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

6
SECTION
3
Size Femur and Establish External Rotation
Size 1
Size 7
Size 12
3 . 2 mm Drill
00-5120-085-00
•After the Anterior Referencing sizer is appropriately
positioned on the femur, read the femoral size from the
engraved lines on the sizer tower and select the closest
size (Fig. 17). There are six even-sizes labeled on the left
side of the tower and six odd-sizes labeled on the right side
of the tower, with lines indicating the in-between sizes.
The 3° or 5° holes in the midline of the A/P portion of the
sizer are used to drill 3.2mm holes for pegs on the Anterior
Referencing 4-in-1 Femoral Cut Guide (Fig 18). A 3.2mm
pin may be placed in the first drilled hole to maintain an
“index” position prior to drilling the second hole. Remove
the screws, then remove the sizer.
•Slightly extend the knee and retract soft tissues to expose
the anterior femoral cortex. Clear any soft tissue from the
anterior cortex. Ensure that the leg is in less than 90° of
flexion (70°-80°). This will decrease the tension of the patellar
tendon to facilitate placement of the Anterior Referencing
Sizer Boom. The Anterior Referencing Sizer Boom telescopes
proximally/distally to facilitate optimal placement along
the anterior cortex. The engraved lines along the top of the
boom approximate the anterior flange lengths of the size 1,
7, and 12 femoral components (Fig. 16a). Once the Anterior
Referencing Sizer Boom is appropriately positioned, it should
be locked in place by tightening the knob at the end of the
boom clockwise (Fig. 16b).
TECHNIQUE TIP 3.C
- Lock boom after positioning to reduce the toggle of the boom tip.
This will also reduce the risk of notching.
- Positioning the sizing boom tip on the “high” part of the femur
by lateralizing the location of the sizing boom tip can often lessen
the likelihood of notching the femur.
- To size accurately, the sizing boom should be telescoped to the
size read from the tower. If the boom is telescoped to the exact size,
the tip of the boom will approximate the exit point of the saw blade
through the anterior cortex.
TECHNIQUE TIP 3.D
- The Multi Pin Puller cannot be used to extract the screw(s).
- This Anterior Referencing Sizer works only with these Anterior
Referencing 4-in-1 Femoral Cut Guides and Provisionals,
and implants referenced in this technique.
Fig. 16a
Fig. 16b
Fig. 18
Fig. 17
3 . 2 mm x 75 mm
Trocar Tipped Drill
Pin (
2 . 5 mm hex)
00-5901-020-00
Instruments

7
SECTION
4
Persona Anterior
Referencing
4 -in- 1
Cut Guide - Size
7
42-5099-085-62
Complete Femoral A/P and Chamfer Resections
Complete Femoral A/P and
Chamfer Resections
•By hand, place the 4-in-1 Cut Guide on the femur by aligning
the 2 pins on the back of the guide with the previously
drilled positioning holes (Fig. 19). Impact the face of the
guide until the guide is flush with the femur.
TECHNIQUE TIP 4.B
If the 2mm shift holes are to be used, assure that the desired holes
on the distal femur are used. The resection guide can be used as final
verification of the anticipated anterior and posterior resections.
Fig. 19
Fig. 20
Fig. 21a
Fig. 21b
Resection Guide
00-5977-084-00
3 . 2 mm Drill
00-5120-085-00
Instruments
•Place the Resection Guide through the anterior slot of the
cut guide to ensure the desired anterior resection (Fig. 20).
•If inadequate bone will be removed from the anterior cortex,
drill through the two holes on the face of the cut guide
(Fig. 21a). Use the Slaphammer to axially remove the cut
guide (Fig. 22a & 22b).
Place the next smaller-sized femoral
cut guide on the femur
in the newly drilled “posteriorized”
drill holes (Fig. 21a & 21b).
