SP 06/01/2021

08:13 AM EDT

MOBIO® Total Knee System

Surgical Technique
for CR and CR Plus Implants

This Document is Intended for Health Care Professionals Only

TABLE OF CONTENTS

» System Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

» Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

» Compatibility Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

» Surgical Snap Shots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

» Distal Femur Resection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

» Proximal Tibial Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

» Extension Gap Assesment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

» Femoral Preparation - PR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

» Femoral Preparation - AR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

» Tibial Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

» Patella Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

» Trial Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

» Implant Components. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

» Prosthesis Removal/Extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

» Implant Ordering Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

» Instrument Ordering Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Cruciate retaining (CR) knee designs allow preservation of the PCL and avoid sacrificing bone

for an intercondylar box. However, these knee designs allow for some anterior translation of the

femur on the tibia especially in early flexion, where Condylar Stabilizing (CR+ plus) inserts provide

anterior posterior stability without the need for a posterior cam.

Condylar Stabilizing (CR+ Plus) inserts have an elevated anterior and deep dish trough creating

more congruency between the femur and polyethylene insert. This improved congruency serves to

prevent anterior subluxation of the femoral condyles during flexion.

SYSTEM OVERVIEW

The b-ONE® Total Knee System is a comprehensive total knee prosthesis system designed by top
R&D, surgeons, and clinicians.

This surgical technique describes use of the cruciate retaining (CR) and condylar stabilizing (CR
Plus) articulations for total knee replacements.

Streamlined, intuitive, sensible instrumentation options designed for surgical preference are
available in the following configurations. Please confirm with your local representative the desired
configuration to have available for surgery.

» Femoral resection options:

- posterior referencing

- anterior referencing

» Intramedullary or extramedullary tibial resection

Femoral components are available in sizes 1-10, with narrow size options also available for sizes 3-7.
They are designed to accomodate CR and CR Plus inserts.

Tibial baseplate components are available in 9 sizes described as A, B, C, D, E, F, G, H , J.

Symmetric patella components are available in standard. Sizes include diameters (mm): 26*, 27,
29, 32, 35, 38, and 41 with incremental thickness increases. *Size 26 is only compatible with femoral
sizes 1 and 2.

Polyethylene inserts are available in standard polyethylene. Sizes include Size A, Size B/C, Size D/E,
Size F/G, Size H/J with thickness (mm) ranging from 9, 10, 11, 12, 13, 14, 16, 19, 22, 25

*The following content presents the surgical technique of the MOBIO® CR and CR Plus Knee
devices. This surgical technique serves as a guideline when using these instruments but the choice
of appropriate steps to follow are ultimately the responsibility of the surgeon performing the
operation.
MOBIO® CR/CR+ Surgical Technique | 4
INDICATIONS AND CONTRADICATIONS

INDICATIONS: CONTRAINDICATIONS:

The MOBIO® Total Knee System is intended for Any active or suspected latent infection of the
total knee arthroplasty due to the following knee joint, or distant foci of infection, or any
conditions: systemic infection.

- Painful, disabling joint disease of the knee Allergy or foreign body sensitivity to any of the
resulting from: noninflammatory degenerative implants materials.
joint disease (including osteoarthritis,
traumatic arthritis, or avascular necrosis), Skeletal immaturity.
rheumatoid arthritis or post traumatic
arthritis. Any conditions which may prevent adequate
fixation or support and thus preclude the use
- Posttraumatic loss of knee joint configuration of these or any other orthopedic implants,
and function. such as severe osteoporosis or osteopenia,
osteomalacia or any metabolic disorders
- Moderate varus, valgus, or flexion deformity which may impair bone formation, vascular
in which the ligamentous structures can be insufficiency, muscular atrophy, neuromuscular
returned to adequate function and stability. disease, and/or incomplete or deficient soft
tissue surrounding the knee.
- Revision of previous unsuccessful knee
replacement or other procedure. Conditions that may place excessive stresses on
bone and implants, such as obesity.
- Fracture of the distal femur and/or proximal
tibia that cannot be stabilized by standard Severe instability of the knee joint secondary to
fracture management techniques. the absence of collateral ligament integrity and
function.
- Additional indications for Posterior Stabilized
(PS) and Posterior Stabilized Plus (PS+) Use in patients whose activity, mental capacity,
components: mental illness, alcoholism, drug abuse,
occupation, or lifestyle may interfere with their
- Ligamentous instability requiring implant ability to follow postoperative restrictions and
bearing surface geometries with increased instructions.
constraint.
Any condition not described in the Indications
- Absent or nonfunctioning posterior cruciate for Use.
ligament.

- Severe anteroposterior instability of the knee

joint.

The MOBIO® Total Knee System is intended for

implantation with bone cement only.

MOBIO® Total Knee System components are not

intended for use with other knee systems.

