Persona®

The Personalized Knee

Surgical Technique
Table of Contents

Introduction............................................................................................................... 2
Constraint Options
Preoperative Planning
Surgical Approach
Patient Preparation
Magnet Usage
Symbols
Screw/Pin Information

Resect Distal Femur................................................................................................... 6

Assemble Adjustable Distal Resection Instrumentation
Establish Femoral Alignment
Resect Distal Femur
Optional Instrument
Optional Cutting Technique

Resect Proximal Tibia.............................................................................................. 12

Assemble Extramedullary (EM) Alignment Guide
Position Alignment Guide
Set Resection Level
Resect Proximal Tibia
Optional Technique

Size Femur and Establish External Rotation........................................................... 19

Complete Femoral A/P and Chamfer Resections................................................... 22

Optional Instrument

Establish Size and Rotation of Tibia......................................................................... 24

Drill and Broach Tibia.............................................................................................. 25

Optional Technique

Prepare the Patella.................................................................................................. 28

Resect the Patella.................................................................................................... 28

Finish the Patella...................................................................................................... 29

CR Femoral Finishing and Trialing........................................................................... 31

PS Femoral Finishing and PS Box Preparation........................................................ 33

Perform Trial Reduction........................................................................................... 38

Table of Contents (cont.)

Tibial Articular Surface Provisional (TASP) Assembly............................................. 39

Implant Components............................................................................................... 43
Tibial Plate
Femoral Component
Bearing
Patellar Component
All-Polyethylene Patella

Close Incision........................................................................................................... 46
Surgeon Notes and Tips

Appendix A............................................................................................................... 47
2 Degrees Valgus Recut Guide
2 Degrees Varus Recut Guide

Appendix B............................................................................................................... 49
Spacer Block Technique

Appendix C: Optional Instruments.......................................................................... 52

Resect Distal Femur: Fixed Distal Resection Instrument
Size Femur - Anterior Referencing Sizer
Shift Block
Resect Distal Femur - PRI Distal Resection Instrument
Implant Components - Attached Tibial Plate Inserter

Appendix D.............................................................................................................. 66
Compatibility Charts
 Surgical Technique
2 | Persona The Personalized Knee Surgical Technique

Introduction

Successful total knee arthroplasty depends in part on The CR femoral provisionals and components can
re-establishment of normal lower extremity alignment, be used when the PCL is sacrificed or deficient and
proper implant design and orientation, secure implant removed, if used with either a MC or ultracongruent
fixation, and adequate soft tissue balancing and (UC) bearing provisionals and components.
stability. Persona The Personalized Knee is designed to
help the surgeon accomplish these goals by combining Also, posterior stabilized (PS) femoral provisionals and
alignment accuracy with a simple, straight-forward components can be used with the PS or constrained
technique. posterior stabilized (CPS) bearings provisionals and
components when the PCL is deficient and removed.
T he instruments and technique assist the surgeon in
restoring the center of the hip, knee, and ankle to lie PS femoral components cannot be used with CR, MC,
in a straight line, establishing a neutral mechanical or UC bearings and CR femoral components cannot be
axis. The femoral and tibial components are used with PS or CPS bearings.
oriented perpendicular to this axis. Femoral rotation The CPS bearings can be used to provide moderate
is determined using the posterior condyles, the varus\valgus constraint in patients to facilitate soft
epicondylar axis, or Whiteside’s line as a reference. tissue balance and stability. The CPS bearings shall
The instruments enable accurate cuts to ensure robust be used with cemented non-porous femoral and tibial
component fixation. components only. Additional information for this
A wide variety of component sizes, shapes, and product may be found in the Constrained Posterior
constraint options allow for optimized component fit Stabilized (CPS) Surgical Technique (97-5026-072-00).
and soft tissue balancing. The femur, tibia, and patella The MC, UC, PS, and CPS implants can be used in
are prepared independently, and can be cut in any the following situations, depending on the degree
sequence using the principle of measured resection of the deformity, the stability of the ligaments, and
(removing enough bone to allow replacement by the the quality of the bone. The surgeon is responsible
prosthesis). Adjustment cuts may be needed later. The for assessing whether a more constraining implant/
anterior referencing technique uses the anterior cortex system or revision implant/system is necessary.
to set the A/P position of the femoral component. The
posterior condyle cut is variable. Marked valgus deformity – requiring PCL
1. 
and lateral soft tissue release.

Constraint Options 2. Prior high tibial osteotomies – soft tissue

balancing is the same as for a valgus deformity
The degree of constraint of the bearing can be
with lateral soft tissue and PCL release.
planned based on surgeon preference and patient
requirements. The use of the cruciate retaining (CR) 3. Patellectomy – PCL incomplete or absent.
femoral provisionals and components can be used with
either a CR or Medial Congruent® (MC) bearing when 4. Most revision situations – PCL deficient
the posterior cruciate ligament (PCL) is intact. or nonfunctional.
 3 | Persona The Personalized Knee Surgical Technique

Introduction (cont.)
Patient Preparation
Note: The MC components can be used with or To prepare the limb for total knee arthroplasty,
without the PCL present. The UC, PS, and CPS adequate muscle relaxation is required. The
components should not be used if the PCL is anesthesiologist should adjust the medication based
present. on the patient’s habitus and weight, and administer
to induce adequate muscle paralysis for a minimum
Please refer to the package inserts for complete of 30-40 minutes. It is imperative that the muscle
product information, including contraindications, relaxant be injected prior to inflation of the tourniquet.
warnings, precautions, and adverse effects. Alternatively, spinal or epidural anesthesia should
produce adequate muscle relaxation. If desired, apply
a proximal thigh tourniquet and inflate it with the
Preoperative Planning knee in hyperflexion to maximize that portion of the
Obtain 36 inch or 53 inch standing anteroposterior quadriceps that is below the level of the tourniquet.
and lateral radiographs of the extremity, as well as a Once the patient is draped and prepped on the
sunrise view of the patella. The entire femur should operating table, determine the landmarks for the
be visualized to rule out any structural abnormalities, surgical incision.
as the distal femoral cut will be referenced from an
intramedullary rod in the medullary canal.

Use the template overlay (available through your

Zimmer Biomet representative) to determine the
angle between the anatomic axis and the mechanical
axis. This angle will be reproduced intraoperatively.
This surgical technique helps the surgeon ensure
that the distal femur will be cut perpendicular to the
mechanical axis and, after soft tissue balancing, will be
parallel to the resected surface of the proximal tibia.

Surgical Approach
The surgeon can choose a midvastus approach, a
subvastus approach, or a parapatellar medial
arthrotomy. Also, depending on surgeon preference,
the patella can be either everted or subluxed. The
femur, tibia, and patella are prepared independently,
and can be cut in any sequence using the principle of
measured resection (removing enough bone to allow
replacement by the prosthesis).
4 | Persona The Personalized Knee Surgical Technique

Introduction (cont.)
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
• Left

• Right

• Varus/Valgus M/L Std

Medial/Lateral Standard Do not implant -
• Medial/Lateral Not for implant

• Standard

• Do not implant - Not for implant

• Do not impact Do not impact Inset Only Anterior Referencing

• Inset Only

• Anterior Referencing

• Lock
Lock Unlock
• Unlock

• Cemented
Cemented Stemmed Narrow
• Stemmed

• Narrow
 5 | Persona The Personalized Knee Surgical Technique

Introduction (cont.)
Screw/Pin Information
The chart below contains relevant information on various 3.2 mm
screws/pins 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.

Shipped Sterile/ Quantity

Screw/Pin Screw/Pin Item # Compatible Driver Non-sterile per Package Single use?

25 mm x 2.5 mm Sterile 2 Yes

Female Hex Screw 2.5 mm Male Hex Driver
42-5099-025-25* 42-5099-025-00

75 mm x 3.2 mm Sterile 4 Yes

Trocar Tipped Drill Pin/Screw Inserter
Pin (2.5 mm hex) 00-5901-021-00
00-5901-020-00

Hex Headed Screw Sterile 2 Yes

33 mm long Pin/Screw Inserter
00-5901-035-33 00-5901-021-00

MIS Quad-Sparing™ Sterile 1 Yes

Total Knee Headed Screw Inserter/Extractor
Screw 48 mm long 00-5983-049-00
00-5983-040-48

25 mm Shorthead Non-Sterile 1 No
Holding Pin
00-5977-056-03 Multi Pin Puller
00-5901-022-00

* The 2.5 mm female hex screws and 2.5 mm male hex driver should not be used in cortical bone,
as this may increase the incidence of stripping of the driver.
6 | Persona The Personalized Knee Surgical Technique

1. Pull
Caution
Marking
2. Insert
Figure 3
Figure 1
Rotate Dial

2. Rotate
1. Press

Shown at '0' setting

Figure 2 Figure 4

Resect Distal Femur

Assemble Adjustable Distal Resection
Instrumentation
Pull the lever on the modular handle and insert the IM Insert the IM rod into the adjustable valgus guide.
rod (Figure 1). Orientation of the IM rod will align with
the polished line on the sides of the modular handle. Note: If desired, align the depth markings on the IM
rod with the flat plate of the adjustable valgus guide
Technique Tip: Alternately, the IM rod may be to set the IM rod at a specific length. Inserting the
inserted into the top of the modular handle to IM rod beyond the double line marking, indicated
accommodate surgical preference. with caution symbols, may prevent assembly of the
modular handle to the IM rod (Figure 3).
Set the valgus angle on the adjustable valgus guide
by pressing the button and rotating the dial to the  efer to Appendix C for Optional Instruments to
R
appropriate left or right valgus angle from 0 degrees resect the distal femur.
to 9 degrees (Figure 2).
S et the resection depth on the adjustable resection
Avoid turning the locking knob excessively in the tower by rotating the dial (Figure 4). The ‘0’ setting
counterclockwise, or "unlocking", direction to prevent indicates a 10 mm resection. Adjustments can be
it from binding. made in 1 mm increments from 10 mm to 14 mm.

Persona 8 mm IM Rod Persona Modular Handle Persona Valgus Alignment Guide Persona Adjustable Resection Tower
42-5099-002-00 42-5099-014-00 42-5099-004-00 42-5099-008-00
 7 | Persona The Personalized Knee Surgical Technique

2. Insert 1. Unlock

Figure 6a

Lock

Figure 5 Figure 6b

Resect Distal Femur (cont.)

Assemble Adjustable Distal Resection
Instrumentation (cont.)
Note: The ‘0’ setting can be set to indicate a 1 mm Insert the adjustable resection tower into the
through 9 mm resection depth, in 1 mm increments, adjustable valgus guide.
by assembling the corresponding resection plate to
the valgus guide. Figure 5 illustrates this with the 9  otate the lock lever on the adjustable resection tower
R
mm resection plate. The 9 mm and 8 mm resection to the unlocked, or “in-line”, position and fully insert
plates may facilitate correction of recurvatum and into the cut guide (Figure 6a). Flip the lock lever to the
the 1 mm–3 mm resection plates can be used for locked, or “vertical”, position to secure it to the cut
recutting the distal femur, if needed. guide (Figure 6b).

Technique Tip: The adjustable resection tower

The size 1 and 2 femoral components are 1 mm
is compatible with the fixed valgus guide and
thinner distally than sizes 3-12. Consider adjusting
the fixed resection tower is compatible with the
the resection depth on these sizes to accommodate
adjustable valgus guide. These instruments can be
for this difference.
interchanged to accommodate surgical preference.
Technique Tip: If it is possible that the femoral
component may be a size 1 or 2, then consider
cutting the distal resection for a size 1 or 2. If the
size of the femur is later determined to be 3-12, then
the additional bone cut can be made using the 1 mm
resection plate.

