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Zimmer Biomet NexGen MIS LPS-Flex Surgical Technique Manual

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Summary of Contents for Zimmer Biomet NexGen MIS LPS-Flex

  • Page 1 NexGen MIS LPS-Flex ® Mobile Implant System Surgical Technique...

  • Page 2: Table Of Contents

    Table of Contents Introduction ............................2 NexGen MIS LPS-Flex Mobile Bearing Knee ...............3 MIS LPS-Flex Mobile Tibial Implant ..................3 MIS Multi-Reference 4-in-1 Instruments ................4 Patient Selection .........................4 Preoperative Planning .......................5 Surgical Technique ...........................6 Patient Preparation ........................6 Incision and Exposure .......................7 MIS Medial Parapatellar Arthrotomy ..................8...
  • Page 3 Step Six: Finish the Femur ......................29 Option One: Anterior Referencing Technique Option Two: Posterior Referencing Technique Surgeon Notes and Tips Step Seven ..........................36 Option One: MIS Notch/Chamfer Trochlear Guide Using the MIS Notch/Chamfer Guide to downsize the femur Option Two: MIS QS Notch Guide Step Eight: Check Flexion Gap ....................

  • Page 4: Introduction

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique Introduction Successful total knee arthroplasty (TKA) depends in part on re-establishment of normal lower extremity alignment, proper implant design and orientation, secure implant fixation, adequate soft tissue balancing and stability.

  • Page 5: Nexgen Mis Lps-Flex Mobile Bearing Knee

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique NexGen MIS LPS-Flex Mobile Bearing Knee MIS LPS-Flex Mobile Tibial Implant The NexGen ® MIS LPS-Flex Mobile Bearing Knee The MIS tibial component is the first tibial implant is a posterior stabilized prosthesis designed to...

  • Page 6: Mis Multi-Reference 4-In-1 Instruments

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique MIS Multi-Reference ® 4-in-1 Instruments Patient Selection MIS Multi-Reference 4-in-1 Instruments are designed Total knee arthroplasty using a less invasive technique to help the surgeon accomplish the goals of total is suggested for nonobese patients with preoperative knee arthroplasty by combining optimal alignment flexion greater than 90°.

  • Page 7: Preoperative Planning

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique Preoperative Planning The surgical technique helps the surgeon ensure that Anatomical axis of femur anatomic alignment of 4° to 6° valgus angulation to the Axis of the tibia mechanical axis is achieved. A full leg A/P radiograph...

  • Page 8: Surgical Technique

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique Surgical Technique Patient Preparation To prepare the limb for total knee arthroplasty, Surgical technique is an important factor to consider adequate muscle relaxation is required. This will when attempting to maximize range of motion in facilitate the eversion of the patella, if desired, and total knee arthroplasty.

  • Page 9: Incision And Exposure

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique Incision and Exposure The skin incision can be made at the surgeon’s discretion with the leg in flexion or extension. Most surgeons find it easier to make the incision with the knee flexed. This provides skin tautness, and some retraction on the skin edges.

  • Page 10: Mis Medial Parapatellar Arthrotomy

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique MIS Medial Parapatellar Arthrotomy Minimally invasive total knee arthroplasty has become a popular procedure with surgeons using a variety of surgical exposures including the limited medial parapatellar arthrotomy; the midvastus approach; subvastus approach; and Quad-Sparing™ approach.

  • Page 11: Mis Midvastus Approach

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique MIS Midvastus Approach The capsular incision from the superomedial corner of the patella distally to the tissue overlying the medial tibia is routine in all medial capsular approaches. Preserve approximately 1 cm of peritenon and capsule medial to the patellar tendon to facilitate complete capsular closure.
  • Page 12 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 10 | MIS Midvastus Approach (cont.) The knee is in extension for the preliminary portion Once the patella is subluxed, one or two standard-size of the lateral knee exposure. First, the mobility of Hohmann retractors placed along the lateral flare of the patella is determined.

  • Page 13: Mis Subvastus Approach

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 11 | MIS Subvastus Approach Becoming accustomed to operating through a small incision and adopting the concept of a mobile window may be facilitated by starting with a shortened medial parapatellar arthrotomy. This will help to improve visualization of the anatomy during the initial stages of becoming familiar with an MIS approach.

