on the femur.

Software User Guide Rev. 1.1 Knee Ver. 3.1 27

Operating Room Setup

Reference Array Placement for Y- and T- Reference Arrays

Figure 6

Steps
1. Slide the reference array onto the pins.
Rotate the array to a position that is visible to the camera in both full flexion and full ex-
2.
tension, adjusting the reference array angle, if necessary.
3. Ensure the array is seated correctly and clicked into position.
4. Fasten the side screw to lock the array firmly to the pins, ensuring all joints are tight.

Ensuring Sufficient Operating Space

Ensure sufficient space to enable incision and implanting without moving the reference arrays.

To avoid contact between reference arrays and surgical instruments, take the size of the
implant, the cutting blocks and the surgical instruments into account when placing the
reference arrays.

Make sure that the position of the reference arrays do not hinder the surgeon’s work before
attaching them to the bone.

Ensuring Secure Attachment

Securely tighten the screws of the reference arrays to the bone before patient registration.

28 Software User Guide Rev. 1.1 Knee Ver. 3.1

SYSTEM SETUP

Do not adjust any of the reference array screws after patient registration is complete.

Make sure that bone quality is suitable for array fixation.

Reflection Artifacts

Artifacts caused by external infrared reflections can cause inaccuracy. Make sure that light
sources or items which are highly reflective do not affect the camera field of view.

Marker Sphere Visibility

Ensure the marker spheres are securely fastened to the instruments and reference arrays.

Use only clean, dry new marker spheres to ensure precision during navigation. Marker
spheres are for single use only.

If the camera cannot detect a reference array, verify that the marker spheres are clean and
undamaged, and that the reference array is not bent.

Movement of Reference Arrays

Do not move the reference array relative to the patient’s anatomy during the procedure.
Movement affects the entire measurement coordinate system, leading to incorrect
instrument display and injury to the patient.

If a reference array changes position relative to the bone, or the array becomes unstable,
check its accuracy, and re-register it if necessary.

If the accuracy decreases or if a reference array must be re-attached, you must re-register
the patient before proceeding to navigation.

Remove X-Press reference arrays prior to sawing.

Removal of Reference Arrays

Be aware that the joint stability data is continuously and automatically recorded. Shield the
marker spheres when detaching a reference array as joint stability graph values continue
recording.

Software User Guide Rev. 1.1 Knee Ver. 3.1 29

Operating Room Setup

2.1.4 Navigation Accuracy

How to Check Accuracy

Steps
Place the pointer on the bone where the corresponding landmarks are on the navigation
1.
screen.
Check if the area shown on the screen correctly corresponds to the actual area on the
2.
bone.

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SYSTEM SETUP

2.1.5 Navigation Instruments in Use

Instrument Overview
The table below outlines the instruments used in conjunction with Knee software.

Instrument Description

The 4 in 1 Cutting Block Template is used to navigate the

anterior femur cut.
NOTE: For further information regarding implant system
availability, contact Brainlab support.

The Brainlab Angled Pointer or Straight Pointer for

Knee is used for anatomical landmark registration and re-
section measuring.

Disposable Reflective Marker Spheres are attached to

reference arrays and instruments allowing the system to
detect the position of the patient and instruments in the
surgical field.

The Knee Plane Tool - Tracking Array provides the Infra-

red reference for either:
• Knee Plane Tool - Cutting Block
• Bone Verification Plate

Software User Guide Rev. 1.1 Knee Ver. 3.1 31

Operating Room Setup

Instrument Description

The Knee Plane Tool - Cutting Block Adapter holds the

cutting block that guides the surgeon when cutting the
bone.

The Knee Plane Tool - Bone Verification Plate with

Spikes is used to verify bone cuts in the Knee3 Express
workflow.

The Knee Plane Tool - Bone Verification Plate Small

verifies bone cuts with the software.

The Femoral and Tibial Cutting Block Adapter "Univer-

sal" allows the system to track the cutting block during
navigation of the cutting block to the planned resection
plane. It self-adjusts to cutting blocks with a slot thickness
of 1.0 mm - 1.8 mm.

32 Software User Guide Rev. 1.1 Knee Ver. 3.1

STARTING KNEE

3 STARTING KNEE
3.1 Starting the Software and Selecting a Patient

How to Start the Software

①
Figure 7
On system launch, Content Manager starts.

Step
Select your Knee workflow ①:
• Knee3 Motion
• Knee3 Universal
• Knee3 Express
• Knee3 Partial
Patient selection opens.

Software User Guide Rev. 1.1 Knee Ver. 3.1 33

Starting the Software and Selecting a Patient

How to Select a Patient

Figure 8

Steps
Enter new patient details as prompted or select Patient List ① to select an existing pa-
1.
tient.
2. Select Done.

NOTE: For further information on patient selection, refer to the Patient Browser Software User
Guide.

How to Start Knee

Step

Select e.g., Knee3 Motion ① to open the software.

34 Software User Guide Rev. 1.1 Knee Ver. 3.1

KNEE WORKFLOWS

4 KNEE WORKFLOWS
4.1 Introduction

Knee Workflow Types

Depending on your selected workflow type, you are required to perform a registration sequence.
Each workflow type requires different steps to provide the surgeon with positioning information.
You can choose between four different navigation workflows as outlined below:

Workflow Type Use Provided Information

• Proximal tibia cut
• Distal femur cut
Knee3 Motion DePuy implants only. • Anterior femur cut
• Long leg alignment
• Joint stability
• Proximal tibia cut
Every implant but no joint stability informa- • Distal femur cut
Knee3 Universal
tion is provided by the software. • Anterior femur cut
• Long leg alignment
Can be adapted to surgeons preferences.
Example combinations are:
• Pinless tibia navigation • Proximal tibia cut
Knee3 Express • Live femur navigation • Distal femur cut
• Providing positioning information of proxi-
mal tibia cut and distal femur cut without
using pinned references.
• Proximal tibia cut
Knee3 Partial Unicondylar knee replacement interventions. • Distal femur cut
• Long leg alignment

Software User Guide Rev. 1.1 Knee Ver. 3.1 35

General Navigation

4.2 General Navigation

General Information
Knee consists of four different workflows and every workflow offers a different solution for the type
of surgery you want to perform. Some features are important for all four workflows and these are
described in the following chapter. Please read this chapter and the information contained for your
chosen workflow to get all the information you need.

Context Sensitivity
Knee is context sensitive, which means that the software recognizes the position of the Knee
Plane Tool (or the Universal Cutting Block Adapter) and automatically displays the right
navigation step.
If you place the Knee Navigation Tool on the bone cut, keeping it still for 2 seconds, the cut is
automatically verified, without screen interaction.

Initial and Final Leg Alignment

Figure 9
In the leg alignment view, the initial and final leg alignment values are stored. These values are
shown in a patient report, see page 111 for more information.

How to Store Initial and Final Leg Alignment

Leg Flexion/ Function Explanation

When the leg flexion is less than 40°, the current leg
alignment values are stored in the report by using the
following:
Leg flexion is less than 40° • Pressing Store
• Using a gesture: Lift the extended leg and hold still
for 2 seconds, a progress bar indicates the verifica-
tion progress
Leg flexion is more than 40° No storage of the current leg alignment is possible.

