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Zimmer Biomet Persona Surgical Technique

Revision knee system
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Persona
Revision
®
Knee System
Surgical Technique

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  • Page 1 Persona Revision ® Knee System Surgical Technique...

  • Page 2: Table Of Contents

    Table of Contents Quick Reference ......................2 Abbreviated Surgical Technique Instrumentation Overview Device Description ....................7 Optional Preoperative Templating ................7 Patient Preparation ....................7 Surgical Approach and Exposure ................7 Component Removal ....................8 Femoral Removal Tibial Removal Preliminary Flexion and Extension Gap Analysis ............. 8 Tibial Preparation Tibial Intramedullary Canal Preparation ..............
  • Page 3 Optional Femoral Augment Resection ..............32 Femoral Box Cut Preparation ................. 33 Patella Resurfacing ....................33 Final Trialing ......................34 CPS and CCK Bearing TASP Assembly TASP Shim Exchange TASP Removal Implant Assembly ....................37 Tibial Implant Assembly Optional Tibial Augment Assembly Femoral Implant Assembly Optional Femoral Augment Assembly Two Stage Cementing Technique ................

  • Page 4: Quick Reference

    Persona Revision Fixed Tibial Surgical Technique ® Quick Reference: Abbreviated Surgical Technique Step 1: Step 2: Step 3: Step 4: Optional Preoperative Tibial Canal Optional Proximal Tibial Sizing Templating Preparation Tibial Resection and Positioning Step 5: Step 6: Step 7:...
  • Page 5 Persona Revision Knee System Surgical Technique ® Step 13: Step 14: Step 15: Femoral Provisional Assembly Trial Reduction (TASP) Femoral Box Cut and Insertion Step 16: Step 17: Step 18: Patella Resurfacing Final Trialing Implant Assembly Step 19: Step 20:...

  • Page 6: Instrumentation Overview

    Note: Do not use implants and/or instruments from other knee systems unless expressly labeled for such use. Note: Do not use implants and/or instruments from the Persona Revision Knee System with other knee systems unless expressly labeled for such use.
  • Page 7 Persona Revision Knee System Surgical Technique ® 5 mm Hex Driver Fastens the: • Tibial and femoral provisional components to stem provisionals Removes the: • Tibial and femoral cone drill guides • Reamers to the stem extension post • Stem extension post •...
  • Page 8 Persona Revision Knee System Surgical Technique ® Instrumentation Overview (cont.) Femoral/Tibial Depths     A Tilt Reamer     B Canal Reamer   C Stem Extension Post   D Broach Pilot Adapter   E Cannulated Reamer   A   B  ...

  • Page 9: Device Description

    ® Device Description Patient Preparation The Persona Revision Knee System is designed for use If desired, provide a thigh tourniquet and inflate with in both complex primary and revision arthroplasty. the knee in hyperflexion to maximize the portion of the Persona Revision Knee System is a constrained revision quadriceps that is below the level of the tourniquet.

  • Page 10: Component Removal

    Persona Revision Knee System Surgical Technique ® Preliminary Flexion and Extension Gap Analysis Component Removal Femoral Removal Fully flex the knee and remove the bearing, allowing greater access to the implant/cement interface of both the femur and tibia. Disrupt the femoral implant/bone interface with flexible osteotomes or thin saw blades with an oscillating saw.

  • Page 11: Tibial Preparation

    Splined +135/+175 10–18, 20, 22, 24 progressively increasing the reamer diameter 6 mm size until cortical chatter is achieved. The Persona Tapered +30/+75 11, 14 Revision Reamer shafts are marked with the minimum ream depth marks to prepare for a...

  • Page 12: Optional Proximal Tibial Resection

    Persona Revision Knee System Surgical Technique 10 | ® Figure 8 Figure 9 Figure 10 Optional Proximal Tibial Resection Assess the remaining proximal tibial bone. Remove Note: Alternatively, the 2/10 mm tibial stylus can the least amount of bone necessary to provide for a be used to determine the amount of bone to resect.
  • Page 13 Persona Revision Knee System Surgical Technique 11 | ® Figure 11 Figure 12 Figure 13 Optional Proximal Tibial Resection (cont.) If necessary, pin the tibial resection cut guide to the tibia (Figure 11). Cut the tibia through the top slot on the tibial resection cut guide (Figure 12).