Persona 8 mm IM Rod Persona Modular Handle Persona Valgus Alignment Persona Adjustable Persona 0° Distal Cut Guide Persona 9 mm Distal
42-5099-002-00 42-5099-014-00 Guide Resection Tower 42-5099-010-00 Resection Plate
42-5099-004-00 42-5099-008-00 42-5099-015-09
8 | Persona The Personalized Knee Surgical Technique

Figure 7 Figure 8a Figure 8b

Resect Distal Femur (cont.)

Establish Femoral Alignment
 rill the IM canal using the 8 mm IM step drill
D S et the orientation of the adjustable valgus guide by
(Figure 7). Suction the canal to remove medullary placing it against the most prominent distal condyle
contents. and rotating it about the IM rod so that the engraved
lines are aligned with the epicondylar axis (Figure 8a).
Insert the IM rod and assembled distal resection
instrumentation into the IM canal far enough to ensure Turn the lock knob on the adjustable valgus guide
the most accurate replication of the anatomic axis. clockwise, to the locked position, to secure orientation
of the assembly (Figure 8b).

Note: Setting rotation of the adjustable valgus

guide is important for creating a distal resection
that matches the desired valgus angle selected. It
does not set the rotation of the femoral component.

8 mm IM Step Drill Persona 8 mm IM Rod Persona Modular Handle Persona Valgus Alignment Guide Persona Adjustable Resection Tower
00-5978-014-00 42-5099-002-00 42-5099-014-00 42-5099-004-00 42-5099-008-00

Persona 0° Distal Cut Guide

42-5099-010-00
 9 | Persona The Personalized Knee Surgical Technique

Figure 9

Rotate Dial
"Click"

Figure 10 Figure 11

Resect Distal Femur (cont.)

Establish Femoral Alignment (cont.)
For additional fixation, or in lieu of using the lock knob, Technique Tip: If unsure of the adjustable
impact the captured pin on the medial or lateral side resection tower depth setting, rotate the dial
of the adjustable valgus guide until the head of the clockwise until a “click” is felt. This occurs when
captured pin is flush with the plate (Figure 9). the dial moves from the ‘4’ setting to the ‘0’ setting.
The bold ‘0’ will be visible on the dial and the line
will be aligned with the ‘0’ mark along the shaft
Resect Distal Femur (Figure 10).
 erify the adjustable valgus guide is set to the proper
V
side (left or right) and angle and that the adjustable Technique Tip: Confirm valgus alignment by
resection tower is set to the appropriate depth. inserting the drop rod adapter into the large holes
on the anterior face of the cut guide and insert an
alignment rod into the drop rod adapter (Figure 11).

Persona 8 mm IM Rod Persona Modular Handle Persona Valgus Alignment Guide Persona Adjustable Resection Tower
42-5099-002-00 42-5099-014-00 42-5099-004-00 42-5099-008-00

Persona 0° Distal Cut Guide Persona Drop Rod Adapter Alignment Rod with Coupler
42-5099-010-00 42-5399-006-00 00-5785-080-00
10 | Persona The Personalized Knee Surgical Technique

1. Unlock

2. Pull

Figure 12 Figure 13

Resect Distal Femur (cont.)

Resect Distal Femur (cont.) Optional Instrument
Insert a trocar tipped pin through each of the standard A fixed distal resection system exists for users who, for
pin holes marked ‘0’ on the anterior surface of the cut all patients, maintain a consistent valgus angle for their
guide (Figure 12). distal cut. For use of this instrument refer to Appendix
C: Optional Instruments: Resect Distal Femur - Fixed
Flip the lock lever on the adjustable resection tower to Distal Resection Instrument Section 1.
the unlocked, or “in-line”, position and pull the handle
to remove the IM rod and assembled distal resection Technique Tip: Additional 2 mm adjustments may
instrumentation leaving only the cut guide attached to be made by using the sets of holes marked -2, +2,
the femur (Figure 13). and +4. These sets of holes indicate, in millimeters,
the amount of additional bone resection each
Note: If the captured pin was deployed it may be will yield relative to the resection setting on the
necessary to first remove it from the bone using the resection tower (where ‘0’ represents 10 mm.
pin puller. Alternatively, removing the IM rod from However, if the 9 mm resection plate is used, the ‘0’
the adjustable valgus guide may facilitate removal represents 9 mm).
of the captured pin from the bone.

Persona 8 mm IM Rod Persona Modular Handle Persona Valgus Alignment Guide Persona Adjustable Resection Tower
42-5099-002-00 42-5099-014-00 42-5099-004-00 42-5099-008-00

Persona 0° Distal Cut Guide 3.2 mm x 75 mm Trocar Tipped Drill Pin Pin Screw Inserter
42-5099-010-00 (2.5 mm hex) 00-5901-021-00
00-5901-020-00
 11 | Persona The Personalized Knee Surgical Technique

Figure 15a

Figure 14
Figure 15b

Resect Distal Femur (cont.)

Optional Instrument (cont.) Optional Cutting Technique
Insert the resection guide into the cut slot of the cut If desired, the bone resection can be made from the
guide to verify the depth of resection. top (most distal) surface of the cut guide (Figure 15a).
The top surface of the cut guide is 4 mm from the cut
Insert a trocar tipped pin through at least one of the slot. Therefore, if cutting from the top surface, the
locking, or oblique, pin holes in the cut guide to further position of the cut guide must be adjusted by moving
secure the cut guide to the femur (Figure 14). the cut guide from the trocar tipped pins through
the ‘0’ holes and reinserting the cut guide onto the
Using a 1.27 mm (0.050 inch) oscillating saw blade
trocar tipped pins through the holes marked ‘+4’
through the cut slot in the cut guide, resect the distal
(Figure 15b). Insert a trocar tipped pin through at least
femur.
one of the locking, or oblique, pin holes in the cut
Note: The flatness of the distal femoral resection guide to further secure the cut guide to the femur prior
is critical to ensuring adequate contact between to cutting the femur.
the porous femoral implant and the bone. If using
a porous femoral implant, evaluate the flatness of
the resection prior to sizing and modify the cut as
necessary so that it is completely flat.

R
 emove all pins and the cut guide.

Persona 0° Distal Cut Guide 3.2 mm x 75 mm Trocar Tipped Drill Pin Pin Screw Inserter Resection Guide Multi Pin Puller
42-5099-010-00 (2.5 mm hex) 00-5901-021-00 00-5977-084-00 00-5901-022-00
00-5901-020-00
12 | Persona The Personalized Knee Surgical Technique

2. Translate 3. Push Down

5. Insert

1. Lift
4. Push

6. Release

2. Insert Rod
1. Push

3. Release

Figure 16 Figure 17

Resect Proximal Tibia

Assemble Extramedullary (EM) Alignment Guide
Depress and hold the button on the EM distal rod and  ttach the selected tibial cut guide to the EM alignment
A
insert the threaded rod on the EM ankle clamp into the guide (Figure 17).
distal rod and release the button. Depress and hold
1. Lift the lever on the EM proximal tube up.
the button on the distal end of the EM proximal tube
and insert the EM distal rod into the EM proximal tube 2. Translate the cut guide onto the top of the EM
and release the button (Figure 16). proximal tube, under the locking cone.

3. Push down the lever on the EM proximal tube to

lock the cut guide in place.

Persona EM Proximal Tube Persona EM Distal Rod Persona EM Ankle Clamp Persona Tibial Cut Guide Persona Tibial Cut Guide
42-5399-001-00 42-5399-002-00 42-5399-003-00 Left - 3° Left - 7°
42-5399-051-03 42-5399-051-07
 13 | Persona The Personalized Knee Surgical Technique

Clockwise
Height Adjustment
Shorten Lengthen

Counter
Varus/Valgus Adjustment
Clockwise
Slope Adjustment

Figure 18 Figure 19

Resect Proximal Tibia (cont.)

Assemble Extramedullary (EM)
Alignment Guide (cont.)
The buttons shown in Figure 18 are used to adjust Technique Tip: It is recommended to use the
the following: varus/valgus angle of the cut guide, 3 degree cut guide for a PS component and the
slope of the cut guide and the height of the cut guide. 7 degree cut guide for a CR component. If the
The height adjustment button can be depressed for UC bearing is to be used, the recommended
macro-adjustment or the dial can be rotated for micro- tibial cut slope is 5–7 degrees. Biasing towards a
adjustment. flatter slope cut for the UC bearing provides an
opportunity to better match flexion and extension
One full rotation of the dial equals 4 mm of height space, considering the flexion space generally
adjustment and ¼ turn equals 1 mm of height increases more than the extension space when
adjustment (Figure 19). Rotating the height the PCL is resected. If the MC bearing is used, the
adjustment dial clockwise shortens the alignment recommended tibial slope is 5 degrees. However,
guide and rotating the dial counterclockwise 7 degrees is allowable particularly when the PCL is
lengthens the alignment guide. retained.
The system includes six different cut guides: a

7 degree cut guide and a 3 degree guide, in left, right,
and universal (non-sided) configurations.

Persona Tibial Cut Guide Persona Tibial Cut Guide Persona Tibial Cut Guide Persona Tibial Cut Guide
Right - 3° Right - 7° Universal - 3° Right - 7°
42-5399-052-03 42-5399-052-07 42-5399-050-03 42-5399-050-07
14 | Persona The Personalized Knee Surgical Technique

Figure 20a
5 mm
AP Axis

Figure 20b Figure 21a Figure 21b

Resect Proximal Tibia (cont.)

Position Alignment Guide
T o improve the exposure of the tibial surface, retract Note: This pin will need to be removed to allow the
the tibia anteriorly. Carefully position the retractor "+2" or "+4" mm shifts with the cut guide.
against the posterior cortex of the tibia subperiosteally
to prevent neurovascular injury. Retract the patella  lign the EM alignment guide with the mechanical
A
laterally. Adjust the EM alignment guide to the axis of the tibia (Figure 21a). The longitudinal axis will
approximate length of the tibia. Place the spring arms usually lie just medial to the mid-point of the tibial
of the EM ankle clamp around the ankle proximal to tubercle and be centered in line with the intercondylar
the malleoli. Align the vertical slot in the cut guide with eminence. The distal end of the EM alignment guide
the medial third of the tibial tubercle. should be positioned about 5 mm–10 mm medial to
the midpoint between the palpable medial and lateral
Technique Tip: Care should be taken when pinning malleoli. The short vertical engraved lines on the
into the tibia to avoid perforating the posterior cortex. varus/valgus adjustment rail are incremented by 5
mm to aid in setting the desired varus/valgus position
 djust the height of the cut guide to the approximate
A of the EM alignment guide (Figure 21b). Excessive soft
desired location. Use the engraved line on the top of tissue or poor exposure or visualization can make it
the cut guide to align the rotational and M/L placement difficult to palpate bony landmarks so care should be
guide (Figure 20b). A 3.2 mm pin or screw may be taken to ensure accurate cuts.
inserted through the 12 mm vertical slot in the cut
guide to secure the desired M/L and rotational position
of the proximal portion of the guide (Figure 20a).

Persona EM Proximal Tube Persona EM Distal Rod Persona EM Ankle Clamp 3.2 mm Drill
42-5399-001-00 42-5399-002-00 42-5399-003-00 00-5120-085-00

3.2 mm x 75 mm Trocar Tipped Drill Pin Pin Screw Inserter Persona Tibial Cut Guide
(2.5 mm hex) 00-5901-021-00 Right - 7°
00-5901-020-00 42-5399-052-07
 15 | Persona The Personalized Knee Surgical Technique

2. Insert

1. Push

3. Release

Figure 22 Figure 23

Resect Proximal Tibia (cont.)

