Zimmer Biomet Persona User manual

Persona®Revision
Knee System
Surgical Technique

Table of Contents
Quick Reference........................................................................................................ 2
Abbreviated Surgical Technique
Instrumentation Overview
Device Description.................................................................................................... 7
Optional Preoperative Templating ........................................................................... 7
Patient Preparation................................................................................................... 7
Surgical Approach and Exposure ............................................................................. 7
Component Removal ................................................................................................ 8
Femoral Removal
Tibial Removal
Preliminary Flexion and Extension Gap Analysis..................................................... 8
Tibial Preparation
Tibial Intramedullary Canal Preparation.................................................................. 9
Canal Preparation and Alignment
Optional Proximal Tibial Resection ........................................................................ 10
Optional Proximal Tibial Bone Preparation
Optional Tibial Augment Resection
Tibial Sizing and Positioning................................................................................... 13
Straight Stem Preparation
Oset Stem Preparation
Tibial Stem Housing Preparation............................................................................ 15
Straight Stem Preparation Only
Oset Stem Preparation Only
Straight and Oset Stem Housing Preparation
Keel Preparation ..................................................................................................... 17
Tibial Baseplate Provisional Assembly and Insertion ............................................ 18
Optional Tibial Augment Resection........................................................................ 20
Femoral Preparation
Femoral Intramedullary Canal Preparation ........................................................... 21
Canal Preparation and Alignment
Optional Distal Femoral Resection......................................................................... 22
Optional Distal Femoral Augment Resection
Optional Femoral Sizing and Positioning............................................................... 23
Straight Stem Preparation
Oset Stem Preparation
Optional Femoral Rotation or Size Adjustment (4-in-1 Cut Guide)........................ 25
Optional Posterior Augment Resection
Femoral Stem Housing Preparation....................................................................... 25
Straight Stem Preparation Only
Oset Stem Preparation Only
Straight and Oset Stem Housing Preparation
Femoral Provisional Assembly and Insertion......................................................... 27
Trial Reduction........................................................................................................ 28
TASP Assembly
TASP Shim Exchange
TASP Removal
Flexion and Extension Gap Analysis

Optional Femoral Augment Resection ................................................................... 32
Femoral Box Cut Preparation ................................................................................. 33
Patella Resurfacing................................................................................................. 33
Final Trialing............................................................................................................ 34
CPS and CCK Bearing TASP Assembly
TASP Shim Exchange
TASP Removal
Implant Assembly................................................................................................... 37
Tibial Implant Assembly
Optional Tibial Augment Assembly
Femoral Implant Assembly
Optional Femoral Augment Assembly
Two Stage Cementing Technique ........................................................................... 40
Tibial Component
Optional Cementing Tibial Augments
Femoral Component
Optional Cementing Femoral Augments
Patella Cementing
Bearing Assembly and Insertion ............................................................................ 46
CCK Bearing Insert Assembly
PS, CPS and CCK Bearing Assembly
CCK Bearing Lockdown Screw Assembly
Close Incision .......................................................................................................... 48
Appendices
Appendix A: Tapered Stem Preparation................................................................. 49
Tibial Tapered Stem Preparation
Femoral Tapered Stem Preparation
Appendix B: Tibial Central Cone Preparation......................................................... 50
Fixed Tibial Cone
Cannulate Ream (Extra-Small, Small, Medium, Large Tibial Central Cone Preparation Only)
Optional Tibial Defect Sizing
Optional Drill Guide (Medium, Large Tibial Central Cone Preparation Only)
Silver/Gold Broach Preparation
Gold Broaches
Tibial Central Cone Insertion
Appendix C: Femoral Central Cone Preparation.................................................... 54
Cannulate Ream (Small, Medium, Large, Extra-Large Femoral Central Cone Preparation Only)
Optional Femoral Defect Sizing
Optional Drill Guide (Medium, Large, Extra-Large Femoral Central Cone Preparation Only)
Silver/Gold Broach Preparation
Gold Broaches
Femoral Central Cone Insertion
Appendix D: Tibial Central Cone Implant Assembly .............................................. 57
Cone Insertion
Tibial Cone Assembly with an Oset or Large Diameter Stem
Optional Tibial Augment Assembly
Appendix E: Femoral Central Cone Implant Assembly .......................................... 60
Cone Insertion
Femoral Cone Assembly with an Oset or Large Diameter Stem
Optional Femoral Augment Assembly
Appendix F: Component Removal.......................................................................... 63
PS, CPS and CCK Bearing Removal
Tibial Baseplate Removal
Femoral Component Removal
Stem Removal
Product Compatibility Charts................................................................................. 65

