RU210530U1 - Device for determining the rotational position of the tibial component of the knee endoprosthesis - Google Patents

Abstract

The utility model relates to medicine, namely to traumatology and orthopedics, and can be used to determine the rotational position of the tibial component during knee arthroplasty. The device for determining the rotational position of the tibial component of the knee joint endoprosthesis contains a body, a position indicator, a handle (10), a protractor (12), a guide (16), a vertical lock (21), a stem (26), a stem lock (29) in the form of a wing screws, a horizontal retainer (30) in the form of a wing screw, a washer (31) of a concave shape corresponding to the sphere of the anterior wall of the upper third of the tibia, and a washer (32) in the form of an ellipse with a decentered position of the through hole. The handle (10) is teardrop-shaped at the end with a threaded section (11). The body (1) is L-shaped at an angle of 90°. The vertical part of the body (1) at the end contains a cylindrical cavity (2) and a through threaded hole (3) for the rod retainer (26). On the bend of the body (1) there is a threaded hole (4) for screwing in the threaded section (11) of the handle (10). The horizontal part of the body (1) is narrowed towards the middle, at the end of the horizontal part there is a recess (5), in which a through hole (6) is located. The end of the horizontal part of the housing (1) has an inclination of 71° relative to the horizontal plane. In the middle of the horizontal part of the body (1), a recess (7) is located on top, a spherical recess (8) is located on the bottom, interconnected by a hole (9). The stem (26) is teardrop shaped. At the bottom of the stem (26) there is a through threaded hole (27). In the upper part there are five recesses (28) along one line, while the rod (26) can be located in the said cylindrical cavity (2) of the body (1) so that the recesses (28) on the rod (26) can coincide with threaded hole (3) on the housing (1). The horizontal latch (30) can be inserted into the through threaded hole (27) of the rod (26) with the possibility of installing the aforementioned concave washer (31) on the end of the horizontal latch (30) with fixation on the horizontal latch (30) by a screw (34). The protractor (12) is made in the form of a half-cylinder with a protrusion (13) in the center. The flat surface of the protractor (12) is marked (14). A threaded hole (15) is located on the protrusion (13) of the protractor (12). The protrusion (13) of the half-cylinder of the protractor (12) is made with the possibility of installation from the bottom of the body (1) in the middle of the horizontal part into a spherical recess (8), so that the hole (15) of the protrusion (13) coincides with the through hole (9) of the body (1) . The protractor (12) is connected to the body (1) by means of a screw (33), which passes from above through the recess (7), the through hole (9) of the body (1) and the threaded hole (15) on the protrusion (13) of the protractor (12 ). The vertical fixator (21) consists of a base (22) with a threaded section (23) at the end of the base (22), a washer (24), a needle (25) for location in the middle of the place of attachment of the posterior cruciate ligament of the knee joint. The guide (16) is L-shaped at an angle of 90°, in the vertical part of the guide (16) there are two through oval holes (17) for passing the reference pin of the installation of the tibial component. At the end of the horizontal part of the guide (16), recesses (19) are made at the top and bottom, on which there is a through threaded hole (20) for the threaded section (23) of the vertical latch (21). On top of the horizontal part of the guide (16) there is a slot (18) extending from the notch (19) to the bend of the guide (16), which is a position indicator. In this case, the washer (32) in the form of an ellipse can be located in the recess (5) on the horizontal part of the body (1) on the through hole (6) of the body (1). In this case, the vertical latch (21) can be screwed into the through threaded hole (6) of the body (1) by the base (22) using the threaded section (23). The advantages of the proposed device lie in the fact that the device determines the high accuracy of the rotational position of the tibial component due to the accuracy of determining anatomical landmarks - the point of attachment of the posterior cruciate ligament, the Akagi line and the middle of the tibial tuberosity with the installation of the device directly into the surgical wound relative to these landmarks, with by determining the zero position along the protractor relative to the Akagi line. The device accurately determines the rotation of the tibial component of the knee endoprosthesis along the protractor by shifting the guide to the left or right, depending on the side of the knee joint. It is not necessary to conduct a comparative study on the contralateral limb to determine rotation. Measurement accuracy is increased due to the stable fixation of the device in the wound relative to specific anatomical landmarks. Establishing the pin as a static, rigidly fixed landmark allows one to orient the rotation of the tibial component during various manipulations.

Description

The utility model relates to medicine, namely to traumatology and orthopedics, and can be used to determine the rotational position of the tibial component during knee arthroplasty.

