JP5659008B2 - Jig for artificial knee joint placement - Google Patents

Description

  The present invention relates to a jig used for artificial knee joint placement.

  Artificial knee joints are sometimes used to treat patients who have osteoarthritis or chronic rheumatism due to wear of the knee cartilage. FIG. 9 is a schematic side cross-sectional view showing the left leg femur and tibia with an artificial knee joint installed. As shown in FIG. 9, the artificial knee joint 100 includes a femur F so as to cover the tibial tray 102 and the surface liner 104 fixed to the proximal end Te of the tibia T and the distal end Fe of the femur F. And a femoral component 106 secured to the body. In some cases, a spacer (not shown) is inserted between the tibial tray 102 and the tibia T. The femur F and the tibia T are connected and pulled together mainly by ligaments (not shown) arranged on the left and right sides thereof, so that the femoral component 106 is pressed against the surface liner 104. ing. In the knee prosthesis 100, the femoral component 106 slides along the surface liner 104 when the knee is moved between a bent position (flexion position) and an extended position (extension position).

  FIG. 10 is a schematic side view showing the left leg tibia and femur partially excised for placement of the knee prosthesis. As shown in FIG. 10, the tibial proximal end Te forms an installation surface for removing the worn cartilage and fixing the tibial tray 102 to the tibia T, that is, the proximal end surface Tc. Has been excised for. Similarly, the femoral distal end Fe is excised to remove worn cartilage and to form five mounting surfaces Fc1-Fc5 for securing the femoral component 106 to the femur F. Has been. The five installation surfaces include a distal end surface Fc1, a front installation surface Fc2 and a rear installation surface Fc3 perpendicular to the distal end surface Fc1, and a distal end surface Fc1, the front installation surface Fc2, and the rear installation surface Fc3. Two inclined installation surfaces Fc4 and Fc5.

  In order to install the knee prosthesis in a direction suitable for the patient, it is necessary to form the installation surfaces Fc1 to Fc5 in an appropriate direction, that is, to cut a bone in an appropriate direction. In order to determine an appropriate direction for resecting (cutting bone), an artificial knee joint placement jig is used (see, for example, Patent Documents 1 and 2). In the conventional jig, an appropriate direction of the installation surface, that is, an appropriate osteotomy direction is determined based on the position of the rod inserted into the medullary cavity from the distal end of the femur. For example, with reference to the rod inserted into the medullary cavity, the osteotomy guide is fixed to the femoral distal end Fe in an appropriate direction, the blade cutter is guided along the guide surface of the osteotomy guide, and the osteotomy is performed. Had gone.

Japanese National Patent Publication No. 11-504532 US Pat. No. 5,735,904

  However, there are cases where it is not desirable to insert the rod from the distal end of the femur into the medullary canal. For example, the case where the rod cannot be inserted deeply due to the large curvature of the femoral shaft, the case where the implant such as an artificial hip joint is buried in the medullary cavity, and there is no space for inserting the rod in the medullary cavity. This is a case where complications due to thrombus and the like are expected by inserting a rod into the bone marrow cavity. In these cases, since an appropriate osteotomy direction cannot be determined with reference to the rod, the appropriate osteotomy direction largely depends on the skills of experienced doctors. Therefore, a jig that can determine an appropriate osteotomy direction in such a case is desired even for a doctor who has little experience in artificial knee joint placement.

  Accordingly, an object of the present invention is to provide a jig capable of determining an appropriate osteotomy direction at the end of the femur without inserting a rod into the femoral bone marrow cavity in artificial knee joint placement. .

  In order to achieve the above object, the artificial knee joint placement jig according to the present invention includes a mounting base that can be held in a groove formed in the patella and / or intercondylar space of the femur, and an anterior-posterior direction of the femur. A pivot holder attached to the mounting base so as to be pivotable about a pivot axis extending to the head, a bone head indicating section that is held by the pivot holder and extends in the proximal direction of the femur, and is held by the pivot holder, An abutment guide configured to abut the anterior portion of the distal end of the femur, and the head pointing portion extends over the femoral head by pivoting of the pivot holder relative to the mounting base The abutment guide has a drill hole in the front of the distal end of the femur at the position of the rotation holder when the head indicator is aligned to extend over the femoral head. It has a guide hole that guides the drill for drilling. It is set to.