Position Alignment Guide (cont.) Set Resection Level
 djust the EM alignment guide in the sagittal plane
A  ach tip of the stylus indicates a different resection
E
to be parallel to the anterior tibial crest. A 3.2 mm level. The 2 mm tip is used to establish the resection
drill or the 3.2 mm pin can be placed through the level from the defective tibial condyle for a minimal
hole in the slot of the cut guide to help assess the cut. The 10 mm tip is used to establish the resection
expected slope of the tibial resection, and if level from the least involved tibial condyle.
desired, match the patient's specific anatomic slope T o assemble, push and hold the lever on the stylus
(Figure 22). As necessary, adjust the tibial slope of the and insert the stylus into the top of the cut guide
EM alignment guide. If there is bulky bandage around and release the lever (Figure 23). The stylus rotates
the ankle or if there is excessive adipose tissue, the and telescopes to facilitate desired positioning of the
guide can be adjusted to create the desired slope. stylus tip.
This will help ensure that the tibia will be cut with the
Technique Tip: Boom tip must be in the vertical
proper slope. Care should be taken to avoid excessive
position to accurately assess resection level.
posterior slope and to verify coronal alignment to the
Correct position is verified with an audible click
mechanical axis.
as the boom twists. WARNING: An excessive bone
resection will result if the boom is not in the vertical
position.
Technique Tip: If using the top surface of the cut
guide to make the resection, follow this technique
for setting the resection level with the stylus. Then
follow the optional technique at the end of this
section. The stylus tips are calibrated to the cut slot.

Persona Tibial Cut Guide Persona Tibial Stylus - 2/10 mm

Right - 7° 42-5399-005-00
42-5399-052-07
16 | Persona The Personalized Knee Surgical Technique

Figure 26

Figure 24 Figure 25 Figure 28

Figure 27

Resect Proximal Tibia (cont.)

Set Resection Level (cont.)
T he 2 mm tip should rest on the defective tibial condyle  resection guide can be placed through the cut
A
(Figure 24). This positions the slot of the cut guide to slot on the cut guide, to verify the desired level and
remove 2 mm of bone below the tip of the stylus. slope of the resection (Figure 26). Insert a 3.2 mm
trocar tipped pin through one of the "0" holes in the
 lternatively, rest the 10 mm tip of the stylus on the
A
cut guide with the pin/screw inserter. Ensure the cut
cartilage of the least involved condyle (Figure 25).
guide is flush to the bone and not impeded by soft
This will allow the removal of the same amount of
tissues before making the cut.
bone that the thinnest tibial component will replace.
These two points of resection will usually not coincide. Insert a second trocar tipped pin through the other
The surgeon must determine the appropriate level of "0" hole in the cut guide with the pin/screw inserter
resection based on patient’s needs, such as age and (Figure 27). Remove the stylus by pushing the lever on
bone quality. Rotate the micro-adjustment dial of the the side of the stylus and remove.
EM proximal tube to position the stylus and the cut To confirm alignment, insert the drop rod adapter into
guide to the desired level. the cut guide and insert the alignment rod into the
Technique Tip: When adjusting the height of the adapter (Figure 28).
EM alignment guide steady the distal portion of the
guide with one hand and use the other hand to adjust
the height of the proximal portion of the guide.

Persona Tibial Stylus - 2/10 mm Persona Drop Rod Adapter 75 mm x 3.2 mm Trocar Resection Guide
42-5399-005-00 42-5399-006-00 Tipped Drill Pin (2.5 mm hex) 00-5977-084-00
00-5901-020-00

Pin/Screw Inserter Alignment Rod with Coupler Persona Tibial Cut Guide Right - 7°
00-5901-021-00 00-5785-080-00 42-5399-052-07
 17 | Persona The Personalized Knee Surgical Technique

2. Translate

1. Lift

Figure 29 Figure 31

Locking Pin
Symbol

Figure 30a Figure 30b Figure 32

Resect Proximal Tibia (cont.)

Resect Proximal Tibia Optional Technique
T he entire EM alignment guide can be left in place for If desired, the resection can be made from the top
additional stability during resection. Optionally, the surface of the cut guide. The top surface of the cut
EM alignment guide can be removed by lifting the guide is 4 mm above the cut slot (Figure 31); therefore,
lever on the EM proximal tube up to the open position, the position of the cut guide must be adjusted by
translating the EM alignment guide anteriorly while moving the cut guide from the headless pins and
leaving the cut guide in place (Figure 29). If the EM reinserting the cut guide through the holes marked
alignment guide has been removed, additional 2 mm "+4" (Figure 32).
adjustments may be made by shifting the cut guide to
the sets of holes marked “+2”, and “+4”. The markings
on the cut guide indicate, in millimeters, the amount of
additional bone resection relative to the standard tibial
resection set by the cut guide and stylus. If a pin or
screw was inserted into the 12 mm vertical slot, it will
need to be removed to make the 2 mm adjustments.
 nce the resection level has been determined, insert a
O
3.2 mm trocar tipped pin in the oblique hole indicated
by a lock pin symbol, to further secure the cut guide
(Figures 30a and 30b). If a pin or screw was inserted
into the 12 mm vertical slot, then a pin through the
oblique hole may not be needed for secure fixation.

Persona Tibial Cut Guide Right - 7° 75 mm x 3.2 mm Trocar Tipped Pin/Screw Inserter Multi Pin Puller
42-5399-052-07 Drill Pin (2.5 mm hex) 00-5901-021-00 00-5901-022-00
00-5901-020-00
18 | Persona The Personalized Knee Surgical Technique

Figure 33 Figure 34 Figure 35

Resect Proximal Tibia (cont.)

Optional Technique (cont.)
Technique Tip: The patellar tendon may be located Remove oblique pins and the tibial cut guide.
behind the lateral side of the cut guide due to the Technique Tip: If unable to complete the resection
patellar tendon relief cutout on the cut guide. Be on the lateral side of the tibia, remove the cut guide,
careful to avoid cutting the patellar tendon when extend the knee and retract the soft tissue on
resecting the tibia. the lateral side. If necessary, use an osteotome to
 se a 1.27 mm (0.050 inch) oscillating saw blade
U complete the resection.
through the slot on the cut guide to resect the proximal I f the cut guide has been removed, the drop rod adapter
surface of the tibia (Figure 33). and alignment rod can be inserted into the holes on

Prior to removing the cut guide, a contralateral or the inverted contralateral or universal cut guide (of any
universal cut guide (of any angle) can be inverted and angle) to verify the desired tibial resection (Figure 35).
placed on the resected tibia to assure that a planar cut Remove all pins.
has been achieved (Figure 34). If necessary, perform a
clean-up cut.
Note: The flatness of the proximal tibial resection is
critical to ensuring adequate contact between the
porous tibial implant and the bone. If using a porous
tibial implant, evaluate the flatness of the proximal
tibial resection prior to drilling for the pegs. Modify
the cut as necessary so that it is completely flat.

Persona Tibial Cut Guide Persona Tibial Cut Guide Persona Tibial Cut Guide 75 mm x 3.2 mm Trocar Multi Pin Puller
Right - 7° Universal - 3° Universal - 7° Tipped Drill Pin (2.5 mm hex) 00-5901-022-00
42-5399-052-07 42-5399-050-03 42-5399-050-07 00-5901-020-00

Persona Drop Rod Adapter Alignment Rod Pin/Screw Inserter

42-5399-006-00 with Coupler 00-5901-021-00
00-5785-080-00
 19 | Persona The Personalized Knee Surgical Technique

Side
Designation

Figure 37

Figure 36 Figure 38

Size Femur and

Establish External Rotation
 otate the feet of the anterior referencing femoral
R If the 3 degrees external rotation holes are to be used
sizing guide so the appropriate “Left” or “Right” to set external rotation, the etched line on the sizer
markings are visible as the femoral sizing guide is should be positioned so it is in line with Whiteside’s line
placed on the bone (Figure 36). External rotation can (Figure 37) to optimize the M/L position of the drill
be set at 3 degrees or 5 degrees from the posterior holes for subsequent 4-in-1 cut guide placement. If
condylar axis. the 5 degrees external rotation holes are to be used,
the sizer can be positioned with the etched line on
Technique Tip: Remove any osteophytes that
interfere with instrument positioning. the sizer 4 mm laterally from Whiteside’s line to better
center the drill holes for subsequent 4-in-1 cut guide
Apply the sizer so that the flat surface of the sizer is placement, due to the M/L offset of the holes. Hold
flush against the resected surface of the distal femur the guide in place and if necessary, secure the sizer
and the feet of the sizer are flush against the posterior to the femur using 25 mm x 3.2 mm (2.5 mm female
condyles. Center the sizer mediolaterally. Both the hex) screws (Figure 38) in one or both of the holes
vertical and horizontal portions of the sizer provide on the lower portion of the guide to help draw the
visual cues relative to the A/P and epicondylar axes of sizer adjacent to the distal femur, particularly in MIS
the femur to help ensure that desired external rotation situations.
is attained.
Note: Do NOT use 48 mm screws for fixation of
Note: Sizer geometry is rotated 3 degrees to align the anterior reference sizer. 48 mm screws are not
to the A/P and epicondylar axes of the femur. The recommended due to potential bone perforation.
3 degrees drill holes are rotated 3 degrees from
the posterior feet and are neutral to the central Technique Tip: Do not impact the sizer onto the
sizer geometry. This enables use of the A/P and femur.
epicondylar axis to set rotation.

Persona Anterior Referencing Sizer 2.5 mm Male Hex Driver 25 mm x 2.5 mm Female Hex Screw
42-5099-088-10 42-5099-025-00 42-5099-025-25
20 | Persona The Personalized Knee Surgical Technique

Size 7 e 12
Siz
Size 1

Figure 39a Figure 39b

Size Femur and

Establish External Rotation (cont.)
S lightly extend the knee and retract soft tissues to Technique Tip: Lock boom after positioning to
expose the anterior femoral cortex. Clear any soft reduce the toggle of the boom tip. This will also
tissue from the anterior cortex. Ensure that the leg reduce the risk of notching.
is in less than 90 degrees of flexion (70 degrees–
80 degrees). This will decrease the tension of the Technique Tip: Positioning the sizing boom tip
patellar tendon to facilitate placement of the sizing on the “high” part of the femur by lateralizing the
boom. The sizing boom telescopes proximally/distally location of the sizing boom tip can often lessen the
to facilitate optimal placement along the anterior likelihood of notching the femur.
cortex. The engraved lines along the top of the boom Technique Tip: To size accurately, the sizing boom
approximate the anterior flange lengths of the size 1, should be telescoped to the size read from the
7, and 12 femoral components (Figure 39a). Once the tower. If the boom is telescoped to the exact size,
sizing boom is appropriately positioned, it should be the tip of the boom will approximate the exit point
locked in place by tightening the knob at the end of the of the saw blade through the anterior cortex.
boom clockwise (Figure 39b).