Verify the anterior and posterior
resection levels with the resection guide to assure that the
desired resections will be attained. If usage of the smaller-
sized femoral cut guide will result in too much posterior bone
removal the original larger-sized femoral cut guide can be
used to make a more conservative posterior resection.
TECHNIQUE TIP 4.A
The flatness of the bone and stability of the 4-in-1 Cut Guide on the
femur is critical to ensuring sufficient contact between the implant
and the bone.

8
SECTION
4
1. Insert
2. Rotate
3. Extract
•After final placement of the desired Cut Guide, insert
3.2mm trocar-tipped pins or 3.2mm Headed Screws (see
Screw Information section for examples) through the
oblique holes in the Cut Guide (Fig. 23). Use a 1.27mm
(.050 in.) thick oscillating saw blade to complete the
anterior and posterior resections followed by the posterior
chamfer and anterior chamfer resections through the cut
slots. (Fig. 24) Upon completion of the cuts, use the Multi
Pin Puller or Pin/Screw Inserter to remove the oblique
pins/screws. Use the Persona Slaphammer to remove the
cut guide from the femur (Fig. 22a & 22b).
Complete Femoral A/P and Chamfer Resections
TECHNIQUE TIP 4.C
If there is a risk of anterior notching, the 4-in-1 cut guide can be
removed, rotated 180° and be replaced on the distal femur. Holes can
then be drilled through the 2mm shift holes on the face of the 4-in-1
guide. The 4-in-1 guide then needs to be removed, rotated 180° and
be placed on the distal femur in the anteriorized holes. This will result
in a 2mm anterior shift of the 4-in-1 femoral resections. Verify that the
desired anterior and posterior resections will be attained.
Fig. 22a Fig. 22b
Fig. 23
Fig. 24
TECHNIQUE TIP 4.E
- Areas where the bone transitions from high to low density, such as
from cancellous to cortical bone, can lead to the saw blade skiving
and inconsistent cuts. Use caution when resection in these regions.
Advancing an oscillating saw blade slowly through the bone while
using high frequency oscillations will help to ensure a flat, consistent
resection.
- Check the flatness of all bone resections to ensure sufficient contact
will result between the implant and the bone. If necessary, modify the
cut surfaces to be completely flat.
TECHNIQUE TIP 4.D
It is not recommended that the following Headed Screws are used
through the oblique holes of the Cut Guides, as the head of the screw
may interfere with the saw blade: 00-5791-041-00, 00-5791-043-00,
00-5791-044-00, 00-5061-063-00.
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
Pin/Screw
Inserter
00-5901-021-00

9
Instruments
SECTION
5
Persona CR Femoral
Provisional
Size
7 Right
42-5027-062-02
Persona Femoral
CR Impactor Pad
42-5099-094-00
Persona Femoral
Inserter/Extractor
42-5099-092-00
•Assemble the Femoral CR Impactor Pad to the Femoral
Inserter/Extractor. Hold the Femoral Inserter/Extractor
with the handle in the open position and insert the Femoral
CR Impactor Pad, aligning the "CR" on the Femoral CR
Impactor Pad with the arrow on the Femoral Inserter/
Extractor (Fig. 25a). The Femoral CR Impactor Pad is keyed,
so the Femoral CR Impactor Pad may have to be rotated
while placing and aligning the Femoral CR Impactor Pad
onto the Femoral Inserter/Extractor.
•Femoral sizes are provided in two profiles, Standard
and Narrow. The Standard femoral provisionals have
intermittent cutouts around the periphery, with the inner
dimension representing the outer profile of the Narrow
femoral implant and the outer dimension representing the
outer profile of the Standard femoral implant (Fig. 25b).
Care should be taken to use the appropriate Standard or
Narrow implant as is related to side (left or right) and size
based on the provisional fit and ROM provided during the
trialing phase.
Fig. 25b
CR Femoral Finishing
TECHNIQUE TIP 5.A
Reference the orientation and size etched and/or engraved markings
to identify the correct provisional.