A device for determining the rotational position of the tibial component of the knee endoprosthesis is known (RF patent No. 2708495 dated 09/02/2019), including a laser emitter located on a tripod, two blocks, and Kirschner spokes. A laser level can be used as a laser emitter, the blocks at the lower end contain a hole for installation on Kirschner spokes. The width of the block groove must match the width of the laser beam.

The disadvantages of this device are that the device has a complex design and is cumbersome to use due to the fact that an artificial light generator (infrared laser emitter) is necessarily used, the requirements of SANPIN are necessarily observed (minimizing the risk of falling (reflecting) the beam into the eyes of personnel and the patient) , the operating field and the operating team adjust to the radiation source, which requires additional movement of operating equipment and medical personnel with the patient (the patient adjusts to the radiation source, since it is static). Increases trauma during surgery and increases the risk of infection in the area of surgical intervention, as the operating field expands due to the fact that the blocks are installed with additional wires percutaneously outside the main operating field to control the passage of the beam, which, in turn, leads to an increase time of the intraoperative period in the patient. The device does not allow determining the correct rotational position of the tibial component of the endoprosthesis and further correcting the rotation, since when installing the blocks relative to the passage of the laser beam, measurements are taken between the blocks and the anatomical landmarks of the segment, and during the implantation of the endoprosthesis components, the position of the endoprosthesis components is determined relative to the beam of the light source, based on the reconstruction of the data obtained during the measurement of the articular surfaces of the knee joint performed before resection.

A device is known for determining the rotational position of the tibial component of the knee joint endoprosthesis (RF patent No. 2215467 dated 03.12.2001), adopted as a prototype, containing a body equipped with a scale, a position indicator made in the form of an arrow with a plumb line, hinged to the body, and position locks , the body is made in the form of a plate with a vertical groove for moving relative to the axis and with a horizontal groove for moving the pins, while the position locks are made in the form of curved branches, the ends of which are located towards each other, and the branches are located on opposite sides of the plate and are interconnected by an axis , at an equal distance from which the pins are fixed.

The disadvantages of this device are that there is a high measurement error, since the landmarks are determined subjectively and by palpation, which, in the presence of pronounced subcutaneous tissue in the measurement area, leads to an incorrect result, which in turn affects the results of the examination and further treatment of the patient. Also, the measurement is made in comparison on both limbs, with a comparison of data, and the determination of the rotation of one or another segment by the difference in the data obtained, which increases the risk of an incorrect result. The scope of the device is narrowed, since with bilateral lesions of the same segments on the limbs, it is impossible to measure.

The technical result of the proposed utility model is the creation of a device free from the above disadvantages.

The specified technical result is achieved by the fact that the device for determining the rotational position of the tibial component of the knee endoprosthesis, containing a body, a position indicator, a handle (10), a protractor (12), a guide (16), a vertical lock (21), a rod (26), a stem retainer (29) in the form of a wing screw, a horizontal retainer (30) in the form of a wing screw, a washer (31) of a concave shape corresponding to the sphere of the anterior wall of the upper third of the tibia, and a washer (32) in the form of an ellipse with a decentered position of the through hole , the handle (10) is teardrop-shaped at the end with a threaded section (11), the body (1) is L-shaped, at an angle of 90°, the vertical part of the body (1) at the end contains a cylindrical cavity (2) and a through threaded hole (3) for the stem lock (26), on the bend of the body (1) there is a threaded hole (4) for screwing in the threaded section (11) of the handle (10), the horizontal part of the body (1) is narrowed towards the in the middle, at the end of the horizontal part there is a recess (5), in which a through hole (6) is located, the end of the horizontal part of the body (1) has an inclination of 71° relative to the horizontal plane, in the middle of the horizontal part of the body (1) there is a recess (7) on top , a spherical recess (8) is located below, interconnected by a hole (9), the stem (26) is made of a teardrop shape, a through threaded hole (27) is located in the lower part of the stem (26), in the upper part there are five recesses (28) along one line, while the rod (26) can be located in the said cylindrical cavity (2) of the body (1) so that the recesses (28) on the rod (26) can coincide with the threaded hole (3) on the body (1) , the horizontal latch (30) can be inserted into the through threaded hole (27) of the rod (26) with the possibility of installation on the end of the horizontal latch (30) of the mentioned washer (31) of a concave shape with fixation on the horizontal latch (30) with a screw (34), the protractor (12) is made in the form of a semi-cylinder with a protrusion (13) in the center, markings (14) are applied on the flat surface of the protractor (12), a threaded hole is located on the protrusion (13) of the protractor (12) (15), the protrusion (13) of the half-cylinder of the protractor (12) is made with the possibility of installation from the bottom of the body (1) in the middle of the horizontal part into the spherical recess (8), so that the hole (15) of the protrusion (13) coincides with the through hole (9) body (1), the protractor (12) is connected to the body (1) by means of a screw (33), which passes from above through the recess (7), the through hole (9) of the body (1) and the threaded hole (15) on the ledge ( 13) a protractor (12), a vertical latch (21) consists of a base (22) with a threaded section (23) at the end of the base (22), a washer (24), a needle (25) for location in the middle of the place of attachment of the posterior cruciate ligament of the knee joint, the guide (16) is L-shaped at an angle of 90°, in the vertical part, for example The guide (16) has two through oval holes (17) for passing the pin-orientation of the installation of the tibial component, at the end of the horizontal part of the guide (16), recesses (19) are made at the top and bottom, on which there is a through threaded hole (20) for the threaded section (23) of the vertical lock (21), on top of the horizontal part of the guide (16) there is a slot (18) passing from the notch (19) to the bend of the guide (16), which is a position indicator, while the washer (32) in the form of an ellipse has the ability to location in the recess (5) on the horizontal part of the body (1) on the through hole (6) of the body (1), while the vertical latch (21) has the ability to screw the base (22) using the threaded section (23) into the through threaded hole ( 6) body (1).