25 mm x 2.5 mm 3.2 mm Drill 2.5 mm Male Hex Driver Persona Anterior Referencing Sizer
Female Hex Screw 00-5120-085-00 42-5099-025-00 42-5099-088-10
42-5099-025-25
 21 | Persona The Personalized Knee Surgical Technique

Figure 40 Figure 41

Size Femur and

Establish External Rotation (cont.)
 fter the sizer is appropriately positioned on the femur,
A Technique Tip: The multi pin puller cannot be used
read the femoral size from the engraved lines on the to extract the screw(s).
sizer tower and select the closest size (Figure 40).
There are six even sizes labeled on the left side of the Technique Tip: This anterior referencing sizer
tower and six odd sizes labeled on the right side of the works only with these anterior referencing 4-in-1
tower, with lines indicating the in-between sizes. The femoral cut guides and provisionals, and implants
3 degrees or 5 degrees holes in the midline of the A/P referenced in this technique.
portion of the sizer are used to drill 3.2 mm holes for Technique Tip: If the femoral size is determined to
pegs on the anterior referencing 4-in-1 femoral cut be a size 3 or bigger but was prepared for a size 1
guide (Figure 41). A 3.2 mm pin may be placed in the or 2, consider cutting additional distal bone using
first drilled hole to maintain an “index” position prior the 1 mm resection plate.
to drilling the second hole. Remove the screws, then
remove the sizer.
22 | Persona The Personalized Knee Surgical Technique

Figure 44b

Figure 42

Figure 44a

3. Extract

1. Insert 2. Rotate

Figure 45b
Figure 43

Figure 45a

Complete Femoral A/P

and Chamfer Resections
 y hand, place the 4-in-1 cut guide on the femur by
B Technique Tip: If the 2 mm shift holes are to be
aligning the two pins on the back of the guide with used, assure that the desired holes on the distal
the previously drilled positioning holes (Figure 42). femur are used. The resection guide can be used
Impact the face of the guide until the guide is flush as final verification of the anticipated anterior and
with the femur. Place the resection guide through posterior resections.
the anterior slot of the cut guide to ensure the Technique Tip: If there is a risk of anterior
desired anterior resection (Figure 43). If inadequate notching, the 4-in-1 cut guide can be removed,
bone will be removed from the anterior cortex, drill rotated 180 degrees and be replaced on the distal
through the two holes on the face of the cut guide femur. Holes can then be drilled through the
(Figure 44a). Use the slaphammer to axially 2 mm shift holes on the face of the 4-in-1 guide.
remove the cut guide (Figures 45a and 45b). Place The 4-in-1 guide then needs to be removed, rotated
the next smaller-sized femoral cut guide on the 180 degrees and be placed on the distal femur in
femur in the newly drilled “posteriorized” drill the anteriorized holes. This will result in a 2 mm
holes (Figures 44a and 44b). Verify the anterior anterior shift of the 4-in-1 femoral resections. Using
and posterior resection levels with the resection the resection guide, verify that the desired anterior
guide to assure that the desired resections will and posterior resections will be attained.
be attained. If too much posterior bone will
be resected the original femoral cut guide can Optional Instrument
be used. The shift block can be used to internally or externally
rotate the 4-in-1 cut guide 2 degrees and/or shift 1
mm in the anterior or posterior direction. Refer to
Appendix C: Optional Instruments: Shift Block, for use.

Persona Anterior Referencing Resection Guide 3.2 mm Drill Persona Slaphammer

4-in-1 Cut Guide - Size 7 00-5977-084-00 00-5120-085-00 42-5099-037-00
42-5099-085-62
 23 | Persona The Personalized Knee Surgical Technique

3. Extract

Figure 46
2. Rotate

1
Figure 48b
3

1. Insert

Figure 47 Figure 48a

Complete Femoral A/P

and Chamfer Resections (cont.)
Optional Instrument (cont.)
fter final placement of the desired anterior
A  se the slaphammer to remove the cut guide from the
U
referencing 4-in-1 cut guide, insert 3.2 mm trocar- femur. Insert the slaphammer, rotate 1/4 turn clockwise
tipped pins or 3.2 mm headed screws (see Screw to engage the locking feature extract (Figures 48a and
Information section for examples) through the 48b).
oblique holes in the anterior referencing 4-in-1 cut Technique Tip: Completing the femoral resections
guide (Figure 46). Use a 1.27 mm (.050 in.) thick in the order of anterior, posterior, posterior chamfer,
oscillating saw blade to complete the anterior, and then anterior chamfer, the 4-in-1 cut guide will
posterior, posterior chamfer, and anterior chamfer have the greatest stability.
resections through the cut slots (Figure 47). Upon
completion of the cuts, use the multi pin puller to
remove the oblique pins.
Technique Tip: It is not recommended that the
following headed screws are used through the
oblique holes of the anterior referencing 4-in-1 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.

75 mm x 3.2 mm Trocar Tipped Pin/Screw Inserter Multi Pin Puller Persona Slaphammer Persona Anterior Referencing
Drill Pin (2.5 mm hex) 00-5901-021-00 00-5901-022-00 42-5099-037-00 4-in-1 Cut Guide - Size 7
0-5901-020-00 42-5099-085-62
24 | Persona The Personalized Knee Surgical Technique

Male-headed Screws/Pins must be removed from these

holes for Tibial Articular Surface Provisionals (TASP)
1. Depress

3. Release
2. Insert

Figure 49a

Figure 49b Figure 50

Establish Size and Rotation of Tibia

 se only Persona tibial sizing, broaching, and provisional
U  hen the desired position has been attained, secure
W
instrumentation for preparation of Persona Implants. the cemented tibial sizing plate by placing 25 mm x 3.2
mm (2.5 mm female hex) screws or 25 mm x 3.2 mm
nce tibial osteophytes have been thoroughly
O
short head holding pins in the medial and lateral holes
removed, select the appropriate right or left sizing
near the PCL cutout of the cemented tibial sizing plate
plate that provides the desired tibial coverage, without
(Figure 49b). The remaining adjunct fixation holes shown
overhang at any location. Appropriate tibial sizing is
on the surface of the cemented tibial sizing plate can be
important as an over sized tibia component can result
used if necessary. If the cemented tibial sizing plate is
in overhang, soft tissue impingement and pain, or
to be used as a provisional in later steps, male-headed
with stemmed components potential distal conflict
screws/pins used in these holes must be removed prior
between stem and bone.
to using the Tibial Articular Surface Provisionals (TASPs)
 ttach the tibial sizing plate handle to the cemented
A (Figure 50). Ensure that the cemented tibial sizing plate
tibial sizing plate (Figure 49a). The recommended remains in the proper position when securing it to the
tibial rotational alignment is within 5 degrees of the bone. Once desired alignment has been verified with the
axis created by the medial 1/3 of the tibial tubercle alignment rod, remove the tibial sizing plate handle from
and the PCL attachment point. The engraved lines the cemented tibial sizing plate.
on the cemented tibial sizing plate can be used to
aid in establishing the desired tibial rotation. Rotate
the cemented tibial sizing plate to attain the desired
tibial rotational alignment. The notch in the lateral 25 mm x 2.5 mm Female Hex Screw 25 mm Shorthead Holding Pin
42-5099-025-25 00-5977-056-03
periphery of the sizing plate is used to establish proper
position with respect to the lateral border of the tibia
without medialization of the sizing plate.

Persona Tibial Sizing Plate Handle Persona Cemented Tibial Multi Pin Puller Alignment Rod with Coupler 2.5 mm Male Hex Driver
42-5399-017-00 Sizing Plate Size F Right 00-5901-022-00 00-5785-080-00 42-5099-025-00
42-5399-075-02
 25 | Persona The Personalized Knee Surgical Technique

Figure 51a Figure 51b

Establish Size and Rotation of Tibia

(cont.)
Technique Tip: Do not impact, lever, or pry the tibial of motion and soft tissue balance can be attained with
sizing plate handle; this instrument is designed for the cemented tibial sizing plate in place prior to drilling
alignment purposes only. Use the alignment rod in and broaching the tibia.
the hole or slot in the tibial sizing plate handle to
verify proper tibial plate varus/valgus alignment. By hand, place and hold the cemented tibial drill
(See Appendix A for correcting varus/valgus guide on the tibia cemented tibial sizing plate, by first
resections) engaging the posterior tabs in the undercuts in the
cemented tibial sizing plate and then making sure that
Technique Tip: If using a screw through the anterior the distal anterior portion of the cemented tibial drill
medial hole on the periphery of the cemented tibial guide is flush against the cemented tibial sizing plate
sizing plate, ensure that the cemented tibial sizing (Figure 51a).
plate remains in the desired position and does not Use the cemented tibial drill and drill until the center
lift off posteriorly. of the size-specific engraved line on the cemented
tibial drill is in line with the top of the cemented tibial
Drill and Broach Tibia drill guide (Figure 51b). After drilling is complete,
The keel of the tibial implant has a unique location for remove the cemented tibial drill and cemented tibial
every size; therefore, it is critical to select the proper drill guide.
size at this step before drilling and broaching. Once Technique Tip: Insert cemented tibial drill into
these subsequent steps have been performed, the size cemented tibial drill guide prior to starting
should not be changed. If desired, femoral finishing cemented tibial drill. By hand, hold the cemented
can be performed in conjunction with provisional tibial drill guide flush against the cemented tibial
trialing at this stage to assure that the desired range sizing plate while drilling.

Persona Cemented Tibial Drill, 15.7 mm Persona Cemented Tibial Drill Guide - 15.7 mm
42-5399-018-10 42-5399-020-00
26 | Persona The Personalized Knee Surgical Technique

Depress

Slide

Figure 52

Drill Stop Window

Figure 53 Figure 54

Drill and Broach Tibia (cont.)

Optional Technique
If desired, the cemented tibial drill stop collar, may be Technique Tip: Verify that the cemented tibial drill
used to aid in drilling to the correct depth. Depress stop collar is locked on the cemented tibial drill by
the button on the cemented tibial drill stop collar and attempting to slide the cemented tibial drill stop
slide the cemented tibial drill stop collar to the desired collar on the cemented tibial drill by hand. The
size-specific position on the cemented tibial drill cemented tibial drill stop collar will make an audible
(Figure 52). click when it locks on the cemented tibial drill.
Confirm that the correct size is displayed in the
Technique Tip: Insert cemented tibial drill into
cemented tibial drill stop collar window (Figure 53) cemented tibial drill guide prior to drilling.
and that the cemented tibial drill stop collar is locked
on the cemented tibial drill. After positioning the cemented tibial drill stop collar in
the proper position, drill through the cemented tibial
drill guide until the cemented tibial drill stop collar
contacts the cemented tibial drill guide (Figure 54).
After drilling is complete, remove the cemented tibial
drill and cemented tibial drill guide from the cemented
tibial sizing plate.

Persona Tibial Sizing Plate Handle Persona Cemented Tibial Persona Cemented Persona Cemented Tibial Persona Cemented Tibial
42-5399-017-00 Sizing Plate Size F Right Tibial Drill, 15.7 mm Drill Guide - 15.7 mm Drill Stop Collar, 15.7 mm
42-5399-075-02 42-5399-018-10 42-5399-020-00 42-5399-019-00
 27 | Persona The Personalized Knee Surgical Technique

Insert

Figure 55 Figure 56 Figure 57

Drill and Broach Tibia (cont.)

Optional Technique (cont.)
Insert the correct-sized cemented tibial broach into Technique Tip: Assure that no metallic debris is
the cemented tibial broach inserter/extractor handle present on the magnetic feet of the cemented
(Figure 55). Retract the impaction head until it locks tibial broach inserter/extractor handle as this
in the fully retracted position, which will facilitate may inhibit the mating with the cemented tibial
placement on the cemented tibial sizing plate. After sizing plate and may introduce unwanted debris
seating the cemented tibial broach inserter/extractor into the surgical site.
handle on the cemented tibial sizing plate, tap the
impaction head once to seat the cemented tibial Technique Tip: Make sure that the cemented tibial
broach. Impact the cemented tibial broach inserter/ broach inserter/extractor handle remains flush
extractor handle assembly with care to prevent fracture against the cemented tibial sizing plate and in
of the tibia (Figure 56). Impact until the impaction full contact with the cemented tibial sizing plate
head bottoms out on the cemented tibial broach and that the cemented tibial broach inserter/
inserter/extractor handle stop (Figure 56 inset). While extractor handle does not tip during impaction. The
holding the cemented tibial broach inserter/extractor orientation of the cemented tibial broach inserter/
handle, impact the extraction button to remove the extractor handle is important to ensure proper and
cemented tibial broach from the bone (Figure 57). complete broaching resulting in full seating of the
Avoid dislodging the cemented tibial sizing plate tibial implant on the bone.
when removing the cemented tibial broach inserter/
Technique Tip: DO NOT extract with mallet blows
extractor handle. on either the medial or lateral side of the under
surface of the impaction head of the cemented
tibial broach inserter/extractor handle. DO NOT
attempt to extract the cemented tibial broach with
a horizontal or angled blow on any side of the
cemented tibial broach inserter/extractor handle.