2 | Persona®Revision Fixed Tibial Surgical Technique
Step 1:
Optional Preoperative
Templating
Step 9:
Femoral Canal
Preparation
Step 2:
Tibial Canal
Preparation
Step 3:
Optional Proximal
Tibial Resection
Step 10:
Optional Distal
Femoral Resection and Augment
Preparation
Step 11:
Optional Femoral
Sizing and Positioning
Step 4:
Tibial Sizing
and Positioning
Step 12:
Femoral Stem
Housing Preparation
Step 8:
Optional Tibial
Augment Preparation
Step 5:
Tibial Stem
Housing Preparation
Step 6:
Keel Preparation
Step 7:
Tibial Provisional
Assembly and Insertion
Quick Reference:
Abbreviated Surgical Technique

3 | Persona®Revision Knee System Surgical Technique
Step 16:
Patella Resurfacing
Step 17:
Final Trialing
Step 18:
Implant Assembly
Step 13:
Femoral Provisional Assembly
and Insertion
Step 19:
Two Stage
Cementing Technique
Step 14:
Trial Reduction (TASP)
Step 20:
Bearing Assembly
and Insertion
Step 15:
Femoral Box Cut
Step 21:
Close Incision

4 | Persona®Revision Knee System Surgical Technique
Quick Reference:
Instrumentation Overview
Attaches to:
• Tibial and femoral impactor pads
• Tibial central and perimeter cone
impactor heads
• Femoral central and metaphyseal
cone impactor head
• Persona Primary Femoral 4-in-1
Cut Block
Attaches to:
• Stem extractor
• Stem provisionals
Removes the:
• Tibial and femoral
provisionals
• Persona Primary
Femoral 4-in-1 Cut Block
• Cone provisionals
Removes the:
• Pin puller
Attaches to:
• Canal Reamers
• Stem extension post
• Broach pilot adapter
• Cannulated reamers
• Tilt reamers
• 5 mm hex driver
• Tapered stem drill bits
Removes the:
• Reamers
• Stem extension post
and broach pilot adapter
• Tapered stem drill bits
Slap Hammer
Quick Connect (QC) Handle
T-Handle
Note: Do not use implants and/or instruments from other knee systems unless expressly labeled for such use.
Note: Do not use implants and/or instruments from the Persona Revision Knee System with other knee
systems unless expressly labeled for such use.

5 | Persona®Revision Knee System Surgical Technique
Removes the:
• Reamers
• Stem extension post
• Broach pilot adapter
• Tapered stem drill bits
Fastens the:
• Tibial and femoral provisional
components to stem provisionals
• Tibial and femoral cone drill guides
to the stem extension post
• Femoral straight and oset reamer
adapters to the reamer
• Femoral/sizing cut guide adapters
to the cut guide
Integrated
Slap Hammer
Note: Can be locked in the up
or down position using
lock/unlock lever
Loosens/Tightens the:
• Tibial boom knob
• Valgus alignment guide knob
• Tibial resection cut guide
Rotates the:
• Oset stem provisionals
Fastens the:
• TASP locking screw
• Tibial and femoral augment
implant screws
Attaches to:
• Gold cone broaches
• Silver cone broaches
• Tibial keel broaches
Attaches to:
• T-Handle
Attaches to:
• Alignment
rod adapter
Diaphyseal Referencing (DR) Handle
Note: Do not use over a canal reamer. The DR handle passes
over the stem extension post or broach pilot adapter.
5 mm Hex Driver
3.5 mm Hex Driver

