Zimmer Persona Trabecular Metal Femoral Component User manual

Surgical Technique
Trabecular Metal™
Femoral Component

INTRO
INTRO.1
Introduction
The Persona®Trabecular Metal™Femoral Component is
designed to unite stable porous femoral component fixation
with compatible cruciate-retaining, ultracongruent, and posterior
stabilized articular surface implants. This Surgical Technique
covers all femoral preparation, finishing, and implantation
steps for the Trabecular Metal Femoral Component; please
reference the appropriate Persona Knee Surgical Technique for
all additional surgical steps including surgical approach, tibia/
patella preparation and implantation, balancing, constraint
options, and compatibility.
Successful porous femoral component arthroplasty is
dependent three key components:
1. Bone Resection Accuracy
Precise, flat bone cuts are essential to maximize
Trabecular Metal material contact with the resected bone
and ensure appropriate press-fit to promote stable,
long-term fixation.
2. Patient Bone Quality
The Persona Trabecular Metal Femoral component should
only be used on patients with good bone quality to ensure
in-growth will occur. Stable fixation may be compromised
if used on soft, osteoporotic bone quality.
3. Ambulation Period
An uncemented total knee replacement requires a
period of time to achieve stable bone growth into the
Trabecular Metal material for successful, long-term
fixation. As such, patient rehabilitation should be
tailored for porous knee components.
To achieve the three key components vital for successful
porous femoral component arthroplasty, some additional
TM-specific technique tips are as follows.
•Saw Blades
Use new saw blades and consider changing the saw
blade during the surgery if it becomes dull or ineffective.
•Distal Thickness
The Trabecular Metal Femoral Component is
approximately 0.5mm thicker distally than the
cemented component. Surgeons may elect to account
for this thickness during the distal femoral resection or
the proximal tibial resection.
Trabecular Metal™Femoral Component
Surgical Technique

INTRO
INTRO.2
Trabecular Metal™Femoral Component
Surgical Technique
•Cut Guide Stability
Two oblique pins are required for proper stability of the
4-in-1 Cut Guide. A well fixed and stable Cut Guide will
help ensure precise bone cuts for proper femoral fit.
Follow the order of femoral cuts as described in the
technique. Strict adherence to the cut order will help
ensure the Cut Guide is stable for all four cuts.
•Femoral Trial/Implant Insertion
Apply upward force on the inserter while impacting
the femoral provisional and/or implant. This will assist
in achieving the proper orientation of the femoral
component on the bone.
Due to the press-fit nature of a porous component,
more force may be required to insert a porous femoral
component than a cemented component.
•Femoral Trial/Implant Fit
A fully seated femoral provisional and/or implant
should have no gaps anteriorly, posteriorly, and distally.
Gaps in the anterior and posterior chamfer areas are to
be expected and can be filled with bone grafting,
if desired.
The Trabecular Metal material is approximately
0.5mm proud of the implant rails and has a darkened
appearance. If no light appears between the distal
bone face and the femoral implant, the implant is
properly seated.
Bone cement is recommended in cases in which
the implant fit has been compromised in any way.
A compromised fit could be encountered due to
femoral re-cuts, component extraction and re-insertion,
or unplanned voids in the bone. Trabecular Metal
Femoral Components are indicated for use with bone
cement if desired.
The complete technique contains further details and
instructions, wherein TM-specific tips are denoted with the
following symbol:

INTRO
INTRO.3
Trabecular Metal™Femoral Component
Surgical Technique
Magnet Usage
Warning: Some instruments in the Persona System contain magnets. All Persona magnetic instruments
should be kept at a safe distance from a patient’s active implantable medical device(s) (i.e. pacemaker).
These types of devices may be adversely affected by magnets. Instruments containing magnets should
be kept on an appropriate table or stand when not in use at the surgical site.
Symbols
Symbols have been established for the following:
• Left
• Right
• Varus/Valgus
• Medial/Lateral
• Standard
• Do not implant – Not for implant
• Lock
• Unlock
• Anterior Referencing
• Do not impact
• Cemented
• Stemmed
• Inset Only
Left Right Medial/Lateral
M/L
Standard
Std
Lock
Unlock
Do not implant -
Not for implant
Do not impact
Varus/Valgus
Inset OnlyCemented Stemmed
Anterior Referencing
*Note: The 2.5mm Female Hex Screws and
2.5mm Male Hex Driver should not be used in
cortical bone, as this may increase the incidence
of stripping of the driver.
The chart below contains relevant information on various 3.2mm Pins/Screws that are compatible
with the Persona system. If these screws/pins are used during the procedure for instrument fixation,
they should be removed prior to closure as they are NOT implantable.
Screw/Pin Screw/Pin Item # Compatible
Driver Shipped Sterile/ Non-sterile Quantity per Package Single use?
25mm x 2.5mm
Female Hex Screw
42-5099-025-25* 2.5mm Male Hex Driver
42-5099-025-00
Sterile 2Yes
75mm x 3.2mm
Trocar Tipped Drill Pin
(2.5mm hex)
00-5901-020-00
Pin/Screw Inserter
00-5901-021-00
Sterile 4Yes
Hex Headed Screw
33mm long
00-5901-035-33
Sterile 2Yes
MIS Quad-Sparing
Total Knee
Headed Screw
48mm long
00-5983-040-48
Screw Inserter/Extractor
00-5983-049-00
Sterile 1Yes
25mm Shorthead
Holding Pin
00-5977-056-03 Multi Pin Puller
00-5901-022-00
Non-Sterile 1 No
Screw/Pin Information