  When using the artificial knee joint placement jig configured as described above, the rotation holder is used as a reference with respect to the attachment base held in the groove formed on the patella surface and / or the intercondylar fossa of the femur. The held head head pointing portion is rotated, and the head head pointing portion is aligned so as to extend on the femoral head. A drill hole is made in the front part of the distal end of the femur at the position of the rotation holder when aligned as described above, with the guide hole of the contact guide held by the rotation holder as a guide. This drill hole becomes a reference position for osteotomy in the artificial knee joint placement operation. For example, the osteotomy guide is positioned at the distal end of the femur with reference to the drill hole, and osteotomy is performed in accordance with the osteotomy direction defined by the osteotomy guide. That is, in an artificial knee joint placement operation, an appropriate osteotomy direction of the femoral end can be determined without inserting a rod into the femoral bone marrow cavity.

  In the above-described jig embodiment, preferably, the rotation holder is separable from the mounting base, and more preferably, one of the mounting base and the rotation holder has a hole along the rotation axis, and the other side. Has a shaft portion that is pivotably fitted into the hole.

  In an embodiment in which the pivot holder is separable from the mounting base, it preferably further comprises a handle portion attachable to the mounting base instead of the pivot holder, the handle portion being located in the distal direction of the femur from the mounting base. And an operating portion extending to the surface. More preferably, the apparatus further includes an instruction portion attached to the handle portion and indicating an attachment direction of the attachment base with respect to the femur.

  In the embodiment of the jig, the head head preferably includes a first rod extending along the femur and a second rod extending from the first rod toward the femoral head.

  In the jig embodiment, preferably the abutment guide is separable from the mounting base.

  In the jig embodiment, preferably, the abutment guide has a guide surface for guiding a blade cutter for cutting the distal end of the femur.

  In order to achieve the above object, an artificial knee joint placement jig according to the present invention includes an attachment base that can be held in a groove formed in the patella and / or intercondyle of the femur, A pivot holder attached to the mounting base so as to be pivotable about a pivot axis extending in the front-rear direction, a head pointing portion held by the pivot holder and extending in the proximal direction of the femur, and held by the pivot holder And an abutment guide configured to abut the anterior portion of the distal end of the femur, and the femoral head indicating portion is placed on the femoral head by pivoting the pivot holder relative to the mounting base. The abutment guide can be aligned to extend, and the abutment guide blades the osteotomy of the distal end of the femur at the position of the pivot holder when the head indicator is aligned to extend over the femoral head A guide surface for guiding the cutter is provided. To have.

    When using the artificial knee joint placement jig configured as described above, the rotation holder is used as a reference with respect to the attachment base held in the groove formed on the patella surface and / or the intercondylar fossa of the femur. The held head head pointing portion is rotated, and the head head pointing portion is aligned so as to extend on the femoral head. The osteotomy direction is determined by the guide surface of the abutment guide held by the rotation holder at the position of the rotation holder when aligned as described above. That is, in an artificial knee joint placement operation, an appropriate osteotomy direction of the femoral end can be determined without inserting a rod into the femoral bone marrow cavity.

  The jig for the knee prosthesis installation according to the present invention can determine the appropriate osteotomy direction of the femoral end without inserting a rod into the femoral bone marrow cavity.

1 is a perspective view of a first embodiment of a jig for artificial knee joint placement according to the present invention. FIG. It is a perspective view of the jig which removed the bone head instruction | indication part. It is a disassembled perspective view of a jig. It is a perspective view of a contact guide. It is a perspective view of an attachment base, a handle part, and an instruction part. It is a disassembled perspective view of an attachment base, a handle | steering-wheel part, and an instruction | indication part. It is a perspective view of an osteotomy guide. It is a perspective view of 2nd Embodiment of the jig for artificial knee joint installation operation by this invention which removed the head head instruction | indication part. It is a schematic side sectional view showing the femur and tibia of the left leg on which the artificial knee joint is installed. FIG. 6 is a schematic side view showing the left leg tibia and femur partially excised for placement of an artificial knee joint.

  Hereinafter, with reference to the drawings, an embodiment of a jig for artificial knee joint placement according to the present invention will be described. In the following description, the terms “distal”, “proximal”, “front” and “rear” representing orientation are used with reference to the femur.

