Tactys Operative Technique - Stryker

Hand & 

Wrist 

TACTYS 

Proximal Interphalangeal 

Joint Prosthesis 

Operative Technique 

Hand & Wrist

TACTYS 

This publication sets forth detailed 

recommended procedures for using 

Stryker Osteosynthesis devices and 

instruments. 

It offers guidance that you should 

heed, but, as with any such technical 

guide, each surgeon must consider 

the particular needs of each patient 

and make appropriate adjustments 

when and as required. 

A workshop training is recommended 

prior to first surgery. 

All non-sterile devices must be 

cleaned and sterilized before use. 

Follow the appropriate instructions 

for use (IFU). Multi-component 

instruments must be disassembled 

for cleaning. Please refer to the 

corresponding assembly/disassembly 

instructions. 

See package insert for a complete 

list of potential adverse effects, 

contraindications, warnings and 

precautions. 

The surgeon must discuss all relevant 

risks, including the finite lifetime of 

the device, with the patient, when 

necessary. 

2

Contents 

Page 

1. Indications and Contraindications 4 

Indications 4 

Contraindications 4 

Concept 4 

Precautions 4 

2. Characteristics 5 

3. Operative Technique 6 

Approaches 6 

Resection of proximal and distal articular surfaces 8 

Preparation of the Proximal Phalanx 10 

Preparation of the Distal Phalanx 12 

Fitting the trial stem 14 

Positioning of the trial articulating surfaces 16 

Fitting the final implants 18 

Closure of the extensor apparatus 19 

Ordering Information – Implants 21 

Ordering Information – Instruments 22 

3

Indications, Precautions & Contraindications 

Indications 

The Tactys prosthesis is intended for 

use in hand proximal interphalangeal 

joint arthroplasty associated with 

osteoarthritis, rheumatoid arthritis, 

trauma (fracture) and revision surgery. 

Concept 

The innovative four-part prosthesis 

simulates the physiological movement 

of the joint while limiting bone 

resection. The design is modular to 

suit different morphologies and to 

enable intraoperative tensioning of 

the joint. 

Precautions 

Stryker Osteosynthesis systems have 

not been evaluated for safety and 

compatibility in MR environment 

and have not been tested for heating 

or migration in the MR environment, 

unless specified otherwise in the product 

labeling or respective operative 

technique. Detailed information is 

included in the instructions for use 

being attached to every implant. 

Contraindications 

• Acute or chronic infections, local 

or systemic. 

• Muscular, neurological or vascular 

severe deficiency affecting the 

articulation. 

• Osseous demineralization or 

destruction being able to affect the 

implant fixing. 

• The association of this implant with 

implants having another origin is not 

agreed. 

• Surgical procedures others that those 

mentioned in the INDICATIONS 

section. 

• Do not use on patients who are 

allergic to the product’s components 

or who have known allergies. 

More than 400 configurations at your disposal 

4

Characteristics 

Proximal articulating surface made of 

polymer that can easily be replaced in 

the event of revision. 

Proximal 

Articulating Surface 

Ultra-High Molecular 

Weight Polyethylene 

Distal Articulating Surface 

Cobalt-Chromium Alloy 

Distal Stem 

Titanium Alloy 

Half Hydroxyapetite 

coating 

Press-fit Anatomical 

Design 

Half Hydroxyapatite 

coating 

Proximal stem 

Titanium Alloy 

Press-fit 

Anatomical Design 

Abutment to 

prevent stem 

from sinking into 

phalanx 

Instrumentation 

• Ergonomic instrumentation specific 

to each phalange. 

• Colour-coding for each instrument 

and the box 

Orange: Distal 

Black: Proximal 

Proximal 


Trial Implants 

Distal 


Identification of XS, S, M, L trial 

implants by specific colour code 

L 

M 

S 

XS 

5


Approaches 

The dorsal approach, thanks to its wide unimpeded access, is particularly 

recommended for implanting the Tactys prosthesis. However, the choice 

of approach is at the surgeon’s discretion according to his experience and training. 

Dorsal trans tendinous approach* 

Perform a curvilinear skin incision 3 

to 4cm along the back of the PIP joint. 