  • Page 14: Optional Tibial Augment Resection

    Persona Revision Knee System Surgical Technique 12 | ® Figure 15 Figure 16 Optional Proximal Tibial Cut (cont.) Optional Tibial Augment Resection If a tibial augment is necessary, use the resection guide (angel wing) to estimate the amount of bone resection needed to establish a supportive plateau through the tibial cut guide augment slots.

  • Page 15: Tibial Sizing And Positioning

    Persona Revision Knee System Surgical Technique 13 | ® Figure 18 Figure 17 Figure 19 Tibial Sizing and Positioning Reinsert the reamer, if necessary. If an offset stem is not required, ensure optimal tibial coverage and rotation and remove the TASP handle.

  • Page 16: Offset Stem Preparation

    Persona Revision Knee System Surgical Technique 14 | ® Figure 21 Figure 20 Figure 22 Tibial Sizing and Positioning (cont.) Offset Stem Preparation Note: Offset stems are available in the splined configuration only. The offset stem reamer adapter has two holes, one for 3 mm offset and one for 6 mm offset (Figure 20).

  • Page 17: Tibial Stem Housing Preparation

    Persona Revision Knee System Surgical Technique 15 | ® Thin Tibial Depth Line Figure 23 Figure 24 Tibial Stem Housing Preparation Tibial Sizing and Positioning (cont.) Straight Stem Preparation Only Ensure optimal tibial coverage and rotation and If the planned stem size has a diameter less than remove the TASP handle.

  • Page 18: Offset Stem Preparation Only

    Persona Revision Knee System Surgical Technique 16 | ® Thin Tibial Depth Line Figure 25 Figure 26 Figure 27 Figure 28 Thin Tibial Depth Line Figure 29 Tibial Stem Housing Preparation Figure 30 (cont.) Offset Stem Preparation Only Use a tilt reamer to clear out bone for the offset If an offset stem is utilized, make sure to align the line transition.

  • Page 19: Keel Preparation

    Appendix B: Tibial Central Cone rotating until locked (Figure 31). Preparation section on page 50. To prepare the tibia for a perimeter cone, reference the Persona Revision Place the tibial keel broach over the stem extension Large Defect Surgical Technique 2723.1-GLBL-en post and align with the marks made on the tibial for surgical steps.

  • Page 20: Tibial Baseplate Provisional Assembly And Insertion

    Persona Revision Knee System Surgical Technique 18 | ® Figure 34 Figure 35 Figure 36 Figure 37 Tibial Baseplate Provisional Assembly and Insertion Note: If planning to prepare for an augment while If an offset stem provisional is used, ensure the...
  • Page 21 Persona Revision Knee System Surgical Technique 19 | ® Figure 38 Figure 39 Figure 40 Tibial Baseplate Provisional Assembly and Insertion (cont.) Assemble the tibial impactor pad to the QC handle (Figure 38). Insert the tibial construct in the tibial canal while ensuring proper rotation.

  • Page 22: Optional Tibial Augment Resection

    Persona Revision Knee System Surgical Technique 20 | ® Figure 41 Figure 42 Figure 43 Figure 44 Optional Tibial Augment Resection Once assembled, insert the tibial augment Note: The keel provisional should not be assembled provisional/s (Figure 44). at this time.

  • Page 23: Femoral Preparation

    +30/+75 11, 14 reamer diameter size until cortical chatter is achieved. The Persona Revision Reamer shafts are marked with Note: + in addition to stem housing the minimum ream depth marks to prepare for a 135 mm and 175 mm stem extension implant for the tibia Note: For specific tapered stem preparation steps, and femur respectively (Figure 47).