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KNEE WORKFLOWS

Pointer Mode

Figure 10
In every workflow you can check the cut resection height and check for notching, using the
pointer.
The distance between the pointer tip and planned/live resection levels ① is measured. The
resection level is represented by a small line.
When the software is in joint line mode (Knee3 Motion only) the joint line shift between planned/
live joint line and pointer tip is measured. The joint line level is represented by a small dashed line.

Cut Verification
Cut verification is very important in order to receive accurate results using navigation. There are
three cut verification options using the Knee Plane Tool with the Bone Verification Plate on the
bone cut:
• Keep it still for 2 seconds. The software shows a progress bar and verifies the cut
automatically.
• Press Verify on screen.
• Press the blue button on the footswitch.

Software User Guide Rev. 1.1 Knee Ver. 3.1 37

Knee3 Motion

4.3 Knee3 Motion

General Information
Knee3 Motion is for use with DePuy implants only.

Software Workflow
Knee3 Motion follows a sequential approach for implant selection, registration and navigation.
The navigation screen is context sensitive and does not follow a preset sequence.

① ②

④ ③

Figure 11

No. Workflow Step Explanation

Implant and treatment Select the implant and treatment side, adjusting the resection
①
side selection presets if needed.
② Registration Acquire anatomical landmarks on the patient.
③ Navigation Navigate the femur and tibia resections.
View and if necessary adjust the proposed resections calculat-
④ Planning (optional)
ed by the software.

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KNEE WORKFLOWS

4.3.1 Implants, Treatment Side and Resection Presets

How to Select Implants, Treatment Side and Resection Presets

① ② ③

④
Figure 12
The software prompts you to select the implant manufacturer and implant system.

Steps
Select an implant ①.
1.
A side menu containing implant systems opens.
2. Select an implant system from the menu ②.
3. Select Right or Left ③ from TREATMENT SIDE for the knee receiving treatment.
4. Adjust RESECTION PRESETS ③ if needed.
5. Select Navigate ④.

Software User Guide Rev. 1.1 Knee Ver. 3.1 39

Knee3 Motion

4.3.2 Registration

Registration Steps
You are required to acquire the following landmarks:

Femur Landmarks Tibia Landmarks

Femur Head Center Medial and Lateral Malleoli
Distal Femur Axis Point Proximal Tibial Axis Point
Medial and Lateral Epicondylar Points (Epicondylar
Tibia Anterior-Posterior Direction
Line)
Anteroposterior Axis (Whiteside’s Line) (optional) Medial Plateau (optional)
Medial Condyle (optional) Lateral Plateau (optional)
Lateral Condyle (optional)
Anterior Cortex

NOTE: Landmarks marked as optional are not mandatory for the workflow and can be skipped.

For more information regarding registration, see page 83.

NOTE: For Knee3 Motion only: Prior to registration you can reset the user profiles. After starting
registration this button disappears.

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4.3.3 Navigation

General Information
From the leg alignment view, the software automatically enters the relevant cut navigation step
when it detects the Plane Tool in its respective cut position.
The following cuts can be navigated:
• Tibia resection
• Distal femur resection
• Anterior femur resection

Navigating to Plan
The colors of the planes indicate the position of the cutting block with reference to the plan.

Figure 13
When the values of the live cut position (blue line) match the planned line (white), the values for
the following turn blue:
• Varus angle
• Valgus angle
• Posterior angle
• Anterior slope
• Resection height
Verified cuts turn from blue to yellow.
NOTE: Deviation for resection heights is ±0.5 mm and deviation for angles is ±0.5°.

Line Color Indication

Blue Live cut position
White Planned cut position
Yellow Verified cut

Software User Guide Rev. 1.1 Knee Ver. 3.1 41

Knee3 Motion

Navigation Workflow
The software switches between leg alignment and individual resection views depending on the
area where the plane tool was recognized by the software.

② ③ ④
Figure 14

No. Workflow Steps

① Leg alignment
② Tibia resection
③ Distal femur resection
④ Anterior femur resection

Plane Tool Placement

The software detects the relevant cut navigation step based on the position of the Plane Tool in
relation to the femur and tibia.
The software displays the distal femur, anterior femur or tibia resection screens as soon as the
Plane Tool is placed into the cutting block for a given resection and when the cutting block is
positioned on the respective bone.
There is no predefined order; all cut resections can be entered at any time during the procedure.
When a resection is performed, the actual resection values are verified by placing the Plane Tool
on the cut surface. The software stores the cut values when the Plane Tool is held still for three
seconds.
NOTE: When the footswitch is used, the cut values are stored by pressing the blue pedal.
Automatic verification is disabled.

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KNEE WORKFLOWS

Screen Components

③
④

⑦ ⑥ ⑤
Figure 15

No. Component Explanation

• The white line indicates the planned resection plane.
① Cutting block position
• The blue line indicates the live/current cutting block position.
Use Verify to confirm new values when parameters are adjust-
② Verify
ed.
• Resection displays the current resection distance relative to
Resection/Joint Line the registered landmarks.
③
Toggle • Joint Line displays the joint line shift between the registered
landmarks and the current implant position.
④ Plan Toggle between navigation and femur planning.
⑤ Tibia insert thickness
⑥ Implant selection Femur implant size
⑦ Implant type (e.g., posterior stabilized)

Software User Guide Rev. 1.1 Knee Ver. 3.1 43

Knee3 Motion

Leg Alignment

① ②

Figure 16
The femur and tibia are visible, leg alignment becomes active.
The flexion and varus/valgus angles are displayed and the joint stability graph can be recorded.

No. Item
① Leg flexion angle
② Varus/valgus angle

Distal Femur Resection

① ②

③
Figure 17

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KNEE WORKFLOWS

No. Item
① Implant flexion angle
② Implant varus/valgus angle
③ Medial and lateral distal resection height or joint line shift

Anterior Femur Resection

② ③

① ④

Figure 18

No. Item
① Anterior shift of the implant
② Implant flexion angle
③ Implant rotation angle based on the chosen rotation reference
④ Medial and lateral posterior resection height or joint line shift

Software User Guide Rev. 1.1 Knee Ver. 3.1 45

Knee3 Motion

Tibia Resection

① ②

Figure 19

No. Item
① Implant slope
② Implant varus/valgus angle
③ Medial and lateral resection height

How to Verify the Resection

①② ③

Figure 20

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KNEE WORKFLOWS

Steps
Place the Plane Tool on the bone cutting surface.
The software detects the position and verifies the type of cut from the following:
1. • Distal femur cut
• Anterior femur cut
• Tibia cut
Hold the Plane Tool still for approx. 2 seconds, observing the progress bar.
Verification status is indicated by the progress bar.
Alternatively, press Verify ①, either:
2. • on screen
• using the footswitch
NOTE: When the footswitch is used, verification is triggered by the blue pedal.

After cut verification the white line turns yellow ② (indicating cut verification). Blue values for
varus/valgus show that the cut is within the plan ③.

Software User Guide Rev. 1.1 Knee Ver. 3.1 47

Knee3 Motion

4.3.4 Planning

Planning Screen

③ ④

⑦ ⑥
Figure 21
The planning screen enables you to plan femur resections, and if necessary adjust the values
proposed by the software.
When resection planes are verified during navigation, the values for the plan and the graph are
automatically updated.

No. Adjustable value

① Anterior shift
② Implant flexion angle
③ Implant rotation
④ Implant varus/valgus angle
⑤ Joint stability graph
⑥ Medial and lateral resection/joint line shift
⑦ Medial and lateral posterior resection/joint line shift

How to Adjust Values

Steps

Select the currently displayed value on the screen.