5 | MOBIO® CR/CR+ Surgical Technique

COMPATIBILITY CHARTS

CR Interchangeability Chart CR+ Interchangeability Chart

A B C D E F G H J A B C D E F G H J

1 1

A/1-3+ Insert
2 2
A/1-4 Insert

3N 3N
3 3

BC/3-5+ Insert
BC/1-6 Insert

4N 4N
4 4

DE/4-6+ Insert
DE/3-7 Insert

5N 5N
5 5
FG/4-9 Insert

6N 6N

FG/6-8+ Insert
6 6
7N 7N
HJ/7-10 Insert

7 7
8 8

HJ/7-10+
Insert
9 9
10 10

Femoral and Patellar Compatibility Chart (mm)

1 2 3N 3 4N 4 5N 5 6N 6 7N 7 8 9 10

26 X X
27 X X X X X X X X X X X X X X X
29 X X X X X X X X X X X X X X X
32 X X X X X X X X X X X X X X X
35 X X X X X X X X X X X X X X X
38 X X X X X X X X X X X X X X X
41 X X X X X X X X X X X X X X X

Femoral Component Dimensions (mm)

1 2 3N 3 4N 4 5N 5 6N 6 7N 7 8 9 10

ML 55 57 57 59 59 62 62 65 65 68 68 71 74 77 80
AP 48 50 53 53 56 56 59 59 62 62 65 65 68 71 74

Tibial Component Dimensions (mm)

A B C D E F G H J

ML 58 61 64 67 70 74 77 80 85
AP 38 40 42 44 46 49 52 55 59

MOBIO® CR/CR+ Surgical Technique | 6

PIN/SCREW INFORMATION

The chart below contains relevant information on the pins and screws that are compatible with this
system.

Pin/Screw Description Catalog Number Compatible Driver/ Description

Extractor

Threaded Headless Pin 8829005001/8829005000 Pin Driver

Pin Puller/Pin
Fluted Pin 8829012002/8829012000 Driver

Tension Screws 8829004000 Pin Driver

Headed Pin, 25 mm 8829006025/8829006250

Pin Puller
Headed Pin, 35 mm 8829006035/8829006350

Headed Screw, 32mm 8829016320

Pin Driver
Headed Screw, 22mm 8829016220

Pin Driver Pin Puller

8829011000 8829003000

* All pins are 3.2mm diameter. Screws are provided non-sterile and pins are provided non-sterile or sterile within the
instrumentation set.

7 | MOBIO® CR/CR+ Surgical Technique

SURGICAL SNAP SHOTS

1 - Drill Femoral IM Canal 2 - Resect Distal Femur 3- Tibial resection, IM or EM 4- Assess Extension Gap
Option and Tissue Balancing
(Optional)

5 - Femoral Sizing & 6 - Femoral 4-in-1 Resection 7 - Tibial Sizing Plate 8 - Tibial Baseplate
Rotation Preparation

9 - Tibial insert trial 10 - Femoral Trial Placement 11-Patella Resection 12 - Patella Sizing and Peg
Drill

13 - Patella trial and Trial 14 - Drill Femoral Peg holes 15 - Final Implantation and
Reduction Closure

MOBIO® CR/CR+ Surgical Technique | 8

RESECT DISTAL FEMUR

Femoral Canal Exposure

Using the IM Drill, drill a hole into the To make the hole larger for depressurization
intramedullary femoral canal. The canal is of the canal, toggle the bit at the entrance.
approximately 10mm anterior to the origin of The tapered feature of the IM Drill assists with
the PCL and slightly medial to the mid-line of this. Irrigate and suction the canal to further
the trochlea. The inferior aspect of the hole decrease the risk of fat embolism
should be approximately 1-2mm anterior to the
intercondylar notch.

9 | MOBIO® CR/CR+ Surgical Technique

Femoral Alignment

Attach the T-Handle to the IM Rod Insert the IM Remove the Distal Femoral Alignment assembly
Rod into the Distal Femoral Alignment Guide by first removing the IM Rod Press the button
Set the valgus angle on the appropriate Left or to disengage the Guide Tower from the DRB
Right scale on the Alignment Guide by pulling and remove the Distal Femoral Alignment Guide
back on the spring-loaded trigger and aligning with the Guide Tower
the appropriate notch with the stop along the
guide axis The angle options range from 0° to Additional resection can be set in 2mm
9° valgus Typical angles range from 4° to 6° increments by sliding the Distal Resection Block
Insert the IM Rod into the femoral IM canal until off the smooth pins and re-aligning the pins
the alignment guide plate contacts the distal with the holes marked “+2” or “+4”, increasing
femur resection by 2mm or 4mm respectively

For additional fixation, place pins along the

medial or lateral sides of the Femoral Distal
Alignment Guide to secure it in place

Assemble the selected Distal Resection Guide

Tower to the Distal Resection Block (DRB)
Insert the posts of the Guide Tower into the two
anterior holes of the Distal Femoral Alignment
Guide to position the DRB on the anterior
femur Confirm the Distal Femoral Alignment
Guide is flush with the most prominent distal
femoral condyle to ensure accurate placement
of the DRB and accurate resection, then fix the
DRB position to the bone with two headless
pins through the “0” holes The Adjustable
Distal Femoral Guide Tower allows resection
adjustment from 8mm-11mm in 1mm increments.

Distal Resection

Once the Distal Resection Block depth is

satisfactory, for additional fixation, place
headless pins through the divergent holes.

Using a .050” (1.27mm) blade, resect the

distal femur.

Remove all pins and the distal block.

MOBIO® CR/CR+ Surgical Technique | 10

RESECT PROXIMAL TIBIA - EXTRAMEDULLARY
TECHNIQUE
To assemble the EM Tibial Alignment Guide, choose either the Tibial Ankle Clamp or Ankle
Rest, depending on surgeon preference. Slide the chosen option into the distal end of the Base
Assembly.

The EM Tibial Alignment Guide Assembly can be assembled with or without a Spiked Uprod,
depending on surgeon preference.

