Zimmer NexGen User manual

Zimmer®
Patient Specific
Instruments (CT)
Surgical Techniques
for NexGen® Complete
Knee Solution

INTRO
INTRO.1
Zimmer® Patient Specific Instruments (CT) – Surgical Techniques
for NexGen® Complete Knee Solution
Introduction
General Considerations
• Zimmer® PSI is not designed for use with the Zimmer
MIS Quad-Sparing™ Total Knee Procedure.
• Zimmer PSI should be used in conjunction with a femur
first technique.
• Verify stability and fixation of all pins. When securing the
conventional tibia cutting guides, avoid the use of spring
pins as these may cause stress / unwanted shift on the
tibia cutting guide.

TOC.1
TOC Zimmer® Patient Specific Instruments (CT) – Surgical Techniques
for NexGen® Complete Knee Solution
Table of Contents
SECTION PAGE
1A
NexGen
®
Conventional Instruments -
Femoral Technique
1
NexGen Conventional Instruments -
Femoral Technique
1
SECTION PAGE
1B
NexGen Conventional Instruments -
Tibial Technique
4
NexGen Conventional Instruments -
Tibial Technique
4
SECTION PAGE
2A
NexGen Posterior Referencing
Instruments - Femoral Technique
8
NexGen Posterior Referencing
Instruments - Femoral Technique
8
SECTION PAGE
2B
NexGen Posterior Referencing
Instruments - Tibial Technique
10
NexGen Posterior Referencing
Instruments - Tibial Technique
10

SECTION
1
NexGen® Conventional Instruments – Femoral Technique 1A
NexGen Conventional Instruments –
Femoral Technique
Position Femoral Pin Guide
• Do not remove osteophytes from the femur.
• Position the Pin Guide on the distal femur (Fig. 1).
• Pin Guide will be captured by the anterior and proximal
ridge of the femur. The guide fits over the edge on the
proximal bone to increase locking.
• The A/P axis reference line on the Pin Guide can be used
to assess alignment. The most distal end of the guide
is parallel to the epicondylar axis and can also be used
as reference.
• Apply anterior proximal pressure to the Pin Guide
and verify a secure fit. Applying posterior pressure
may destabilize the Pin Guide.
Drill and Pin the Anterior Pin Holes
• Drill and pin the medial and lateral anterior pin holes of
the Pin Guide using the Universal Disposable Drill
(2001-00-000) (Fig. 2).
Drill Distal Pin Holes
• Drill the distal pin holes of the Pin Guide (do not place pins)
(Fig. 3).
Fig. 2
Fig. 3
Fig. 1
Instruments
PSI Femoral
Pin Guide
00-5970-015/
018-00
Universal Pin
and Drill Kit
2001-00-000

SECTION
2
Instruments
TECHNIQUE TIP 1A.B
In the event the drilled distal holes are covered up following the distal
cut, clean the area. Alternatively, prior to removing the anterior pins,
place the Pin Guide back over the anterior pins and locate the distal
pins through the distal Pin Guide holes (Fig. 6).
Fig. 4
Fig. 5
Fig. 6
Place Distal Cut Guide and Cut Femur
• Remove the Pin Guide by sliding it off the pins, leaving the
anterior pins in the bone.
• Secure the MIS Distal Cut Guide (00-5967-036-00).
• Verify the distal resection on the medial and lateral side
with a resection guide (00-5977-084-00). Check alignment
if desired, and make the cut (Fig. 4).
Remove Distal Cut Guide and Place Distal Pins
• Locate the drilled pin holes.
• Remove the anterior pins
• Place the distal pins in drilled holes of the distal femur
(Fig. 5).
TECHNIQUE TIP 1A.A
When performing the cuts, excessive force (considering the pressure
being applied to the guide) on the medial or lateral side of the cut
guide could influence the amount of varus/valgus in the cut.
Instruments
MIS Distal
Cut Guide
00-5967-036-00
Resection Guide
00-5977-084-00
PSI Femoral
Pin Guide
00-5970-015/
018-00
NexGen® Conventional Instruments – Femoral Technique
1A

SECTION
3
Fig. 7
Place Femoral Finishing Guide
• Place the NexGen 4-in-1 Femoral Finishing Guide (silver) or
the Flex Femoral Finishing Guide (gold) over the distal pins.
• Adjust the M/L positioning for appropriate placement.
• Secure the Finishing Guide and remove the pins.
Verify resections using a resection guide and make
the cuts (Fig. 7).
Follow 4-in-1 Femoral Surgical Technique
• Following the 4-in-1 cuts, proceed with the surgery as
suggested in the Zimmer MIS Multi-Reference® 4-in-1
Femoral Instrumentation Surgical Technique.
NexGen® Conventional Instruments – Femoral Technique 1A
Instruments
NexGen MIS
4-in-1 Femoral
Finishing Guide
00-5983-031/38-00
NexGen MIS
4-in-1 Flex Femoral
Finishing Guide
00-5983-041/48-00
Resection Guide
00-5977-084-00
-OR-