1.
Arrow buttons appear alongside.

2. Adjust to the desired value.

NOTE: Value adjustment is optional.

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4.3.5 Joint Stability Graph

General Information
The joint stability graph shows two curves for the medial and the lateral gap between the femur
and tibia implants over the leg's flexion range.

Planned Cut View Example

Figure 22
The graph only displays valid curves for flexion positions where stress was applied to the medial
and lateral soft tissue structure.

Color Line Description

Blue Live Navigation
Red Negative Gaps
White Planned Values
Yellow Verified Cuts

Software User Guide Rev. 1.1 Knee Ver. 3.1 49

Knee3 Motion

Live Navigation View Example

Figure 23
The blue marked area ① displays live real-time values, the red area ② indicates that the gap is
too tight.

Verified Cut View Example

Figure 24
The yellow marked area indicates that all cuts have been verified.

Joint Stability Data Acquisition

The joint stability graph shows the maximum available gap range. It is therefore necessary to
extend the medial and lateral tendons. This is done by using an injoint spreader or by applying

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KNEE WORKFLOWS

medial and lateral stress. When the ligament situation changes, e.g., by performing the tibia cut or
ligament releases, the acquisition must be updated for the flexion ranges which are dependent on
ligament change.

Be aware that the joint stability data is continuously and automatically recorded.

How to Delete Recorded Data

Step

Press Erase to delete all recorded joint stability data.

NOTE: Erase is not available for every surgical step.

NOTE: Recording restarts again automatically.

Implant Position Adjustment and Cut Verification

The implant position influences the joint stability graph. Any adjustment results in an immediate
update of the graph. Use the Plane Tool to navigate cuts, place implants or use the Plan page to
adapt the plan.

Verifying the cuts with the Plane Tool synchronizes the performed cuts with the software.

Software User Guide Rev. 1.1 Knee Ver. 3.1 51

Knee3 Motion

4.3.6 Research and Recording

General Information

①
Figure 25
By activating Record Button ① from Settings, the user can record live leg alignment and gap
values for later studies or research purposes. The recorded values are then attached to the case
report (e.g., ResearchData_ROMRecording.raw1).
A number traces the number of recordings the user has made.

How to Record

①
Figure 26
A record button is displayed in the leg alignment view, once activated.

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KNEE WORKFLOWS

Step

Press Record to commence recording, press again to stop.

Research Data

Figure 27
The recorded research data is attached to the case report. Pressing the paper clip ① in the pdf
opens all attachments.

Software User Guide Rev. 1.1 Knee Ver. 3.1 53

Knee3 Universal

4.4 Knee3 Universal

General Information
Knee3 Universal can be used with implants that are not integrated into the database.
You can navigate:
• the distal femur resection
• the rotational alignment of the femoral implant
• the tibial resection
NOTE: As no implant data is used, the software cannot calculate the joint stability graph.

Software Workflow

② ③

Figure 28

No. Workflow Step Explanation

① Treatment side selection Select the treatment side.
② Registration Acquire anatomical landmarks on the patient.
③ Navigation Navigate the femur and tibia resections.

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KNEE WORKFLOWS

4.4.1 Treatment Side Selection

How to Select the Treatment Side

②
Figure 29

Steps
1. Select Right or Left ① for the knee receiving treatment.
2. Select Navigate ②.

Software User Guide Rev. 1.1 Knee Ver. 3.1 55

Knee3 Universal

4.4.2 Registration

Landmarks Requiring Registration

You are required to acquire the following landmarks:

Femur Landmarks Tibia Landmarks

Femur Head Center Medial and Lateral Malleoli
Distal Femur Axis Point Proximal Tibial Axis Point
Medial and Lateral Epicondylar Points (Epicondylar Line) Tibia Anterior-Posterior Direction
Anteroposterior Axis (Whiteside’s Line) (optional) Medial Plateau (optional)
Medial Condyles (optional) Lateral Plateau (optional)
Lateral Condyles (optional)

For more information regarding registration, see page 83.

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KNEE WORKFLOWS

4.4.3 Navigation

General Information
From the leg alignment view, the software automatically enters the relevant cut navigation step
when it detects the Plane Tool in its respective cut position.
The following cuts can be navigated:
• Tibia resection
• Distal femur resection
• Anterior femur resection

Navigation Workflow
You can switch between leg alignment and individual resection views.

② ③ ④
Figure 30

No. Workflow Steps

① Leg alignment
② Tibia resection
③ Distal femur resection
④ Anterior femur resection

Software User Guide Rev. 1.1 Knee Ver. 3.1 57

Knee3 Universal

Leg Alignment

① ② ③

Figure 31
If the Y- and T-reference arrays are visible, the leg alignment view becomes active.
The flexion and varus/valgus angles are displayed.

No. Item
① Leg flexion angle
② Varus/valgus angle
③ Store button for saving initial/final leg alignment

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Distal Femur Resection

② ③

① ④
Figure 32

No. Item
① Cutting block position
② Implant flexion angle
③ Implant varus/valgus angle
④ Medial and lateral distal resection height

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Knee3 Universal

Anterior Femur Resection

② ③

Figure 33

No. Item
① Cutting block position
② Implant flexion angle
③ Implant rotation angle of the chosen rotation reference

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Tibia Resection

① ②

④ ③
Figure 34

No. Item
① Implant slope
② Implant varus/valgus angle
③ Medial and lateral resection height
④ Cutting Block position

Software User Guide Rev. 1.1 Knee Ver. 3.1 61

Knee3 Express

4.5 Knee3 Express

General Information
Knee3 Express allows you to measure the position of the tibia and distal femoral cutting blocks
and the resections relative to the tibial and femoral mechanical axis.
Knee3 Express is a pinless workflow, using the Knee Plane Tool on its own or combined with a
cutting block as a reference. As the software works without fixed references it is intended as a
static measurement tool. The measured values are displayed immediately after registration and
become invalid if the Knee Plane Tool or cutting block position changes in relation to the bone.
The measurements provided by the alignment verification depend on accurate landmark
registration and minimal movement of the Knee Plane Tool relative to the cutting block and bone.
Knee3 Express also allows live navigation of the tibia or femur, so you can adapt the navigation
to your preferences, e.g., you can fully navigate the femur but only check your tibia cut or vice
versa.

Do not use or rely on the measurement information when the clinical situation has changed
or after an extended period of time. To assess accuracy of the measurement re-registration
is required. Repeat registration if accuracy is in doubt.

Workflow
Required Instruments for the Knee3 Express workflow:
• Knee Plane Tool
• Pointer

② ③

Figure 35

No. Workflow Step Explanation

① Treatment side selection Select the treatment side.
Choose between:
② Start Navigation • Measuring the cutting block position
• Live Navigation

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KNEE WORKFLOWS

No. Workflow Step Explanation

Registration and Measurement/ Acquire anatomical landmarks on the patient or nav-
③
Navigation igate the femur and tibia resections.

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Knee3 Express

4.5.1 Treatment Side Selection

How to Select the Treatment Side

②
Figure 36
The software first prompts you to select the treatment side.

Steps
1. Select Right or Left ① for the knee receiving treatment.
2. Select Navigate ②.

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KNEE WORKFLOWS

How to Select the Navigation Type

① ③
Figure 37
Choose whether to measure the cutting block position or perform live navigation.