  As shown in FIGS. 1 and 2, a jig 1 for artificial knee joint placement according to a first embodiment of the present invention includes an attachment base 2 and a rotation holder 4 that is rotatably attached to the attachment base 2. And an elongated bone head indicating portion 6 held by the rotation holder 4 and a contact guide 8 held by the rotation holder.

  The attachment base 2 can be held in a groove F2 (see FIG. 5) formed in the patella and / or the intercondylar fossa F1 of the femur F. The groove F2 preferably extends in the front-rear direction AB of the femur F. During the operation, the front-rear direction AB is substantially vertical. The width of the groove F2 is, for example, 0.5 to 1.0 mm, and the depth of the groove F2 is the deepest part, for example, 5 to 10 mm.

  As shown in FIG. 3, the attachment base 2 has an attachment portion 2a that is engaged and held in the groove F2, and a cylindrical portion 2b that is formed adjacent to the attachment portion 2a. The attachment portion 2a is preferably plate-shaped. It is preferable that the thickness of the plate-like attachment portion 2a is slightly thinner toward the tip. The cylindrical portion 2b is formed integrally with the plate-like attachment portion 2a, and has a circular cross-sectional elongated hole 2c along the rotation axis X extending in the front-rear direction AB of the femur F, opposite to the attachment portion 2a. And a distal plane 2d located on the side. The elongated hole 2c has an upper opening. The rotation axis X is preferably close to the patella surface and / or the intercondylar fossa F1, and as a result, is preferably located in the vicinity of the rotation axis of the knee. Since the direction of the rotational axis of the knee cannot be accurately grasped during the operation, the rotational axis X is actually oriented in a direction perpendicular to the relatively flat part of the anterior part of the femur F. Is preferred. The distal plane 2d is preferably perpendicular to the direction in which the plate-like attachment portion 2a extends toward the femur. The distal plane 2d is preferably parallel to the rotation axis X.

  The rotation holder 4 is held by the mounting base 2 so as to be rotatable about the rotation axis X. Specifically, the rotation holder 4 includes a shaft portion 10 that is rotatably fitted in the elongated hole 2c of the cylindrical portion 2b, a first portion that is positioned on the front side of the shaft portion 10 and that holds the contact guide 8. 1 holding part 12 and a second holding part 14 which is located in front of the first holding part 12 and holds the head pointing unit 6. The shaft portion 10 can be inserted into the elongated hole 2 c, and thus the rotation holder 4 can be separated from the mounting base 2.

  The first holding portion 12 includes a groove 12a extending laterally with respect to the rotation axis X in order to position the contact guide 8 with respect to the rotation holder 4, and a screw on the contact guide 8 to the rotation holder 4. It has a threaded hole 12b for fastening and a proximal plane 12c against which the abutment guide 8 is pressed by fastening with screws.

  The second holding portion 14 has a hole 14 a that holds the head pointing unit 6. The hole 14a is located on the rotation axis X and extends laterally thereto. The direction in which the hole 14a extends is preferably perpendicular to the proximal plane 12c. It is preferable that a plurality of holes 14a are provided so that the distance between the femoral head indicating portion 6 held by the rotation holder 4 and the femur can be adjusted. In the present embodiment, four holes 14a penetrating through a cylindrical projection are provided.

  The femoral head indicator 6 extends in the proximal direction C of the femur F. Specifically, the femoral head indicating unit 6 includes a first rod 16 that extends straight along the femur F, and a second rod 18 that extends from the first rod 16 toward the femur. . The first rod 16 can be inserted into the hole 14 a, and thus the bone head indicating unit 6 can be separated from the rotation holder 4. The first rod 16 has a distal end portion 16a having a diameter larger than that of the hole 14a, and a fitting portion 16b that is adjacent to the distal end portion 16a and engages with the hole 14a. The rod 16 can be inserted into the hole 14a from the distal side to the proximal side. The second rod 18 has a hole 18 a that can be inserted into the proximal end portion 16 c of the first rod 16, and is slidable along the first rod 16. Moreover, it is preferable that the 2nd rod 18 is rotatable with respect to the 1st rod 16 so that it may face directly below with the dead weight. The femoral head indicating unit 6 can be positioned so as to extend on the femoral head by the rotation of the rotation holder 4 with respect to the mounting base 2.