6 | Persona®Revision Knee System Surgical Technique
Instrumentation Overview (cont.)
Thick Femoral Depth Line (Distal Cut)
Thin Tibial Depth Line (Proximal Cut)
Femoral/Tibial Depths
A
Tilt Reamer

B
Canal Reamer
C
Stem Extension Post
D
Broach Pilot Adapter
E
Cannulated Reamer
A B C D E

7 | Persona®Revision Knee System Surgical Technique
Device Description
The Persona Revision Knee System is designed for use
in both complex primary and revision arthroplasty.
Persona Revision Knee System is a constrained revision
knee prosthesis consisting of anatomically designed
components including:
• Femoral Components
• Articular Surfaces (Bearings)
• Tibial Baseplates
• Stem Extensions
• Femoral and Tibial Augments
• Femoral and Tibial Trabecular Metal™ Cones
Optional Preoperative Templating
Obtain a 36 inch or 53 inch standing anteroposterior
and lateral radiograph of the extremity, as well as a
sunrise view of the patella. Utilize the supplied surgical
templates to preoperatively plan for necessary
implants (Figure 1).
Patient Preparation
If desired, provide a thigh tourniquet and inflate with
the knee in hyperflexion to maximize the portion of the
quadriceps that is below the level of the tourniquet.
Once the patient is draped and prepped on the
operating table, determine the landmarks for the
surgical incision (Figure 2).
Surgical Approach and Exposure
Exposure should be performed by the surgeon’s
preferred approach. Typically the approach is made
through the previous incision. Care should be taken to
avoid avulsion of the patellar tendon. Various extensile
exposures may be utilized including an extended
medial parapatellar arthrotomy, quadriceps snip,
quadriceps turn down and tibial tubercle osteotomy.
Depending on surgeon preference, the patella can be
either everted or subluxed laterally.
Figure 2
Figure 1

8 | Persona®Revision Knee System Surgical Technique
Component Removal
Femoral Removal
Fully flex the knee and remove the bearing, allowing
greater access to the implant/cement interface of both
the femur and tibia. Disrupt the femoral implant/bone
interface with flexible osteotomes or thin saw blades
with an oscillating saw. Once the prosthetic bone
interface is loosened, a femoral extraction tool may
be used to aid in removal of the femoral component
from the bone. If there is still a great deal of resistance
in removing the femoral component, attention should
be redirected to the prosthetic cement bone interface
and thin flexible osteotomes should be reinserted to
further loosen the component.
Note: In the case of a porous component, disrupt
the bone/implant interface using a gigli saw, thin
blade of a reciprocating saw or flexible osteotomes.
Tibial Removal
Disrupt the cement along the tibial plateau with a thin
blade reciprocating saw prior to using a mallet and
extractiondevice.Inthe caseofstemmedcomponents,
remove screws, if equipped, and disengage the tapers.
This allows for direct access to the stem once the tibial
component is removed. Once access to the stem is
achieved, disrupt the cement interface around the
stem with either osteotomes or a pencil-tipped high-
speed burr. Then attempt to remove the stem. Prior
to tibial or femoral preparation, remove all existing
cement and complete a full debridement.
Preliminary Flexion
and Extension Gap Analysis
The spacer blocks may be used to assess flexion
and extension gaps. The spacer block represents the
combined thicknesses of the tibial baseplate, bearing
and femoral component. The size labeled on the
spacer block represents the bearing thickness needed
to balance the flexion/extension gaps.
Start by inserting the spacer block into the joint. Check
flexion and extension gaps. Increase the thickness
of the spacer blocks until the desired thickness is
achieved (Figure 3).
Note: Spacer blocks are oered in 10–18 mm in 2
mm increments. A +10 mm spacer block adapter
is available to increase the thickness of the spacer
block to represent the 20, 22, 24 and 26 mm
bearings. For example, to increase the thickness of
the 10 mm spacer block to 22 mm, insert the post
of the +10 mm adapter block into the pocket of the
12 mm spacer block (Figure 4).
Figure 3
Figure 4

