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NexGen Tibia

Jun 03, 2018

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    Designed for minimally invasive procedures

    ZimmerNexGenMIS

    Tibial ComponenCemented

    Surgical Technique

    IMAGE TOCOME

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    Zimmer NexGen MIS Tibial Component Cemented Surgical Technique 1

    Table of Contents

    Finish the Tibia 2

    Position Based on Anatomic Landmarks 2

    Lateral Posterior Hook 2

    Medial Posterior Hook 2

    No Posterior Hooks 2

    Position Based on Trial Range of Motion 4

    MIS Tibial Component Preparation without Stem Extension 4

    MIS Tibial Component Preparation with Drop Down Stem Extension 6

    Implant Components 8

    Technique for MIS Flex Articular Surface Locking Screw 9

    ZimmerNexGenMIS

    Tibial ComponentCemented SurgicalTechniqueDeveloped in conjunction with

    Thomas M. Coon, MDOrthopedic Surgical InstituteRed Bluff, California

    E. Marlowe Goble, MDAdjunct Clinical Professorof OrthopaedicsUniversity of UtahSalt Lake City, Utah

    Alfred J. Tria, MDClinical Professor ofOrthopaedic SurgeryUniversity of Medicineand Dentistry - New JerseyRobert Wood Johnson Medical SchoolNew Brunswick, New Jersey

    Jean-Nol Argenson, MDProfessor of Orthopaedic SurgeryAix-Marseille UniversitySainte Marguerite HospitalMarseille, France

    Francesco Benazzo, MDProfessor of Orthopaedic SurgeryUniversity of PaviaPavia, Italy

    Richard Berger, MDAssociate Professor ofOrthopaedic SurgeryRush University Medical CollegeChicago, Illinois

    Kim Bertin, MDUtah Hip and Knee CenterSalt Lake City, Utah

    Robert Booth, MDProfessor of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphia, Pennsylvania

    Anthony DiGioia III, MDDirector, Center for Medical Roboticsand Computer Assisted SurgeryCarnegie Mellon UniversityPittsburgh, Pennsylvania

    Mark Hartzband, MDDirector, Total Joint Replacement ServiceDepartment of OrthopedicsHackensack University Medical CenterHackensack, New Jersey

    Ngai Nung Lo, MDSenior Consultant OrthopaedicSurgeon and Deputy HeadDirector of Adult Reconstruction ServiceDepartment of Orthopaedic SurgerySingapore General HospitalSingapore

    Mark Pagnano, MDMayo ClinicRochester, Minnesota

    Wayne Paprosky, MDAssociate Professor ofOrthopaedic SurgeryRush University Medical CollegeChicago, Illinois

    Aaron Rosenberg, MDProfessor of Orthopaedic SurgeryRush University Medical CollegeChicago, Illinois

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    Zimmer NexGen MIS Tibial Component Cemented Surgical Technique2

    Finish the Tibia

    The tibia can be finished prior to trial

    reduction if the implant position will be

    chosen based on anatomic landmarks

    (Fig. 1). Alternatively, the femoral

    and articular surface provisionals,

    in combination with the sizing plate,

    can be used to perform a trial range of

    motion to aid in tibial location.

    Position Based on AnatomicLandmarks

    Posterior hooks on the lateral and medial

    side of the sizing plate can be deployed

    to aid in size selection and positioning

    of the MISTibial Sizing Plate.

    There are several options available

    for use of the posterior hooks during

    sizing plate selection and positioning.

    The surgeon can decide which optionis appropriate depending on patient

    anatomy or incision size, as well as

    whether a medial or lateral incision

    is used. Make sure that the posterior

    edge of the tibia is free of osteophytes

    and soft tissues which could interfere

    with the proper positioning of the

    posterior hooks.

    Lateral Posterior Hook

    Deploy the posterior hook that

    corresponds to the lateral side of

    the tibia using the Small Hexhead

    Screwdriver (Fig. 2).

    Purpose - Placing the posterior hook

    behind the lateral side of the tibia

    provides an anchor on anatomy

    that is not easily visualized with a

    small incision on the medial side.

    The sizing plate can then be rotated

    on the medial side until proper

    rotational alignment is achieved

    (Fig. 3).

    Consideration - The A/P dimension

    of the proximal tibia is generally

    larger on the medial side comparedto the lateral side. When the sizing

    plate is positioned correctly in

    rotation, there could be a tendency

    to slightly underhang the tibia on

    the posteromedial edge.

    Medial Posterior Hook

    Deploy the posterior hook that

    corresponds to the medial side of

    the tibia using the Small Hexhead

    Screwdriver.

    Purpose - Placing the posterior hook

    behind the medial side of the tibia

    provides an anchor on anatomy that

    is not easily visualized with a small

    incision on the lateral side.