3 - 4cm 

Perform a median longitudinal 

incision into the extensor apparatus 

moving to the centre of the insertion 

of the central slip and continuing with 

the dorsal periosteum of P2. 

The incision begins in the middle 

of the proximal phalanx and runs 

through the centre of the middle 

phalanx. 

3 - 4cm 

Separate the two flaps of the extensor 

apparatus, one to radial and the other 

to ulnar in order to expose the joint. 

It is not necessary to detach the 

periosteum. 

* Source: Scientific literature on pg 20 

6


Approaches 

Chamay-type approach* 

The skin approach is curvilinear or 

linear dorsal. The incision starts at 

the base of P1 and ends at the base 

of P2. 

3 - 4cm 

Proceed with the incision of the 

extensor apparatus. The incision starts 

from the distal base of P2, at the union 

of the lateral slips and of the central 

slip and ends in a V or U-shape at the 

proximal metaphysis of P1. 

Note: 

Take care not to incise the 

periosteum. It must remain 

intact to prevent adhesions 

with the tendon. 

Lift back the V or U-shape flap of the 

extensor. If necessary, proceed with 

a resection, exercising caution with 

respect to the distal osteophyte. 


7


Resection of proximal and distal articular surfaces 

Resection of the proximal articular 

surface (P1) 

Resection of the condyle is performed 

very close to the proximal insertion 

of the lateral ligaments using the 

oscillating saw while remaining 

perpendicular in both planes to 

the axis of the phalanx. 

Resect the dorsal osteophytes 

if necessary. 

Note: 

Flex the joint to its maximum 

extent. The cut through the 

condyle must pass very close 

to the lateral ligaments. 

Resection of the distal articular 

surface (P2) 

Perform a minimal resection of the 

articular surface of the 2nd phalanx 

with the aim of obtaining a flat surface 

perpendicular to the two planes and 

to the axis of the phalanx. Take care to 

give consideration to the insertion of 

the lateral ligaments. 

The resection is performed using an 

oscillating saw or using a burr, a gouge 

forceps or bone-cutting forceps. 

Note: 

The Chamay approach does 

not always permit the use of an 

oscillating saw for the preparation 

of P2. A truncated conical burr 

(maximum 5mm diameter) can 

be used instead. Be aware of the 

central slip when completing the 

resection. 

Reposition the two phalanges 

one facing the other to check the 

orthogonality of the cuts relative to 

the axis of the finger. 

8


Checking the thicknesses of cuts 

The sizing control gauge 

(Ref XDI008001) allows you to both: 

1. Identify the anatomical dimensions 

of the surfaces and thus identify the 

most suitable L, M or S implant for 

the proximal and distal surface. 

Note: 

Make a note of the size of the 

articular surface previously 

selected in order to select the 

sizing pin for insertion. 

The prothesis is modular. The choice of the sizes of the articular surfaces can be 

changed intra-operatively. 

2. Measure the gap between the 

two phalanges to check whether 

the bone resection is sufficient to 

accommodate at least one distal 

articular surface of thickness “L-, 

M- or S-” 

If the pin can be inserted into the joint 

space then the bone resection 

is sufficient. 

If the pin does not fit, then the bone 

resections need to be adjusted to 

achieve a sufficiently large gap adapted 

to the selected size (S-, L-, M-). 

9


Preparation of the Proximal Phalanx 

Proximal seat 

Use of the pre-drilling punch 

The punch (Ref XDI006001) has an 

anatomical design shaped like the 

articular surface. The punch enables 

the identification of the drilling 

position in the medullary canal. 

Position Check 

Insertion of the 1.5 diameter wire 

(Provided in the Tactys instrument 

set.) 

Take a frontal and lateral X-Ray. 

Radiographic criteria: 

Positioning must be perfectly 

intramedullary and into the axis 

of the phalanx in both planes. 

Seat Preparation 

Fitting a S, M, L Stem 

Start the preparation of the housing 

using the proximal cannulated rasp 

(Ref XRP005001) until it abuts the 

proximal surface. 