The claimed utility model is illustrated by the following images, where in Fig. 1 - photograph, body, top view, fig. 2 - photograph, housing, bottom view, fig. 3 - photograph, body, rear view, fig. 4 - photograph, case, front view, fig. 5 - photograph, case, side view, fig. 6 - photograph, handle, general view, fig. 7 - photograph, protractor, top view, fig. 8 - photograph, protractor, bottom view, fig. 9 - photograph, guide, top view, fig. 10 - photograph, guide, bottom view, fig. 11 - photograph, guide, rear view, fig. 12 - photograph, guide, front view, fig. 13 - photograph, vertical latch, general view, fig. 14 - photograph, stem, top view, fig. 15 - photograph, stock, bottom view, fig. 16 - photograph, retainer, general view, fig. 17 - photograph, horizontal latch, general view, fig. 18 - photograph, washer, top view, fig. 19 - photograph, washer, bottom view, fig. 20 - photograph, puck, general view, fig. 21 - photograph, screw, general view, fig. 22 - photograph, screw, general view, fig. 23 - photograph, body and handle assembly, side view, fig. 24 - photograph, assembly of the body, handle and protractor, top view, fig. 25 - photograph, assembly of the guide and the vertical retainer, side view, fig. 26 - photograph, assembly of the body, handle, protractor, guide and vertical lock, top view, fig. 27 - photograph, assembly of the body, handle, protractor, guide and vertical lock, side view, fig. 28 - photograph, assembly of the body, handle, protractor, guide and vertical lock, stem, side view, fig. 29 - photograph, assembly of the body, handle, protractor, guide and vertical latch, stem, horizontal latch, side view, fig. 30 - photograph, assembly of the device, general view, fig. 31 - photograph, installation of the device in the wound, fig. 32, fig. 33 - photograph, determination of the rotational position, fig. 34 - photograph, pin installation, fig. 35 - photograph, removal of the device from the wound, fig. 36 is a photograph of the pin set after removing the device, fig. 37 - photograph, installation of the test tibial component, fig. 38 - photograph, removal of the test tibial component, pin, formation of the bed, fig. 39 - photograph, installation of a permanent tibial component.

