Surgical Concepts
A tibia-cut-first approach similar to the successful Total Condylar procedure was chosen to provide a logical, time-tested method of establishing a stable, reproducible flexion gap which can then be easily balanced by an equal and stable extension-gap. This provides total knee stability throughout the range of active and passive motion. Such stability maintains contact pressure on mobile bearings and prevents subluxations or dislocations. This surgical technique can be used for either cemented or cementless application of the implants, since the resection surfaces are designed for press-fit stability of all components.

Primary femoral bone cuts preserve a maximum of bone stock using the anterior femoral shaft, epicondyles and center of the femoral canal for surgical reference points. Slight external rotation of the femoral component allows for a perpendicular resection of the proximal tibia in the medial-lateral plane, while providing equal medial and lateral compartment tension in flexion, as well as providing a more stable tracking position for the patella.

Posterior inclination of the proximal tibial cut, parallel to the anatomical inclination angle during this procedure, provides compressive loading of tibial components and avoids the shearing effects associated with perpendicular lateral plane resections.

Resection of the patellar articulating surface at the level of the quadriceps and patella tendons, respectively, allows sufficient bone stock and blood supply to implant a three peg fixturing element, which stabilizes the rotating-bearing patella replacement.

The use of mobile bearing elements in the Buechel-Pappas Tricompartmental System, combined with the precise use of instruments for insertion provides the surgeon with superior alignment and placement of all components with bearing elements designed for maximum wear resistance without mechanical restrictions to movement. These implants have been in clinical use in their present articulating geometry for more than 25 years.