  As shown in FIGS. 1 and 2, the abutment guide 8 is configured to abut against the front portion of the femoral distal end Fe and is separable from the mounting base 2. As shown in FIGS. 3 and 4, the contact guide 8 includes a convex portion 8 a that fits into the groove 12 a of the rotating holder 4, a screw portion 8 b that engages with a threaded hole 12 b, and a screw portion 8 b. And a contact portion 8d extending above the anterior portion of the distal end of the femur. The abutting portion 8d has a flat surface 8e that abuts the femur and at least two guide holes 8f that guide a drill (not shown) that opens a drill hole (not shown) in the front portion of the femur distal end Fe. And have. In the present embodiment, two guide holes 8f penetrating through a cylindrical projection are provided.

  As shown in FIGS. 5 and 6, the jig 1 preferably further includes a handle portion 20 that can be attached to the attachment base 2 instead of the rotation holder 4. The handle portion 20 is connected to the first shaft portion 20a that can be inserted into the hole 2c of the cylindrical portion 2b of the mounting base 2, and the front end portion of the first shaft portion 20a, and along the first shaft portion 20a. The support portion 20b extends, the operation portion 20c extends from the support portion 20b in the distal direction D of the femur F, and the second shaft portion 20d extends forward A from the front end of the first shaft portion 20a. Yes. The support portion 20b has a proximal plane 20e that engages the plane 2d of the tubular portion 2b so as to prevent the handle portion 20 from pivoting about the pivot axis X relative to the mounting base 2. Yes. The second support portion 20d has a distal plane 20f. The operation portion 20c is preferably rod-shaped.

  The jig 1 is preferably attached to the handle portion 20 and has an indication portion 22 for instructing the attachment direction of the attachment base 2 with respect to the femur F. The indication portion 22 includes a cylindrical portion 22a that can be inserted into the second shaft portion 20d of the handle portion 20, a screw portion 22b for fixing the indication portion 22 to the second shaft portion 20d of the handle portion 20, and a cylinder. And an indicator element 22c extending from the shaped portion 22a onto the front of the distal femur Fe. The tubular portion 22a is slidable along the second shaft portion 20d to adjust the distance between the indicating element 22c and the femur F. The screw portion 22b is pressed against the distal plane 20f of the second shaft portion 20d in order to fix the position of the cylindrical portion 22a with respect to the second shaft portion 20d. The tip portion 22d of the indicating element 22c preferably extends perpendicularly to the rotation axis X of the mounting base 2. In the present embodiment, the instruction element 22c has a bent shape.

  As shown in FIG. 7, the jig 1 preferably has an osteotomy guide 24. The osteotomy guide 24 includes a pin hole 24a that fits into a positioning pin 26 inserted in a drill hole (not shown) formed in the front portion of the femur distal end Fe, and an artificial knee in the femur F. It has a guide surface 24b for guiding a blade cutter (not shown) to form a distal mounting surface Fc1 for the joint. In the present embodiment, the guide surface 24b is formed by a slot.

  Each component of the jig may be made of a material that allows sterilization by a sterilizer (autoclave). Such a material is, for example, a stainless steel material.

  Next, a method of using the jig for installing an artificial knee joint according to the present invention will be described.

  A groove F2 having a depth of 6 to 7 mm (deepest part) is formed on the patella and / or the intercondylar fossa F1 of the femur F with a medical saw in a state where the patient's knee is in a bent position.

  The handle portion 20 is attached to the attachment base 2. Specifically, the orientation of the proximal plane 20 e of the handle portion 20 is aligned with the distal plane 2 d of the mounting base 2, and the first shaft portion 20 a of the handle portion 20 is inserted into the hole 2 c of the mounting base 2.

  The instruction unit 22 is attached to the handle unit 20. Specifically, the cylindrical portion 22 a of the instruction portion 22 is inserted into the second shaft portion 20 d of the handle portion 20. The indication portion 22 may be fixed to the second shaft portion 20d at an appropriate position using the screw portion 22b.

  Holding the operation portion 20c of the handle portion 20, the attachment portion 2a of the attachment base 2 is pushed into the groove F2 formed in the femur F, and the attachment base 2 is attached to the groove F2. The operating portion 20c is moved to adjust the mounting direction of the mounting base 2 so that the rotation axis X faces the front-rear direction AB. This adjustment may be performed with reference to the direction in which the operation portion 20c extends with respect to the femur F, or may be performed with reference to the direction in which the distal end portion 22d of the pointing unit 22 extends with respect to the femur F. . When referring to the direction in which the distal end portion 22d extends, it is preferable to adjust the position of the pointing portion 22 with respect to the second shaft portion 20d and bring the distal end portion 22d into contact with the front portion of the femur F.