TECHNIQUE TIP 5.B
Do not impact the anterior flange of the CR Femoral Provisional. Do not
impact the medial or lateral aspects or the release lever of the
Femoral Inserter/Extractor.
Narrow Cutouts
Note: Narrow phantom
lines are for illustration
clarity only.
Release Lever
Alignment Arrows
Fig. 25a
CR Femoral Finishing

10
SECTION
5
CR Femoral Finishing
Pinch to
release
•Remove any posterior osteophytes or overhanging bone
on the femur to facilitate maximum knee flexion. Attach
the Femoral Inserter/Extractor to the correct CR Femoral
Provisional by inserting the tab on the Femoral Inserter/
Extractor arm into the anterior notch in the CR Femoral
Provisional and close the handle on the Femoral Inserter/
Extractor to secure the CR Femoral Provisional (Fig. 26).
Place the correct CR Femoral Provisional onto the femur in
the desired medial/lateral position. Impact the end of the
Femoral Inserter/Extractor handle and apply an upward
force to fully seat the CR Femoral Provisional onto the femur
in the proper orientation. (Fig. 27). To remove the Femoral
Inserter/Extractor from the CR Femoral Provisional, pinch
the release lever on the proximal portion of the Femoral
Inserter/Extractor (Fig. 27). Alternatively, if the CR Femoral
Provisional is placed on the femur by hand, the CR femoral
Impaction Pad/inserter assembly can be used to impact
the provisional onto the femur. If this insertion/impaction
method is used, the inserter handle must be in the closed
and locked position. For additional fixation of the fully
seated provisional, insert the 25mm x 3.2mm screw
(2.5mm female hex) with the 2.5mm Male Hex Driver through
the hole in the lateral anterior flange of the CR Femoral
Provisional (Fig. 28).
Note: Do NOT use a 48mm screw in the anterior lateral fixation
hole. 48mm screws are not recommended due to potential
bone perforation.
•Once the tibia has been prepared, a trial range of motion can
be performed to assure proper positioning of the CR Femoral
Provisional prior to femoral peg hole preparation. Once
desired medial-lateral placement has been attained, drill the
peg holes for the femoral implant through the CR Femoral
Provisional with the NexGen®6.4mm Patella/Femoral Drill
(Fig. 29). If a screw was used to provide adjunct fixation,
remove the screw from the anterior flange in the CR Femoral
Provisional. The Slaphammer can be used to remove the
CR Femoral Provisional from the bone using the medial
hole on the CR Femoral Provisional (Fig. 30). Alternatively,
the Femoral Inserter/Extractor can be re-attached to the CR
Femoral Provisional to remove it from the bone. If necessary,
place the round end of the Slaphammer in the extraction
hole of the Femoral Inserter/Extractor to facilitate removal.
TECHNIQUE TIP 5.C
Do not impact the anterior flange of the CR Femoral Provisional
for removal, as this may damage the CR Femoral Provisional.
Fig. 26
Fig. 27 Fig. 28
Fig. 29
Fig. 30
Persona CR Femoral
Provisional
Size
7 Right
42-5027-062-02
Persona Femoral
CR Impactor Pad
42-5099-094-00
Persona Femoral
Inserter/Extractor
42-5099-092-00
NexGen
6 . 4 mm
Patella/Femoral
Drill
00-5120-052-01
Persona
Slaphammer
42-5099-037-00
1. Insert
2. Rotate
3. Extract
2 . 5 mm Male
Hex Driver
42-5099-025-00
25 mm x 3 . 2 mm
(2.5mm female hex)
42-5099-025-25
Instruments

11
Instruments
SECTION
6
Persona PS
Femoral Provisional
Size
7 Right
42-5007-062-02
Persona Femoral
PS Impactor Pad
42-5099-093-00
Fig. 31a
Fig. 31b
•Assemble the Femoral PS Impactor Pad to the Femoral
Inserter/Extractor. Hold the Femoral Inserter/Extractor,
with the handle in the open position and insert the Femoral
PS Impactor Pad, aligning the "PS" on the Femoral PS
Impactor Pad with the arrow on the Femoral Inserter/
Extractor (Fig. 31a). The Femoral PS Impactor Pad is keyed,
so the Femoral PS Impactor Pad may have to be rotated
while placing and aligning the Femoral PS Impactor Pad
onto the Femoral Inserter/Extractor .
