Establish REVISION the - Stabilize Tibial Platform the Knee in Flexion REVISION - Stabilize Establish the Knee Tibial in Platform Flexion Evaluate Size 1. Previous Prosthesis Measure the size of the revised previous prosthesis. TECHNIQUE TIP 2.E If you can t insert the, or if the rotation is incorrect, proceed to page 22 and make the femoral bone cuts. Caution: When using the previous prosthesis to determine size, note the primary TKA failure may have been caused by the component being over or undersized. 2. Epicondylar Width The epicondylar width of the femur also aids in selecting the appropriate femoral size. Measure the width of the epicondyles and use the following chart to assist in defining the appropriate size (Fig. 25). By measuring the epicondyles, the maximum size has been determined. NexGen Component Size Related to the Transepicondylar Width Transepicondylar Width (mm) Female Size Male Size 75 C 80 D C 85 E D 90 F E 95 G F 100 G With the knee in flexion, insert the / Cutting Guide Assembly onto the distal femur. Seat the Assembly on the existing bone. If the components will not seat, use a rongeur to carefully remove any anterior or posterior bone that is preventing insertion. Caution: Be careful not to over resect. Insert the tabs of the Revision Rotational Alignment Guide into the posterior augment resection slots of the (Fig. 27). The handles of the Alignment Guide should line up with the transepicondylar axis. Fig. 27 TECHNIQUE TIP 2.C Evaluation of the pre-op x-ray of the patient s other knee may help in making the final sizing decision. Fig. 25 Insert the Headless Holding Pins to set femoral rotation (Fig. 28). These Pins can be used later to position the LCCK 4-in-1 Cut Block. Fig. 28 Establish Flexion Gap and Stability Prepare for Trialing Insert the appropriate size into the appropriate size LCCK /Cutting Guide (Fig. 26). Begin by inserting the thinnest LPS Articular Surface of the color indicated on the Tibial and. TECHNIQUE TIP 2.F TECHNIQUE TIP 2.D If the does not provide adequate coverage, use an. Fig. 26 The LCCK Articular Surface s cannot be used because the intercondylar box cut has not yet been made. Evaluate the stability in flexion (Fig. 29). Fig. 29 00-5989-020-11 / Cutting Guide 00-5995-013-91,Lt 00-5995-013-92,Rt Tibial Rotational Alignment Guide 00-5987-051-01 Headless Holding Pins 00-5222-039-00, 48mm 00-5997-084-00, 75mm Mallet 00-0155-002-00 LPS Articular Surface 00-5996-030-10 / Cutting Guide 00-5995-013-91, Lt 00-5995-013-92, Rt 00-5989-020-11 10 11 Distal 00-5987-090-05 Posterior 00-5987-089-05
Establish PRIMARY - the Stabilize Tibial Platform the Knee in Flexion PRIMARY - Stabilize Establish the Knee Tibial in Platform Flexion Use a 0.050 inch/1.27mm oscillating saw blade to start the resection of the distal femur through the slot in the Mini Distal Cutting Guide (Fig. 57). Loosen the thumb screw on the 0 Distal Placement Guide. Remove the 6 Distal Guide and 0 Distal Placement Guide from the Reamer or Stem Assembly and finish the cut (Fig. 57). Remove 2. Sizer Place the Mini A/P Sizing Guide flat on the smoothly cut distal femur so the feet are flush against the posterior condyles. TECHNIQUE TIP 2.H Check the position by looking through both windows of the Mini A/P Sizing Guide to ensure the medullary canal is not visible through either. Remove the Mini Distal Cutting Guide, leaving the Reamer or Stem Assembly in place. Fig. 57 Use the Hex-headed Screws to fix the Mini A/P Sizing Guide to the distal femur. Evaluate Size 1. Epicondylar Width The epicondylar width of the femur also aids in selecting the appropriate femoral size. Measure the width of the epicondyles and use the following chart to assist in defining the appropriate size (Fig. 58). By measuring the epicondyles, the maximum size has been determined. TECHNIQUE TIP 2.G Evaluation of the pre-op x-ray of the patient s other knee may help in making the final sizing decision. NexGen Component Size Related to the Transepicondylar Width Fig. 58 Transepicondylar Width (mm) Female Size Male Size 75 C 80 D C 85 E D 90 F E 95 G F 100 G TECHNIQUE TIP 2.I Do not overtighten the Screws or the anterior portion of the Mini A/P Sizing Guide will not slide on the distal femur. Attach the MIS Locking Boom to the Mini A/P Sizing Guide. Lock the Boom when it is appropriately positioned (Fig. 59). Read the femoral size directly from the Guide between the engraved lines on the sizing tower (Fig. 60). TECHNIQUE TIP 2.J If the indicator is between two sizes, the smaller size is typically chosen to help prevent excessive ligament tightness in flexion. Fig. 59 TECHNIQUE TIP 2.K Although the Mini A/P Sizing Guide has eight engraved sizes, the LCCK system only contains sizes C-G. Fig. 60 Mini Distal Cutting Guide 00-5967-036-00 0 Distal Placement Guide 00-5967-031-00 LCCK 6 Distal Guide 00-5987-061-01, Lt 00-5987-061-02, Rt Mini Standard Cut Block 00-5967-045-00 Stem Adapter 00-5987-016-00 Hex-headed Screws 00-5983-040-27, 27mm 00-5983-040-33, 33mm 00-5983-040-48, 48mm MIS Screw Inserter/Extractor 00-5983-049-00 Tibial 24 25 Mini A/P Sizing Guide 00-5967-055-00 MIS Screw Inserter/Extractor 00-5983-049-00 Hex-headed Screws 00-5983-040-27, 27mm 00-5983-040-33, 33mm 00-5983-040-48, 48mm MIS Locking Boom 00-5983-028-30 Tibial
Zimmer Nexgen Sizing Chart
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