Steps
Select either:
1. • Select Tibia or Femur in LIVE NAVIGATION ① or;
• Your cutting block positioning step from POSITION VERIFICATION ②.
2. Select Done ③.

Software User Guide Rev. 1.1 Knee Ver. 3.1 65

Knee3 Express

4.5.2 Registration

Registration Steps
You are required to acquire the following landmarks:

Femur Tibia
Femur Block:
Tibia Block:
• Femur Head Center
• Medial and lateral Malleoli
• Distal Femur Axis Point
• Proximal Tibia axis point
• Anteroposterior Axis (Whiteside Line) or Epicondylar Line
• Tibial A-P direction
(medial and lateral Epicondyle)
Femur Cut: Tibia Cut:
• Bone Verification Plate • Bone Verification Plate
• Femoral Head Center • Medial and lateral Malleoli
Femur Live Navigation:
Tibia Live Navigation:
• Femur Head Center
• Medial and lateral Malleoli
• Distal Femur Axis Point
• Proximal Tibia axis point
• Anteroposterior Axis (Whiteside Line) or Epicondylar Line
• Tibia A-P direction
(medial and lateral Epicondyle)
• Medial Plateau
• Medial Distal Condyle
• Lateral Plateau
• Lateral Distal Condyle

For more information regarding registration, see page 83.

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4.5.3 Navigation

General Information
Use the Plane Tool on its own or combined with a cutting block as a reference to measure the
position of the tibia and distal femoral cutting blocks and the resections relative to the tibial and
femoral mechanical axis.
The software works without fixed references and is intended as a static measurement tool.
You can also perform live navigation of the tibia or femur, so you can adapt the navigation to your
preference.
The following cuts can be navigated:
• Tibia resection
• Distal femur resection

Cutting Block Positioning

Choose your cutting block position ①, Tibia Block or Femur Block from POSITION
VERIFICATION depending on your procedure.

Figure 38

Plane Tool Placement

Position the Knee Plane Tool in the cutting block and start registration (see page 83).
NOTE: The software displays the tibia or femur resection screens as soon as the Plane Tool is
placed into the cutting block and when the cutting block is positioned on the respective bone.

Software User Guide Rev. 1.1 Knee Ver. 3.1 67

Knee3 Express

Register Points

Figure 39
Registration restarts as soon the Knee Plane Tool has moved.

Step
Place the Knee Plane Tool laterally in the cutting block so that you can still register directions
and mechanical axis points.

NOTE: After registration the software gives you the measurements for the current cutting block
position.

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4.5.4 Block Position Verification

Tibia Block Position Verification

① ②

Figure 40

No. Item
① Implant slope
② Implant varus/valgus angle

Tibia Block Position Verification using a Pointer

① ②

Figure 41

Software User Guide Rev. 1.1 Knee Ver. 3.1 69

Knee3 Express

You can check the resection height with a pointer ③.

No. Item
① Implant slope
② Implant varus/valgus angle
③ Resection height check

Femur Block Position Verification

① ②

Figure 42

No. Item
① Implant flexion angle
② Implant varus/valgus angle

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Femur Block Position Verification Using a Pointer

① ②

Figure 43

No. Item
① Implant flexion angle
② Implant varus/valgus angle
③ Resection height check

Software User Guide Rev. 1.1 Knee Ver. 3.1 71

Knee3 Express

4.5.5 Cut Verification

How to Verify a Tibia Cut

① ②

Figure 44
For cut verification you need to change the Knee Plane Tool Cutting Block Adapter with the
Knee Plane Tool Verification Plate.
Verification starts with registration using the Knee Plane Tool.

Steps

Select the cut you want to verify from POSITION VERIFICATION,

1.
e.g., Tibia Cut.

Place the Knee Plane Tool Verification Plate on the cut surface, aligning it with :
2. • The A-P direction ① and;
• The hole on the mechanical axis point
3. Register the malleoli points ② as prompted on screen.

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Verification Values

Figure 45
The verification values are displayed following registration.

How to Verify a Femur Cut

① ②

Figure 46

Steps

1. Select Femur Cut from POSITION VERIFICATION.

Femur Cut

Software User Guide Rev. 1.1 Knee Ver. 3.1 73

Knee3 Express

Steps
Place the Knee Plane Toolas shown ①.
2.
The software automatically registers the axis endpoint and defines the A-P direction.
3. Pivot the hip to register the center of rotation ②, without moving the plane tool.

Verification Values

Figure 47
The verification values are displayed following registration.

Live Navigation
Knee3 Express gives you also the opportunity to switch to live navigation for navigating the tibia
or femur block. If you want to use live navigation you need a fixed reference array on the part of
the knee you want to navigate.

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KNEE WORKFLOWS

How to Use Live Navigation

Figure 48

Steps
1. Choose Tibia or Femur from LIVE NAVIGATION.
2. Start full registration, see page 83.
3. Navigate the cutting block.
4. Verify the cut.

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Knee3 Partial

4.6 Knee3 Partial

General Information
Knee3 Partial provides the surgeon with positioning information for the following during
unicondylar knee replacements:
• Proximal tibia cut
• Distal femur cut
• Limb axis alignment

Workflow

① ②

③ ④

Figure 49

No. Workflow Step Explanation

Treatment side selection and Com- Select the treatment side and the treated compart-
①
partment ment.
② Start Registration Acquire anatomical landmarks on the patient.
③ Leg Alignment/ Start Navigation
Navigate the femur and tibia resections.
④ Navigation

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4.6.1 Treatment Side Selection

How to Select the Treatment Side and Compartment

① ②

③
Figure 50
The software first prompts you to select the treatment side.

Steps
1. Select Right or Left ① for the knee receiving treatment.
2. Select Medial or Lateral for COMPARTMENT ②.
3. Select Navigate ③.

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Knee3 Partial

4.6.2 Registration

Registration Steps
You are required to acquire the following landmarks.

Femur Tibia
• Femur Head Center • Medial and Lateral Malleoli
• Distal Femur Axis Point • Proximal Tibia Axis Point
• Anteroposterior Axis (Whiteside Line) or Epicondylar Line • Tibial A-P direction
(medial and lateral Epicondyle) • Selected Tibia Plateau Point
• Selected Distal Condyle (optional) (optional)

For more information regarding registration, see page 83.

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4.6.3 Navigation

General Information
From the leg alignment view, the software automatically enters the relevant cut navigation step
when it detects the Plane Tool in its respective cut position.
The following cuts can be navigated:
• Tibia resection
• Distal femur resection

Position Verification
You can switch between the leg alignment and individual resection views.

② ③

Figure 51

No. Workflow Steps

① Leg alignment
② Tibia resection
③ Distal femur resection

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Knee3 Partial

Leg Alignment

① ② ③

Figure 52
The femur and tibia are visible, leg alignment becomes active.