The device for determining the rotational position of the tibial component of the knee joint endoprosthesis is made of durable materials, such as metal, is prefabricated and contains a body (1) made of a cylindrical rod, L-shaped at an angle of 90°, the vertical part of the body (1) at the end contains a cylindrical cavity (2) and a threaded hole (3), on the bend of the body (1) there is a threaded hole (4), the horizontal part of the body (1) is narrowed towards the middle, at the end of the horizontal part there is a recess (5), in which a through hole (6), the end of the horizontal part of the body (1) has an inclination of 71° relative to the horizontal plane, in the middle of the horizontal part of the body (1) there is a recess (7) on top, a spherical recess (8) is located on the bottom, interconnected by a hole (9) (Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5), a handle (10) made in the form of a teardrop shape, at the end containing a threaded section (11) (Fig. 6), a nporter (12), made of a cylindrical rod, made in the form of a half-cylinder with a protrusion (13) in the center, markings (14) are applied on the flat surface of the protractor (12), a threaded hole (15) is located on the protrusion (13) of the protractor (12) (Fig. 7, fig. 8), a guide (16) made of a cylindrical rod, made L-shaped at an angle of 90°, two through oval holes (17) are made in the vertical part of the guide (16), a slot is made on the top of the horizontal part of the guide (16) ( 18), at the end of the horizontal part of the guide (16), recesses (19) are made at the top and bottom, on which a through threaded hole (20) is located, the slot (18) extends from the recess (19) to the bend of the guide (16) (Fig. 9 , Fig. 10, Fig. 11, Fig. 12), a vertical retainer (21), consisting of a base (22) with a threaded section (23) at the end of the base (22), a washer (24), a needle (25) (Fig. 13), a rod (26) made of a cylindrical teardrop-shaped rod, in the lower part of the rod (26) there is a through threaded hole (27), in the upper part there are five recesses (28) along one line (Fig. 14, Fig. 15), latch (29) made in the form of a wing screw (Fig. 16), horizontal latch (30) made in the form of a wing screw nta (Fig. 17), a washer (31) of a concave shape (Fig. 18, Fig. 19), a washer (32) made in the form of an ellipse with a decentered position of the through hole (Fig. 20), a screw (33) (Fig. 21), screw (34) (Fig. 22). The horizontal part of the body (1) is narrowed towards the middle in order to increase the view so that all the numbers on the protractor (12) can be seen. In the center of the protrusion (13) of the protractor (12) there is a risk corresponding to the zero position. The end of the horizontal part of the body (1) has an inclination of 71° relative to the horizontal plane, thereby providing an overview of the position of the anterior part of the test tibial component. The numbers (15-15)° on the markup (14) show the amount of internal rotation of the tibial component inwards on the left or right, depending on the side of the operated knee joint. The width of the through oval holes corresponds to the pin that is passed through these holes (17) during the operation. The height of the through oval holes (17) corresponds to the height of patients and bone density of patients with various diseases and disorders of bone density, so that it is possible to install the pin into dense bone without displacement. When the patient grows up to 170 cm, the upper through oval hole (17) is used. Above 170 cm - the lower through oval hole (17). The slot (18) is taken as the position indicator. Its setting to the zero position along the protractor (12) and parallel to the Akagi line corresponds to the zero position and the absence of rotation. Five recesses (28) on the stem allow you to vary the depth of the stem (26). The depth of entry of the stem (26) depends on the size of the resection of the tibial articular surface. With a minimum resection of up to 5 mm, the first recess is used, with a maximum resection of up to 25 mm, the fifth recess is used. The washer (31) is concave, the shape corresponds to the sphere of the anterior wall of the upper third of the tibia. The washer (32), made in the form of an ellipse, with a decentered position of the through hole, makes it possible to exclude involuntary twisting of the vertical lock (21) during manipulations with the guide (16). Screw (33) to fix the protractor (12) to the body (1). Screw (34) to fix the washer (31) on the horizontal clamp (30).

The device is used as follows.

Stage 1 - Assembling the device.

The handle (10) is screwed into the body (1) into the threaded hole (4) using the threaded section (11) (Fig. 23). The protractor (12) is installed with a protrusion (13) from the bottom of the body (1) in the middle of the horizontal part into a spherical recess (8) so that the hole (15) of the protrusion (13) coincides with the through hole (9) of the body (1). From above, through the recess (7), the through hole (9) of the body (1) and the threaded hole (15) on the protrusion (13) of the protractor (12), a screw (33) is inserted, and the protractor (12) is fixed to the body (1) (Fig. .24). In the through threaded hole (20) located on the recess (19) of the guide (16), the vertical lock (21) is screwed with the base (22) using the threaded section (23) (Fig. 25). Next, a washer (32) is placed in the recess (5) on the through hole (6) of the body (1), and the vertical lock (21) is screwed with the base (22) using the threaded section (23) into the through threaded hole (6) of the body (1 ) (Fig. 26, Fig. 27). A rod (26) is inserted into the cylindrical cavity (2) in the vertical part of the body (1) so that the recesses (28) on the rod (26) coincide with the threaded hole (3) on the body (1). A latch (29) is inserted through the threaded hole (3) on the vertical part of the body (1), and the rod (26) is fixed to the body (1) (Fig. 28). The horizontal retainer (30) is inserted into the threaded through hole (27) of the stem (26). A washer (31) is installed on the end of the horizontal latch (30) and fixed with a screw (34) (Fig. 29, Fig. 30).