EM Tibial Alignment Guide without

spiked Uprod
Attach the desired Tibial Resection Block (Left
or Right, 0°, 3° or 5° posterior slope) to the EM
Tibial Non-spiked Uprod, and slide the EM Tibial
Non-spiked Uprod into the proximal end of the
EM Tibial Base Tube.

Ankle Rest

EM Tibial Alignment Guide with Spiked

Uprod
Attach the desired Tibial Resection Block (Left
or Right, 0°, 3° or 5° posterior slope) to the
Tibial Cut Block Adapter.

Slide the Tibial Cut Block Adapter/Resection

Block Assembly onto the tube of the Spiked
Uprod as shown in the image above; note the
flat end of the Spiked Uprod tube will align
with the flattened aspect of the Tibial Cut Block
Adapter hole.

Then slide the distal end of the Spiked Uprod

tube into the proximal end of the Base
Assembly tube.

11 | MOBIO® CR/CR+ Surgical Technique

EM Tibial Alignment Guide Alignment

If using the Ankle Clamp option, place the ankle

clamp arms around the ankle. Adjust the length
of the EM Tibial Alignment Guide to position the
Resection Block near the proximal tibia.

If using the Spiked Uprod, impact the long

spike into the proximal tibia for adjustable
Adjusting Anterior/
stability. Posterior Position

The M/L position of the Guide can be adjusted

by loosening the knob at the ankle, on the front
of the assembly, and sliding the assembly along
the capture of the ankle clamp.

The slope can be adjusted by loosening the

second knob by the ankle, and sliding the Guide
along the ankle post.

The goal is to align the EM Alignment Guide so

that it aligns over the medial third of the tibial Adjusting Varus/
tubercle and second toe. Valgus Position

If using the Spiked Uprod, impact the second

spike to secure the assembly.

EM Tibial Alignment Guide Resection

Level

Attach the Tibial Depth Resection Stylus on to

the Tibial Resection Block. It is recommended
that the 2mm tip rest on the lowest point of the
damaged compartment or the 9mm tip rest on
the least damaged compartment.

The Tibial Resection block can be pinned

through the center slot to provide M/L stability.
Slope and micro superior/inferior adjustments
of the EM Tibial Alignment Guide can be made.

Use the Angel Wing to verify the desired

resection level and slope. Once the desired
level/slope is determined, tighten the knobs on
Alignment Assembly.

Fix the position of the tibial block with two

headless pins through the “0” holes.

MOBIO® CR/CR+ Surgical Technique | 12

Spiked Uprod Removal

To remove the Spiked Uprod Assembly, loosen

the top knob of the Spiked Uprod and detach
the Cut Block Adapter from the Resection Block
by depressing the button on the Adapter.

Slide the Extraction Hook, attached to the

Slaphammer, into the hole on the Spiked Uprod
as shown in the image to the right.

Be sure to disengage the Cut Block Adapter

from the Cut Block before applying force to the
Slaphammer.

RESECT PROXIMAL TIBIA - INTRAMEDULLARY

TECHNIQUE

Tibial IM Canal Exposure and

Alignment
Using the IM Drill, locate and drill a hole into the
intramedullary tibial canal. Define the correct
rotational tibia axis referring to the condylar
axis, medial 1/3 of the tibia tubercle and the
center of the ankle.

Attach the T-Handle to the IM Rod and insert

into the drilled canal. Remove the T-Handle,
leaving the IM Rod in the canal.

Assemble the desired Tibial Resection Block

(left or right, 0°, 3° or 5° posterior slope) to
the IM Tibial Alignment Guide, and slide the
IM Tibial Alignment Guide Assembly onto the
IM Rod. Attach the Tibial Depth Resection
Stylus on to the Tibial Resection Block. It is
recommended that the 2mm tip rest on the
lowest point of the damaged compartment
or the 9mm tip rest on the least damaged
compartment. Once the desired resection level
is determined, tighten the knobs on Alignment
Assembly. Use the Angel Wing to verify the
desired level and slope of the resection.

Fix the position of the tibial block with two

headless pins through the “0” holes.
13 | MOBIO® CR/CR+ Surgical Technique
Proximal Resection

Remove all the Alignment Assembly instruments to leave the tibial block. For additional stability,
place a headless pin through the angled hole, located below the “0” holes and indicated by an X
mark, to serve as a crosspin.

To check the varus/valgus position of the resection block, place the flat end of the alignment rod
adapter into the resection slot of the Tibial Resection Block. Slide the Alignment Rod through the
hole of the Alignment Rod Adapter. The Alignment Rod should be parallel with the tibial axis.

Resect the tibia using a .050” (1.27mm) oscilating saw blade through the captured slot.

Additional resection can be set in 2mm increments by removing the crosspin and sliding the
Resection Block off the smooth pins and re-aligning the pins with the holes marked “+2” or “+4”,
increasing resection by 2mm or 4mm, resepectively.

Remove all pins and the Tibial Resection Block.

MOBIO® CR/CR+ Surgical Technique | 14

EXTENSION GAP ASSESSMENT

Gap Assesment

To check the extension gap, fully extend the

leg and place the appropriate size Spacer
Block between the resected surfaces. The
Spacer Block represents the total combined
thickness of the baseplate, insert, and femoral
component. The labeled size refers to the
corresponding insert thickness.

If the extension gap is not balanced, reassess

resection amount and angle, or perform
appropriate soft-tissue releases to achieve
balance.

The Alignment Rods with couplers can be

inserted into the Spacer Block to assess
alignment of the leg.