9 | Persona®Revision Knee System Surgical Technique
Figure 5 Figure 6 Figure 7
Note: For specific tapered stem preparation steps,
proceed with the standard technique until the
Tibial Stem Housing Preparation section on page
15. Then proceed to Appendix A for Tapered Stem
Preparation steps on page 49.
Fully flex the knee and locate the canal position of
the tibia. Use the 8 mm stepped drill bit to create a
medullary canal entry hole, if necessary (Figure 5).
Canal Preparation and Alignment
If desired, alignment may be checked while reaming.
To assist with proper reamer alignment, attach the
alignment rod with coupler to the reamer alignment
guide and connect to the reamer post (Figure 6).
Tibial Preparation
Note: The guide is designed with a slip fit in
order for it to remain in place while reaming.
Using a T-handle or power, ream the tibial
intramedullary canal to the appropriate depth,
progressively increasing the reamer diameter
size until cortical chatter is achieved. The Persona
Revision Reamer shafts are marked with the
minimum ream depth marks to prepare for a
135 mm or 175 mm stem extension implant for
the tibia and femur respectively (Figure 7). A “T”
indicates the line for the proximal tibial resection
plane and a “F” indicates the distal femoral resection
plane.
Leave the final reamer diameter used in the tibial
canal for proximal tibial resection, if necessary.
Note: The Persona Revision Tibial Baseplates
are designed with a 0° cut slope. Take caution
while reaming. The weight of a drill can push the
reamer into flexion.
Record the diameter and the tibial stem length
reamed.
Stem Type Stem Length
(mm)
Diameters
(mm) Oset
Smooth +135/+175 10– 24 Even
Sizes Only Straight Only
Splined +135/+175 10–18, 20, 22, 24 Straight, 3 mm,
6 mm
Tapered +30/+75 11, 14 N/A
Note: + in addition to stem housing
Tibial Intramedullary
Canal Preparation
Thin Tibial Depth Line

10 | Persona®Revision Knee System Surgical Technique
Figure 8 Figure 9 Figure 10
Optional Proximal Tibial Resection
Assess the remaining proximal tibial bone. Remove
the least amount of bone necessary to provide for a
stable tibial provisional construct.
Optional Proximal Tibial Bone Preparation
If the tibial bone needs to be resected, slide the
IM tibial resection boom over the reamer (Figure 8).
Attach the “Left” or “Right” tibial resection cut guide
to the IM tibial resection boom. Secure by tightening
the tibial resection cut guide knob in a clockwise
direction (Figure 9).
Use the resection guide (angel wing) to determine
the amount of bone to resect. Adjust the height and
rotation of the tibial resection cut guide by moving
the IM tibial resection boom. Secure by tightening the
tibial resection boom knob in a clockwise direction
(Figure 10).
Note: Alternatively, the 2/10 mm tibial stylus can
be used to determine the amount of bone to resect.
Note: If excessive bone was resected, ream distally
until the tibial line is flush with the new proximal
tibial surface.

11 | Persona®Revision Knee System Surgical Technique
Optional Proximal Tibial Resection
(cont.)
If necessary, pin the tibial resection cut guide to the
tibia (Figure 11). Cut the tibia through the top slot on
the tibial resection cut guide (Figure 12).
If desired, the tibial resection boom and reamer can
be removed if additional space is needed. To remove,
loosen the tibial resection cut guide knob and the tibial
resection boom knob in a counterclockwise direction
(Figure 13). To remove the construct, rotate the tibial
resection boom medially and attach the slap hammer
or T-handle to the reamer and extract (Figure 14).
Note: The pocket of the 5 mm hex driver can be
used if the knobs cannot be loosened by hand.
Figure 11 Figure 12 Figure 13
Figure 14