  • Page 14: Mis Quad-Sparing™ Arthrotomy

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 12 | MIS Quad-Sparing™ Arthrotomy Soft Tissue Releases Training available at The Zimmer Biomet Institute. Total knee arthroplasty is a soft tissue operation as well as a bone resection operation. The objective of...

  • Page 15: Varus Release

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 13 | Varus Release To correct most fixed varus deformities (Figure 10), progressively release the tight medial structures Tensed until they reach the length of the lateral supporting structures. The extent of the release can be monitored by inserting laminar spreaders within the femorotibial joint and judging alignment with a plumb line.

  • Page 16: Valgus Release

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 14 | Valgus Release When correcting a fixed valgus deformity, the lateral release will include the arcuate complex, iliotibial Tensed band and lateral collateral ligament. When possible the popliteus tendon is preserved to maintain flexion stability.

  • Page 17: Step One: Resect Proximal Tibia

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 15 | Tibial Cut Guide Tubercle Anchor MIS Tibial Adjustable Rod MIS Distal Telescoping Rod Ankle Clamp Figure 1b or Spring Arrows showing correct alignment Ankle Bar Figure 1a MIS tibial cut guide assembly...
  • Page 18 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 16 | Tubercle Anchor Figure 1c Figure 1d Assemble the Guide (cont.) Insert the correct right or left tibial cut guide into Attach the correct right or left tubercle anchor onto the adjustable rod and rotate the thumb wheel the corresponding side of the adjustable rod.

  • Page 19: Position The Guide

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 17 | Tibial Cut Guide Tubercle Anchor Hole Figure 1e Figure 1f Figure 1g Position the Guide Place the spring arms of the ankle clamp around the Note: Be sure that only the low-profile portion...
  • Page 20 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 18 | Resection Guide Figure 1h Figure 1i Position the Guide (cont.) Adjust the distal end of the MIS distal telescoping rod Use the hex-head screwdriver to tighten all of the by moving the slide at the foot of the rod medially or screws on the tibial assembly to maintain position.

  • Page 21: Set The Final Resection Level

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 19 | MIS Tibial Depth Resection Stylus Figure 1j Figure 1k Set the Final Resection Level With the tibial cut guide flush against the anteromedial Alternatively, swing the 10 mm arm of the MIS tibial...

  • Page 22: Set The Final Resection Level

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 20 | Figure 1l Figure 1m Set the Final Resection Level (cont.) Remove the MIS tibial depth resection stylus. Place These two points of resection will usually not coincide. another MIS screw through the central anterior hole The surgeon must determine the appropriate level of on the cutting head (Figure 1m).

  • Page 23: Resect The Proximal Tibia

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 21 | Figure 1n Resect the Proximal Tibia Use a Kocher clamp to remove the tibial bone fragment. Use a 1.27 mm (0.050 in) oscillating saw blade through the slot on the tibial cut guide to cut the proximal Then trim any remaining bone spikes on the posterior and lateral aspects of the resected tibial surface.

  • Page 24: Step Two: Establish Femoral Alignment

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 22 | Figure 2a Figure 2c Figure 2b Step Two: Establish Femoral Alignment Use the 8 mm IM drill w/step to drill a hole in the The adjustable IM alignment guide is available with center of the patellar sulcus of the distal femur (Figure two intramedullary rod lengths.
  • Page 25 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 23 | Hex-head Screwdriver Figure 2e Standard Cut Plate Figure 2d Figure 2f Step Two: Establish Femoral Alignment (cont.) The standard cut plate must be attached to the Insert the IM guide into the hole in the distal femur.

  • Page 26: Step Three: Cut The Distal Femur

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 24 | Figure 3a Figure 3b Figure 3c Step Three: Cut the Distal Femur While the adjustable IM alignment guide is being Using the 3.2 mm drill bit, drill holes through the two inserted by the surgeon, the scrub nurse should attach standard pin holes marked “0”...
  • Page 27 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 25 | Figure 3e Figure 3d Figure 3f Step Three: Cut the Distal Femur (cont.) If more fixation is needed, use two 3.2 mm headed Completely loosen the attachment screw (Figure 3e) in screws (Figure 3d) or predrill and insert two hex-head the distal placement guide.