  • Page 24: Optional Distal Femoral Resection

    Persona Revision Knee System Surgical Technique 22 | ® Figure 48 Figure 49 10 mm 5 mm 0 mm Figure 50 Figure 51 Figure 52 Optional Distal Femoral Resection Depending on the available femoral bone stock and Note: The 0 mm cut slot is designed to provide a surgical approach, it may be necessary to correct the clean up cut.

  • Page 25: Optional Femoral Sizing And Positioning

    Persona Revision Knee System Surgical Technique 23 | ® Figure 53 Figure 54 Figure 55 Optional Femoral Sizing and Positioning Straight Stem Preparation The femoral sizing/cut guide and straight stem reamer Note: If an offset stem is required, proceed to the adapter may be used to determine femoral size, Offset Stem Preparation section on page 24.

  • Page 26: Offset Stem Preparation

    Persona Revision Knee System Surgical Technique 24 | ® Figure 56 Figure 57 Figure 58 Figure 59 Optional Femoral Sizing and Positioning (cont.) Offset Stem Preparation Note: Offset stems are available in the splined Note: The numbers on the offset stem reamer configuration only.

  • Page 27: Optional Femoral Rotation Or Size Adjustment (4-In-1 Cut Guide)

    Persona Revision Knee System Surgical Technique 25 | ® Thick Femoral 10 mm Depth Line 5 mm 0 mm Figure 60 Figure 61 Figure 62 Optional Femoral Rotation or Size Adjustment (4-in-1 Cut Guide) If the primary knee resections need to be adjusted,...

  • Page 28: Straight And Offset Stem Housing Preparation

    Appendix C: Femoral Central be removed by hand, use the slap hammer to retrieve. Cone Preparation section on page 54. To prepare the femur for a metaphyseal cone, reference the Persona Revision Large Defect Surgical Technique 2723.1-GLBL-en for surgical steps.

  • Page 29: Femoral Provisional Assembly And Insertion

    Persona Revision Knee System Surgical Technique 27 | ® Figure 68 Figure 69 Figure 70 Figure 71 Figure 72 Femoral Provisional Assembly and Insertion Assemble the QC handle and the femoral impactor pad Remove the stem extension post and disassemble the and insert the femoral provisional construct into the stem provisional.

  • Page 30: Trial Reduction

    22-26 mm and shim. Select the TASP bottom that matches the tibial baseplate provisional. Select the TASP top that Note: The Persona Primary TASP System is not matches the same size tibial baseplate provisional and compatible with the Persona Revision TASP the femoral provisional.

  • Page 31: Tasp Shim Exchange

    Persona Revision Knee System Surgical Technique 29 | ® Figure 74 Figure 75 Figure 76 Figure 77 Trial Reduction (cont.) Attach the tibial sizing plate handle to the appropriate It is recommended that the thinnest TASP construct shim (Figure 74). While holding the TASP top and...

  • Page 32: Tasp Removal

    Persona Revision Knee System Surgical Technique 30 | ® Figure 78 Figure 79 Trial Reduction (cont.) TASP Removal The entire TASP construct must be removed to exchange the bottom in the TASP construct. To remove or exchange the bottom, flex the knee greater than 30...

  • Page 33: Flexion And Extension Gap Analysis

    Persona Revision Knee System Surgical Technique 31 | ® Flexion and Extension Decision Matrix Tight in Extension Stable in Extension Loose in Extension Use distal femoral augments and Decrease tibial bearing thickness Downsize femur thinner tibial bearing Tight in Use distal femoral augments and...

  • Page 34: Optional Femoral Augment Resection

    Persona Revision Knee System Surgical Technique 32 | ® 15 mm 10 mm 5 mm 15 mm 10 mm 5 mm Figure 81 Figure 82 Figure 83 Optional Femoral Augment Preparation Femoral augments are available in distal and posterior Note: Alternatively, the femoral sizing/cut guide...

  • Page 35: Femoral Box Cut Preparation

    With the femoral provisional in place and the desired the box cut plane. position set, resect along each interior edge of the Note: Consider using the Persona Revision Femoral femoral provisional with a reciprocating saw. Make Retractor while in flexion to elevate the femur and...