15 | MOBIO® CR/CR+ Surgical Technique

FEMORAL SIZING AND ROTATION - PR

PR Femoral Sizing & Rotation

Mount the PR Rotational Sizer against the

distal resected surface and the sizer feet flush
against the posterior condyles. Adjust to the
desired amount of external rotation, from 0° to
7°, for Left or Right leg setting. The sizer center
slot should be positioned to be in line with
Whiteside’s line for M/L drill hole optimization.

If necessary, secure the sizer feet to the femur

using headless pins. The external rotation can
be locked into place by tightening the 3.5mm
hex located on the face of the right foot of the
sizer, below the optional pin hole.

Position the stylus tip on the highest point of

the anterior cortex of the femur while adjusting
the sizer stylus to indicate the proper femoral
component size. The stylus will then be near the
exit point of the resecting saw blade.

After the PR Sizer is appropriately positioned

on the femur, flush against the distal femoral
resection, the femoral component size is
determined, and correct external rotation is
confirmed, use the 3.2mm Drill through the M/L
holes on the PR Sizer to pre-drill the holes for
the pegs on the PR 4-in-1 Cut Block.

Remove all pins and the PR Sizer.

MOBIO® CR/CR+ Surgical Technique | 16

FEMORAL BONE CUTS - PR

Femoral 4-in-1 Resections

Select the appropriate size PR 4-in-1 Cut block.

The PR 4-in-1 Cut Block allows visualization

of the M/L boundary of the final implant
components: the outer width of the cut block
represents the M/L boundary of the Standard
femoral components. The cut-out edge
represents the M/L boundary of the narrow
femoral components.

Note: the AP dimension increases 3mm per size.

ML width of narrow
implant
ML width of standard
implant

Place the PR 4-in-1 Cut block on the distal

femur, aligning the backside pegs into the drill
holes determined by the PR Sizer. The Tibial
Tray Trial Inserter can be used to insert the PR
4-in-1 Cut block and struck with a mallet to
ensure the block is flush with the bone.

Use the Angel Wing through the resection slots

to visualize the resections.

For additional fixation of the 4-in-1 Cut Block,

use headless pins or Tension Screws through the
M/L holes. Once the block is stabilized, proceed
with bone resection cuts using an oscillating
sawblade of .050” (1.27mm) thickness.

Remove all pins/screws. If needed, the

Slaphammer can be used to extract the 4-in-1
Cut Block by sliding the extraction hook into the
hole under the anterior cut slot of the Cut Block.

17 | MOBIO® CR/CR+ Surgical Technique

FEMORAL SIZING AND ROTATION - AR

AR Femoral Sizing & Rotation

Mount the AR Rotational Sizer against the

distal resected surface and the sizer feet flush
against the posterior condyles. Adjust to the
desired amount of external rotation, from 0° to
7°, for Left or Right leg setting. The sizer center
slot should be positioned to be in line with
Whiteside’s line for M/L drill hole optimization.

If necessary, secure the sizer feet to the femur

using headless pins. . The external rotation can
be locked into place by tightening the 3.5mm
hex located on the face of the right foot of the
sizer, below the optional pin hole.

Position the stylus tip on the highest point of

the anterior cortex of the femur while adjusting
the sizer stylus to indicate the proper femoral
component size. The stylus will then be near the
exit point of the resecting saw blade.

After the AR Sizer is appropriately positioned

on the femur, flush against the distal femoral
resection, the femoral component size is
determined, and correct external rotation is
confirmed, use the 3.2mm Drill through the M/L
holes on the AR Sizer to pre-drill the holes for
the pegs on the AR 4-in-1 Cut Block.

Note that the A/P location of these holes will

change with the size, so be sure to hold the
sizer so that it does not move while drilling.

Alternatively, use smooth pins to pin one hole

to hold the sizer in place, and then proceed to
drilling the second hole. Remove all pins and the
AR Sizer.

MOBIO® CR/CR+ Surgical Technique | 18

FEMORAL BONE CUTS - AR

Femoral 4-in-1 Resections

Select the appropriate size AR 4-in-1 Cut block.

The AR 4-in-1 Cut Block allows visualization

of the M/L boundary of the final implant
components: the outer width of the cut block
represents the M/L boundary of the Standard
femoral components. The cut-out edge
represents the M/L boundary of the narrow
femoral components.

Note: the AP dimension increases 3mm per size.

ML width of narrow
implant
Place the AR 4-in-1 Cut block on the distal ML width of standard
femur, aligning the backside pegs into the drill implant
holes determined by the AR Sizer. The Tibial
Tray Trial Inserter can be used to insert the AR
4-in-1 Cut block and struck with a mallet to
ensure the block is flush with the bone.

Use the Angel Wing through the resection slots

to visualize the resections.

For additional fixation of the 4-in-1 Cut Block,

use headless pins or Tension Screws through the
M/L holes. Once the block is stabilized, proceed
with bone resection cuts using an oscillating
sawblade of .050” (1.27mm) thickness.

Alternativey, the posterior resection can be

made, the block removed, and the flexion gap
assessed. The block can be replaced in the
described fashion and the remaining resections
finished.

Remove all pins/screws. If needed, the

Slaphammer can be used to extract the
4-in-1 Cut Block by sliding one of the legs
into any side of the AR 4-in-1 cut block and
backslapping.