10


Note: 

If very hard bone is encountered, 

it may be necessary to alternate 

between using the cannulated 

rasp and the intramedullary 

reamer (Ref XFR003001; 

Maximum speed limit of the 

centromedullar reamer: 100 

000 min- 1 ) or guide wire (Ref 

XVIPR02001) in order to 

successfully create the housing. 

It is advisable to take an X-Ray 

to check the progress of the rasp. 

Fitting an XS stem 

For an XS-sized stem (usually the 5th 

digital ray) the housing is prepared 

directly using the XS proximal rasp 

(Ref XRP006001). 

Withdraw the wire, then rasp using 

the proximal progressive rasp 

(Ref XRP007001) until successfully 

obtaining a properly adapted seat. 

11


Use the graduated markings on 

the measuring tool (Ref XDI007001) 

to assess which stem to select. 

Note: 

As the prosthesis is fully modular, 

the articular surface selected 

is compatible with any stem 

S, M or L. 

Preparation of the Distal Phalanx 

Distal seat 

Using the pre-drilling punch 

The punch (Ref XDI006002) has an 

anatomical design shaped like the 

articular surface. The punch enables 

the identification of the drilling 

position in the medullary canal. 

Position Check 

Insert a 1.5mm diameter wire and take 

a frontal and lateral X-Ray to check 

that it is correclty positioned. 

Radiographic criteria: 

Positioning must be perfectly 

intramedullary and into the axis 

of the phalanx in both planes. 

12


Seat Preparation 

Fitting a stem S, M or L 

Start to prepare the seat by using 

the distal cannulated rasp 

(Ref XRP005002). 

Note: 

If very hard bone is encountered, 

it may be necessary to alternate 

between using the cannulated 

rasp and the intramedullary 

reamer (Ref XFR003001; 

Maximum speed limit of the 

centromedullar reamer: 100 

000 min- 1 ) or guide wire (Ref 

XVIPR02001) in order to 

successfully create the housing. 

It is advisable to take an X-Ray to 

check the progress of the rasp. 

Fitting an XS stem 

In the case of an XS-sized stem 

(5th digital ray mainly) the seat 

is prepared directly using the 

“XS distal rasp”. 

Withdraw the wire, then rasp using 

the distal progressive rasp (Ref 

XRP007002), until successfully 

obtaining a properly adapted seat. 

13


Use the graduated markings on the 

measuring tool (Ref XDI007002) 

to assess which stem to select. 

Note: 

The prosthesis is modular. 

The distal stem is neither 

dependent on the predetermined 

size using the checking tool, 

nor on the proximal stem implant 

that was originally identified as 

being suitable. 

Fitting the trial stem 

Fitting the proximal trial stem 

Fit the stem into the seat then proceed 

with impaction using the proximal 

impactor (Ref XIM007001). 

14


Fitting the distal trial stem 

Impaction is performed using the 

distal impactor (Ref XIM007002). 

Palmar proximal resection 

using the cutting guide 

The guide (Ref XVIPR001001) 

is positioned to rest against the dorsal 

stop of the proximal trial stem. 

The pin of the guide is inserted 

into the housing of the trial stem. 

Use an oscillating saw to complete the 

palmar resection 

Note: 

The use of a narrow saw is 

recommended so as to minimise 

the risk of damage to the lateral 

ligaments. 

Dorsal cortex removal 

Take care to free the dorsal cortex 

of P1 (1), using a saw or a gouge 

forceps, so as to eliminate residual 

bone debris. If this is necessary, use 

the saw to remove final bone debris 

from the palmar resection (2). 

Note: 

The presence of bone debris at the 

periphery of the stem may impair 

the impactaction of the final 

surface and its retention on the 

stem. 

15


Positioning of the trial articulating surfaces 

Fitting the articulating 

trial surfaces 

Choose articulating surface implants 

taking into account the anatomical 

dimensions of the condyle and the gap 

previously identified using the sizing 

control tool (step 2, page 9). Ensure 

that the selected surfaces match the 

patient’s anatomy as closely as possible. 

Start by positioning a proximal trial 

surface, then select a distal trial surface 

within the smallest thickness range 

(S-, M- or L-). 