TOC
Trabecular Metal™Femoral Component
Surgical Technique
TOC.1
Table of Contents
Establish Femoral Alignment 1
Resect Distal Femur 3
Size Femur and Establish 5
External Rotation
Complete Femoral A/P 7
and Chamfer Resections
CR Femoral Finishing 9
PS Femoral Finishing 11
and PS Box Preparation
Implant Femoral Component 14
Persona
Trabecular Metal
Femoral Component
Surgical Technique

1
SECTION
Instruments
Establish Femoral Alignment
Insert
Unlock
Establish Femoral Alignment
Please refer to the appropriate surgical technique if other distal
femoral alignment and distal femoral resection instrumentation
is to be used to accomplish the distal femoral resection.
•
After attaining the desired soft tissue exposure, use the 8mm
IM Step Drill to make a starter hole (Fig. 1).
• Suction the canal to remove medullary contents.
• Insert the Femoral IM Rod into the Modular T-Handle (Fig. 2)
and insert the IM rod into the femur far enough to ensure the
most accurate replication of the anatomic axis, then remove
the T-handle (Fig. 3).
Fig. 1
Fig. 2
Fig. 3
TECHNIQUE TIP 1.A
As the symbol on the T-handle indicates – do not impact the T-Handle.
8mm IM Step Drill
00-5978-014-00
Modular
T-Handle
00-5901-061-00
Femoral IM Rod
00-5901-060-00
1

2
SECTION
Establish Femoral Alignment
TECHNIQUE TIP 1.B
If the epicondyles are visible, the epicondylar axis may be used as a
guide in setting the orientation of the Femoral Valgus Alignment Guide.
This does not set the rotation of the femoral component, but keeps the
distal cut oriented to the final component rotation. If desired, the guide
can be pinned to provide rotational stability (Fig. 6).
2. Rotate
1. Retract 3. Release Retraction
Optional Pinning Holes
5° Right Valgus Setting
•Retract the spring-loaded button on the top of the
Femoral Valgus Alignment Guide and rotate the valgus
adjustment dial to the desired valgus angle and release
the button to lock the valgus angle from 0° to 9°, ensuring
that the proper left or right setting is attained (Fig. 4).
•
Place the Femoral Valgus Alignment Guide on the IM Rod
against the most prominent condyle and confirm the
desired valgus setting (Fig. 5).
Fig. 4
Fig. 5
Fig. 6
75 mm x 3 . 2 mm
Trocar Tipped Drill
Pin (
2 . 5 mm hex)
00-5901-020-00
Femoral Valgus
Alignment Guide
00-5901-067-00
Pin/Screw
Inserter
00-5901-021-00
1

3
SECTION
2
Adjustment Dial
0 ° Captured/
Uncaptured
Cutting Head
00-5901-064-00
Distal Femoral
Resection Guide
00-5901-063-00
Femoral Valgus
Alignment Guide
00-5901-067-00
Modular
T-Handle
00-5901-061-00
Femoral IM Rod
00-5901-060-00
Resect Distal Femur
Resect Distal Femur
•Attach the 0° Captured Cutting Head to the Distal Femoral
Resection Guide (Fig. 7). The adjustment dial on the
resection guide can be set from “-2” to “+4”. The “0”
represents a 10mm distal resection (Fig. 8). The -1 setting
represents a 9mm resection while the +4 setting represents
a 14mm resection. Upon rotation, the dial has palpable
stops and clear markings at each 2mm location. One half
rotation creates 1mm of adjustment. Insert the resection
guide with the cutting head into the alignment guide until
the cutting head rests on the anterior femoral cortex.
Verify the desired resection setting on the resection guide
and/or rotate the adjustment dial to attain the desired
setting (Fig. 9). Insert trocar-tipped pins through the two
standard pin holes marked “0” on the anterior surface of
the cutting head (Fig. 10). Additional 2mm adjustments
may be made by removing the cutting head from the pins
and replacing the cutting head on the pins in the sets of
holes marked -2, +2, and +4. The markings on the cutting
head indicate, in millimeters, the amount of bone resection
each will yield relative to the initial distal resection setting.
TECHNIQUE TIP 2.A
If more fixation is desired, insert trocar-tipped pins in the small
oblique holes on the cutting head.
TECHNIQUE TIP 2.B
The Trabecular Metal Femoral Component is approximately 0.5mm
thicker distally than the Persona Cemented Femoral Component.
If desired, additional thickness may be accounted for in the distal
femoral resection or the proximal tibia resection.
Fig. 7
Fig. 8
Fig. 9
Instruments
•If pin(s) were used to maintain rotational alignment of the
alignment guide, use the Multi Pin Puller to remove the
pin(s). Alternatively, the Pin/Screw Inserter can be used
to remove these pin(s).

