Experience Summary

In this 360-degree video, observe the scrub nurse set up the instruments ready for a total knee replacement using the ATTUNE system.

Clinical Context

Proper equipment setup is essential for the safe and efficient performance of a total knee replacement (TKR) using the ATTUNE Knee System by DePuy Synthes. The ATTUNE system is a modern, modular knee replacement platform designed to improve functional outcomes and patient satisfaction through enhanced kinematics, stability, and implant design. Given the specificity and complexity of the system, meticulous preparation of instruments and implants is critical to ensure a smooth operative flow.

Prior to entering the operating theatre, the surgical team—particularly the scrub nurse and operating department practitioner (ODP)—must confirm that all necessary trays and components are available, sterilised, and match the surgical plan. This includes referencing the surgeon’s preferences and the patient’s preoperative templating, which helps anticipate required component sizes and configurations.

Instrument Tray Setup

The ATTUNE system includes several instrument trays used in a specific sequence during the procedure:

• Femoral preparation tray: Contains cutting blocks, reamers, sizing guides, and chamfer tools for accurate preparation of the femoral component.
• Tibial preparation tray: Includes extramedullary alignment jigs, cutting blocks, and reamers for tibial bone preparation.
• Trial components: Sizing trials for femoral, tibial, and patellar components, along with polyethylene inserts, are required for assessing fit, alignment, and stability before final implantation.
• Patellar preparation instruments: Used if resurfacing is planned, including patella clamps and reamers.
• Cementing and insertion tools: Include impactors, cement guns, and pressurisation tools for secure fixation.

All trays should be opened using aseptic technique, with instruments arranged in a logical and accessible order to facilitate efficient use. The scrub team must inspect each instrument for function and cleanliness before the case begins.

Implant and Ancillary Equipment Preparation

The circulating nurse confirms the availability of the ATTUNE implant components in the expected sizes, with alternatives on hand in case intraoperative adjustments are needed. Implants are typically stored in colour-coded, clearly labelled packaging. The theatre must also be equipped with:

• A functioning tourniquet (if used),
• Power tools (oscillating saw, drill) with spare blades,
• Pulse lavage system,
• Suction setup,
• Bone cement and mixing system (if using cemented implants).

Learning Outcomes

1. Observe the operating room setup for a total knee replacement surgery
2. Understand the importance of aseptic technique and its importance in the operating theatre.

External Resources

• RCS England - Total Knee Replacement Information