    Consideration - The A/P dimension

    of the proximal tibia is generally

    larger on the medial side compared

    to the lateral side. When the sizing

    plate is positioned correctly in

    rotation, there could be a tendency

    to slightly overhang the tibia on the

    posterolateral edge.

    No Posterior Hooks

    When neither posterior hook is

    deployed, traditional tibial anatomic

    landmarks may be used.

    Purpose - With a mini or open

    procedure the tibial surface can be

    subluxed forward and visualized. In

    this circumstance, tibial coverage

    can be better visualized and the

    posterior hooks may not need to bedeployed.

    Consideration - pay special

    attention to the posterior bumps

    on the sizing plate to ensure they do

    not come into contact with the distal

    femur, which could push the sizing

    plate anterior.

    Fig. 1 MISTibial Sizing Plate on PreparedTibial Surface.

    Fig. 3 Placing the posterior hook behind thelateral side of the tibia.

    Fig. 2 Deploying the Posterior Hook.

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    Zimmer NexGen MIS Tibial Component Cemented Surgical Technique 3

    Locate the edge of the posterior tibial

    cortex with the hook and rotate the MIS

    Sizing Plate into position (Fig. 6). Checkthat the sizing plate is not overlapping

    the posterior edges of the bone and

    that soft tissues have been cleared.

    Insert a pin or MISScrew into the

    anterior hole on the sizing plate (Fig. 7).

    A second pin or MISScrew is inserted

    into the hole on the sizing plate. It is

    recommended to use one anterior pin

    hole and one hole on the opposite side

    of the sizing plate on the plate face to

    assure plate stability.

    Caution: do not impact or lever

    the MISSizing Plate Handle;

    this instrument is designed for

    alignment purposes only.

    Technique Tip - when using the

    anterior pin holes, pay special

    attention to the posterior aspect

    of the sizing plate to ensure lift-off

    does not occur from over tightening/

    seating.

    In extension, place the knee in valgus

    to view or palpate the lateral side of the

    tibia to check sizing plate fit laterally.

    Be sure that the component is properly

    positioned rotationally. Tibial plate

    rotation and varus/valgus alignment

    can be checked by inserting the

    Alignment Rod through the hole or slot

    in the handle of the MISSizing Plate

    Handle (Fig. 8). There are two options

    available for use of the alignment rod

    (Fig. 9):

    Slot - check varus/valgus and

    rotational alignment Round hole - check slope of tibial

    cut (distal end of rod should point

    to second metatarsal)

    Fig. 8 Check alignment by inserting theAlignment Rod through the hole or slot inthe handle of the MISSizing Plate Handle.

    Fig. 4 Verify proper tibial plate varus/valgus and rotational alignment using thealignment rod.

    Fig. 5 Secure the MISSizing Plate Handle to

    the MISTibial Sizing Plate.

    Fig. 6 Locate the edge of the posterior cortexwith the hook and rotate the MISSizing

    Plate into position.

    Fig. 7 Insert a pin or MISScrew into theanterior hole on the sizing plate.

    Fig. 9 Close-up of MISSizing Plate Handleshowing hole and slot.

    Technique Tip - use the alignment

    rod in the hole or slot in the MIS

    Sizing Plate Handle to verify propertibial plate varus/valgus and

    rotational alignment (Fig. 4).

    Posterior Tab Deployed

    Check that the chosen posterior hook(s)

    is completely deployed. Attach the MIS

    Sizing Plate Handle to the selected MIS

    Tibial Sizing Plate (Fig. 5). The handle

    should be inserted on the medial side

    of the sizing plate to provide clearance

    for the patella. Note: If lateral incision,then attach to lateral side of sizing

    plate.Extend the lever on the

    handle and engage the tabs on the

    handle with the grooves on the sizing

    plate by positioning the lever lateral to the

    dovetail, and clamp the lever to secure.

    Note: This instrument contains several

    moving parts. If trigger becomes

    hard to engage, apply instrument

    lubrication.

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    Zimmer NexGen MIS Tibial Component Cemented Surgical Technique4

    MIS Tibial ComponentPreparation without Stem

    ExtensionPlace the knee in appropriate flexion

    angle for broaching.

    Assemble the proper size MIS

    Cemented Broach to the MISTibial

    Broach Impactor as shown (Fig. 12).

    Seat the MISTibial Broach Impactor

    assembly on the MISTibial Sizing Plate

    in the detents (Fig. 13).

    Position Based on Trial Range ofMotion

    Prepare the patella. Then select theproper size MISTibial Sizing Plate. Do

    not deploy either the posteromedial

    or posterolateral hooks on the sizing

    p

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