•Femoral sizes are provided in two profiles, Standard
and Narrow. The Standard femoral provisionals have
intermittent cutouts around the periphery, with the inner
dimension representing the outer profile of the Narrow
femoral implant and the outer dimension representing
the outer profile of the Standard femoral implant (Fig. 31b).
Care should be taken to use the appropriate Standard or
Narrow implant as is related to side (left or right) and size
based on the provisional fit and ROM provided during the
trialing phase.
PS Femoral Finishing
and PS Box Preparation
TECHNIQUE TIP 6.A
Reference the orientation and size etched and/or engraved markings to
identify the correct provisional.
Persona Femoral
Inserter/Extractor
42-5099-092-00
Narrow Cutouts
Alignment Arrows
Release Lever
PS Femoral Finishing and PS Box Preparation
Note: Narrow phantom
lines are for illustration
clarity only.

12
SECTION
6
PS Femoral Finishing and PS Box Preparation
Persona PS
Box Provisional
6 - 9 Right
42-5007-060-12
Persona PS Box
Cut Guide
6 - 9
42-5099-060-03
TECHNIQUE TIP 6.B
Do not impact the anterior flange of the PS Femoral Provisional. Do not
impact the medial or lateral aspects or the release lever of the
Femoral Inserter/Extractor.
TECHNIQUE TIP 6.C
Do not impact the PS Box Cut Guide into the provisional.
•Remove any posterior osteophytes or overhanging bone
on the femur to facilitate maximum knee flexion. Attach
the Femoral Inserter/Extractor to the correct PS Femoral
Provisional by inserting the tab on the Femoral Inserter/
Extractor arm into the lateral notch in the PS Femoral
Provisional and close the handle on the Femoral Inserter/
Extractor to secure the PS Femoral Provisional (Fig. 32).
Place the correct PS Femoral Provisional onto the femur in
the desired medial/lateral position. Impact the end of the
Femoral Inserter/Extractor handle and apply an upward
force to fully seat the PS Femoral Provisional onto the femur
in the proper orientation. (Fig. 33). To remove the Femoral
Inserter/Extractor from the PS Femoral Provisional, pinch
the release lever on the proximal portion of the Femoral
Inserter/Extractor (Fig. 33). Alternatively, if the PS Femoral
Provisional is placed on the femur by hand, the PS Femoral
Impaction Pad/inserter assembly can be used to impact
the provisional into the femur. If this insertion/impaction
method is used, the inserter handle must be in the closed
and locked position. For additional fixation of the fully
seated PS Femoral Provisional, insert the 25mm x 3.2mm
screw (2.5mm female hex) with the 2.5mm Male Hex Driver
through the hole in the lateral anterior flange of the PS
Femoral Provisional (Fig. 34a).
Note: Do NOT use a 48mm screw in the anterior lateral fixation
hole of the PS Femoral provisional. 48mm screws are not
recommended due to potential bone perforation.
•By hand, insert and hold the correct-sized PS Box Cut Guide
into the anterior holes of the PS Femoral Provisional (Fig. 34b).
For additional fixation of the fully seated PS Box Cut Guide,
insert the 25mm x 3.2mm screw (2.5mm female hex) with the
2.5mm Male Hex Driver through one of the holes in the PS Box
Cut Guide. Separate PS Box Cut Guides exist for the PS Femoral
Provisional for sizes 3-5,6-9, and 10-12.