4
SECTION
2
Oblique Hole
Squeeze
to Unlock
Remove
Multi Pin Puller
00-5901-022-00
75 mm x 3 . 2 mm
Trocar Tipped Drill
Pin (
2 . 5 mm hex)
00-5901-020-00
Persona
Slaphammer
42-5099-037-00
Resect Distal Femur
TECHNIQUE TIP 2.C
- It is recommended to use new saw blades for femoral resections.
- Areas where the bone transitions from high to low density, such as
from cortical to cancellous bone, may cause the saw blade to skive
and result in an inconsistent cut. Use caution when resecting in these
regions and operate the saw at high speed but advance the saw
slowly to ensure a consistent cut.
- The flatness of the distal femoral resection is critical to ensuring
sufficient contact between the Persona Trabecular Metal femoral
implant and the bone. Evaluate the flatness of the distal femur
resection with a flat surface, such as the distal resection cutting
guide, especially around the intercondylar notch, prior to sizing.
Modify the distal femoral surface, if necessary, to ensure
subsequent guides and the implant fit properly.
Fig. 10
•After completing the cut, remove pins and the cutting head.
•Squeeze the button on the resection guide (Fig. 11) to
release and remove the alignment guide and resection guide
assembly from the cutting head. The modular T-handle is used
to remove the IM Rod, prior to the distal femoral resection.
•Alternatively, the T-handle can be used to remove the IM
Rod while the button on the resection guide is squeezed to
facilitate rapid removal of the IM rod, the alignment guide and
the resection guide at the same time. If necessary, the round
end of the Slaphammer Extractor can be used in conjunction
with the central hole in the T-Handle to remove the IM rod.
•Cut the distal femur through the cutting slot in the cutting
head, using a 1.27mm (0.050 in.) oscillating saw blade
(Fig. 12). If the optional uncaptured technique is used,
the distal femur should be cut on the outside surface
of the capture.
Note: The flatness of the distal femoral resection is
critical to ensuring adequate contact between the Persona
Trabecular Metal femoral implant and the bone. Evaluate
the flatness of the distal femur resection prior to sizing.
Fig. 11
Fig. 12
Pin/Screw
Inserter
00-5901-021-00

5
SECTION
3
Side Designation
2 . 5 mm Male
Hex Driver
42-5099-025-00
Persona Anterior
Referencing Sizer
42-5099-088-10
•Apply the Anterior Referencing Sizer so that the flat surface
of the Anterior Referencing Sizer is flush against the resected
surface of the distal femur and the feet of the Anterior
Referencing Sizer are flush against the posterior condyles.
Center the Anterior Referencing Sizer mediolaterally. Both the
vertical and horizontal portions of the Anterior Referencing
Sizer provide visual cues relative to the AP and epicondylar
axes of the femur to help ensure that desired external rotation is
attained. If the 3° external rotation holes are to be used to set
external rotation, the etched line on the Anterior Referencing
Sizer should be positioned so it is in line with Whiteside’s
line (Fig. 14) to optimize the M/L position of the drill holes for
subsequent Anterior Referencing 4-in-1 Cut Guide placement.
If the 5° external rotation holes are to be used, the sizer can
be positioned with the etched line on the Anterior Referencing
Sizer 4mm laterally from Whiteside’s line to better center the
drill holes for subsequent Anterior Referencing 4-in-1 Cut
Guide placement, due to the M/L offset of the holes. Hold the
Anterior Referencing Sizer in place and if necessary, secure the
Anterior Referencing Sizer to the femur using 25mm x 3.2mm
(2.5mm female hex) screws (Fig. 15) in one or both of the
holes on the lower portion of the Anterior Referencing Sizer to
help draw the Anterior Referencing Sizer adjacent to the distal
femur, particularly in MIS situations.
Note: Do not use 48mm screws for fixation of the Anterior
Referencing Sizer. 48mm screws are not recommended due to
potential bone perforation.
Size Femur and Establish External Rotation
Size Femur and Establish
External Rotation
•Rotate the feet of the Anterior Referencing Sizer so the
appropriate “Left” or “Right” markings are visible as the
Anterior Referencing Sizer is placed on the bone (Fig. 13).
External rotation can be set at 3° or 5° from the posterior
condylar axis.
TECHNIQUE TIP 3.A
Remove any osteophytes that interfere with instrument positioning.
TECHNIQUE TIP 3.B
Do not impact the Anterior Referencing Sizer onto the femur.
Fig. 14
Fig. 15
Fig. 13
Instruments
25 mm x 3 . 2 mm
(2.5mm female hex)
42-5099-025-25