12 | Persona®Revision Knee System Surgical Technique
Optional Proximal Tibial Cut (cont.)
Optional Tibial Augment Resection
If a tibial augment is necessary, use the resection
guide (angel wing) to estimate the amount of bone
resection needed to establish a supportive plateau
through the tibial cut guide augment slots.
Use a reciprocating saw to make the vertical augment
resection through the cut guide to the planned depth
(Figure 15). Use an oscillating saw to make a 5 mm
or 10 mm bone resection (Figure 16). Remove the
instruments and finish cuts if needed.
Note: If two 10 mm or 15 mm tibial augments
are being utilized, they will cover the fins of the
keel reducing rotational resistance. Consider
using a Trabecular Metal Cone to restore rotational
resistance.
Note: Tibial augment resection can also be
prepared using the tibial augment cut guide
at a later stage in the surgical procedure in the
Optional Tibial Augment Resection section on
page 20.
Figure 15 Figure 16

13 | Persona®Revision Knee System Surgical Technique
Tibial Sizing and Positioning
Reinsert the reamer, if necessary.
Straight Stem Preparation
Select the estimated “Left” or “Right” tibial sizing
plate that provides the desired tibial coverage and
rotation. Attach the tibial sizing plate to the TASP
handle for easier handling and estimate size, rotation
and coverage (Figure 17).
Once tibial size has been confirmed, attach the
straight stem reamer adapter to the tibial sizing plate
and slide over the reamer. Confirm that the “ANT”
marking on the straight stem reamer adapter is facing
anterior (Figure 18). If coverage and rotation using
the straight stem reamer adapter are not adequate,
choose another tibial size or the use of an oset stem
may be required.
Note: If an oset stem is required, proceed to the
Oset Stem Preparation section on page 14.
If an oset stem is not required, ensure optimal tibial
coverage and rotation and remove the TASP handle.
Mark tibial rotation and the keel fins. The medial 1/3rd
of the tibial tubercle can be used as a reference for
tibial rotational alignment (Figure 19).
Note: It is important to mark the fins to align for the
keel. Tibial rotation cannot be adjusted after the
keel has been prepared.
Remove the reamer using the slap hammer or T-handle,
if necessary.
Proceed to the Tibial Stem Housing Preparation
section on page 15.
Note: If the use of a tapered stem is necessary,
proceed to Appendix A: Tapered Stem Preparation
section on page 49.
Figure 17 Figure 19
Figure 18

14 | Persona®Revision Knee System Surgical Technique
Tibial Sizing and Positioning (cont.)
Oset Stem Preparation
Note: Oset stems are available in the splined
configuration only.
The oset stem reamer adapter has two holes, one for
3 mm oset and one for 6 mm oset (Figure 20). Once
the tibial size has been estimated, insert the oset
stem reamer adapter to the tibial sizing plate and slide
over the reamer. Confirm that the “ANT” marking
on the oset stem reamer adapter is facing anterior
(Figure 21).
Rotate the tibial oset stem reamer adapter until the
preferred oset is achieved which provides the best
tibial plateau coverage while maintaining rotational
alignment (Figure 22). Resize the tibia, if necessary.
Note: The numbers on the tibial oset stem reamer
adapter determine the selected oset direction of
the tibia with respect to the stem.
Figure 20
Figure 21
Figure 22

15 | Persona®Revision Knee System Surgical Technique
Tibial Sizing and Positioning (cont.)
Ensure optimal tibial coverage and rotation and
remove the TASP handle. Mark tibial rotation and the
keel fins. The medial 1/3rd of the tibial tubercle can
be used as a reference for tibial rotational alignment
(Figure 23).
Note: It is important to mark the fins to align for the
keel. Tibial rotation cannot be adjusted after the
keel has been prepared.
Remove the reamer using the slap hammer or
T-handle, if necessary.
Figure 24Figure 23
Tibial Stem Housing Preparation
Straight Stem Preparation Only
If the planned stem size has a diameter less than
16 mm, the bone must be cleared to accommodate
the tibial stem provisional. The 16 mm tilt reamer can
be used for this purpose. Drive the tilt reamer in the
tibial canal until the thin tibial line is level with the
most proximal tibial resection (Figure 24).
Thin Tibial Depth Line