Fig.32
Fig. 34a Fig. 34b
Fig. 33
Persona Femoral
Inserter/Extractor
42-5099-092-00
Persona PS
Femoral Provisional
Size
7 Right
42-5007-062-02
Persona Femoral
PS Impactor Pad
42-5099-093-00
Pinch to
release
Instruments

13
SECTION
6PS Femoral Finishing and PS Box Preparation
• Make the anterior to posterior PS box cut with a 1.27mm
(.050 in.) thick, ½" wide oscillating or reciprocating saw
blade, by resting the saw blade in a parallel manner on the
front surface of the PS Box Cut Guide. Control the saw to
avoid over resection of the medial and lateral condyle in
the proximal area of the PS box (Fig. 35a). After completing
the anterior-to-posterior box cut, make the vertical wall cuts
for the PS notch cuts by resting the saw blade in a parallel
manner against the interior sidewalls of the PS Femoral
Provisional
(Fig. 35b). If a screw was used to provide adjunct
fixation, remove the screw and the PS Box Cut Guide. By hand,
insert the correct-sized PS Box Provisional into the PS Femoral
Provisional to assure that adequate bone has
been removed
for the implant AND for proper patella trialing.
Separate left
and right PS Box Provisionals exist for sizes
3-5, 6-9, and
10-12 PS Femoral Provisionals
(Fig. 36).
TECHNIQUE TIP 6.D
If the appropriately sized PS Box Provisionals does not easily seat into
the PS Femoral Provisional, perform clean up cuts to assure adequate
bone has been removed. Do NOT impact the PS Box Provisional. Make
sure the PS Femoral Provisional is fully seated after inserting the
correct PS Box Provisional.
Fig. 35a Fig. 35b
Fig. 36
•Drill the peg holes for the femoral implant through the
PS Femoral Provisional with the NexGen 6.4mm Patella/
Femoral Drill (Fig 37). Remove the screw from the anterior
flange in the PS Femoral Provisional. Remove the PS Box
Provisional. The Slaphammer can be used to remove the
PS Femoral Provisional from the bone using the medial
hole on the PS Femoral Provisional (Fig 38). Alternatively,
the Femoral Inserter/Extractor can be re-attached to the PS
Femoral Provisional to remove it from the bone. If necessary,
insert the Slaphammer in the extraction hole of the Femoral
Inserter/Extractor to facilitate removal.
Fig. 37
Fig. 38
TECHNIQUE TIP 6.E
Do not impact the anterior flange of the PS Femoral Provisional
for removal, as this may damage the PS Femoral Provisional.
NexGen 6.4mm
Patella/Femoral
Drill
00-5120-052-01
Persona
Slaphammer
42-5099-037-00
2. Insert
1. Remove
3. Rotate
4. Extract
2.5mm Male
Hex Driver
42-5099-025-00
25 mm x 3 . 2 mm
(
2 . 5 mm female hex)
42-5099-025-25
Instruments

14
SECTION
7
Implant Femoral Components
Persona
Trabecular Metal
PS Femoral Component
Size 7Right
42-5008-062-02
Persona
Trabecular Metal
CR Femoral Component
Size 7 Right
42-5028-062-02
1. Unlock Collar
2. Insert
3. Release
4. Rotate
Implant Femoral Components
After the implants have been chosen, make a final check to
ensure that the size chosen for the femoral, tibial, and articular
surface are compatible.
Cementless Implantation Option
•With the knee in 70°-90° of flexion, retract the soft tissue in
the desired manner.
Attach the Femoral Inserter/Extractor to
the femoral component (Fig. 39a & 39b). Insert the femoral
component onto the distal femur by translating the component
laterally until the lateral peg aligns with the drill hole in the
lateral femoral condyle. Take care to avoid scratching the
implant component surfaces. After the femoral component is
placed on the femur and the inserter/extractor is removed, the
impaction head/inserter assembly can be used to impact the
component onto the femur. If this insertion/impaction method
is used,the inserter handle must be in the closed and locked
position. Ensure that soft tissue is not trapped beneath the
implant. Alternatively, assemble the Quick Connect Handle to
the Femoral Impactor Head (Fig. 40). Use the Femoral Impactor
Head assembly to fully seat the femoral component (Fig. 41).