19 | MOBIO® CR/CR+ Surgical Technique

TIBIAL SIZING AND KEEL PREPARATION

Tibial Sizing and Rotation Tibial Post Prep

Attach the Trial Inserter Handle to the Attach the Tibial Drill/Keel Guide to the Tibial
appropriate size Tibial Tray Trial that provides Tray Trial by inserting the underside spikes into
desired tibial coverage without overhang in the the two anterior M/L holes on the Tray.
proper rotation. Refer to the sizing charts for
femorotibial compatibility. The Alignment Rod Ensuring the Guide is fully seated, drill through
with coupler may be inserted through the hole the center of the Guide with the Tibial Post Drill
or slot on the Trial Inserter Handle to confirm on power until the drill bottoms out.
the overall alignment and slope. Secure the
Tibial Tray Trial with Headed Pins in the two
holes near the PCL cutout. There are also two
pin holes on the anterior rim for additional
stability.

Keel Prep
Assemble the Tibial Keel Punch Adaptor on
to the Modular Handle. Then assemble the
appropriate size Tibial Keel Punch onto the
Adaptor based on tibial tray sizing. For example,
use a size 4-7 keel punch on a size 5 tibial trial.
Impact the Keel Punch through the Tibial Drill/
Keel Guide until it bottoms out on the Guide.
The Keel Punch is fully seated when the boss
on the adaptor is flush with the top of the Tibial
Keel Punch Guide. To leave the Keel Punch in
for trialing, turn the Modular handle counter-
clockwise to disengage the Keel Punch. This
will also engage the peg of the punch adaptor
with the Guide to remove the Modular Handle/
Adapter assembly with the Guide together.

MOBIO® CR/CR+ Surgical Technique | 20

TIBIAL INSERT TRIAL ASSESMENT

Select the preferred thickness of the Tibial Insert Trial and slide it posteriorly onto the Tibial Tray
Trial until it falls flush into place.

At this point, trial reduction with the femur, tibia, and insert can be performed, or proceed to the
patella resection should patella resurfacing be desired.

21 | MOBIO® CR/CR+ Surgical Technique

FEMORAL TRIAL ASSESMENT

Assemble the appropriate size Femoral Trial to the Femoral Inserter- Extractor claws, attached
to the Modular Handle. Rotate the handle until adequate grip on the trial is obtained. Impact the
Femoral Trial onto the prepared distal femur. Alternatively, position the trial onto the distal femur
by hand and use the Femoral Finishing Impactor to impact the femoral trial until seated.

Remove the Femoral Inserter-Extractor by loosening the handle and disengaging the claws.
Remove any problematic osteophytes. Assess fit.

Note: The outer edge on all trials mimic the Standard femoral components. Femoral Trial sizes 3-7
have intermittent cutouts along the medial and lateral edges to indicate the edge of the Narrow
femoral components.

MOBIO® CR/CR+ Surgical Technique | 22

PATELLA PREPARATION

Patella Resection

Measure the most prominent anterior-posterior

thickness of the patella using the Caliper.

Set the bone resection amount on the Patella

Resection Guide by turning the knob until
the line on the gauge indicates the desired
resection. Refer to the patella-femoral sizing
chart for patella implant thickness. Note the
resection amount will be from where the stylus
rests. Grip the patella with the Patella Resection
Guide jaws with the stylus touching the most
prominent point on the bone. The ratchet along
the Patella Resection Guide handle should
secure the jaws in place. Tighten the knob tight
against the handle for secure hold.

Patella Resection Guide

Using a .050” (1.27mm) oscillating saw blade,

resect the patella through the slot.

Remove the patella resection guide.

23 | MOBIO® CR/CR+ Surgical Technique

Patella Sizing and Peg Prep

Use the Patella Sizing Guide to select the

largest patella diameter that does not overhang
the bone.

Connect the appropriate size Patella Drill Guide

to the Patella Clamp Handle and clamp the drill
guide flush and centered to the resected patella
bone surface. Use the Patella Peg Drill to drill
all 3 peg holes on the drill guide. The drill will
bottom out on the Drill Guide.

Remove the Patella Clamp Handle Assembly,

and insert the corresponding Patella Trial into
the drilled bone.

MOBIO® CR/CR+ Surgical Technique | 24

TRIAL REDUCTION

Once the adequate tibial insert thickness is

selected, perform a ROM to check component
position and joint stability. Perform a ROM
to check the patellar tracking. For additional
fixation of the femoral component during ROM,
place a pin through the anterior surface hole.

If the flexion/extension gap imbalance exist,

refer back to gap balancing.

If on the patella, tilting or subluxation occurs,

rotation and alignment of the trials should be
checked or if they are positioned correctly, then
lateral retinacular release should be considered.

FEMORAL PEG PREPARATION

Once the trial reduction is complete and the

femoral trial is at the desired M/L position, using
the Femoral Peg Drill, drill through the two peg
holes located distally on the femur until the drill
bottoms out.

Remove all trial components accordingly. Use

the Cement Removal Tool to hook into the
insert trial anterior notch cut slot for extraction.

On the next steps to follow, it’s up to the

surgeon preference for implantation order.

Avoid scratching any of the implants during

handling.

25 | MOBIO® CR/CR+ Surgical Technique

IMPLANTATION

Tibial Component Implantation

Select the appropriate size tibial baseplate. Mix

a batch of cement and coat the underside of
the tibial baseplate, around the keel area, on the
proximal tibial resected surface and in the tibial
IM canal. Assemble the Tibial Tray Finishing
Impactor to the Modular Handle. Position the
tibial implant over the tibial resected bone
surface, and use the impactor to fully seat the
implant flush to the surface. Remove any excess
cement using the Cement Removal Tool.