  Next, the contact guide 8 is attached to the rotation holder 4. Specifically, the convex portion 8a of the contact guide 8 is fitted into the groove 12a of the first holding portion 12 of the rotation holder 4, the screw portion 8b is tightened into the threaded hole 12b, and the contact portion 8d is fixed. The contact guide 8 is fixed to the rotation holder 4 so as to be pressed against the proximal plane 12c.

  The handle portion 20 and the instruction portion 22 are removed from the mounting base 2, and instead, the rotating holder 4 to which the contact guide 8 is mounted is mounted on the mounting base 2. Specifically, the shaft portion 20 a of the handle portion 20 is extracted from the hole 2 c of the mounting base 2, and the shaft portion 10 of the rotation holder 4 is inserted into the hole 2 c of the mounting base 2.

  Also, the first rod 16 of the bone head indicating portion 6 is inserted into an arbitrary hole 14 a of the second holding portion 14 of the rotation holder 4, and the second rod 18 is inserted into the proximal end portion of the first rod 16. Insert into 16c. The first rod 16 and the second rod 18 are located outside the patient.

  By rotating the head indicating unit 6 and the rotation holder 4 about the rotation axis X, the head indicating unit 6 is aligned so that the head indicating unit 6 extends over the femoral head Fh. In this embodiment, the position of the femoral head Fh is examined in advance using an image device, a mark is made on the skin, and the tip of the second rod 18 is aligned with the mark.

  A drill (not shown) is inserted into the guide hole 8f of the abutment guide 8 while maintaining the position of the rotation holder 4 when the head head pointing portion 6 is aligned so as to extend above the femoral head Fh. A drill hole (not shown) is formed in the front portion of the femur distal end Fe. Thereafter, the positioning pin 26 is inserted into a drill hole (not shown).

  The jig 1 (the mounting base 2, the rotation holder 4, the head head pointing portion 6, and the contact guide 8) is removed from the femur F. The pin hole 24a of the osteotomy guide 24 is aligned with the positioning pin 26, the osteotomy guide 24 is attached to the femur F, the blade cutter is moved along the guide surface 24b of the osteotomy guide 24, and the distal end of the femur F An installation surface Fc1 is formed.

  Next, a jig for artificial knee joint placement according to a second embodiment of the present invention will be described. As shown in FIG. 8, the artificial knee joint placement jig 50 according to the second embodiment of the present invention is a jig for artificial knee joint placement according to the first embodiment of the present invention except for the contact guide 8 '. 1 has the same structure.

  The abutment guide 8 ′ is configured to abut against the front portion of the femur distal end Fe and is separable from the mounting base 2. As shown in FIG. 8, the contact guide 8 ′ is a contact that extends over the convex portion (not shown) that fits into the groove 12 a of the rotation holder 4 and the front portion of the femoral distal end Fe. Part 8d '. The abutting portion 8d ′ includes at least two guides for guiding a flat surface 8e ′ that abuts the femur and a drill (not shown) that drills a drill hole (not shown) in the front portion of the femur distal end Fe. It has a hole 8f 'and a guide surface 24b' for guiding a blade cutter (not shown) in order to form a distal placement surface Fc1 for the artificial knee joint in the femur F. The convex portion 8 a ′ incorporates a magnet, and the abutting portion 8 ′ can be attached to the rotating holder 4 by magnetic force.

  In this jig 50, a drill hole (at the front part of the distal end Fe of the femur is maintained while maintaining the position of the rotation holder 4 when the head pointing part 6 is aligned so as to extend above the femoral head Fh. After forming the positioning pin 26 in the drill hole (not shown) and moving the blade cutter along the guide surface 24b 'of the contact guide 8', the distal end of the femur F is formed. The installation surface Fc1 can be formed.

  Although the embodiments of the present invention have been described above, the present invention is not limited to the above-described embodiments, and various modifications are possible within the scope of the invention described in the claims. Needless to say, these are also included within the scope of the present invention.

  In the above embodiment, the attachment portion 2a of the attachment base 2 is a single plate-like portion, but the shape of the attachment portion 2a is arbitrary as long as the attachment base 2 can be attached to the groove F2. For example, the attachment portion 2a may be a plurality of protrusions or plate-like portions.