  • Page 28: Step Four: Check Extension Gap

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 26 | Figure 4a Step Four: Check Extension Gap After the proximal tibia and distal femur have been Drop the alignment rod with coupler into the spacer/ resected, the extension gap is evaluated.

  • Page 29: Step Five: Size Femur And Establish External Rotation

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 27 | Figure 5a Figure 5b Step Five: Size Femur and Establish External Rotation Flex the knee to 90°. Attach the MIS threaded handle threaded handle before using the screw inserter/ extractor. Then remove the threaded handle and to the medial side of the mini A/P sizing guide, and insert a 3.2 mm (1/8 in.) headed screw or predrill and...
  • Page 30 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 28 | Figure 5d Figure 5c Figure 5e Step Five: Size Femur and Establish External Rotation (cont.) Read the femoral size directly from the guide between Use a 3.2 mm drill to drill through the two holes that the engraved lines on the sizing tower (Figure 5c).

  • Page 31: Step Six: Finish The Femur

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 29 | Figure 6a Step Six: Finish the Femur Option One: Anterior Referencing Technique Option One Select the correct size MIS femoral finishing guide Anterior Referencing Technique (silver colored) or MIS flex femoral finishing guide...
  • Page 32 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 30 | Figure 6b Figure 6d Figure 6c Figure 6e Option One: Anterior Referencing Technique (cont.) When the proper rotation and the mediolateral and Use the resection guide through the anterior cutting...
  • Page 33 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 31 | Figure 6f Figure 6h Figure 6g Figure 6i Option One: Anterior Referencing Technique (cont.) Use the patellar/femoral drill bit to drill the post holes Remove the headless holding pins from the femoral if not done previously.

  • Page 34: Option Two: Posterior Referencing Technique

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 32 | Figure 6k Figure 6j Figure 6l Option Two: Posterior Referencing Technique Select the appropriate size MIS femoral finishing guide Place the finishing guide on the distal femur, bringing (silver-colored) or MIS flex femoral finishing guide...
  • Page 35 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 33 | Figure 6m Figure 6o Figure 6n Option Two: Posterior Referencing Technique (cont.) When the proper rotation and the mediolateral and For additional fixation, drill the post holes using the anteroposterior position are achieved, secure the patellar/femoral drill bit (Figure 6n).
  • Page 36 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 34 | Figure 6p Figure 6r Figure 6q Figure 6s Option Two: Posterior Referencing Technique (cont.) Use the patellar/femoral drill bit to drill the post holes Alternatively, the MIS locking boom attachment can if not done previously.

  • Page 37: Surgeon Notes And Tips

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 35 | Surgeon Notes and Tips • Although a sequence of femoral cuts has been • An oscillating saw with a narrow blade may also be provided, the cuts may be made in any sequence.

  • Page 38: Step Seven

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 36 | Figure 7b Insert two short headed pins or short screws through the anterior flange Figure 7a Figure 7c Position the MIS notch/chamfer guide flush against the femur Secure the MIS notch/chamfer guide to the femur...
  • Page 39 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 37 | Figure 7d Figure 7f Cut the sides and base of the intercondylar box Apply the matching size MIS trochlear cuide with the holes aligned Figure 7e Figure 7g Cut the anterior and posterior chamfers...

  • Page 40: Using The Mis Notch/Chamfer Guide To Downsize The Femur

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 38 | Figure 7h Cut the sides and base of the trochlear groove Using the MIS Notch/Chamfer Guide to downsize the femur Protect the tibia. Use a reciprocating saw through the Select the preferred size notch/chamfer guide and...

  • Page 41: Option Two: Mis Qs Notch Guide

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 39 | Figure 7i Figure 7k Figure 7j Option Two: MIS QS Notch Guide Position the appropriate size MIS QS notch guide Secure the MIS QS notch guide to the femur with two onto the femur so it is flush against the resected 3.2 mm (1/8 in.) headed screws or predrill and insert...
  • Page 42 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 40 | Figure 7l Figure 7m Option Two: MIS QS Notch Guide (cont.) With the knee in flexion, remove posterior osteophytes with a 3/4 in. curve-on-flat osteotome (Figure 7l). Use a laminar spreader and the posterior femoral retractor...