Femoral Component Implantation

Select the appropriate size femoral component.

Assemble the Femoral Inserter-Extractor to the

Modular Handle and assemble to the femoral
prosthesis in the same manner as to the femoral
trial.

Mix a batch of cement and coat the underside

of the femoral component, and in the drilled
peg holes on the distal femur.

Position the femoral component onto the

distal femur, aligning the pegs to the drilled
holes, if applicable. Impact the femoral
inserter-extractor, removing excess cement
with the Cement Removal Tool or curettes
as appropriate. Once the prosthesis is flush,
remove the Inserter-Extractor.

Assess the seating of the femoral component.

If additional impaction is necessary, Impactor
assembled to the Modular Handle can be used.
Remove any excess cement using the Cement
Removal Tool.

MOBIO® CR/CR+ Surgical Technique | 26

Tibial Insert Implantation

Select the appropriate tibial insert based on

size, constraint, and thickness as determined
by the trial ROM. Place the tibial insert implant
onto the tibial tray and apply pressure on
the anterior edge to engage the insert in the
tibial tray. Assemble the Tibial Insert Finishing
Impactor to the Modular Handle. Align the
impactor over the insert trochlear groove, and
impact to fully seat the implant flush to the
tray. When fully seated, the anterior wire in the
insert would of engaged behind the anterior lip
of the tray.

Patella Component Implantation

Select the appropriate size patella implant. Mix

a batch of cement and coat the underside of
the patella component, including the pegs, and
in the drilled peg holes on the patella bone.
Assemble the Patella Cement Clamp Insert to
the Patella Cement Clamp Handle and with
it, locate the drilled peg holes and secure the
patella implant tightly to the patella bone.
Remove any excess cement using the Cement
Removal Tool. Release the patella clamp once
the cement is hard.

CLOSURE

Reduce the knee and perform ROM where

all aspects are checked. Once everything is
confirmed, the knee can be closed in layers
using the surgeon’s preferred technique.
Refer to package insert for complete product
information, warnings, precautions, adverse
effects, and including contraindications.

27 | MOBIO® CR/CR+ Surgical Technique

PROSTHESIS REMOVAL/EXTRACTION

Standard techniques should be used to remove all cemented components.

To remove the tibial insert, use a small osteotome in the central window between the tibial insert
and the baseplate. Apply force to leverage the tibial insert from the baseplate. Note: Removal of
the tibial insert will damage the tibial insert locking wire.

To remove the tibial baseplate, slide the feet of the Tibial Baseplate Extractor around the central
island of the baseplate, as shown in below figure. Turn the lock knob clockwise to expand the
extractor and engage the anterior rim of the baseplate. The Torque Knob can be used to securely
tighten the lock knob. Attach the Slap Hammer to the Tibial Extractor. Alternatively, the Unviversal
Handle can be used. Back slap the assembly until the baseplate is removed.

To remove the femoral component, the Femoral Inserter/Extractor can be used as shown in below
figure.

Components must not be reused once removed.

MOBIO® CR/CR+ Surgical Technique | 28

IMPLANT ORDERING INFORMATION

CR Femur
Part Numbers Desciption Part Numbers Desciption
8821121011 Size 1, Left 8821122052 Size 5 Narrow, Right
8821121012 Size 1, Right 8821121061 Size 6, Left
8821121021 Size 2, Left 8821121062 Size 6, Right
8821121022 Size 2, Right 8821122061 Size 6 Narrow, Left
8821121031 Size 3, Left 8821122062 Size 6 Narrow, Right
8821121032 Size 3, Right 8821121071 Size 7, Left
8821122031 Size 3 Narrow, Left 8821121072 Size 7, Right
8821122032 Size 3 Narrow, Right 8821122071 Size 7 Narrow, Left
8821121041 Size 4, Left 8821122072 Size 7 Narrow, Right
8821121042 Size 4, Right 8821121081 Size 8, Left
8821122041 Size 4 Narrow, Left 8821121082 Size 8, Right
8821122042 Size 4 Narrow, Right 8821121091 Size 9, Left
8821121051 Size 5, Left 8821121092 Size 9, Right
8821121052 Size 5, Right 8821121101 Size 10, Left
8821122051 Size 5 Narrow, Left 8821121102 Size 10, Right