Persona Cemented Persona Cemented Tibial Broach Persona Cemented Tibial

Tibial Broach Size EF Inserter/Extractor Handle Sizing Plate Size F Right
42-5399-022-05 42-5399-023-00 42-5399-075-02
28 | Persona The Personalized Knee Surgical Technique

Figure 58
Figure 60

Persona Standard Implant Patella Size & Thickness

1. Depress Collar
26 mm x 7.5 mm* 35 mm x 9.0 mm
29 mm x 8.0 mm** 38 mm x 9.5 mm
32 mm x 8.5 mm** 41 mm x 10.0 mm 2. Rotate Collar

* The 26 mm patella must always be inset.

** The 29 mm and 32 mm patellae must be inset when used with sizes
10–12 Persona PS femoral components.

See package insert for complete details.

Figure 59 Figure 61

Prepare the Patella Resect the Patella

If the surgeon determines that the condition of the Please refer to the appropriate surgical technique if
patient's patella is satisfactory, it is not necessary other patella instrumentation is to be used to resect
to resurface the patella. The geometry, depth, and the patella.
length of the patella groove on the Persona Femoral
Component accommodates the unresurfaced patella. Refer to the sizing chart for patella dimensions
(Figure 59). Use a 3.2 mm drill to drill the highest
Technique Tip: These instruments are designed for portion of the medial facet perpendicular to the
onlaying all-poly patella only. articular surface approximately 12 mm deep centered
on the medial sagittal ridge (Figure 60). This acts as a
Place the leg in full extension, evert the patella to guide for proper medialization of the patella.
at least 90 degrees. Stabilize the patella, using two
inverted towel clips. Incise the soft tissue around  se the patella osteotomy guide with the stylus set for
U
the patella down to the insertion of the quadriceps the desired amount of resection. Depress the button
and patellar tendons. Before making any bone cuts, on the stylus while twisting to set the stylus at the
determine the maximum thickness of the patella by desired resection level (Figure 61). If the patella is very
using the femur caliper to measure the most prominent worn, resect less bone.
anterior-to-posterior dimension (Figure 58).
Technique Tip: Assure that the patella osteotomy
Technique Tip: The femur caliper has a tolerance of guide stylus is referencing the most prominent
± 0.25 mm. point on the patella before resecting.

Technique Tip: At least 10 mm of bone must remain

to ensure that the pegs of the patella implant do not
protrude through the anterior surface (see image).

Femur Caliper 3.2 mm Drill

00-5903-030-00 00-5120-085-00
 29 | Persona The Personalized Knee Surgical Technique

2. Depress

1. Squeeze

Figure 62 Figure 63 Figure 64

Resect the Patella (cont.) Finish the Patella

Apply the patella osteotomy guide medially and Using the NexGen® Patella Sizing Template, select
laterally with the jaws at the osteochondral juncture the maximum-sized patella that does not overhang,
with the handles of the jig oriented toward the foot. centered over the 3.2 mm drill hole as a reference for
Apply the guide with the jaws parallel to the dorsal proper medialization (Figure 64).
surface of the patella, while positioning the patella
osteotomy guide stylus over the most prominent Technique Tip: Do not drill through the center hole
point on the patella. Make the resection with a 1.27 of the NexGen Patella Sizing Template.
mm (0.050 inch) thick saw blade (Figure 62). Cut the
Technique Tip: Eccentric placement of the patella
patella flat so that a smooth surface remains. 3–4 mm medially allows for better patella tracking.
Technique Tip: To facilitate unlocking the patella
osteotomy guide from the patella, apply slight
gripping pressure on the handles of the patella
osteotomy guide and depress the release lever to
unlock the patella osteotomy guide (Figure 63).

Patella Osteotomy Guide NexGen Patella Sizing Template

00-5903-010-00 00-5903-041-00
30 | Persona The Personalized Knee Surgical Technique

Figure 65

Figure 67

2. Depress

1. Squeeze

Figure 66 Figure 68

Finish the Patella (cont.)

I nsert the appropriately-sized NexGen Patella Peg Drill  se the NexGen 6.4 mm Patella/Femoral Drill to drill
U
Guide into the patella clamp in the proper orientation through the 3-peg holes in the NexGen Patella Peg
(Figure 65). Place the patella clamp with the NexGen Drill Guide (Figure 67).
Patella Peg Drill Guide over the cut surface of the
patella, centered slightly toward the medial facet over Technique Tip: To facilitate unlocking the patella
the 3.2 mm drill hole with the clamp oriented so two clamp from the patella, apply slight gripping
of the holes are biased toward the medial side of the pressure on the handles of the patella clamp and
patella (Figure 66). depress the release lever to unlock the patella
clamp (Figure 68).
Technique Tip: For hard/sclerotic bone it may
be necessary to impact the NexGen Patella Peg
Drill Guide face to fully seat the drill guide. This is
necessary to assure that adequate bone removal is
attained during drilling to fully seat the implant.

NexGen Patella Peg Drill Guide Patella Clamp NexGen 6.4 mm Patella/Femoral Drill
Sizes 29, 32, 35, 38, 41 00-5903-020-00 00-5120-052-01
00-5903-023-29/41
 31 | Persona The Personalized Knee Surgical Technique

Release Lever

Narrow Cutouts

Alignment Arrows

Figure 69a Figure 69b Figure 70

CR Femoral Finishing and Trialing

Technique Tip: Reference the orientation and size Femoral sizes 1 and 2 are provided in one profile, narrow;
etched and/or engraved markings to identify the and femoral size 12 provided in one profile, standard.
correct provisional. Thus the size 1, 2 and 12 femoral provisionals do not
have intermittent cutouts. Care should be taken to use
Assemble the femoral CR impactor pad to the femoral the appropriate standard or narrow implant as is related
inserter/extractor. Hold the femoral inserter/extractor to side (left or right) and size based on the provisional fit
with the handle in the open position and insert the and ROM provided during the trialing phase.
femoral CR impactor pad, aligning the "CR" on the
femoral CR impactor pad with the arrow on the femoral Technique Tip: Do not impact the anterior flange
inserter/extractor (Figure 69a). The femoral CR impactor of the CR femoral provisional. Do not impact the
pad is keyed, so the femoral CR impactor pad may have medial or lateral aspects or the release lever of the
to be rotated while placing and aligning the femoral CR femoral inserter/extractor.
impactor pad onto the femoral inserter/extractor.
 emove any posterior osteophytes or overhanging
R
Femoral sizes 3 through 11 are provided in two profiles, bone on the femur to facilitate maximum knee flexion.
standard and narrow. The size 3 through 11 standard Attach the femoral inserter/extractor to the correct
femoral provisionals have intermittent cutouts around CR femoral provisional by inserting the hook on the
the periphery, with the inner dimension representing femoral inserter/extractor arm into the anterior notch
the outer profile of the narrow femoral implant and the in the CR femoral provisional and close the handle
outer dimension representing the outer profile of the on the femoral inserter/extractor to secure the CR
standard femoral implant (Figure 69b). femoral provisional (Figure 70).

Persona Femoral Inserter/Extractor Persona Femoral CR Impactor Pad Persona CR Femoral Provisional Size 7 Right
42-5099-092-00 42-5099-094-00 42-5027-062-02
32 | Persona The Personalized Knee Surgical Technique

Pinch to
release

Figure 71 Figure 73

2. Rotate
3. Extract

1. Insert

Figure 72 Figure 74

CR Femoral Finishing and Trialing

(cont.)
Place the correct CR femoral provisional onto the femur If the tibia has been prepared, a trial range of motion
in the desired medial/lateral position. Impact the end can be performed to assure proper positioning of
of the femoral inserter/extractor handle to fully seat the CR femoral provisional prior to femoral peg hole
the CR femoral provisional onto the femur (Figure 71). preparation. Once desired medial-lateral placement
To remove the femoral inserter/extractor from the has been attained, drill the peg holes for size 3 through
CR femoral provisional, pinch the release lever while 12 femoral implants through the CR femoral provisional
pulling out/down (Figure 71). Alternatively, if the CR with the NexGen 6.4 mm Patella/Femoral Drill (Figure
femoral provisional is placed on the femur by hand, the 73). For size 1 and 2 femoral implants use the NexGen
femoral inserter/extractor handle must be in the closed 4.4 mm Femoral Peg Drill. If a screw was used to provide
and locked position prior to engaging the CR femoral adjunct fixation, remove the screw from the anterior
provisional. Then the femoral inserter/extractor can flange in the CR femoral provisional. The slaphammer
be used to impact the provisional onto the femur. For can be used to remove size 3 through 12 CR femoral
additional fixation of the fully seated provisional, insert provisionals (Figure 74). Rotate the slaphammer a ¼
the 25 mm x 3.2 mm screw (2.5 mm female hex) with the turn outward. For size 1 and 2 CR femoral provisionals
2.5 mm male hex driver through the hole in the lateral the slaphammer can be inserted into the notch on the
anterior flange of the CR femoral provisional (Figure 72). medial or lateral side of the provisional. Alternatively,
the femoral inserter/extractor can be reattached to
Technique Tip: Ensure the shoulder of drill is seated the CR femoral provisional to remove it from the bone.
at bottom of the femoral provisional counterbore. If necessary, place the round end of the slaphammer in
the extraction hole of the femoral inserter/extractor to
Persona Femoral Persona Femoral Persona CR Femoral facilitate removal.
Inserter/Extractor CR Impactor Pad Provisional Size 7 Right 42
42-5099-092-00 42-5099-094-00 5027-062-02

25 mm x 2.5 mm NexGen 6.4 mm Patella/ Persona Slaphammer 2.5 mm Male Hex Driver NexGen 4.4mm Femoral Drill for size
Female Hex Screw Femoral Drill 42-5099-037-00 42-5099-025-00 1 and 2 Femoral Provisionals
42-5099-025-25 00-5120-052-01 00-5965-009-00
 33 | Persona The Personalized Knee Surgical Technique
Release Lever

Alignment Arrows

Figure 75a Figure 75b

CR Femoral Finishing and Trialing

(cont.)
Technique Tip: Ensure oval hole of the femoral The femoral PS impactor pad is keyed, so the femoral PS
provisional is free of debris prior to inserting impactor pad may have to be rotated while placing and
slaphammer. aligning the femoral PS impactor pad onto the femoral
inserter/extractor.
Technique Tip: If trialing with TASP leave femoral
provisional in place until trialing is complete. Femoral sizes 3 through 11 are provided in two profiles,
standard and narrow. The size 3 through 11 standard
Technique Tip: Do not impact the anterior flange of femoral provisionals have intermittent cutouts around
the CR femoral provisional for removal, as this may the periphery, with the inner dimension representing
damage the CR femoral provisional. the outer profile of the narrow femoral implant and
the outer dimension representing the outer profile of
PS Femoral Finishing the standard femoral implant (Figure 75b). Femoral
sizes 1 and 2 are provided in one profile, narrow; and
and PS Box Preparation femoral size 12 provided in one profile, standard. Thus
Technique Tip: Reference the orientation and size the size 1, 2, and 12 femoral provisionals do not have
etched and/or engraved markings to identify the intermittent cutouts. Care should be taken to use the
correct provisional. appropriate standard or narrow implant as is related to
side (left or right) and size based on the provisional fit
Assemble the femoral PS impactor pad to the femoral
and ROM provided during the trialing phase.
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 (Figure 75a).