Note: 

When fitting the proximal 

surface, it is necessary to 

thoroughly check that the 

proximal surface is in positive 

contact with the trial stem. If not, 

cleaning of the stem periphery 

(page 15) must be repeated. 

Articular tension and 

check adjustment 

It is possible to adjust articular tension 

by inserting a distal surface of a greater 

or lesser thickness. 

Complete several tests to determine 

the best performing combination. 

Note: 

With a transtendinous approach, 

the correctness of the articular 

tension can be assessed by the 

effect of tenodesis. During 

flexion-extension of the wrist, 

the tenodesis effect of the extensor 

apparatus must allow full flexion 

and extension of the PIP. 

Implants, stems and surfaces are interchangeable. 

16


Osteophyte check 

Take frontal and lateral X-Rays 

of the trial implants. Check that 

no osteophyte is impairing the 

positioning of the implants 

Removal of the trial implants 

Remove the articulating surfaces using 

the forceps (Ref XPI009001) and then 

the stems using the removal forceps 

(Ref XPI009002). 

17


Fitting the final 

implants 

Preparation of the extensor 

apparatus in the case of 

a transtendinous approach and 

reinsertion* of the central slip. 

Before fitting the final stems, make 

two holes on the dorsal face of the 

median phalanx for reinsertion of the 

extensor apparatus. 

Note: 

Reinsertion of the central slip is at 

the surgeons discretion. 

A reinsertion with excessive 

tension may cause postoperative 

stiffness. 

Fitting the final implants 

The procedure for fitting the final 

implants is exactly the same as the 

procedure for fitting the trial implants. 

Impaction of the articulating surfaces 

is completed using distal and proximal 

articulating surface impactors. 

1. Insertion of the proximal stem. 

2. Inserting the distal stem. 

3. Impaction of the proximal surface. 

4. Impaction of the distal surface. 

Note: 

Be sure to follow the correct 

order for fitting components. It is 

preferable to impact the proximal 

surface before the distal surface. 


18


X-Ray check 

Check that the final implants are 

properly positioned using frontal 

and lateral X-Rays. 

Closure of the 

extensor apparatus 

Dorsal transtendinous approach* 

Reinsert the strip of the extensor 

apparatus (Fig.1) without excessive 

tension of the latter at the base of P2 

using two transosseous holes. 

Fig.2 shows reinsertion of the extensor 

apparatus without reinsertion of the 

central slip. 

Fig.1 

Fig.2 

Chamay approach* 

Once the prosthesis is fitted, suture 

the extensor using a fairly fine thread 

by means of individual, separate 

points. 20 to 25 points are generally 

required. 

After closing up the cutaneous flap, 

the finger is bandaged and strapped 

to the adjoining digit for immediate 

mobilization of the phalanges. 

Note: 

It is important not to hold the 

joint in strict extension. 

Chamay approach 


19

Proposed postoperative care protocol 

The protocol must be tailored to each patient 

The following is recommended: 

• Strap the finger to the adjoining digit for 15 days and avoid any compressive 

dressing 

• Prevent any strict, prolonged immobilization in extension 

• Prevent any hyperextension 

• Focus on immediate rehabilitation in flexion 

• Elevate the hand 

A 15-day check-up will allow you to assess the degree of mobility of the joint, 

to prevent any eventual complications. An X-Ray in full flexion is recommended. 

* Scientific Literature: Transtendinous dorsal approach, Chamay approach 

Afifi, A. M., A. Richards, et al. (2010). “The extensor tendon splitting approach 

to the proximal interphalangeal joint: do we need to reinsert the central slip?” J 

Hand Surg Eur Vol 35(3): 188-91. 

Bickel, K. D. (2007). “The Dorsal Approach to Silicone Implant Arthroplasty of 

the Proximal Interphalangeal Joint.” The Journal of Hand Surgery 32(6): 909-913. 

Chamay, A. (1988). “Le lambeau tendineux triangulaire dorsal inversé, porte 

ouverte sur l’articulation interphalangienne proximale (IPP).” Annales de 

Chirurgie de la Main 7(2): 179-183. 

Mercer, D., J. FitzPatrick, et al. (2009). “Extensor Tendon Repair With and 

Without Central Slip Reattachment to Bone: A Biomechanical Study.” The Journal 

of Hand Surgery 34(1): 108-111. 