CR Tibial Insert

Part Numbers Desciption Part Numbers Desciption

8821321009 Size A/1-4, 9 mm 8821321314 Size DE/3-7, 14 mm
8821321010 Size A/1-4, 10 mm 8821321316 Size DE/3-7, 16 mm
8821321011 Size A/1-4, 11 mm 8821321319 Size DE/3-7, 19 mm
8821321012 Size A/1-4, 12 mm 8821321322 Size DE/3-7, 22 mm
8821321013 Size A/1-4, 13 mm 8821321325 Size DE/3-7, 25 mm
8821321014 Size A/1-4, 14 mm 8821321509 Size FG/4-9, 9 mm
8821321016 Size A/1-4, 16 mm 8821321510 Size FG/4-9, 10 mm
8821321019 Size A/1-4, 19 mm 8821321511 Size FG/4-9, 11 mm
8821321022 Size A/1-4, 22 mm 8821321512 Size FG/4-9, 12 mm
8821321025 Size A/1-4, 25 mm 8821321513 Size FG/4-9, 13 mm
8821321109 Size BC/1-6, 9 mm 8821321514 Size FG/4-9, 14 mm
8821321110 Size BC/1-6, 10 mm 8821321516 Size FG/4-9, 16 mm
8821321111 Size BC/1-6, 11 mm 8821321519 Size FG/4-9, 19 mm
8821321112 Size BC/1-6, 12 mm 8821321522 Size FG/4-9, 22 mm
8821321113 Size BC/1-6, 13 mm 8821321525 Size FG/4-9, 25 mm
8821321114 Size BC/1-6, 14 mm 8821321709 Size HJ/7-10, 9 mm
8821321116 Size BC/1-6, 16 mm 8821321710 Size HJ/7-10, 10 mm
8821321119 Size BC/1-6, 19 mm 8821321711 Size HJ/7-10, 11 mm
8821321122 Size BC/1-6, 22 mm 8821321712 Size HJ/7-10, 12 mm
8821321125 Size BC/1-6, 25 mm 8821321713 Size HJ/7-10, 13 mm
8821321309 Size DE/3-7, 9 mm 8821321714 Size HJ/7-10, 14 mm
8821321310 Size DE/3-7, 10 mm 8821321716 Size HJ/7-10, 16 mm
8821321311 Size DE/3-7, 11 mm 8821321719 Size HJ/7-10, 19 mm
8821321312 Size DE/3-7, 12 mm 8821321722 Size HJ/7-10, 22 mm
8821321313 Size DE/3-7, 13 mm 8821321725 Size HJ/7-10, 25 mm

29 | MOBIO® CR/CR+ Surgical Technique

CR PLUS Tibial Insert
Part Numbers Description Part Numbers Description
8821311009 Size A/1-3+, 9 mm 8821311314 Size DE/4-6+, 14 mm
8821311010 Size A/1-3+, 10 mm 8821311316 Size DE/4-6+, 16 mm
8821311011 Size A/1-3+, 11 mm 8821311319 Size DE/4-6+, 19 mm
8821311012 Size A/1-3+, 12 mm 8821311322 Size DE/4-6+, 22 mm
8821311013 Size A/1-3+, 13 mm 8821311325 Size DE/4-6+, 25 mm
8821311014 Size A/1-3+, 14 mm 8821311509 Size FG/6-8+, 9 mm
8821311016 Size A/1-3+, 16 mm 8821311510 Size FG/6-8+, 10 mm
8821311019 Size A/1-3+, 19 mm 8821311511 Size FG/6-8+, 11 mm
8821311022 Size A/1-3+, 22 mm 8821311512 Size FG/6-8+, 12 mm
8821311025 Size A/1-3+, 25 mm 8821311513 Size FG/6-8+, 13 mm
8821311109 Size BC/3-5+, 9 mm 8821311514 Size FG/6-8+, 14 mm
8821311110 Size BC/3-5+, 10 mm 8821311516 Size FG/6-8+, 16 mm
8821311111 Size BC/3-5+, 11 mm 8821311519 Size FG/6-8+, 19 mm
8821311112 Size BC/3-5+, 12 mm 8821311522 Size FG/6-8+, 22 mm
8821311113 Size BC/3-5+, 13 mm 8821311525 Size FG/6-8+, 25 mm
8821311114 Size BC/3-5+, 14 mm 8821311709 Size HJ/8-10+, 9 mm
8821311116 Size BC/3-5+, 16 mm 8821311710 Size HJ/8-10+, 10 mm
8821311119 Size BC/3-5+, 19 mm 8821311711 Size HJ/8-10+, 11 mm
8821311122 Size BC/3-5+, 22 mm 8821311712 Size HJ/8-10+, 12 mm
8821311125 Size BC/3-5+, 25 mm 8821311713 Size HJ/8-10+, 13 mm
8821311309 Size DE/4-6+, 9 mm 8821311714 Size HJ/8-10+, 14 mm
8821311310 Size DE/4-6+, 10 mm 8821311716 Size HJ/8-10+, 16 mm
8821311311 Size DE/4-6+, 11 mm 8821311719 Size HJ/8-10+, 19 mm
8821311312 Size DE/4-6+, 12 mm 8821311722 Size HJ/8-10+, 22 mm
8821311313 Size DE/4-6+, 13 mm 8821311725 Size HJ/8-10+, 25 mm

INSTRUMENT ORDERING INFORMATION

CR Femur Trials
Part Numbers Description Part Numbers Description
8829111011 Size 1, Left 8829111111 Size 1, Left
8829111012 Size 1, Right 8829111112 Size 1, Right
8829111021 Size 2, Left 8829111121 Size 2, Left
8829111022 Size 2, Right 8829111122 Size 2, Right
8829111031 Size 3, 3N, Left 8829111131 Size 3, 3N, Left
8829111032 Size 3, 3N, Right 8829111132 Size 3, 3N, Right
8829111041 Size 4, 4N, Left 8829111141 Size 4, 4N, Left
8829111042 Size 4, 4N, Right 8829111142 Size 4, 4N, Right
8829111051 Size 5, 5N, Left 8829111151 Size 5, 5N, Left
8829111052 Size 5, 5N, Right 8829111152 Size 5, 5N, Right
8829111061 Size 6, 6N, Left 8829111161 Size 6, 6N, Left
8829111062 Size 6, 6N, Right 8829111162 Size 6, 6N, Right
8829111071 Size 7, 7N, Left 8829111171 Size 7, 7N, Left
8829111072 Size 7, 7N, Right 8829111172 Size 7, 7N, Right
8829111081 Size 8, Left 8829111181 Size 8, Left
8829111082 Size 8, Right 8829111182 Size 8, Right
8829111091 Size 9, Left 8829111191 Size 9, Left
8829111092 Size 9, Right 8829111192 Size 9, Right
8829111101 Size 10, Left 8829111201 Size 10, Left
8829111102 Size 10, Right 8829111202 Size 10, Right