SECTION
4
NexGen® Conventional Instruments – Tibial Technique
NexGen Conventional Instruments –
Tibial Technique
Position Tibial Pin Guide
• Remove the meniscus.
• Do not remove osteophytes from the tibia. Clean the bone
around the ACL and anterior tibia where the guide fits.
Remove any soft tissues that may prevent proper placement
of the Pin Guide.
• Position the Pin Guide on the tibia (Fig. 8).
• The rotation cylinders do not make contact with bone surface .
Both cylinders will be above the tibia surface. All other
contact with the Pin Guide should ensure a proper fit.
• The mechanical axis and proximal resection lines may be
used to asses the alignment. Additionally, the alignment
arch (00-5977-024-00) and rod (00-5785-080-00) may
be used to verify alignment. Additionally, the alignment
adapter (00-5970-024-00) and rod (00-5785-080-00)
may be used to verify alignment.
Drill and Pin Anterior Pin Holes
• Drill and pin the medial and lateral anterior holes of the
Pin Guide (Fig. 9).
Fig. 8
Fig. 9
1B
Instruments
PSI Tibia
Pin Guide
00-5970-015/
018-00
Universal Pin
and Drill Kit
2001-00-000
Alignment Adapter
00-5970-024-00
Alignment Rod
00-5785-080-00

SECTION
5
NexGen® Conventional Instruments – Tibial Technique
Establish Tibia Rotation (Drill Proximal Holes)
• Tibia rotation may be established through the Pin Guide
per surgeon discretion.
• Drill the proximal medial and lateral holes of the Pin Guide
(do not place pins) (Fig. 11).
Remove Tibial Pin Guide
• Remove the Pin Guide by sliding anteriorly off the pins
(Fig. 12). Do not pry the Pin Guide from the tibia as this
could shift the pins.
Fig. 11
Fig. 12
1B
Instruments
PSI Tibia
Pin Guide
00-5970-015/
018-00
Universal Pin
and Drill Kit
2001-00-000
TECHNIQUE TIP 1B.A
When drilling the proximal holes, excessive side loads through the
proximal guide cylinders could alter the planned hole position.

SECTION
6
Fig. 15
Secure Cut Guide and Cut Tibia
• Secure the NexGen Tibial Cut Guide. Verify the
proximal resection on the medial and lateral side
with a resection guide.
• Make tibial cut (Fig. 14).
• Use the appropriate right or left tibia cut guide.
0° Left Cut Guide 00-5997-075-00
0° Right Cut Guide 00-5997-076-00
• Insert the Alignment Arch into the Tibial Cut Guide, insert
the Alignment Rod and check alignment.
Note: Two options are available for visually verifying the tibia
alignment.
• The first option uses the standard alignment arch (00-
5977-024-00). The pin placement of the tibial Pin Guide
is offset 20 degrees medially to avoid soft tissues. Noting
this offset placement, ensure the alignment rod is parallel
with respect to the tibial shaft (Fig. 15).
• The second option uses the alignment adapter which
accounts for the medial offset and provides a more
traditional observance (aligned to the tibia shaft) for the
visual alignment check.
Alignment Adapter 00-5970-024-00
Alignment Arch 00-5977-024-00
Alignment Rod 00-5785-080-00
TECHNIQUE TIP 1B.C
When performing the cuts, excessive force (considering the pressure
from leaning on the guide) on the medial or lateral side of the cut
guide could influence the amount of varus/valgus in the cut.
Fig.14
TECHNIQUE TIP 1B.B
When fixating the Cut Guide, excessive force from screws can alter the
planned location and could influence the amount of varus/valgus in
the cut.
NexGen® Conventional Instruments – Tibial Technique
1B
Instruments
NexGen Tibial
Cut Guide
00-5997-075/
076-00
Alignment Rod
00-5785-080-00
Alignment Adapter
00-5970-024-00