Persona Femoral Inserter/Extractor Persona Femoral PS Impactor Pad Persona PS-CPS Femoral Provisional Size 7 Right
42-5099-092-00 42-5099-093-00 42-5047-062-02
34 | Persona The Personalized Knee Surgical Technique

Figure 78a
Figure 76

Pinch to
release

Figure 77 Figure 78b

PS Femoral Finishing
and PS Box Preparation (cont.)
Technique Tip: Do not impact the anterior flange Alternatively, if the PS femoral provisional is placed
of the PS femoral provisional. Do not impact the on the femur by hand, the femoral inserter/extractor
medial or lateral aspects or the release lever of the handle must be in the closed and locked position
femoral inserter/extractor. prior to engaging the PS femoral provisional. Then the
femoral inserter/extractor can be used to impact the
 emove any posterior osteophytes or overhanging
R provisional onto the femur. For additional fixation of the
bone on the femur to facilitate maximum knee flexion. fully seated PS femoral provisional, insert the 25 mm
Attach the femoral inserter/extractor to the correct x 3.2 mm screw (2.5 mm female hex) with the 2.5 mm
PS femoral provisional by inserting the hook on the male hex driver through the hole in the lateral anterior
femoral inserter/extractor arm into the lateral notch in flange of the PS femoral provisional (Figure 78a).
the PS femoral provisional and close the handle on the
femoral inserter/extractor to secure the PS femoral By hand, insert and hold the correct-sized PS box
provisional (Figure 76). cut guide into the anterior holes of the PS femoral
provisional (Figure 78b). For additional fixation of the
Place the correct PS femoral provisional onto the fully seated PS box cut guide, insert the 25 mm x 3.2
femur in the desired medial/lateral position. Impact mm screw (2.5 mm female hex) with the 2.5 mm male
the end of the femoral inserter/extractor handle to hex driver through one of the holes in the PS box cut
fully seat the PS femoral provisional onto the femur guide. Separate PS box cut guides exist for the PS
(Figure 77). To remove the femoral inserter/extractor femoral provisional for sizes 1–2, 3–5, 6–9, and 10–12.
from the PS femoral provisional, pinch the release
lever while pulling out/down (Figure 77).

Persona Femoral Persona Femoral PS Persona PS-CPS Femoral 2.5 mm Male Hex Driver 25 mm x 2.5 mm Persona PS Box
Inserter/Extractor Impactor Pad Provisional Size 7 Right 42-5099-025-00 Female Hex Screw Cut Guide 6-9
42-5099-092-00 42-5099-093-00 42-5047-062-02 42-5099-025-25 42-5099-060-03
 35 | Persona The Personalized Knee Surgical Technique

Figure 79a Figure 79b

PS Femoral Finishing
and PS Box Preparation (cont.)
Technique Tip: Do not impact the PS box cut guide After completing the anterior-to-posterior box cut,
into the provisional. make the vertical wall cuts for the PS notch cuts by
resting the saw blade in a parallel manner against
Make the anterior to posterior PS box cut with a the interior sidewalls of the PS femoral provisional
1.27 mm (0.050 inch) thick, ½ inch wide oscillating or (Figure 79b).
reciprocating saw blade, by resting the saw blade in
a parallel manner on the front surface of the PS box
cut guide. Avoid undercutting the medial and lateral
condyles. This is particularly important for smaller
femurs (Figure 79a).

Persona PS-CPS Femoral Persona PS Box Cut Guide 6-9 2.5 mm Male Hex Driver 25 mm x 2.5 mm
Provisional Size 7 Right 42-5099-060-03 42-5099-025-00 Female Hex Screw
42-5047-062-02 42-5099-025-25
36 | Persona The Personalized Knee Surgical Technique

Figure 80

PS Femoral Finishing
and PS Box Preparation (cont.)
Technique Tip: Keep blades against the support Technique Tip: If the appropriately sized PS box
features of the cut guide and femoral provisional to provisionals does not easily seat into the PS femoral
ensure adequate bone resection. The cut planes (A/P provisional, perform clean up cuts to assure
and vertical) extend below the top of the PS cam. adequate bone has been removed. Do NOT impact
the PS box provisional. Make sure the PS femoral
Technique Tip: Align the raised bumps on the provisional is fully seated after inserting the correct
exterior side walls of the box provisional with the PS box provisional.
grooves in the interior sidewalls of the femoral
provisional.

I f 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 1–2, 3–5, 6–9, and 10–12 PS femoral
provisionals (Figure 80). The constrained posterior
stabilized (CPS) cut slot must be used if a CPS bearing
is selected. The CPS cut slot may also be used for PS
box resections. Additional information for this product
may be found in the Constrained Posterior Stabilized
(CPS) Surgical Technique (97-5026-072-00).

2.5 mm Male Hex Driver 25 mm x 2.5 mm Persona PS Box Cut Persona PS-CPS Box Provisional
42-5099-025-00 Female Hex Screw Guide 6-9 Size 6-7 Right
42-5099-025-25 42-5099-060-03 42-5047-007-12
 37 | Persona The Personalized Knee Surgical Technique

1. Remove

3. Rotate

4. Extract

2. Insert

Figure 81 Figure 82

PS Femoral Finishing
and PS Box Preparation (cont.)
Technique Tip: Ensure the shoulder of drill is Technique Tip: Ensure oval hole of the femoral
seated at bottom of the femoral provisional provisional is free of debris prior to inserting
counterbore. slaphammer.
 rill the pegs holes for the size 3 through 12 femoral
D Technique Tip: If trialing with TASP leave femoral
implants through the PS femoral provisionals with the provisional in place until trialing is complete.
NexGen 6.4 mm Patella/Femoral Drill (Figure 81). The
size 1 and 2 femoral components do not have pegs thus Technique Tip: Do not impact the anterior flange
drilling is not required for those sizes. Remove the screw of the PS femoral provisional for removal, as this
from the anterior flange in the PS femoral provisional. may damage the PS femoral provisional.
Remove the PS box provisional. The slaphammer
can be used to remove size 3 through 12 PS femoral
provisionals (Figure 82). Rotate the slaphammer a ¼
turn outward. For size 1 and 2 PS femoral provisionals
the slaphammer can be inserted into the notch on the
medial or lateral side of the provisional. 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.

NexGen 6.4 mm 2.5 mm Male Hex Driver 25 mm x 2.5 mm Persona PS-CPS Box Persona Slaphammer Persona PS-CPS Femoral
Patella/Femoral Drill 42-5099-025-00 Female Hex Screw Provisional Size 6-7 Right 42-5099-037-00 Provisional Size 7 Right
00-5120-052-01 42-5099-025-25 42-5047-007-12 42-5047-062-02
38 | Persona The Personalized Knee Surgical Technique

Figure 83a Figure 83b

Perform Trial Reduction

 emove any posterior osteophytes or overhanging
R emove the femoral inserter/exactor from the
R
bone on the femur to ensure maximum knee flexion. provisional. With the knee in extension, ensure that the
In this step, a trial reduction is performed to check provisional is flush against the resected distal surface
component position, patellar tracking, range of of the femur on the medial condyle. Retract the lateral
motion (ROM), and joint stability. Depending on the side and check to make sure it is flush distally, on
order of the surgical steps, some of the provisional the lateral side. If preparation for patella resurfacing
components may already be in place. For example if has been performed, insert the appropriate patella
the cemented tibial sizing plate is to be used, it may provisional during the trialing phase.
already be in place. If the femoral provisional was
the last bone preparation step, it will already be in
place. If not, attach the femoral inserter/extractor to
the appropriate femoral provisional and insert on the
bone in the correct position (Figures 83a and 83b).

Technique Tip: Be sure that soft tissue is not

trapped beneath the provisionals. Impact until fully
seated.

Quick Connect Handle Tibial Impactor Head Persona Stemmed Tibial Persona Femoral Persona Cemented Tibial Persona Femoral CR
00-5901-034-00 00-5901-033-00 Provisional Size F Right Inserter/Extractor Sizing Plate Size F Right Impactor Pad
42-5321-075-02 42-5099-092-00 42-5399-075-02 42-5099-094-00

Persona CR Femoral Persona Femoral PS Persona PS-CPS Box Persona PS-CPS Femoral Standard All-Poly Tibial Provisional Extractor
Provisional Size 7 Right Impactor Pad Provisional Size 6-7 Right Provisional Size 7 Right Patella Provisional, 00-5977-017-00
42-5027-062-02 42-5099-093-00 42-5047-007-12 42-5047-062-02 Size 35 mm x 9 mm
00-5971-065-35
 39 | Persona The Personalized Knee Surgical Technique

Pin Slots

Pins

Figure 84a Figure 84b

Tibial Articular Surface Provisional

(TASP) Assembly
T he TASP consists of three parts: a TASP bottom, a Technique Tip: As shown on the anterior face of the
TASP shim, and a TASP top. Select the TASP bottom TASP top, confirm the correct constraint, femoral
that matches the cemented tibial sizing plate or tibial compatibility, tibial size, and side.
baseplate implant. Select the TASP top that mates with
both the TASP bottom and the femoral provisional or Technique Tip: Apply gentle manual pressure
component as marked on the anterior face of the TASP without impacting the TASP construct with either
top (Figure 84a). In addition to the markings on the a mallet or hand. The TASP construct includes the
parts, the same colors are used for the mating TASP TASP top, bottom, shim, and tibial sizing plate
tops and bottoms. Axially align the pin slots on the handle.
TASP top with the pins on the TASP bottom during Technique Tip: As described on page 13, if using
assembly as these parts must be assembled BEFORE the cemented tibial sizing plate during the trialing
the TASP shim can be used (Figure 84b). Select the set phase, please assure that the necessary male-
of TASP shims that match the selected Tibial implant headed screws/pins are removed from the anterior
size. surface of the cemented tibial sizing plate to avoid
interference and potential damage to the TASP.
Technique Tip: There are two TASP bottom
thicknesses +0 mm and +6 mm. Use +0 mm bottom
for 10–14 mm constructs and the +6 mm bottom
for 16–20 mm constructs.

Note: TASP bottom pins are offset to prevent

assembly of left TASP tops on right TASP bottoms
and vice versa.