16 | Persona®Revision Knee System Surgical Technique
Tibial Stem Housing Preparation
(cont.)
Oset Stem Preparation Only
Use a tilt reamer to clear out bone for the oset
transition. Drive the tilt reamer in the tibial canal until
the thin tibial line is level with the tibial plateau. Tilt the
tilt reamer in the same direction as the arrow of the
oset stem reamer adapter to remove the necessary
amount of bone for a 3 mm or 6 mm oset stem
(Figure 25).
Straight and Oset Stem Housing Preparation
Assemble the appropriate diameter, length, straight or
oset stem provisional based on the last sized reamer
used to the stem extension post and insert into the
tibia by hand or with the T-handle (Figures 26 and 27).
Note: The stem provisionals are designed with a
tight fit and may require being tapped into the canal
until the tibial depth line of the stem extension post
is level with the tibial plateau.
Figure 26 Figure 27 Figure 28
Figure 29
Figure 30
If an oset stem is utilized, make sure to align the line
of the oset number previously determined anteriorly
while inserting (Figure 28).
Verify that the tibial depth line on the stem extension
post is level or distal to the highest point of the resected
tibial plateau (Figure 29). Ensure the stem extension
post is stable in the canal. Tap into place, if necessary.
Ream for the tibial stem housing by placing the
19.5 mm cannulated reamer (22.5 mm cannulated
reamer for tibial cone use) over the stem extension
post. Start power prior to bone contact and ream until
the thin tibial line on the reamer is aligned with the
proximal tibial plane (Figure 30).
Note: If medial or lateral augments are being
utilized, leave the extension post proud to the
corresponding thickness.
Figure 25
Thin Tibial Depth Line
Thin Tibial Depth Line

17 | Persona®Revision Knee System Surgical Technique
Note: If a Trabecular Metal Tibial Cone is required,
proceed to Appendix B: Tibial Central Cone
Preparation section on page 50. To prepare the tibia
for a perimeter cone, reference the Persona Revision
Large Defect Surgical Technique 2723.1-GLBL-en
for surgical steps.
Remove all provisional components from the tibial
canal. If the construct is dicult to remove or cannot
be removed by hand, use the slap hammer to retrieve.
Keel Preparation
Attach the appropriately sized keel broach to the DR
handle by pulling back the lever on the handle and
rotating until locked (Figure 31).
Place the tibial keel broach over the stem extension
post and align with the marks made on the tibial
plateau previously for the keel fins (Figure 32). Impact
the tibial keel broach using a mallet (Figure 33). The
broach is fully seated when the top of the fins are level
with the tibia plateau.
Note: Silver keel broaches are only used for fixed
keel provisionals (not kitted).
Note: If two tibial augments are being utilized to
build up the construct, the top of the broach should
be level with where the anticipated tibial baseplate
will sit.
Note: The 0, +5 and +10 marks on the DR handle are
for femoral use only.
Figure 31
Figure 33
Figure 32

18 | Persona®Revision Knee System Surgical Technique
Tibial Baseplate Provisional
Assembly and Insertion
Note: If planning to prepare for an augment while
trialing, proceed with building the tibial provisional
construct without the keel provisional.
Disassemble the stem provisional from the
stem extension post and select the tibial
baseplate provisional that matches the same
size tibial sizing plate used. Select the tibial keel
provisional that matches the tibial size. Place
the keel provisional onto the tibial baseplate
provisional aligning the fins with the tabs on
the underside of the tibial baseplate provisional
(Figure 34). Attach the stem provisional to the tibial
baseplate provisional. Hold the baseplate screw in
place with your index finger and rotate the stem
provisional in a clockwise direction (Figure 35). Use
the 5 mm hex driver for final tightening (Figure 36).
Note: The fixed keel provisional (not kitted) does
not have a modular keel attachment. No keel
assembly is required.
Figure 34 Figure 35 Figure 36 Figure 37
If an offset stem provisional is used, ensure the
offset number determined previously is aligned
with the anterior mark on the tibial keel provisional
or the stem housing on the tibia provisional
(Figure 37). Rotate to the planned offset, then
lockdown using the 5 mm hex driver.