No. Item
① Leg flexion angle
② Verify, used for saving initial/final leg alignment
③ Varus/valgus angle

Tibia Cut

② ③

① ④
Figure 53

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KNEE WORKFLOWS

No. Item
① Cutting block position
② Implant slope
③ Implant varus/valgus angle
④ Resection height for the selected compartment

Distal Femur Cut

② ③

① ④
Figure 54

No. Item
① Cutting block position
② Implant flexion angle
③ Implant varus/valgus angle
④ Distal resection height for the selected compartment

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Knee3 Partial

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REGISTRATION

5 REGISTRATION
5.1 Registration Overview

About Registration
Registration is the process of acquiring specific landmarks to calculate the length and angles
required for resection. This enables the software to provide measurement information during
surgery.
During registration, you use the pointer to acquire (register) landmarks and bone surfaces on the
patient’s femur and tibia.
The software uses the registered points to automatically plan and calculate the following:
• Implant size
• Implant position
• Resection levels

Total Landmarks Requiring Registration

Femur Landmarks Tibia Landmarks

Femur Head Center Proximal Tibial Axis Point
Distal Femur Axis Point Tibia Anterior-Posterior Direction
Medial and Lateral Epicondylar Points Medial and Lateral Plateau Points
Anteroposterior Axis (Whiteside’s Line) Medial and Lateral Malleoli
Medial and Lateral Condyles
Medial and Lateral Distal Condyles
Anterior Cortex

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Registration Overview

5.1.1 Registration Workflows

Overview
Knee has 4 workflow types available for performing registration:
• Knee3 Motion
• Knee3 Universal
• Knee3 Express
• Knee3 Partial
The following sections outline which landmarks are required for registration within each workflow:

Knee3 Motion

No. Workflow Section Registration Steps

Femur:
• Femoral Head Center
• Distal femur axis point
• Medial and Lateral Epicondyles (Epicondylar Line)
• Anteroposterior Axis (Whiteside’s Line)
• Medial Condyle
• Lateral Condyle
① Registration
• Anterior Cortex
Tibia:
• Medial and lateral Malleoli
• Proximal Tibia axis point
• Tibia anterior-posterior direction
• Medial plateau
• Lateral plateau
Implants and Treatment
②
Side Selection
③ Planning
④ Navigation
⑤ Joint Stability

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Knee3 Universal

No. Workflow Section Registration Steps

Femur:
• Femoral Head Center
• Distal femur axis point
• Medial and Lateral Epicondyles (Epicondylar Line)
• Anteroposterior Axis (Whiteside’s Line)
• Medial Condyle
① Registration • Lateral Condyle
Tibia:
• Medial and lateral Malleoli
• Proximal Tibia axis point
• Tibia anterior-posterior direction
• Medial plateau
• Lateral plateau
② Treatment Side Selection
③ Planning
④ Navigation

Knee3 Express

No. Workflow Section Registration Steps

Femur Block:
• Femoral Head Center
• Distal femur axis point
• Anteroposterior Axis (Whiteside’s Line)
Femur Cut:
• Bone Verification Plate
• Femoral Head Center
Tibia Block:
• Medial and lateral Malleoli
• Proximal Tibia axis point
• Tibial A-P direction
Tibia Cut:
① Registration
• Bone Verification Plate
• Medial and lateral Malleoli
Femur Live Navigation:
• Femoral Head Center
• Distal femur axis point
• Anteroposterior Axis (Whiteside’s Line)
Tibia Live Navigation:
• Medial and lateral Malleoli
• Proximal Tibia axis point
• Tibia anterior-posterior direction
• Medial plateau
• Lateral plateau
② Treatment Side Selection

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Registration Overview

No. Workflow Section Registration Steps

③ Navigation

Knee3 Partial

No. Workflow Section Registration Steps

Femur:
• Femoral head center
• Distal femur axis point
• Anteroposterior axis (Whiteside’s Line)
① Registration • Selected distal condyle
Tibia:
• Proximal tibia axis point
• Tibia anterior-posterior direction
• Selected tibia plateau

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5.1.2 Point Acquisition

Overview
You can register landmarks using the following options:
• Pointer
• Clip-On Remote
• Footswitch

How to Use a Brainlab Pointer

Figure 55
In standard pointer registration, you pivot a calibrated pointer to acquire (register) specific
landmarks on the patient’s bone.

Step
Hold the pointer tip on the landmark indicated and pivot the pointer slightly around its tip.
• If the tip moves during pivoting, the point is not acquired.
• When a point is acquired, the software indicates the next point to acquire, or opens the next
step.

How to Use a Clip-On Remote Control

Registration using Brainlab Angled Pointer can also be performed with the aid of a disposable
clip-on remote control.

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Registration Overview

Step
Hold the pointer tip on the indicated landmark and press the control button on the remote control
①.
• If the tip moves when you press the button, the point is not acquired.
• When a point is acquired, the software indicates the next point to acquire, or opens the next
step.
NOTE: The Clip-On Remote Control reacts upon pressing the control button, not upon releas-
ing.

How to Activate the Clip-On Remote Control

Steps

1. Choose Settings from the fly-out menu.

Select Clip-on Remote Control from TOOLS.

2. NOTE: When the Clip-On Remote Control is activated pivoting is disabled.

How to Use a Footswitch

Figure 56
Registration can also be performed by using a footswitch to reduce touchscreen interaction.

Step
Hold the pointer tip on the indicated landmark and press the blue button on the footswitch.
• If the tip moves when you press the button, the point is not acquired.
• When a point is acquired, the software indicates the next point to acquire, or opens the next
step.
NOTE: The Clip-On Remote Control reacts upon pressing the control button, not upon releas-
ing.

NOTE: The footswitch activates automatically when plugged-in.

NOTE: The Clip-On Remote Control and footswitch can be used concurrently.

Footswitch Pedal Functions

Pedal Function
Blue Registers landmarks or select element marked in blue.
Yellow Selects element marked in yellow.

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REGISTRATION

Pedal Function
Black Cycles through controllable elements in navigation and planning.

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Registration Overview

5.1.3 Landmark Registration

Overview
You can register landmarks using the following options:
• Pointer
• Clip-On Remote
• Footswitch

Landmark Registration Example

Figure 57

How to Register Landmarks Using a Brainlab Pointer

Step
Hold the pointer tip on the landmark indicated and pivot the pointer slightly around its tip.
• If the tip moves during pivoting, the point is not acquired.
• When a point is acquired, the software indicates the next point to acquire, or opens the next
step.

How to Register Landmarks Using the Clip-On Remote Control

Step
Hold the pointer tip on the indicated landmark and press the control button on the remote con-
trol.
• If the tip moves when you press the button, the point is not acquired.
• When a point is acquired, the software indicates the next point to acquire, or opens the next
step.
NOTE: The Clip-On Remote Control reacts upon pressing the control button, not upon releas-
ing.

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REGISTRATION

How to Register Landmarks Using the Footswitch

Step
Hold the pointer tip on the indicated landmark and press the blue button on the footswitch.
• If the tip moves when you press the button, the point is not acquired.
• When a point is acquired, the software indicates the next point to acquire, or opens the next
step.
NOTE: The Clip-On Remote Control reacts upon pressing the control button, not upon releas-
ing.

NOTE: The footswitch activates automatically when plugged-in.

NOTE: The Clip-On Remote Control and footswitch can be used concurrently.

Software User Guide Rev. 1.1 Knee Ver. 3.1 91

Registration Overview

5.1.4 Axis Direction Registration

Axis Registration Example

Figure 58

How to Register an Axis Direction Using a Brainlab Pointer

In standard pointer registration, you pivot a calibrated pointer to acquire (register) specific
landmarks on the patient’s bone.

Step
Hold the pointer tip still, angling it along the required axis as indicated on screen.
The axis is registered after approx. 2 seconds. A progress bar indicates the registration status.