  • Page 43: Step Eight: Check Flexion Gap

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 41 | Figure 8a Step Eight: Check Flexion Gap Balance Flexion/Extension Gaps Knee in 90° flexion. Use the spacer/alignment guides Knee in extension. Attach the alignment rod to the or MIS spacer/alignment guides to check ligament alignment rod with coupler.

  • Page 44: Step Nine: Prepare The Tibia

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 42 | Figure 9a Figure 9c Figure 9b Figure 9d Step Nine: Prepare the Tibia Note: If using the headless pins or small-head Assemble the LPS-Flex mobile broach and trialing holding pins, predrill using the 3.2 mm bone screw plate.
  • Page 45 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 43 | Figure 9e Figure 9f Step Nine: Prepare the Tibia (cont.) Attach the MIS sizing plate handle to the broach and Insert a small head holding pin into the lateral pin hole trialing plate assembly (Figure 9e).
  • Page 46 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 44 | Figure 9g Figure 9h Step Nine: Prepare the Tibia (cont.) A short-head pin or MIS screw is inserted into the Be sure that the component is properly positioned medial anterior oblique hole on the broach plate rotationally.

  • Page 47: Optional Technique: Position Based On Trial Range Of Motion

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 45 | Optional Technique: Position Based on Trial Range of Motion Insert the proper size femoral provisional, assembled After this process has occurred, mark the position of broach and trialing plates, and articular surface the component with methylene blue, electrocautery, provisional.

  • Page 48: Step Ten: Perform Trial Reduction

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 46 | PS or CR femoral rotation setting Trigger PS or CR tension setting Instrument hook Femoral rotation adjustment knob Locking handle Tension adjustment knob Slaphammer slot Figure 10a Figure 10b Insertion of Femoral Provisional Using...
  • Page 49 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 47 | Figure 10c Figure 10d Figure 10e Insertion of Femoral Provisional Using Optional MIS Femoral Inserter/Extractor (cont.) If needed, turn the adjustment knob (C) to achieve Translate the femoral provisional laterally until the...

  • Page 50: Removal Of Femoral Provisional Using Optional Mis Femoral Inserter/Extractor

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 48 | Figure 10f Figure 11a Figure 11b Removal of Femoral Provisional using Step Eleven: Finish the Tibia Optional MIS Femoral Inserter/Extractor Use the slaphammer extractor or small osteotome Ensure that (A) and (B) are still set properly for the to remove the trialing plate, leaving the broach plate provisional type being used (PS).
  • Page 51 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 49 | Figure 11c Figure 11e Figure 11d Figure 11f Step Eleven: Finish the Tibia (cont.) Technique Tip – When encountering unusually hard, Assemble the proper size MIS cemented broach to sclerotic bone on the proximal tibia, it is recommended the MIS tibial broach impactor (Figure 11d).
  • Page 52 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 50 | Figure 11i Figure 11g Figure 11h Figure 11j Step Eleven: Finish the Tibia (cont.) The orientation of the broach handle is important to Remove the tibial broach impactor assembly and bone ensure proper and complete broaching, resulting in plug (Figure 11h).

  • Page 53: Step Twelve: Prepare The Patella

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 51 | Figure 12a Step Twelve: Prepare the Patella Knee flexed 90°. Turn the patella approximately 90°. Remove all osteophytes and synovial insertions from To facilitate exposure, apply two towel clips to the around the patella.