Persona TASP Top Persona TASP Top Right Persona TASP Top Right Persona TASP Top Right Persona TASP Right EF Persona TASP Right
Right CR 3-11/EF Medial Congruent 6-7/EF Ultracongruent 4-11/EF PS 6-9/EF +0 Bottom EF +6 Bottom
42-5270-005-10 42-5271-007-10 42-5272-005-10 42-5274-007-10 42-5270-005-05 42-5270-005-15
40 | Persona The Personalized Knee Surgical Technique

> 30 degrees

1. Depress
3. Release 2. Insert

Figure 85a Figure 86a Figure 87a

5-15 degrees

Figure 85b Figure 86b Figure 87b

Tibial Articular Surface Provisional

(TASP) Assembly (cont.)
T he shims (10, 11, 12, 13, and 14 mm) are not side- The shims are incremented by 1 mm to create TASP
specific. Attach the tibial sizing plate handle to the constructs of 10 mm, 11 mm, 12 mm, 13 mm, or 14 mm
appropriate 10 mm shim (Figure 85a). While holding to match the implant offering. The +6 mm bottoms are
the TASP top and bottom together with one hand, included for instances where the TASP construct needs
lock the TASP top and bottom together by inserting to be 16 mm, 18 mm, or 20 mm. In these circumstances,
the appropriate 10 mm shim with the tibial sizing the 10 mm, 12 mm, and 14 mm shims are to be used to
plate handle (Figure 85b). The 10 mm shim will create create the respective TASP constructs.
a TASP construct which matches the thickness of the
Note: The maximum thickness of available CR
thinnest tibial bearing implant, 10 mm (Figures 86a implants is 18 mm. MC, UC, and PS implants are
and 86b). available in thicknesses up to 20 mm. Also, 15 mm,
Technique Tip: During assembly of the TASP 17 mm, and 19 mm thicknesses are NOT available
construct, slide the shim in using a direct anterior in CR, MC, UC, or PS.
approach between the TASP top and bottom. It is recommended that the thinnest TASP construct
To avoid inadvertent separation, maintain slight (10 mm) be inserted into the joint space, with the knee
pressure between the TASP top and bottom while at greater than 30 degrees of flexion (Figure 87a), to
inserting the shim. perform an initial ROM assessment.
If a thicker construct is needed to appropriately
fill and balance the joint space, place the knee in
approximately 5–15 degrees of flexion (Figure 87b)
to facilitate in vivo removal and insertion of the shims
with the tibial sizing plate handle.

Persona TASP Right Persona TASP Top Right Persona TASP Top Right Persona TASP Top Right Persona Tibial Sizing Persona TASP Shim EF
EF +6 Bottom Ultracongruent 4-11/EF CR 3-11/EF Medial Congruent 6-7/EF Plate Handle 10 mm
42-5270-005-15 42-5272-005-10 42-5270-005-10 42-5271-007-10 42-5399-017-00 42-5279-005-00
 41 | Persona The Personalized Knee Surgical Technique

Lift (>30 degrees)

then rotate. 10 mm
13 mm

11 mm
14 mm

12 mm

TASP Shim/Construct Thickness

Anterior divots in the shim correspond to the overall construct thickness
as shown in the image above.
Figure 87c

Color Coded Side Specific Shared Sizing*

Tibial Sizing Plate No Yes No
Articular Surface Tops Yes Yes Yes
+0 Bottoms Yes Yes Yes
+6 Bottoms Yes Yes Yes
Shims No No Yes

Figure 87d *Shared Sizing - A and B, C and D, E and F, G and H Cemented Tibial Sizing Plates
have common TASP Tops, Bottoms and Shims respectively.

Figure 88

Tibial Articular Surface Provisional

(TASP) Assembly (cont.)
T he entire TASP construct can be removed to exchange  s shown (Figure 88), size A and B tibias, size C and D
A
the shims of the TASP construct. This is accomplished tibias, size E and F tibias, and size G and H tibias, share
by flexing the knee greater than 30 degrees, then side-specific tibial bottoms, tibial tops, and color,
lifting the tibial sizing plate handle while attached to respectively.
the TASP construct. Once the anterior lip of the TASP
bottom is above the anterior rail of the tibial sizing  hen using the stemmed tibia provisional, assemble
W
plate (Figure 87c), rotate the TASP out of the joint the stemmed tibia provisional to the tibial provisional
space medially or laterally (Figure 87d). This will aid in extractor and insert in the prepared tibia bone. For
preventing unwanted shim disassembly during TASP additional fixation of the fully seated provisional, insert
removal. the 25 mm x 3.2 mm screw (2.5 mm female hex) with
the 2.5 mm male hex driver through the two screw
Technique Tip: Varus/Valgus forces may make it fixation holes in the medial and lateral compartments
difficult to remove the TASP construct. To aid in the on the STP.
removal of the TASP and prevent breakage, ensure
that the joint is in a neutral position when removing Note: Do NOT use 48 mm screws for cemented
the TASP construct. tibial sizing plate fixation. 48 mm screw are not
recommended due to potential bone perforation.

Persona TASP Right Persona TASP Top Right Persona TASP Top Right Persona TASP Top Right Persona Tibial Sizing
EF +6 Bottom Ultracongruent 4-11/EF CR 3-11/EF Medial Congruent 6-7/EF Plate Handle
42-5270-005-15 42-5272-005-10 42-5270-005-10 42-5271-007-10 42-5399-017-00

Persona TASP Shim EF 10 mm Persona Stemmed Tibial Tibial Provisional Extractor

42-5279-005-00 Provisional Size F Right 00-5977-017-00
42-5321-075-02
42 | Persona The Personalized Knee Surgical Technique

Consider resecting the PCL if the

femur appears to book open.

Figure 89

Tibial Articular Surface Provisional

(TASP) Assembly (cont.)
 heck ligament stability in extension and in 30
C The constrained posterior stabilized (CPS) TASP
degrees, 60 degrees, and 90 degrees of flexion. may also be assessed if further stability is needed.
Attempt to distract the joint in flexion to ensure that it Additional information for this product may be found
will not distract. If a posterior stabilized component is in the Constrained Posterior Stabilized (CPS) Surgical
used, hyperflex the knee and verify that the spine still Technique (97-5026-072-00). When greater varus/
engages the cam. Insert the patellar provisional onto valgus constraint is needed and/or stems or augments
the resected patellar surface. Perform a ROM to check are required, the surgeon should consider using a
patellar tracking. When component position, ROM, revision implant system.
and joint stability have been confirmed, remove all
ssemble the tibial provisional extractor to the
A
provisional components.
stemmed tibia provisional to remove the stemmed
If a CR femoral implant is to be used and the PCL is tibia provisional prior to implanting the components.
recessed or becomes deficient intraoperatively, the
PCL should be fully resected and the Medial Congruent Technique Tip: If the TASP construct is used
with the femoral and/or tibial implants, contact
(MC) or ultracongruent (UC) TASP should be trialed to
with bone cement should be avoided to prevent
assure desired ROM and joint stability prior to bearing
potential damage to the TASP components.
implant selection.
 hen trialing with either a CR or MC insert and the
W Technique Tip: The articular surface inserter
should not be used with the TASP.
PCL is retained, posterior soft tissue tightness may
occur, resulting in the femur booking open (Figure 89). Technique Tip: Use only the tibial sizing plate
Should this occur, consider resecting the PCL. If the PCL handle to remove the TASP construct. The use of
is resected, either a MC or UC bearing should be used. other instruments may damage or break the TASP.
If unacceptable flexion/extension gap imbalances
exist, refer to the "Balance Flexion/Extension Gaps"
section of Appendix B for potential options.

Persona Tibial Sizing Plate Handle

42-5399-017-00
 43 | Persona The Personalized Knee Surgical Technique

1. Unlock Collar
3. Release

2. Insert
4. Rotate

Figure 90 Figure 91

Implant Components Tibial Plate

Technique Tip: Prior to cementing implants S ublux the tibia anteriorly to allow adequate clearance
remove provisionals and use pulse lavage to remove to insert the tibial implant into the prepared bone. Do
unwanted debris from the resected bone surfaces not apply substances other than bone cement to the
and the joint space. tibial implant (i.e. do not dip implant into antibiotics
or other substances). Keep the implant clean and free
In this step, the final components are implanted, of debris prior to cementing. Place a layer of cement
and the tibial bearing is secured to the implanted on the underside of the tibial baseplate, around the
tibial baseplate. When using cemented components, keel, on the resected tibial surface, and in the tibial IM
it is recommended to use two batches of cement. canal. Assemble the quick connect handle to the tibial
After the implants have been chosen, make a final impactor head (Figure 90). Unlock collar and hold,
check to ensure that all components are compatible. insert handle into impactor head, release collar, and
If the resected surfaces of the tibia and/or femur rotate handle until “click” is heard. Refer to the option
are sclerotic, drill multiple holes with a small drill of an attached inserter for the tibial plate insertion,
(2.0 mm–3.2 mm) to improve cement intrusion. Mix located in Appedix C. Position the tibial plate onto the
the cement following the manufacturer's guidelines tibia and use the tibial impactor to impact it until fully
for cement prep including but not limited to mix, work, seated (Figure 91). Thoroughly remove any excess
and set time. cement in a consistent manner. Allow the cement to
fully cure before performing a trial ROM or inserting
the bearing.

Standard All-Poly Patella Quick Connect Handle Tibial Impactor Head Persona Cemented Stemmed
Provisional, Size 35 mm x 9 mm 00-5901-034-00 00-5901-033-00 Tibial Plate Sizes F Right
00-5971-065-35 42-5320-075-02
44 | Persona The Personalized Knee Surgical Technique

Figure 94
1. Unlock Collar
3. Release
Figure 92a
1.
2.

2. Insert
4. Rotate

Figure 92b Figure 93 Figure 95

Implant Components (cont.)

Femoral Component Bearing
 ith the knee in 70 degrees – 90 degrees of flexion,
W The articular surface inserter applies both downward
retract the soft tissue in the desired manner. Place a and rearward forces to aid in the insertion of the bearing
layer of cement on the underside of the prosthesis and onto the tibial base plate. Choose the correct tibial
in the holes drilled in the femur. Attach the femoral bearing based on size, side, constraint and thickness as
inserter/extractor to the femoral component (Figures determined by the trial range of motion. Place the bearing
92a and 92b). Insert the femoral component onto the onto the tibial base plate. Apply pressure anterior to
distal femur by translating the component laterally posterior to properly engage the tibial component and
until the lateral peg aligns with the drill hole in the tibial bearing for final seating. This is necessary to allow
lateral femoral condyle. Take care to avoid scratching the inserter to properly engage the tibial component
the implant component surfaces. After the femoral and tibial bearing for final seating (Figure 95). Steady
component is placed on the femur and the femoral the surface of the base plate with one hand by applying
inserter/extractor is removed, the femoral inserter/ downward pressure near the posterior cruciate cutout.
extractor can be used to fully seat the implant onto
the femur. If this method is used,the femoral inserter/ Technique Tip: Insert a bearing only once. Never
extractor handle must be in the closed and locked reinsert the same bearing onto a tibial base plate.
position. Ensure that soft tissue is not trapped beneath
the implant. Alternatively, assemble the quick connect
handle to the femoral impactor head (Figure 93). Use
this assembly to fully seat the femoral implant (Figure
94). Remove retractors, and check the medial and
lateral sides to make sure the femoral implant is fully Femoral Impactor Head Tibial Impactor Head Quick Connect Handle
00-5901-032-00 00-5901-033-00 00-5901-034-00
impacted distally. Remove any excess cement in a
thorough and consistent manner.

Persona Femoral Persona Femoral PS Persona Femoral CR Persona CR Femoral Persona PS Femoral
Inserter/Extractor Impactor Pad Impactor Pad Component Size 7 Right Component Size 7 Right
42-5099-092-00 42-5099-093-00 42-5099-094-00 42-5026-062-02 42-5006-062-02
 45 | Persona The Personalized Knee Surgical Technique

Figure 96a Figure 96b Figure 97

Implant Components (cont.)