  In the above embodiment, the mounting base 2, the rotation holder 4, the head pointing unit 6, and the contact guide 8 are separable from each other, but some or all of them may not be separated.

  In the above embodiment, the first rod 16 of the head pointing unit 6 is configured to be insertable into the hole 14a from the distal side to the proximal side, but can be inserted into the hole 14a from the proximal side to the distal side. It may be configured. Further, the form of the bone head indicating portion 6 is arbitrary as long as it is configured to extend over the bone head, and the first rod 16 and the second rod 18 may be formed integrally, or the second The rod 18 may be omitted, may be formed in an elongated plate shape, or may be bent.

  In the above embodiment, the mounting base 2 is provided with the hole 2c, and the rotating holder 4 is provided with the cylindrical portion 10. On the contrary, the mounting base is provided with the shaft portion, and the rotating holder is provided with the hole. May be.

  For the contact guides 8 and 8 ′, only the guide hole 8f may be provided as in the first embodiment, or the guide hole 8f and the guide surface 24b ′ are provided as in the second embodiment. It may be provided, or only the guide surface 24b ′ may be provided. When only the guide surface 24b 'is provided, the contact guide is preferably held by the rotating holder 4 by the screw portion 8b as in the first embodiment.

  The jig 1 may have the handle part 20 and the instruction part 22, or may not have them.

DESCRIPTION OF SYMBOLS 1 Jig 2 Mounting base 2c Hole 4 Rotating holder 6 Bone head indicating part 8 Contact guide 8f Guide hole 10 Shaft part 16 First rod 18 Second rod 20 Handle part 20c Operation part 22 Instruction part 24b Guide surface F Femur F1 femoral patellar surface and / or intercondylar fossa F2 groove Fe femur distal end Fh femoral head X rotation axis

Claims (9)

A jig for knee prosthesis installation,
An attachment base that can be held in a groove formed in the patella and / or intercondylar fossa of the femur;
A rotation holder attached to the attachment base so as to be rotatable around a rotation axis extending in the front-rear direction of the femur;
A femoral head indicator held by the pivot holder and extending in the proximal direction of the femur;
An abutment guide held by the pivot holder and configured to abut the anterior portion of the distal end of the femur;
The bone head indicating portion can be aligned to extend over the femoral head by rotation of the rotation holder with respect to the mounting base,
The abutment guide includes a drill for making a drill hole in the front portion of the distal end of the femur at the position of the rotation holder when the head pointing portion is aligned to extend over the femoral head. A jig having a guide hole for guiding.   The jig according to claim 1, wherein the rotation holder is separable from the mounting base.   3. One of the mounting base and the rotation holder has a hole along the rotation axis, and the other has a shaft portion that is rotatably fitted in the hole. The jig described in   Furthermore, it has a handle part which can be attached to the attachment base instead of the rotation holder, and the handle part has an operation part extending in the distal direction of the femur from the attachment base. The jig according to claim 2 or 3. 5. The indicator of claim 4, further comprising an indicator attached to the handle portion and extending over an anterior portion of the distal end of the femur to indicate an attachment direction of the attachment base relative to the femur. Jigs.   6. The head according to claim 1, wherein the head pointing unit includes a first rod extending along the femur and a second rod extending from the first rod toward the femoral head. The jig according to item 1.   The jig according to claim 1, wherein the contact guide is separable from the mounting base.   The jig according to any one of claims 1 to 6, wherein the contact guide has a guide surface for guiding a blade cutter for cutting the distal end of the femur. A jig for knee prosthesis installation,
An attachment base that can be held in a groove formed in the patella and / or intercondylar fossa of the femur;
A rotation holder attached to the attachment base so as to be rotatable about an axis extending in the front-rear direction of the femur in the vicinity of the patella and / or intercondylar fossa of the femur;
A femoral head indicator held by the pivot holder and extending in the proximal direction of the femur;
An abutment guide held by the pivot holder and configured to abut the anterior portion of the distal end of the femur;
The bone head indicating portion can be aligned to extend over the femoral head by rotation of the rotation holder with respect to the mounting base,
Said abutment guide, at the location of said pivot holder when said condyle instruction section aligned to extend over the femoral head, the blade cutter for bone resection of the distal femur portion, a knee prosthesis A jig having a guide surface that guides in a direction to form a distal mounting surface for .

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