  • Page 36: Final Trialing

    Persona Revision Knee System Surgical Technique 34 | ® Figure 87 Figure 88 Figure 89 Final Trialing CPS and CCK Bearing TASP Assembly Select the TASP bottom that matches the tibial Shim Thickness Bottom Thickness Screw Length Tibial Construct (mm)

  • Page 37: Tasp Shim Exchange

    Persona Revision Knee System Surgical Technique 35 | ® Figure 90 Final Trialing (cont.) TASP Shim Exchange If a thicker TASP construct is needed to appropriately Lightly tighten the provisional lockdown screw with fill and balance the joint space, begin by loosening the the 3.5 mm hex driver until the head of the provisional...

  • Page 38: Tasp Removal

    Persona Revision Knee System Surgical Technique 36 | ® Figure 92a Figure 92b Figure 91 Figure 92 Final Trialing (cont.) TASP Removal All other provisional components can be removed by The entire TASP construct must be removed to exchange the bottom in the TASP construct. To remove...

  • Page 39: Implant Assembly

    Persona Revision Knee System Surgical Technique 37 | ® Figure 95a Figure 93 Figure 94 Figure 95 Implant Assembly Note: A stem extension implant must be utilized with the tibial and femoral components. The steps below are for assembling tibial and femoral implant constructs for use with or without an augment.

  • Page 40: Femoral Implant Assembly

    Persona Revision Knee System Surgical Technique 38 | ® Figure 98 Figure 100 Figure 99 Figure 101 Implant Assembly (cont.) Optional Femoral Augment Assembly Femoral Implant Assembly If a distal or posterior augment is being utilized, Prior to assembly of the final construct, place the...
  • Page 41 Persona Revision Knee System Surgical Technique 39 | ® Figure 102a Figure 102 Figure 103 Implant Assembly (cont.) While protecting the tip of the stem with a soft cloth, Place the stem in the femur. If using a straight splined firmly impact the stem to engage the tapers.

  • Page 42: Two Stage Cementing Technique

    Persona Revision Knee System Surgical Technique 40 | ® Figure 104 Figure 105 Two Stage Cementing Technique Proceed with preparing the tibial bone with cement Cleanse all cement-receiving bone surfaces after the final implants have been assembled. Due thoroughly using pulse lavage and dry with a clean, to space constraints, the tibial component should be dry lap sponge (Figure 105).

  • Page 43: Optional Cementing Tibial Augments

    Persona Revision Knee System Surgical Technique 41 | ® Figure 106 Figure 107 Figure 108 Figure 109 Figure 110 Two Stage Cementing Technique (cont.) As soon as cement properties permit, apply a thick Set the cone back down lightly on the cement mantle layer of cement over the entire underside of the of the tibial baseplate implant.
  • Page 44 Persona Revision Knee System Surgical Technique 42 | ® Figure 111 Figure 112 Figure 113 Two Stage Cementing Technique (cont.) If cementing the tibial canal, a bone plug or cement Insert the tibial component into the prepared tibial restrictor should be used to plug the tibial canal.

  • Page 45: Femoral Component

    Persona Revision Knee System Surgical Technique 43 | ® Figure 114 Figure 115 Figure 116 Figure 117 Figure 118 Two Stage Cementing Technique (cont.) Femoral Component If the femoral bone is dense or sclerotic, it may be Note: The 30 and 75 mm stems are intended for full necessary to perforate the femur by drilling with the cemented use.

  • Page 46: Patella Cementing

    Note: Coat any exposed Trabecular Metal Material Patella Cementing that may come in contact with soft tissues with cement or biological material to prevent soft tissue If necessary, reference the Persona Primary Surgical irritation or attachment. Technique 97-5026-001-00 for cement steps.
  • Page 47 Persona Revision Knee System Surgical Technique 45 | ® Figure 122 Two Stage Cementing Technique (cont.) The knee should be placed in extension for the cement Once the cement has cured, remove any excess to cure. A TASP can be used to assist with compression cement before final bearing assembly.