SECTION
7
Position Tibial Sizing Plate
• Position the tibial sizing plate to align with the drilled
proximal holes (Fig. 16).
TECHNIQUE TIP 1B.D
In the event the drilled proximal holes are covered up following the
proximal cut, clean the area. Alternatively, prior to removing the
anterior pins, place the Pin Guide back over the anterior pins and
locate the proximal holes through the Tibial Pin Guide.
Fig. 16
Follow 4-in-1 Femoral Surgical Technique
• Following the positioning of the tibial plate, proceed with the
surgery as suggested in the Zimmer MIS Multi-Reference 4-in-1
Femoral Instrumentation Surgical Technique.
NexGen® Conventional Instruments – Tibial Technique 1B
Instruments
NexGen Tibial
Sizing Plate
(see above)
NexGen Locking
Tibial Tray
Provisional Handle
00-5977-096-00
NexGen PRI
Offset Sizing
Plate Handle
00-5953-096-00
Alignment Rod
00-5785-080-00
-OR-
3o Fluted Tibial Plate (00-5999-060-01_02)
7o Fluted Tibial Plate (00-5997-060-01_02)
Trabecular Metal™ Tibial Plate
(00-5953-012-02_08)
Trabecular Metal Monoblock Tibial Plate
(00-5887-043_048-00)
Pegged Tibial Plate (00-5977-015-01_10)
7o Fluted Tibial Plate (00-5997-060-03_10) A/P Wedged Tibial Plate (00-5987-043_048-00)
3o Fluted Tibila Plate (00-5999-060-03_08) Stemmed Tibial Plate (00-5951-019-01_10)

SECTION
8
NexGen® Posterior Referencing Instruments – Femoral Technique
NexGen Posterior Referencing
Instruments – Femoral Technique
Position Femoral Pin Guide
• Do not remove osteophytes from the femur.
• Position the Pin Guide on the distal femur (Fig. 17).
• Pin Guide will be captured by the anterior and proximal
ridge of the femur. The guide fits over the edge on the
proximal bone to increase locking.
• The A/P axis reference line on the Pin Guide can be used
to assess alignment. The most distal end of the guide is
parallel to the epicondylar axis and can also be used as
reference.
• Apply anterior proximal pressure to the Pin Guide and verify
a secure fit. Applying posterior pressure may destabilize the
Pin Guide.
Drill and Pin the Anterior Pin Holes
• Drill and pin the medial and lateral pin holes of the Pin
Guide using the Universal Disposable Drill (2001-00-00)
(Fig. 18).
Drill Distal Pin Holes
• Drill the distal pin holes of the Pin Guide (do not place pins)
(Fig. 19).
Fig. 18
Fig. 19
Fig. 17
2A
Instruments
PSI Femoral
Pin Guide
00-5970-015/
018-00
Universal Pin
and Drill Kit
2001-00-000

SECTION
9
NexGen® Posterior Referencing Instruments – Femoral Technique
TECHNIQUE TIP 2A.A
When performing the cuts, excessive force (considering the pressure
being applied to the guide) on the medial or lateral side of the cut
guide could influence the amount of varus/valgus in the cut.
Fig. 20
Fig. 21
Fig. 22
Place Distal Cut Guide and Cut Femur
• Remove the Pin Guide by sliding it off the pins, leaving the
anterior pins in the bone.
• Secure the NexGen Posterior Referencing Distal Femoral
Resection Guide (00-5901-064-00)
• Verify the distal resection on the medial and lateral side
with a resection guide (00-5977-084-00). Check alignment
if desired, and make the cut (Fig. 20).
Place Posterior Referencing Femoral Cut Guide
• Secure the NexGen Posterior Referencing 4-in-1 Flex
Femoral cut guide, verify resections with a resection
guide and finish the femur following the instructions f
rom the Zimmer NexGen CR-Flex and LPS-Flex Knees
Surgical Technique with Posterior Referencing
Instrumentation (Fig. 22).
Remove Distal Cut Guide
• Locate the drilled pin holes.
• Remove the anterior pins (Fig. 21).
2A
Instruments
NexGen Posterior
Referencing
Distal Femoral
Resection Guide
00-5901-064-00
Resection Guide
00-5977-084-00
NexGen Posterior
Referencing
4-in-1 Flex Femoral
Cut Guide
00-5901-041/048-00
TECHNIQUE TIP 2A.B
In the event the drilled distal holes are covered up following the distal
cut, clean the area. Alternatively, prior to removing the anterior pins,
place the Pin Guide back over the anterior pins and locate the distal
pins through the distal Pin Guide holes.
TECHNIQUE TIP

SECTION
10
Instruments
NexGen Posterior Referencing
Instruments – Tibial Technique
Position Tibial Pin Guide
• Remove the meniscus.
• Do not remove osteophytes from the tibia. Clean the bone
around the ACL and anterior tibia where the guide fits.
• Remove any soft tissues that may prevent proper placement
of the Pin Guide.
• Position the Pin Guide on the tibia (Fig. 23).
• The rotation cylinders do not make contact with bone surface .
Both cylinders will be above the tibia surface. All other
contact with the Pin Guide should ensure a proper fit.
• The mechanical axis and proximal resection reference lines
on the Pin Guide can be used to assess alignment.
Drill and Pin Anterior Pin Holes
• Drill and pin the medial and lateral anterior holes of the
Pin Guide (Fig. 24).
Fig. 23
Fig. 24
Instruments
PSI Tibia
Pin Guide
00-5970-015/
018-00
Universal Pin
and Drill Kit
2001-00-000
NexGen® Posterior Referencing Instruments – Tibial Technique
2B