Stage 2 - Device operation.

The surgical field is treated, a tourniquet is applied. An arcuate access is made along the anterior surface of the knee joint. Cut through the skin, subcutaneous tissue, the entrance to the joint is carried out by medial capsulotomy approximately 1 cm from the medial border of the patella. The m.quadriceps tendon is dissected in length to ensure patellar dislocation and sufficient flexion at the knee joint, a moderate amount of clear synovial fluid and synovial hypertrophy are noted. The synovial membrane is subtotally excised. The remains of the anterior cruciate ligament are removed, the posterior cruciate ligament is excised to the point of attachment, and the menisci are resected. The femoral canal is determined and opened, an intramedullary guide is installed. The distal sawdust template of the thigh with valgus deviation is fixed. Perform distal resection of the femoral condyles. The meter determines the size of the femoral component. According to the figured sawdust block with rotation according to the intercondylar line, a figured sawdust of the femoral condyles is produced. Remove paraarticular ossificates from the back of the thigh. The tibial plateau is brought forward. A tibial resection template is set along the extramedullary guide perpendicular to the mechanical axis. It produces sawdust of the articular surface of the tibia. The femoral and tibial test components are implanted with a test insert. They perform control of the axis of the limb, conduct tests for the stability and balance of the ligamentous apparatus, control the range of motion and slip of the patella. Next, the test insert, femoral and tibial test components are removed. Then, the rotational position of the test tibial component of the knee joint endoprosthesis is determined. The device for determining the rotational position of the tibial component of the knee endoprosthesis is installed with the needle (25) of the vertical fixator (21) in the middle of the place of attachment of the posterior cruciate ligament of the knee joint. The height of the stem (26) is fixed through the threaded hole (3) in the body (1) with a latch (29) into one of the recesses (28) depending on the size of the patient's bone, so that the washer (31) is projected onto the middle of the tibial tuberosity. Then the horizontal fixator (30) is screwed through the through threaded hole (27) of the rod (26) to the tibia in such a way that the washer (31) falls on the middle of the tibial tuberosity, thereby fixing the device in a position that corresponds to the reference point, the line " Akagi" (Fig. 31). Then the slot (18) on the guide (16) is set to the initial zero position along the protractor (12), located in the center of the protrusion (13), and in a parallel position to the horizontal lock (30) and the Akagi line. Further, depending on the operated side - the right or left knee joint - the guide (16) is moved inwards and the slot (18) is aligned with the marking from 0° to 15° on the right knee joint, and accordingly on the left knee joint from 15° to 0° on the protractor (12), determining the rotational position of the tibial component of the endoprosthesis (Fig. 32, Fig. 33). Then, in one of the through oval holes (17) of the guide (16), depending on the height of the patient and the structure of his bone, a pin is installed parallel to the slot (18), which serves as a guide for installing the test tibial component of the endoprosthesis, and later on the permanent tibial component of the endoprosthesis (Fig. 34). Next, the horizontal lock (30) is unscrewed, and the washer (31) is displaced from the middle of the tibial tuberosity. The needle (25) of the vertical fixator (21) is removed from the middle of the place of attachment of the posterior cruciate ligament of the knee joint (Fig. 35). Next, the device is removed by tilting it down and forward, displacing the device relative to the pin in the slot down, so that the installed pin passes through the hole (17) of the guide (16) and remains in the tibia (Fig. 36). Then, the test tibial component is reinstalled so that the marks on the test tibial component coincide with the installed pin, which corresponds to the correct rotational position of the test tibial component of the endoprosthesis. Next, the test tibial component is fixed with two fixing devices, for example, pins with a hat (Fig. 37). Then the pin is removed, and a bed of the tibial component of the endoprosthesis of the appropriate shape is formed using a punch. The test tibial component is then removed (FIG. 38). Implantation of a permanent endoprosthesis of the knee joint is performed. At the first stage, the tibial component of the permanent endoprosthesis is installed on the bone cement, focusing on the previously formed bed of the tibial component (Fig. 39). Then, in the second stage, the femoral component is placed on the bone cement. Then install a polyethylene liner. After the cement hardens, the range of motion in the knee joint is controlled. They take off the tourniquet. Control bleeding. The wound is sutured in layers. Apply an aseptic bandage.