  • Page 48: Bearing Assembly And Insertion

    Persona Revision Knee System Surgical Technique 46 | ® Figure 123 Figure 124 Bearing Assembly and Insertion PS, CPS and CCK Bearing Assembly Note: To avoid post impingement with the femoral The TASP construct can be used to check for final...
  • Page 49 Persona Revision Knee System Surgical Technique 47 | ® Figure 125 Figure 126 Bearing Assembly and Insertion (cont.) Note: The articular surface inserter applies both downward and rearward forces to aid in the insertion of the bearing onto the tibial baseplate.

  • Page 50: Cck Bearing Lockdown Screw Assembly

    Persona Revision Knee System Surgical Technique 48 | ® Figure 127 Figure 128 Figure 129 Figure 130 Bearing Assembly and Insertion (cont.) Close Incision CCK Bearing Lockdown Screw Assembly Freely irrigate the wound to ensure unwanted debris is Insert the screw packaged with the bearing through removed from the joint space prior to closure.

  • Page 51: Appendices

    Persona Revision Knee System Surgical Technique 49 | ® Appendices Figure 1 Figure 2 Figure 3 Figure 4 Appendix A: Tapered Stem Preparation Using the appropriate 30 mm or 75 mm tapered stem 30 mm and 75 mm tapered stems are available for...

  • Page 52: Appendix B: Tibial Central Cone Preparation

    Persona Revision Knee System Surgical Technique 50 | ® Thin Tibial Depth Line Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Appendix B: Tibial Central Cone Preparation Fixed Tibial Cone The fixed tibial cone does not require preparation Invert the cone provisional to simulate the size of distal of the bone using the cannulated reamer.

  • Page 53: Silver/Gold Broach Preparation

    Persona Revision Knee System Surgical Technique 51 | ® Figure 6 Figure 7 Figure 8 Figure 9 Appendix B: Tibial Central Cone Preparation (cont.) Silver/Gold Broach Preparation Attach the smallest sized broach that best fits the size Note: The silver broaches are designed to be...

  • Page 54: Tibial Central Cone Insertion

    Persona Revision Knee System Surgical Technique 52 | ® 1 mm Cement Mantle Figure 11a Figure 10 Figure 11 Appendix B: Tibial Central Cone Preparation (cont.) Tibial Central Cone Insertion Attach the QC handle to the appropriate tibial central cone impactor. Insert the tibial central cone provisional that is the same size as the last broach used and position into the tibia (Figures 10 and 11).
  • Page 55 Persona Revision Knee System Surgical Technique 53 | ® Figure 12 Figure 13 Figure 14 Appendix B: Tibial Central Cone Preparation (cont.) Insert the tibial provisional construct into the tibial Ensure the provisional construct is stable and the canal by hand. Assemble the QC handle and the...

  • Page 56: Appendix C: Femoral Central Cone Preparation

    Persona Revision Knee System Surgical Technique 54 | ® Thick Femoral Depth Line Thick Femoral Depth Line Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Appendix C: Femoral Central Cone Preparation Optional Drill Guide (Medium, Large, Extra-Large Cannulate Ream (Small, Medium, Large, Extra-...

  • Page 57: Silver/Gold Broach Preparation

    Persona Revision Knee System Surgical Technique 55 | ® Figure 6a Figure 8 Figure 6 Distal Surface 5 mm Augment Cut No Femoral Distal 5 mm Femoral Distal Augmentation Augmentation Figure 7 Appendix C: Femoral Central Cone Preparation (cont.) Silver/Gold Broach Preparation...

  • Page 58: Femoral Central Cone Insertion

    Persona Revision Knee System Surgical Technique 56 | ® Distal Surface Figure 9 Figure 10 Figure 11 Minimum Cone Depth Figure 12 Figure 13 Figure 14 Appendix C: Femoral Central Cone Preparation (cont.) Femoral Central Cone Insertion Remove the instruments from the femoral canal...