SECTION
11
Instruments
Establish Tibia Rotation (Drill Proximal Holes)
• Tibia rotation may be established through the Pin Guide
per surgeon discretion.
• Drill the proximal medial and lateral holes of the Pin Guide
(do not place pins) (Fig. 26).
Remove Tibial Pin Guide
• Remove the Pin Guide by sliding anteriorly off the pins
(Fig. 27). Do not pry the Pin Guide from the tibia as this could
shift the pins.
Fig. 26
Fig. 27
Instruments
PSI Tibia
Pin Guide
00-5970-015/
018-00
Universal Pin
and Drill Kit
2001-00-000
NexGen® Posterior Referencing Instruments – Tibial Technique 2B
TECHNIQUE TIP 2B.A
When drilling the proximal holes, excessive side loads through the
proximal guide cylinders could alter the planned hole position.

SECTION
12
Instruments
Fig. 30
Secure Cut Guide and Cut Tibia
• Secure the NexGen Posterior Referencing Tibial Cut Guide.
Verify the proximal resection on the medial and lateral side
with a resection guide.
• Make tibial cut (Fig. 29).
• Use the appropriate right or left tibia cut guide.
0° PRI Left Cut Guide 00-5901-075-00
0° PRI Right Cut Guide 00-5901-076-00
• Insert the Alignment Adapter into the Tibial Cut Guide,
insert the Alignment Rod and check alignment.
Note: If you wish to check alignment, use of the Tibia
Alignment Rod with the NexGen Posterior Referencing Tibia
Cut Guides allows for a standard observance of the tibia
alignment rod (Fig. 30).
PRI Alignment Adapter 00-5901-086-00
Alignment Rod 00-5785-080-00
TECHNIQUE TIP 2B.C
When performing the cuts, excessive force (considering the pressure
from leaning on the guide) on the medial or lateral side of the cut
guide could influence the amount of varus/valgus in the cut.
Fig. 29
TECHNIQUE TIP 2B.B
When fixating the Cut Guide, excessive force from screws can alter the
planned location and could influence the amount of varus/valgus in
the cut.
Instruments
NexGen PRI
Tibial Cut Guide
00-5901-075/
076-00
PRI Alignment
Adapter
00-5901-086-00
Alignment Rod
00-5785-080-00
NexGen® Posterior Referencing Instruments – Tibial Technique
2B

SECTION
13
Instruments
Position Tibial Sizing Plate
• Position the tibial sizing plate to align with the
drilled proximal holes (Fig. 31).
TECHNIQUE TIP 2B.D
In the event the drilled proximal holes are covered up following the
proximal cut, clean the area. Alternatively, prior to removing the
anterior pins, place the Pin Guide back over the anterior pins and
locate the proximal holes through the Tibial Pin Guide.
Follow NexGen Posterior Referencing
Instrumentation Surgical Technique
• Following the positioning of the tibial component,
proceed with the surgery as suggested in the Zimmer
NexGen CR-Flex and LPS-Flex Knees Surgical Technique
with Posterior Referencing Instrumentation.
Fig. 31
Instruments
NexGen Tibial
Sizing Plate
(see above)
NexGen Locking
Tibial Tray
Provisional Handle
00-5977-096-00
NexGen PRI
Offset Sizing
Plate Handle
00-5953-096-00
Alignment Rod
00-5785-080-00
-OR-
NexGen® Posterior Referencing Instruments – Tibial Technique 2B
3o Fluted Tibial Plate (00-5999-060-01_02)
7o Fluted Tibial Plate (00-5997-060-01_02)
Trabecular Metal Tibial Plate
(00-5953-012-02_08)
Trabecular Metal Monoblock Tibial Plate
(00-5887-043_048-00)
Pegged Tibial Plate (00-5977-015-01_10)
7o Fluted Tibial Plate (00-5997-060-03_10) A/P Wedged Tibial Plate (00-5987-043_048-00)
3o Fluted Tibila Plate (00-5999-060-03_08) Stemmed Tibial Plate (00-5951-019-01_10)

97-5970-075-00 1203-K02 ©2012 Zimmer, Inc.
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This documentation is intended exclusively for physicians and is not intended for laypersons.
Information on the products and procedures contained in this document is of a general nature
and does not represent and does not constitute medical advice or recommendations. Because
this information does not purport to constitute any diagnostic or therapeutic statement with
regard to any individual medical case, each patient must be examined and advised individually,
and this document does not replace the need for such examination and/or advice in whole or
in part. Please refer to the package inserts for important product information, including, but not
limited to, contraindications, warnings, precautions, and adverse effects.
Contact your Zimmer representative or visit us at www.zimmer.com
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