The advantages of the proposed device are that the device determines the high accuracy of the rotational position of the tibial component due to the accuracy of determining anatomical landmarks - the point of attachment of the posterior cruciate ligament, the Akagi line and the middle of the tibial tuberosity, with the installation of the device directly into the surgical wound, relative to these landmarks , with the definition of the zero position on the protractor relative to the line "Akagi". The device accurately determines the rotation of the tibial component of the knee endoprosthesis along the protractor by shifting the guide to the left or right, depending on the side of the knee joint. It is not necessary to conduct a comparative study on the contralateral limb to determine rotation. Measurement accuracy is increased due to the stable fixation of the device in the wound relative to specific anatomical landmarks. Establishing the pin as a static, rigidly fixed landmark allows one to orient the rotation of the tibial component during various manipulations of the limb during the operation. Wide range of application, as the device can be used for bilateral lesions of the same segments on the limbs. The device does not require additional actions from the medical staff, it is mobile in use and is fixed directly in the surgical wound. It is used for small surgical accesses and with a different position of the patient during surgery on the operating table, which leads to low trauma.

The device for determining the rotational position of the tibial component of the knee endoprosthesis is made of high-quality, high-quality, modern materials using modern equipment, using modern technologies.

Claims (1)

A device for determining the rotational position of the tibial component of the knee joint endoprosthesis, containing a body, a position indicator, characterized in that it has a handle (10), a protractor (12), a guide (16), a vertical lock (21), a rod (26), a lock a rod (29) in the form of a wing screw, a horizontal retainer (30) in the form of a wing screw, a washer (31) of a concave shape corresponding to the sphere of the anterior wall of the upper third of the tibia, and a washer (32) in the form of an ellipse with a decentered position of the through hole, the handle (10) is tear-shaped at the end with a threaded section (11), the body (1) is L-shaped at an angle of 90°, the vertical part of the body (1) at the end contains a cylindrical cavity (2) and a through threaded hole (3 ) for the stem lock (26), on the bend of the body (1) there is a threaded hole (4) for screwing in the threaded section (11) of the handle (10), the horizontal part of the body (1) is narrowed towards the middle, at the end of the horizontal in the antal part there is a recess (5), in which a through hole (6) is located, the end of the horizontal part of the body (1) has an inclination of 71° relative to the horizontal plane, in the middle of the horizontal part of the body (1) there is a recess (7) on top, a spherical notch (8), interconnected by a hole (9), the stem (26) is made of a teardrop shape, in the lower part of the stem (26) there is a through threaded hole (27), in the upper part there are five recesses (28) in one line, with In this case, the rod (26) can be located in the said cylindrical cavity (2) of the body (1) so that the recesses (28) on the rod (26) can coincide with the threaded hole (3) on the body (1), the horizontal lock ( 30) has the possibility of introducing a rod (26) into the through threaded hole (27) with the possibility of installing the aforementioned washer (31) of a concave shape on the end of the horizontal latch (30) with fixation on the horizontal latch (30) with a screw ( 34), the protractor (12) is made in the form of a half-cylinder with a protrusion (13) in the center, markings (14) are applied on the flat surface of the protractor (12), a threaded hole (15) is located on the protrusion (13) of the protractor (12), a protrusion ( 13) of the half-cylinder of the protractor (12) is configured to be installed from the bottom of the body (1) in the middle of the horizontal part into a spherical recess (8) so that the hole (15) of the protrusion (13) coincides with the through hole (9) of the body (1), the connection of the protractor (12) with the body (1) is made with the help of a screw (33), which passes from above through the recess (7), the through hole (9) of the body (1) and the threaded hole (15) on the protrusion (13) of the protractor (12) , the vertical fixator (21) consists of a base (22) with a threaded section (23) at the end of the base (22), a washer (24), a needle (25) for location in the middle of the place of attachment of the posterior cruciate ligament of the knee joint, a guide (16) made L-shaped at an angle of 90°, in the vertical part of the guide (16) two through oval holes (17) for passing the pin-orientation of the installation of the tibial component, at the end of the horizontal part of the guide (16) recesses (19) are made at the top and bottom, on which there is a through threaded hole (20) for the threaded section (23) of the vertical fixator (21), on top of the horizontal part of the guide (16) there is a slot (18) passing from the recess (19) to the bend of the guide (16), which is a position indicator, while the washer (32) in the form of an ellipse can be located in the recess (5 ) on the horizontal part of the body (1) on the through hole (6) of the body (1), while the vertical latch (21) can be screwed into the through threaded hole (6) of the body (1) using the threaded section (23) ).

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