  • Page 59: Appendix D: Tibial Central Cone Implant Assembly

    Persona Revision Knee System Surgical Technique 57 | ® Figure 1 Figure 2 Figure 3 Figure 4 Appendix D: Tibial Central Cone Implant Assembly Cone Insertion Implant the Trabecular Metal Central Tibial Cone On the back table, use the provisional constructs as a guide for building the final implants.

  • Page 60: Tibial Cone Assembly With An Offset Or Large Diameter Stem

    Persona Revision Knee System Surgical Technique 58 | ® Stem Extensions Straight Cemented (Splined) (Smooth) Fixed 16 mm 16 mm XSML 18 mm 18 mm 18 mm 18 mm 18 mm 18 mm 18 mm 18 mm Figure 8a Figure 6...

  • Page 61: Optional Tibial Augment Assembly

    Persona Revision Knee System Surgical Technique 59 | ® Figure 10 Appendix D: Tibial Central Cone Implant Assembly (cont.) Optional Tibial Augment Assembly Proceed to the Two Stage Cementing Technique If an augment is being utilized, position the augment section on page 40.

  • Page 62: Appendix E: Femoral Central Cone Implant Assembly

    Persona Revision Knee System Surgical Technique 60 | ® Figure 1 Figure 2 Distal Surface Figure 3 Appendix E: Femoral Central Cone Implant Assembly Cone Insertion Assemble the appropriate femoral cone impactor On the back table, use the provisional constructs as a guide for building the final implants.

  • Page 63: Femoral Cone Assembly With An Offset Or Large Diameter Stem

    Persona Revision Knee System Surgical Technique 61 | ® Stem Extensions Straight Cemented (Splined) (Smooth) 16 mm 16 mm 16 mm 16 mm 17 mm 18 mm XLRG 17 mm 18 mm Figure 4 Figure 6 Figure 5 Figure 7 Appendix E: Femoral Central Cone Implant Assembly (cont.)
  • Page 64 Persona Revision Knee System Surgical Technique 62 | ® Figure 9a Figure 8 Figure 9 Figure 10 Appendix E: Femoral Central Cone Implant Assembly (cont.) Femoral Cone Assembly with an Offset or Large Diameter Stem (cont.) Place the Trabecular Metal Femoral Central Cone Note: The 2 mm hex driver has an over-torque Implant over the femoral stem housing (Figure 8).

  • Page 65: Appendix F: Component Removal

    Persona Revision Knee System Surgical Technique 63 | ® Figure 1 Figure 2 Appendix F: Component Removal PS, CPS and CCK Bearing Removal Tibial Baseplate Removal In the event that the bearing needs to be removed In the event that the tibial baseplate needs to be...

  • Page 66: Femoral Component Removal

    (cont.) Femoral Component Removal Stem Removal In the event that a Persona Stem needs to be removed In the event that the femoral implant needs to be from the tibial or femoral canals, the stem extractor removed, Disrupt the femoral implant/bone interface with flexible osteotomes or thin saw blades with an may be used to assist in removal.

  • Page 67: Product Compatibility Charts

    Persona Revision Knee System Surgical Technique 65 | ® Product Compatibility Charts Persona Revision Femoral Component Used on Persona Revision CCK, Persona CPS or Persona PS Bearing Persona Revision Femoral Components 1-1+/AB 3-5+/AB 1-1+/CD 3-5+/CD 7-9+/CD 3-5+/EF 7-9+/EF 11-11+/EF 7-9+/GH...
  • Page 68 NexGen Primary Porous Patellar Component (00-5878-065-XX) (mm sizes) i: INSET patella with Persona Revision Femoral Component Compatible Incompatible Persona Revision Femoral Component Used with Persona Revision Femoral Central Cone Persona Revision Femoral Components Persona Revision Femoral Central Cones XLRG Compatible Incompatible...
  • Page 69 Notes...
  • Page 70 Notes...
  • Page 72 All content herein is protected by copyright, trademarks, and other intellectual property rights, as applicable, owned by or licensed to Zimmer Biomet or its affiliates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Zimmer Biomet.

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