MOBIO® CR/CR+ Surgical Technique | 30

CR Tibial Insert Trials
Part Numbers Description Part Numbers Description
8829301109 Size A/1-4, 9mm 8829304114 Size DE/3-7, 14mm
8829301110 Size A/1-4, 10mm 8829304116 Size DE/3-7, 16mm
8829301111 Size A/1-4, 11mm 8829304119 Size DE/3-7, 19mm
8829301112 Size A/1-4, 12mm 8829304122 Size DE/3-7, 22mm
8829301113 Size A/1-4, 13mm 8829304125 Size DE/3-7, 25mm
8829301114 Size A/1-4, 14mm 8829305109 Size FG/4-9, 9mm
8829301116 Size A/1-4, 16mm 8829305110 Size FG/4-9, 10mm
8829301119 Size A/1-4, 19mm 8829305111 Size FG/4-9, 11mm
8829301122 Size A/1-4, 22mm 8829305112 Size FG/4-9, 12mm
8829301125 Size A/1-4, 25mm 8829305113 Size FG/4-9, 13mm
8829303109 Size BC/1-6, 9mm 8829305114 Size FG/4-9, 14mm
8829303110 Size BC/1-6, 10mm 8829305116 Size FG/4-9, 16mm
8829303111 Size BC/1-6, 11mm 8829305119 Size FG/4-9, 19mm
8829303112 Size BC/1-6, 12mm 8829305122 Size FG/4-9, 22mm
8829303113 Size BC/1-6, 13mm 8829305125 Size FG/4-9, 25mm
8829303114 Size BC/1-6, 14mm 8829306109 Size HJ/7-10, 9mm
8829303116 Size BC/1-6, 16mm 8829306110 Size HJ/7-10, 10mm
8829303119 Size BC/1-6, 19mm 8829306111 Size HJ/7-10, 11mm
8829303122 Size BC/1-6, 22mm 8829306112 Size HJ/7-10, 12mm
8829303125 Size BC/1-6, 25mm 8829306113 Size HJ/7-10, 13mm
8829304109 Size DE/3-7, 9mm 8829306114 Size HJ/7-10, 14mm
8829304110 Size DE/3-7, 10mm 8829306116 Size HJ/7-10, 16mm
8829304111 Size DE/3-7, 11mm 8829306119 Size HJ/7-10, 19mm
8829304112 Size DE/3-7, 12mm 8829306122 Size HJ/7-10, 22mm
8829304113 Size DE/3-7, 13mm 8829306125 Size HJ/7-10, 25mm

CR PLUS Tibial Insert Trials

Part Numbers Description Part Numbers Description
8829301209 Size A/1-3+, 9mm 8829304214 Size DE/4-6+, 14mm
8829301210 Size A/1-3+, 10mm 8829304216 Size DE/4-6+, 16mm
8829301211 Size A/1-3+, 11mm 8829304219 Size DE/4-6+, 19mm
8829301212 Size A/1-3+, 12mm 8829304222 Size DE/4-6+, 22mm
8829301213 Size A/1-3+, 13mm 8829304225 Size DE/4-6+, 25mm
8829301214 Size A/1-3+, 14mm 8829305209 Size FG/6-8+, 9mm
8829301216 Size A/1-3+, 16mm 8829305210 Size FG/6-8+, 10mm
8829301219 Size A/1-3+, 19mm 8829305211 Size FG/6-8+, 11mm
8829301222 Size A/1-3+, 22mm 8829305212 Size FG/6-8+, 12mm
8829301225 Size A/1-3+, 25mm 8829305213 Size FG/6-8+, 13mm
8829303209 Size BC/3-5+, 9mm 8829305214 Size FG/6-8+, 14mm
8829303210 Size BC/3-5+, 10mm 8829305216 Size FG/6-8+, 16mm
8829303211 Size BC/3-5+, 11mm 8829305219 Size FG/6-8+, 19mm
8829303212 Size BC/3-5+, 12mm 8829305222 Size FG/6-8+, 22mm
8829303213 Size BC/3-5+, 13mm 8829305225 Size FG/6-8+, 25mm
8829303214 Size BC/3-5+, 14mm 8829306209 Size HJ/8-10+, 9mm
8829303216 Size BC/3-5+, 16mm 8829306210 Size HJ/8-10+, 10mm
8829303219 Size BC/3-5+, 19mm 8829306211 Size HJ/8-10+, 11mm
8829303222 Size BC/3-5+, 22mm 8829306212 Size HJ/8-10+, 12mm
8829303225 Size BC/3-5+, 25mm 8829306213 Size HJ/8-10+, 13mm
8829304209 Size DE/4-6+, 9mm 8829306214 Size HJ/8-10+, 14mm
8829304210 Size DE/4-6+, 10mm 8829306216 Size HJ/8-10+, 16mm
8829304211 Size DE/4-6+, 11mm 8829306219 Size HJ/8-10+, 19mm
8829304212 Size DE/4-6+, 12mm 8829306222 Size HJ/8-10+, 22mm
8829304213 Size DE/4-6+, 13mm 8829306225 Size HJ/8-10+, 25mm

31 | MOBIO® CR/CR+ Surgical Technique

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System CR/CR Plus Surgical Technique
Rev. A

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