How to Register an Axis Direction Using the Clip-On Remote Control

Steps
1. Hold the pointer tip still, angling it along the required axis as indicated on screen.
Press the control button to register the axis direction.
2. NOTE: The Clip-On Remote Control reacts upon pressing the control button, not upon
releasing.

How to Register an Axis Direction Using the Footswitch

Steps
1. Hold the pointer tip still, angling it along the required axis as indicated on screen.
Press the blue pedal on the footswitch to register the axis direction.
2. NOTE: The Clip-On Remote Control reacts upon pressing the control button, not upon
releasing.

NOTE: The footswitch activates automatically when plugged-in.

NOTE: The Clip-On Remote Control and footswitch can be used concurrently.

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5.1.5 Surface Registration

Surface Registration Example

Figure 59

How to Register Surfaces Using Brainlab Angled Pointer

Steps
1. Hold the pointer tip on the condyle.
2. Pivot the pointer to initiate registration.
Glide the pointer tip over the condyle, making sure to include the entire area indicated.
3. NOTE: Registration can be paused by pivoting the pointer.

How to Register Surfaces Using the Clip-On Remote Control

Steps
1. Hold the pointer tip on the condyle.
2. Press the control button to start condyle surface registration.
Glide the pointer tip over the condyle, making sure to include the entire area indicated.
3. NOTE: Registration can be paused by pivoting the pointer.

How to Register Surfaces Using the Footswitch

Steps
1. Hold the pointer tip on the condyle.
2. Press the blue pedal to start condyle surface registration.
Glide the pointer tip over the condyle, making sure to include the entire area indicated.
3. NOTE: Registration can be paused by pivoting the pointer.

NOTE: The Clip-On Remote Control and footswitch can be used concurrently.

Software User Guide Rev. 1.1 Knee Ver. 3.1 93

Femur Registration

5.2 Femur Registration

5.2.1 Femor Head Center

Overview
The registration sequence performed during surgery depends on the selected workflow. See
below for available workflow options:
• Knee3 Motion
• Knee3 Universal
• Knee3 Express
• Knee3 Partial

How to Register the Femoral Head Center

Figure 60
This step defines the:
• Proximal point of the femoral mechanical axis
• Start point of the weight bearing axis (Mikulicz line)

Step
Rotate the leg in the hip joint in a circular manner.
Begin with larger circles and gradually decrease to smaller circles.
NOTE: The screen indicates the status of the registration.

During the Calculation

Make sure that the femoral reference array is visible to the camera as the leg is being rotated.

To ensure accurate measurement, avoid too much movement of the hip during pivoting
and do not change the camera position.

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5.2.2 Distal Femur Axis Point

Overview
Defining the femoral mechanical axis point is very important to get a good planning result. The
femoral mechanical axis determines the varus/valgus and flexion/extension alignment of the
femoral component, as well as overall leg alignment. The acquisition of this point, along with the
femoral head center, completes the femoral mechanical axis.
NOTE: Remove any osteophytes before proceeding registration.

How to Register the Distal Femur Axis Point Using the Pointer

Figure 61
The pointer should be placed slightly medial at the posterior aspect of the femoral notch point (as
indicated on screen).
The software uses the femoral mechanical axis point to determine the varus/valgus and the
flexion/extension alignment of the femoral resection planes. This affects the overall leg alignment.

Step
Hold the pointer tip on the indicated bone landmark and pivot the pointer slightly around its tip.

Software User Guide Rev. 1.1 Knee Ver. 3.1 95

Femur Registration

5.2.3 Medial and Lateral Epicondylar Points

Overview
The points defined on the medial and lateral epicondyles define the epicondylar axis, the first of
three possible references for the rotational alignment of the femoral implant.
The software also uses these points for a secondary sizing check of the femoral component in
order to prevent medial-lateral overhang of the component.

How to Register the Medial and Lateral Epicondylar Points Using the Pointer

Figure 62

Step
Register a single point at the medial and then lateral epicondyle using the pointer tip as indicated
on screen.

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REGISTRATION

5.2.4 Anteroposterior Axis (Whiteside’s Line)

Overview
The Anteroposterior axis is one of three possible references for calculating the rotational
alignment of the femoral implant.

How to Register Axis Direction Using the Pointer

Figure 63
This axis is a line drawn from the deepest part of the trochlear groove anteriorly to the center of
the intercondylar notch posteriorly.

Step
Hold the pointer still and angle it along the required axis in the direction indicated on screen.
The axis is registered after approx. 2 seconds.
A progress bar indicates the status of the acquisition.

Ensure you acquire the tibia A-P direction, with the pointer pointing from anterior to
posterior.

Ensure the Whiteside’s line is acquired accurately, even small deviations can cause the
axis to rotate.

Software User Guide Rev. 1.1 Knee Ver. 3.1 97

Femur Registration

5.2.5 Medial and Lateral Condyles

Overview
The condyle surfaces are registered by acquiring a point cloud or cluster.
The software uses the acquired points on the medial and lateral condyles to calculate the most
distal and posterior points on the condyles.
It is important to reach the posterior parts of the condyles, as the posterior line is used as a
reference for the axial rotation of the femoral implant. Additionally, the epicondylar points are used
for implant sizing to avoid overlapping. These points are used as references for resection levels
and joint lines.

Condyle Segmentation

Figure 64
Items to note when acquiring points:
• The condyle is divided into segments.
• A minimum number of points must be acquired for each segment.
• Once a sufficient number of points are acquired, the segments are no longer visible.
• Point acquisition continues until all segments are no longer visible.

Color Status
White Current segment
Blue Segment(s) still requiring acquisition

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How to Register the Condyles

Figure 65

Steps
1. Hold the pointer tip on the condyle.
2. Pivot the pointer to initiate registration.
Glide the pointer tip over the condyle, making sure to include the entire area indicated.
3. NOTE: Registration can be paused by pivoting the pointer.

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Femur Registration

5.2.6 Medial and Lateral Distal Condyles

Overview
The condyle surfaces are registered by acquiring a point cloud or cluster.
The software uses the acquired points on the medial and lateral condyles to calculate the most
distal points on the condyles.
These points are used as references for resection levels.

Condyle Segmentation
Points to note when acquiring points:
• The condyle is divided into segments.
• A minimum number of points must be acquired for each segment.
• Once a sufficient number points have been acquired, the segments are no longer visible.
• Point acquisition continues until all segments are no longer visible.

Color Status
White Current segment
Blue Segment(s) still requiring acquisition

How to Register the Distal Condyles

Figure 66

Steps
1. Hold the pointer tip on the condyle.
2. Pivot the pointer to initiate registration.
Glide the pointer tip over the condyle, making sure to include the entire area indicated.
3. NOTE: Registration can be paused by pivoting the pointer.

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REGISTRATION

5.2.7 Anterior Cortex

General Information
The collected points on the anterior cortex are used as a reference for the exit of the anterior cut
plane and they determine the femoral components A-P position.

How to Register the Anterior Contex

Figure 67

Steps
1. Hold the pointer tip on the condyle.
2. Pivot the pointer to initiate registration.
Glide the pointer tip over the condyle, making sure to include the entire area indicated.
3. NOTE: Registration can be paused by pivoting the pointer.

Software User Guide Rev. 1.1 Knee Ver. 3.1 101

Tibia Registration

5.3 Tibia Registration

5.3.1 Proximal Tibia Axis Point

Overview
The proximal point on the tibial mechanical axis is defined by acquiring the posterior aspect of the
ACL tibial insertion point. You can also use the intersection of the mid-coronal and mid-sagittal
planes to register this point.