20

Ordering Information – Implants 

REF 

Description 

WIPSP11 

Proximal surface size L 

WIPSP10 

Proximal surface size M 

WIPSP07 

Proximal surface size S 

WIPTP18 

Proximal stem size L 

WIPTP16 

Proximal stem size M 

WIPTP14 

Proximal stem size S 

WIPTP12 

Proximal stem size XS 

WIPSD1205 Distal surface size L- 

WIPSD1210 

Distal surface size L0 

WIPSD1215 Distal surface size L+ 

WIPSD1005 Distal surface size M- 

WIPSD1010 

Distal surface size M0 

WIPSD1015 Distal surface size M+ 

WIPSD0705 Distal surface size S- 

WIPSD0710 

Distal surface size S0 

WIPSD0715 Distal surface size S+ 

WIPTD15 

Distal stem size L 

WIPTD13 

Distal stem size M 

WIPTD11 

Distal stem size S 

WIPTD09 

Distal stem size XS 

21

Ordering Information – Instruments 

REF 

Description 

XDI006001 

Proximal punch 

XDI006002 

Distal punch 

XRP005001 

Proximal canulated rasp 

XRP005002 

Distal canulated rasp 

XRP007001 

Progressive proximal rasp 

XRP007002 

Progressive distal Rasp 

XRP006001 

Proximal XS rasp 

XRP006002 

Distal XS rasp 

XDI007001 

Proximal stem measuring tool 

XDI007002 

Distal stem measuring tool 

XIM007001 

Proximal stem impactor 

XIM007002 

Distal stem impactor 

XIM007003 

Proximal surface impactor 

XIM007004 

Distal surface impactor 

XVIPR001001 

Palmar cutting guide 

XPI009001 

Surface forceps 

XPI009002 

Stem forceps 

AGK0215100 

Kirchner wire 

XTU001001 

Wire tube 

XDI008001 

Size Control Gauge 

XFR003001 

Centromedullary reamer 

XVIPR02001 

Guide Wire 

22

Ordering Information – Trials 

REF 

Description 

XFA010110 

Proximal surface trial size L 

XFA010120 

Proximal surface trial size M 

XFA010130 

Proximal surface trial size S 

XFA009110 

Proximal stem trial size L 

XFA009120 

Proximal stem trial size M 

XFA009130 

Proximal stem trial size S 

XFA009140 

Proximal stem trial size XS 

XFA010210 Distal surface trial size L- 

XFA010211 

Distal surface trial size L0 

XFA010212 Distal surface trial size L+ 

XFA010220 Distal surface trial size M- 

XFA010221 

Distal surface trial size M0 

XFA010222 Distal surface trial size M+ 

XFA010230 Distal surface trial size S- 

XFA010231 

Distal surface trial size S0 

XFA010232 Distal surface trial size S+ 

XFA009210 

Distal stem trial size L 

XFA009220 

Distal stem trial size M 

XFA009230 

Distal stem trial size S 

XFA009240 

Distal stem trial size XS 

23

Notes 

24

Notes 

25

1275 0120 

This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own 

professional clinical judgment when deciding whether to use a particular product when treating a particular patient. 

Stryker does not 1275 

dispense medical advice and recommends that surgeons be trained in the use of any particular 

product before using it in surgery. 

Manufactured by: 

Memometal Technologies SA 

Campus de Ker Lann 

Rue Blaise Pascal 

35170 Bruz 

France 

www.stryker.com 

The information presented is intended to demonstrate a Stryker product. A surgeon must always refer to the package 

insert, product label and/or instructions for use, including the instructions for Cleaning and Sterilization (if 

applicable), before using any Stryker product. Products may not be available in all markets because product availability 

is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker representative 

if you have questions about the availability of Stryker products in your area. 

Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following 

trademarks or service marks: Tactys, Stryker. All other trademarks are trademarks of their respective owners or 

holders. 

The products listed above are CE marked. 

Literature Number : 982384 Rev 0 

Copyright © 2012 Stryker

Tactys Operative Technique - Stryker

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