  • Page 54: Resect The Patella

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 52 | Figure 12c Figure 12b Figure 12d Resect the Patella MIS Resection Guide Technique Note: The MIS patella resection guide is not Use the engraved lines to visualize the position of indicated for use with a lateral approach.
  • Page 55 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 53 | Figure 12f Figure 12e Figure 12g Resect the Patella (cont.) MIS Resection Guide Technique (cont.) Determine amount of bone to remain after Note: When releasing the buttons at the desired resection.
  • Page 56 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 54 | Figure 12h Figure 12j Figure 12i Figure 12k Resect the Patella (cont.) Patellar Reamer Technique – Universal Saw Guide Technique Total Surfacing Procedure Use the patellar reamer surfacing guides as templates Apply the universal patellar saw guide in line with the patellar tendon.
  • Page 57 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 55 | Figure 12m Figure 12l Figure 12n Resect the Patella (cont.) Patellar Reamer Technique – Total Surfacing Procedure (cont.) Apply the patellar reamer clamp at a 90° angle to the Attach the appropriate size patellar reamer blade...
  • Page 58 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 56 | 2 mm Figure 12o Figure 12p Resect the Patella (cont.) Insetting Technique Use the patellar reamer insetting guides as templates Use the patellar reamer depth stops to control the to determine the appropriate size guide and reamer.

  • Page 59: Finish The Patella

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 57 | Figure 12q Figure 12r Figure 12s Finish the Patella For the NexGen Primary Porous Patella With Trabecular Metal Material For the NexGen All-Polyethylene Patella Center the appropriate patellar drill guide over the...

  • Page 60: Optional Patella Protectors

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 58 | Suture Hole Figure 12t Optional Patella Protectors The patella may be resected before any other bone After the initial patella cut is completed, use thumb cuts. In that case, care should be taken to avoid pressure to press the patella protector against the bone.

  • Page 61: Step Thirteen: Perform A Final Trial Reduction

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 59 | Figure 13a Figure 13c Figure 13b Step Thirteen: Perform a Final Trial Reduction Insert the tibial plate provisional. Use the correct Use the femoral inserter/extractor and align the size MIS LPS-Mobile tibial plate provisional to ensure...
  • Page 62 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 60 | Figure 13d Figure 13e Step Thirteen: Perform a Final Trial Reduction (cont.) Check ligament stability in extension and in 30°, 60°, Knee in extension. Check to ensure that the femoral provisional is flush against the resected surface on the and 90°...

  • Page 63: Step Fourteen: Implant Components

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 61 | Figure 14a Use the Tibial Impactor to impact the tibial base plate. Step Fourteen: Implant Components Tibial Base Plate In this step, the final components are implanted, and Position the PCL retractor posteriorly, the collateral...

  • Page 64: Femoral Component

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 62 | Figure 14b Femoral Component Knee in 70°-90° flexion. Place the collateral retractor Remove the femoral impactor/extractor, and the laterally, an Army-Navy retractor anteriorly, and a rake retractors. Use the femoral impactor and mallet to make sure the femoral component is fully impacted.

  • Page 65: Tibial Articular Surface Implantation

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 63 | Figure 14c Figure 14d Tibial Articular Surface Implantation Next, bring the tibia into extension while the articular Knee in 70°-90° flexion. When the appropriately-sized surface is held in place against the femoral component.

  • Page 66: Techniques For 17 Mm And 20 Mm Articular Surface Assembly

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 64 | Figure 14e Figure 14f Techniques for 17 mm and 20 mm Articular Surface Assembly A secondary locking screw is required for the 17 mm- Alternatively, the LCCK tibial plate wrench that and 20 mm-thick articular surface components.

  • Page 67: Nexgen All-Polyethylene Patella

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 65 | Patellar Component – NexGen Primary Porous NexGen All-polyethylene Patella Patella with Trabecular Metal Material Knee in 70°-90° flexion. Apply cement to the anterior Knee in 70°-90° flexion surface and pegs of the patellar component while in a Note: If the implant post begins to engage at doughy consistency.

  • Page 68: Closure

    NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 66 | Figure 14h Figure 14i Closure Rehabilitation Protocol Freely irrigate the wound with the solution of choice. An equally important factor in gaining or maintaining A drain may be placed within the capsule. Proceed high flexion after successful total knee arthroplasty is with wound closure.
  • Page 70 NexGen MIS LPS-Flex Mobile Implant System Surgical Technique 68 | Notes...
  • Page 72 Please refer to the package inserts for important product information, including, but not limited to, indications, contraindications, warnings, precautions, and adverse effects. ©2017 Zimmer Biomet Legal Manufacturer Zimmer, Inc. 0086 1800 West Center Street...

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