How to Register the Proximal Tibia Axis Point

Step
Hold the pointer tip on the indicated bone landmark and pivot the pointer slightly around its tip.

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5.3.2 Tibia Anterior-Posterior (A-P) Direction

Overview
The Tibia Anterior-Posterior (A-P) direction is the reference for the neutral rotational alignment.
The pointer direction defines the initial rotation of the tibial implant. The system determines the
direction the tibia is facing and the direction of any intended slope which may need to be cut,
avoiding a compound tibial slope (oblique tibial slope).
Accurate acquisition of the A-P direction avoids an oblique tibial slope in the anteromedial to
posterolateral or anterolateral to posteromedial directions.

Do not register the tibia A-P direction in reverse (pointing from posterior to anterior).

How to Register the Tibia A-P Direction

Figure 68
To define the slope direction exactly, use the medial 1/3 of the tibial tubercle, the tibial mechanical
axis point and the posterior cruciate ligament for orientation.

Step
Hold the pointer still and angle it along the required axis in the direction indicated on screen.
The axis is registered after approx. 2 seconds.

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Tibia Registration

5.3.3 Medial and Lateral Plateau Points

Overview
The software shows the resection height from this reference point.

How to Register the Medial and Lateral Plateau Points

Figure 69
A single point on each plateau is used to calculate the tibial resection level. The acquisition of the
tibia points has to be at the deepest point of the plateaus.
NOTE: Careful consideration should be given if there is a bone defect present.

Step
Hold the pointer tip on the indicated bone landmark and pivot the pointer slightly around its tip.

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REGISTRATION

5.3.4 Medial and Lateral Malleoli

Overview
Acquiring the malleoli defines the distal point of the axis.

How to Register the Medial and Lateral Malleoli

Figure 70

Step
Hold the pointer tip on the indicated bone landmark and pivot the pointer slightly around its tip.

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Verification in Knee3 Express

5.4 Verification in Knee3 Express

5.4.1 Femoral Mechanical Axis and A-P Direction

Overview
Register the axis endpoint to define the A-P direction of the femur using the Bone Verification
Plate.

How to Register the Femoral Mechanical Axis and A-P direction

Figure 71

Step

1. Select Femur Cut to begin registration with the Bone Verification Plate.
Femur Cut

2. Place the Bone Verification Plate onto the resected femur as shown on screen.
Ensure the arrow on the instrument is facing in the A-P direction and the opening of the
3.
Bone Verification Plate is positioned on the axis endpoint.
Hold the Bone Verification Plate in place and press Register to acquire the Femoral A-P
4. direction and axis endpoint.
NOTE: You can fix the verification plate onto the distal femoral cut using screws.

5. Register the hip center as shown on screen.

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REGISTRATION

5.4.2 Tibial Mechanical Axis and A-P Direction

Overview
Register the axis endpoint to define the A-P direction of the tibia using the Bone Verification
Plate.

How to Register the Tibial Mechanical Axis and A-P Direction

Figure 72

Step

1. Select Tibia Cut to begin registration with the Bone Verification Plate.
Tibia Cut

2. Place the Bone Verification Plate onto the resected tibia as shown on screen.
Ensure the arrow on the instrument is facing in the A-P direction and the opening of the
3.
Bone Verification Plate is positioned on the axis endpoint.
Hold the Bone Verification Plate in place and press Register to acquire the tibial A-P
4.
direction and axis endpoint.
5. Register the tibial malleoli.

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Additional Registration Functions

5.5 Additional Registration Functions

5.5.1 Skipping Landmarks

Overview
To reduce the registration effort, certain landmarks can be skipped. However, this results in less
information during navigation.
The table below explains the effects of skipping specific landmarks:

Skipped Landmark Effect

Tibia Plateaus No tibia resection heights are shown
• No tibia resection heights are shown
Condyles • The initial femoral implant size is determined from the anterior cortex
point
Whiteside’s Line Only the epicondylar axis is available as a rotation reference

Skip Options

Button Explanation

Skips the landmark for the current workflow.

Skips the landmark for the current and future workflows.

NOTE: A skipped landmark can be registered later by selecting it from the fly-out menu.

How to Skip Landmarks

Step
Press Skip or Skip Always on the registration screen.
Registration proceeds to the next step.

NOTE: If landmarks are skipped, less navigation information is displayed during cut navigation.

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REGISTRATION

5.5.2 Re-Registration

Overview
Specific landmarks or even a whole femur or tibia can be re-registered (e.g., due to an array
becoming loose) at any point in the workflow by selecting that registration step in the menu.
Once re-registration is complete, the software returns to its previous step.
NOTE: Re-registration of landmarks is not possible with the Pinless Workflow. If you want to re-
register landmarks in that workflow, you have to start a new registration.

How to Perform Re-Registration

Figure 73

Steps

1. Select the fly-out menu.

Select the landmark for re-registration from either Femur Registration or Tibia Registra-
2.
tion.
Register the point(s) as prompted.
3.
On completion, the software takes you back to the previous step.

Reset & Register Again

After full registration of the femur and tibia, Reset & Register Again becomes active. This allows
you to re-register the whole femur or tibia.

Software User Guide Rev. 1.1 Knee Ver. 3.1 109

Additional Registration Functions

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PATIENT REPORT

6 PATIENT REPORT
6.1 Creating a Patient Report

General Information
Following surgery, you can create a patient report containing the most important data.

How to Create a Patient Report

Figure 74

Steps

Select Done after surgery is finished.

1.
The report app opens.

Select Back to return to navigation or Done to save the report to the pa-
2. tient folder.
The software switches back to Content Manager.

Software User Guide Rev. 1.1 Knee Ver. 3.1 111

Creating a Patient Report

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FLY-OUT MENU AND TOOL BAR

7 FLY-OUT MENU AND TOOL

BAR
7.1 Fly-out Menu

How to Access the Fly-out Menu

Step

Select the arrow icon from the tool bar.

Menu Options
The fly-out menu provides links to the following:

Figure 75

Options See
Implants & Treatment Side Page 39
Femur Registration Page 94
Tibia Registration Page 102
Navigation Page 41
Plan Page 48
Camera Page 23

Software User Guide Rev. 1.1 Knee Ver. 3.1 113

Fly-out Menu

Options See
Settings Page 117
Reset & Register Again
Page 109
(not available for Knee3 Express)

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FLY-OUT MENU AND TOOL BAR

7.2 Tool Bar

Tool Bar Overview

The tool bar contains color-coded camera status indicators for the reference arrays and
instruments.
Also available on the navigation and plan screens are the following functions:
• Plan
• Done
• Screenshot
• Resection or Joint Line toggle switch

Tool Bar Color-Coding

Status Explanation

Reference array or instrument is visible, in active use and interacting with the
software (reference array or instrument is on a blue background).

Reference array or instrument is visible (highlighted in blue).

Reference array or instrument is NOT visible (grayed out).

Reference array or instrument is NOT visible but is required for the procedure
step (reference array or instrument is on a red background).

Tool Bar Components

Icon Explanation

Represents the femur reference array.

Represents the tibia reference array.

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Tool Bar

Icon Explanation

Represents the pointer.

Represents the plane tool.

Represents the cutting block template.

Indicates tracking errors.