Remove retractors, and check the medial and lateral sides to
make sure the femoral component is fully impacted distally.
Fig. 39a Fig. 39b
Fig. 41
Fig. 42
Fig. 40
Quick Connect
Handle
00-5901-034-00
Femoral Impactor
Head
00-5901-032-00
Persona Femoral
Inserter/Extractor
42-5099-092-00
Persona Femoral
PS Impactor Pad
42-5099-093-00
Persona Femoral
CR Impactor Pad
42-5099-094-00
TECHNIQUE TIP 7.A
- Apply upward force on the Femoral Inserter/Extractor while
impacting the femoral implant to ensure component is placed
in proper orientation.
-Carefully engage the pegs or the intercondylar box of the femoral
implant into the pre-drilled peg holes or resected box and impact the
femur onto the bone until stable. Periodically check the alignment
with the bone cuts to ensure the implant is seating properly.
- The Trabecular Metal material extends above the femoral implant
rail by approximately 0.5mm and has a dark color, which may appear
not fully seated. If no light is visible beneath the distal surface
and the bone, the implant is fully seated. Small gaps between the
Trabecular Metal surface and the chamfer bone cuts may be visible
and are acceptable (Fig. 42).
- Do not intra-operatively re-insert a previously extracted Persona
Trabecular Metal femoral implant.
Instruments

15
Instruments
SECTION
7
Cemented Implantation Option
TECHNIQUE TIP 7.B
Prior to cementing implants remove provisionals and use pulse lavage
to remove unwanted debris from the resected bone surfaces
and the joint space.
•Cement may be used to fix the Persona Trabecular Metal
Femoral Component. After the implants have been chosen,
make a final check to ensure that all components are
compatible. If the resected surfaces of the femur is sclerotic,
drill multiple holes with a small drill (2.0mm-3.2mm) to
improve cement intrusion. The cement should have a doughy
consistency when ready for use.
•With the knee in 70°-90° of flexion, retract the soft
tissue in the desired manner. Place a layer of cement on
the underside of the prosthesis and in the holes drilled
in the femur. Attach the Femoral Inserter/Extractor to the
femoral component (Fig. 43a & 43b). Insert the femoral
component onto the distal femur by translating the
component laterally until the lateral peg aligns with the
drill hole in the lateral femoral condyle. Take care to avoid
scratching the implant component surfaces. After the
femoral component is placed on the femur and the inserter/
extractor is removed, the impaction head/inserter assembly
can be used to implant the component onto the femur.
If this inserter/extractor method is used, the inserter handle
must be in the closed and locked position. Ensure that soft
tissue is not trapped beneath the implant. Alternatively,
assemble the Quick Connect Handle to the Femoral Impactor
Head (Fig. 44). Use this assembly to fully seat the femoral
implant (Fig. 45). Remove retractors, and check the medial
and lateral sides to make sure the femoral implant is fully
impacted distally. Remove any excess cement in a thorough
and consistent manner.
Implant Femoral Components
Fig. 43a Fig. 43b
Tibial Impactor
Head
00-5901-033-00
Quick Connect
Handle
00-5901-034-00
Femoral Impactor
Head
00-5901-032-00
Persona Femoral
Inserter/Extractor
42-5099-092-00
Persona Femoral
PS Impactor Pad
42-5099-093-00
Persona Femoral
CR Impactor Pad
42-5099-094-00
Persona
Trabecular Metal
PS Femoral Component
Size 7Right
42-5008-062-02
Persona
Trabecular Metal
CR Femoral Component
Size 7Right
42-5028-062-02
1. Unlock Collar
2. Insert
3. Release
4. Rotate
Fig. 45
Fig. 44