NOTE: If the camera becomes disconnected during the workflow, the software displays the
tracking error icon. If you press an icon, the camera application opens and provides you detailed
information about the problem and possible solutions.

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SETTINGS

8 SETTINGS
8.1 Sound and Tools

General Information
Additional settings are accessed from the fly-out menu.

How to Access Sound and Tools Settings

Figure 76

Step
Press Settings in the fly-out menu to adjust:
• SOUND
- Sound Output (On/Off)
- Sound Volume
- Visibility Sound (On/Off)
• TOOLS
- Clip-On Remote Control activation
• ADVANCED SETTINGS
- Record Button
- Reset User Settings...

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Screenshots

8.2 Screenshots

How to Take a Screenshot

You can take screenshots at any point throughout navigation or planning.

Step

#3
Press Screenshot on any navigation or planning page.
The images are stored in the patient folder.
Screenshot

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INDEX

INDEX
Numerics Fine-adjustable Cutting Block.................................................14
Knee Plane Tool..................................................................... 14
4 in 1 Cutting Block Template.....................................................14 Knee Plane Tool - Bone Verification Plate with Spikes...........32
Knee Plane Tool - Bone Verification Small............................. 32
Knee Plane Tool - Cutting Block Adapter............................... 32
A Knee Plane Tool - Tracking Array........................................... 31
artifacts.......................................................................................29 Marker Spheres...................................................................... 31
Reference Array, X-Press.......................................................14
Reflective Markers..................................................................31
B straight pointer........................................................................31
T-shaped array....................................................................... 25
Bone Fixator “2-Pin”, X-Press.................................................... 14 Y-shaped array....................................................................... 25
Bone Fixator: Bone Fixator “1-Pin”, X-Press (Sizes S, M or L).. 14

J
C
Joint Stability.............................................................................. 49
camera deleting recorded data............................................................51
positioning.............................................................................. 22 recording data.........................................................................51
Clip-on Remote Control..............................................................88
Compatible
Brainlab medical instruments................................................. 14 K
Brainlab medical software...................................................... 15
cut verification............................................................................ 37 Knee Plane Tool......................................................................... 14
Knee3 Express........................................................................... 62
Knee3 Motion............................................................................. 38
D Knee3 Partial..............................................................................76
Knee3 Universal......................................................................... 54
Disposable Clip-on Remote Control........................................... 14
disposal instructions..................................................................... 8
distal femur cut........................................................................... 81 L
documentation............................................................................19
landmarks
malleoli................................................................................. 105
F plateau points....................................................................... 104
proximal tibia axis point........................................................ 102
Femoral and Tibial Cutting Block Adapter “Universal”................14 re-registering........................................................................ 109
Fine-adjustable Cutting Block.....................................................14 registering epicondylar points.................................................96
fly-out menu..............................................................................113 registering single landmarks...................................................95
Footswitch................................................................... 16,88,91,92 registering using the Clip-on Remote Control...............87,90,92
registration....................................................................88,89,93 registering using the pointer.................................... 87,90,92,93
skipping................................................................................ 108
G leg alignment.............................................................................. 36
light interference.........................................................................29
guides.........................................................................................19 live navigation.............................................................................75

I M
implants manuals......................................................................................19
compartment...........................................................................77
compatible implants................................................................16
navigation type....................................................................... 65 N
resection presets.................................................................... 39 navigation................................................................................... 42
selection................................................................................. 39 anterior femur resection.....................................................46,61
treatment side..........................................................39,55,65,77 block positioning..................................................................... 67
instrument visibility..................................................................... 24 checking accuracy.................................................................. 30
instruments distal femur resection........................................................ 45,59
4 in 1 Cutting Block Template............................................ 14,31 leg alignment................................................................ 44,58,80
angled pointer.........................................................................31 overall workflow............................................................ 42,57,79
Bone Fixator “1-Pin”, X-Press (Sizes S, M or L).....................14 performing a distal femur cut.................................................. 81
Bone Fixator “2-Pin”, X-Press.................................................14 position verification................................................................. 67
Brainlab Pointer, Angled......................................................... 14 screen layout.......................................................................... 44
Brainlab Pointer, Straight........................................................14 tibia resection.................................................................... 46,61
Disposable Clip-on Remote Control....................................... 14
Disposable Reflective Marker Spheres.................................. 14
Femoral and Tibial Cutting Block Adapter “Universal”.......14,32

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INDEX

P starting....................................................................................33
starting the software
patient information patient selection......................................................................34
entering...................................................................................34 selecting Knee........................................................................ 34
plane tool start knee workflow.................................................................34
verification.............................................................................. 43 Support.........................................................................................7
planning sustainability.................................................................................8
screen layout.......................................................................... 48
value adjustment.................................................................... 48
Pointer......................................................................... 87,90,92,93
T
Pointer Angled............................................................................14 tibia cut....................................................................................... 81
Pointer Straight for Knee............................................................ 14 tool bar
color coding.......................................................................... 115
R components.......................................................................... 116
tool placement detection....................................................... 43,68
recording data............................................................................ 53 training........................................................................................18
reference array
visibility................................................................................. 115
Reference Array, X-Press...........................................................14
U
reference arrays user guides.................................................................................19
attaching................................................................................. 25
femoral fixation....................................................................... 26
movement...............................................................................29 V
tibial fixation............................................................................28
verification
reflections................................................................................... 29
block position..........................................................................71
registration.............................................................................56,83
femur...................................................................................... 71
A-P direction.................................................................. 106,107
femur block position................................................................71
anterior contex......................................................................101
femur cut.................................................................................74
axis directions.........................................................................97
tibia block position............................................................. 69,70
femoral condyles........................................................ 93,99,100
tibia cut................................................................................... 72
femoral head center.........................................................94,106
using a pointer................................................................... 70,71
femur............................................................................... 94,106
mechanical axis............................................................. 106,107
medial and lateral condyles............................................. 99,100 W
medial and lateral malleoli.................................................... 105
medial and lateral plateau points..........................................104 WEEE...........................................................................................8
re-registering landmarks.......................................................109 workflows
registering Anteroposterior Axis (Whiteside’s Line)................97 Knee3 Express....................................................................... 62
reset and register again........................................................109 Knee3 Motion......................................................................... 38
single landmarks................................................................95,96 Knee3 Partial.......................................................................... 76
surfaces...................................................................... 93,99,100 Knee3 Universal..................................................................... 54
tibia................................................................................ 102,107 type.........................................................................................35
tibial A-P direction.................................................................103
using the Clip-on Remote Control................................ 87,90,92
using the footswitch......................................................88,91-93
using the pointer...................................................... 87,90,92,93
registration steps
Knee3 Express.................................................................. 66,86
Knee3 Motion.................................................................... 40,85
Knee3 Partial..................................................................... 78,86
Knee3 Universal................................................................ 56,85
research data............................................................................. 53
resections
performing a distal femur resection................................... 45,60
performing a tibia resection............................................... 46,61
performing an anterior femur resection............................. 46,61
verification.............................................................................. 46

S
Screenshots..............................................................................118
settings
Clip-on Remote Control........................................................ 117
Screenshots..........................................................................118
sound output......................................................................... 117
Skip.......................................................................................... 108
Skip Always.............................................................................. 108
skipping landmarks...................................................................108
software
camera....................................................................................24
create a patient report........................................................... 111
instrument visibility................................................................. 24
settings................................................................................. 117

120 Software User Guide Rev. 1.1 Knee Ver. 3.1

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