Bearing (cont.)
Engage the hook on the articular surface inserter with Technique Tip: Only in vivo assembly of the
the mating slot in the front of the base plate and close ultracongruent bearing is recommended because
the lever with your index finger. This locks the inserter the design of the ultracongruent bearing precludes
to the tibial plate (Figure 96a). Squeeze the handle cement removal from the PCL cutout area at the
of the articular surface inserter to seat the bearing tibial baseplate/bone interface.
(Figure 96b). Open the lever and remove the articular
surface inserter. Assemble the quick connect handle to the tibial
impactor head. Unlock collar and hold, insert quick
Alternatively the bearing can be locked into the connect handle into tibial impactor head, release
tibial plate as described above, prior to tibial plate collar, and rotate handle until “click” is heard. Position
implantation. If PS femoral implants are used, the the tibial plate bearing construct onto the tibia and
femoral implant should be implanted before the use the tibial impactor to impact it until fully seated
tibial implant to avoid the excessive joint distraction (Figure 97). Thoroughly remove any excess cement in
required to clear the post while implanting the PS a consistent manner.
femoral implant. If CR femoral implants are used, the
tibial implant should be implanted prior to the femoral Technique Tip: Do NOT impact or lever the articular
implant to facilitate the removal of excess cement surface inserter or extractor tools when they are
from the posterior aspect of the tibia, prior to femoral attached to the tibial plate as this may disrupt the
implantation. fixation of the tibial plate to the bone and/or cause
damage to the implant or instrument. Also, do not
impact the bearing.
To remove a bearing from the baseplate, engage
Persona Stemmed Persona CR Tibial Persona MC Tibial the hook on the articular surface removal instrument
Cemented Tibial Articular Component Articular Component
Component Size F Right Size 3-11/EF Right 6-7/EF Right with the mating slot on the front of the baseplate and
42-5320-075-02 42-5210-005-10 42-5221-007-10 squeeze the handle to disengage the bearing from the
base plate. The articular surface removal instrument
should not be used for provisional removal.

Persona UC Tibial Articular Persona PS Tibial Articular Persona Articular Surface Inserter Articular Surface Removal Instrument
Component Size 4-11/EF Right Component Size 6-9/EF Right 42-5299-001-00 00-5977-021-00
42-5212-005-10 42-5214-007-10
46 | Persona The Personalized Knee Surgical Technique

Figure 98

Implant Components (cont.)

Patellar Component Close Incision
Please refer to the appropriate surgical technique Freely irrigate the wound with the solution of choice to
if other patella instrumentation is to be used to assure unwanted debris is removed from the joint space
accomplish the patella implantation. prior to closure. A drain may be placed intracapsularly.
Then close the wound with sutures and apply a
All-Polyethylene Patella bandage. Please refer to package insert for complete
product information, including contraindications,
 ith the knee in 70 degrees – 90 degrees of flexion,
W warnings, precautions, and adverse effects.
apply cement to the anterior surface and pegs of the
patellar component while in a doughy consistency.
Surgeon Notes and Tips
Alternatively, this step can be performed with the
knee in full extension. Locate the drilled peg holes and T ake care that the retractors do not inadvertently
use the patella clamp assembly to insert and secure dislodge the tibial baseplate, particularly on the
the patella in place. Fully open the jaws of the patella posterolateral corner. Verify that the femoral
clamp and align the tooth to the anterior surface of component is fully seated before closing the wound.
the patella and the patella clamp head to the posterior Confirm that no portion of the quadriceps mechanism
surface of the implant (Figure 98). Use the patella has been pinned beneath the femoral component.
clamp to apply enough pressure to fully seat the
implant on the patellar surface. Remove any excess
cement in a thorough and consistent manner.

Patella Clamp Patella Clamp Head Persona All-poly Patella Size 32 mm

00-5903-020-00 00-5903-021-00 42-5400-000-32
 47 | Persona The Personalized Knee Surgical Technique

Appendix A

Valgus Recut Correction

Needed Resection

Figure 99 Figure 100

2 Degrees Valgus Recut Guide

Insert the Persona Drop Rod Adapter into the tibial cut Technique Tip: The fixation holes for the valgus
guide. Place the alignment rod with coupler into the recut guide are at oblique angles to improve fixation
drop rod adaptor and assess the cut (Figure 99). of the guide.

If a valgus correction cut is needed, place the valgus Perform resection, remove trocar tipped pins, and the
recut guide on the resected tibial plateau by attaching valgus recut guide (Figure 100).
the alignment rod with coupler and the NexGen PRI
Alignment Adaptor. Align with the medial 1/3 of the
tubercle. Once it has been determined that the desired
correction cut will be attained, slide the medial portion
of the valgus recut guide so it is flush with the medial
portion of the tibial cortex to provide a planar recut of
the tibia. Affix with 3.2 mm trocar tipped pins using the
pin and screw inserter.

Alignment Rod with Coupler 2° Valgus Recut Guide NexGen PRI Alignment Adapter
00-5785-080-00 00-5901-090-00 00-5901-086-00

Pin/Screw Inserter Persona Drop Rod Adapter Persona Tibial Cut Guide Right - 7° 75 mm x 3.2 mm Trocar Tipped Drill Pin
00-5901-021-00 42-5399-006-00 42-5399-052-07 (2.5 mm hex)
00-5901-020-00
NX APPENDIX
SECTION

Establish the Tibial

Varus/Valgus RecutPlatform
Guides
48 | Persona The Personalized Knee Surgical Technique A1 Establish the Tibial
Varus/Valgus RecutPlatform
Guides

2° Varus Recut Guide Appendix A (cont.) 2° Varus Recut Guide

Insert the Alignment Adapter into the tibial cut guide. Place the Insert the Alignment Adapter into the tibial cut guide. Place the
Alignment Rod with Coupler into the alignment adapter and Alignment Rod with Coupler into the alignment adapter and
assess the cut. (Fig. 100) If a varus correction cut is needed, assess the cut. (Fig. 100) If a varus correction cut is needed,
place the 2° Varus Recut Guide on the resected tibial plateau place the 2° Varus Recut Guide on the resected tibial plateau
and affix with 3.2mm trocar-tipped pins with the Pin and Varuswith
and affix Recut
3.2mm trocar-tipped pinsCorrection
with the Pin and Varus Recut Correction
Screw Inserter. Needed
Screw Inserter. Resection Needed Resection

Varus Recut Correction

CHNIQUE TIP A.2 TECHNIQUE TIP A.2
Needed Resection
e fixation holes for the recut guide are at oblique angles to improve The fixation holes for the recut guide are at oblique angles to improve
ation of the guide. fixation of the guide.

Insert the alignment adapter into the recut guide. Place the Insert the alignment adapter into the recut guide. Place the
alignment rod into the alignment adapter and verify the alignment rod into the alignment adapter and verify the
desired alignment. (Fig. 101) Remove the alignment adapter desired alignment. (Fig. 101) Remove the alignment adapter
and alignment rods, perform resection, remove the trocar-tipped and alignment rods, perform resection, remove the trocar-tipped
pins and the guide. pins and the guide.

Fig. 100 Fig. 101 Fig. 100 Fig. 101

Figure 101 Figure 102

Instruments Instruments

2 Degrees Varus Recut Guide

Alignment Adapter Alignment Rod 2° Varus Tibial Cut Guide, Tibial Cut Guide, Alignment
Tibial CutAdapter
Guide, Tibial Cut Guide,
Alignment Rod 2° Varus
Tibial Cut Guide, Tibial Cut Guide, Tibial Cut Guide, Tibial Cut Guide, Tibial Cut Guide, Tibial Cut Guide,
00-5901-086-00 with Coupler Recut Guide 7°, Left 7°, Right 00-5901-086-00
7°, Universal with0°, Left
Coupler Recut
0°, Guide
Right 7°, Left 7°, Right 7°, Universal 0°, Left 0°, Right
00-5785-080-00 00-5901-090-01 00-5901-077-00 00-5901-078-00 00-5901-080-00 00-5901-075-00
00-5785-080-00 00-5901-090-01
00-5901-076-00 00-5901-077-00 00-5901-078-00 00-5901-080-00 00-5901-075-00 00-5901-076-00

Insert the Persona Drop Rod Adapter into the tibial cut Technique Tip: The fixation holes for the varus
guide. Place the alignment rod with coupler into the recut guide are at oblique angles to improve fixation
drop rod adaptor and assess the cut (Figure 101). of the guide.
Tibial Cut Guide, Pin/Screw Inserter 3.2mm x 75mm Multi Pin Puller Tibial Cut Guide, Pin/Screw Inserter 3.2mm x 75mm Multi Pin Puller
0°, Standard
00-5901-079-00
If a varus correction cut is needed, place the varus
00-5901-021-00 Trocar Tipped
Drill Pin (2.5 hex)
00-5901-022-00 0°, Standard
00-5901-079-00
00-5901-021-00 Trocar Tipped
Drill Pin (2.5 hex)
 erform resection, remove trocar tipped pins, and the
P
00-5901-022-00

00-5901-020-00
recut guide on the resected39tibial plateau by attaching
00-5901-020-00
varus recut guide (Figure 102).
the alignment rod with coupler and the NexGen PRI
Alignment Adaptor. Align with the medial 1/3 of the
tubercle. Once it has been determined that the desired
correction cut will be attained, slide the lateral portion
of the varus recut guide so it is flush with the lateral
portion of the tibial cortex to provide a planar recut of
the tibia. Affix with 3.2 mm trocar tipped pins using the
pin and screw inserter.

Alignment Rod with Coupler 2° Valgus Recut Guide NexGen PRI Alignment Adapter
00-5785-080-00 00-5901-090-00 00-5901-086-00

Pin/Screw Inserter Persona Drop Rod Adapter Persona Tibial Cut Guide Right - 7° 75 mm x 3.2 mm Trocar Tipped Drill Pin
00-5901-021-00 42-5399-006-00 42-5399-052-07 (2.5 mm hex)
00-5901-020-00
 49 | Persona The Personalized Knee Surgical Technique

Appendix B

Figure 103 Figure 104

Spacer Block Technique

Technique Tip: The distal thickness of the Persona  se the spacer/alignment guides or MIS spacer/
U
CR and PS Femoral Components is 9 mm for sizes alignment guides to check the extension gap. Insert
3-12 and 8 mm for sizes 1-2. The posterior thickness the thinnest appropriate spacer/alignment guide
of the Persona CR Component is 9 mm for sizes between the resected surfaces of the femur and tibia
3-12 and 8 mm for sizes 1-2. The posterior thickness (Figure 103). If necessary, insert progressively thicker
of the Persona PS Component is 10 mm for sizes spacer/alignment guides until the desired soft tissue
3-12 and 9 mm for sizes 1-2. tension is obtained. Drop the alignment rod with
coupler into the spacer/alignment guide. Check the
Note: The spacer block techniques described flatness, slope and alignment of the tibial cut. Apply
below only apply when the femoral bone cuts have varus and valgus stress for optimal ligament balancing.
been made for a size 3-12 femur. If the femoral bone Ligament releases should be performed until the
cuts have been made for a size 1-2 femur, adjust extension gap is rectangular. When the extension gap
the technique to account for the distal femoral is balanced, proceed to size femur, establish external
thickness difference described above. rotation, and finish the femoral cuts.

Check Extension Gap Check Flexion Gap

 fter the proximal tibia and distal femur have been
A  fter the femoral finishing cuts have been completed
A
resected, the extension gap can be evaluated using and with the knee in 90 degrees flexion, use the spacer/
spacer blocks or a tensioning device. Position the knee alignment guides or MIS spacer/alignment guides to
in full extension. The distal thickness of the Persona check ligament balance and joint alignment in flexion.
Femoral Component is 9 mm and the minimum Insert the alignment rod with coupler into the guide
Persona Tibial Articular Surface/Baseplate Construct and check the alignment of the tibial resection (Figure
is 10 mm. If a 10 spacer block (19 mm thickness) does 104). Then check ligament balance. If necessary, insert
not fit into the resected joint space in extension, it progressively thicker spacer blocks until the desired
will be necessary to remove additional bone from soft tissue tension is obtained.
either the tibia or the femur. The spacer block physical
thicknesses are 9 mm more than what are shown on
the spacer blocks to represent the combined Persona
distal femoral thickness and the corresponding tibial
component thickness.
50 | Persona The Personalized Knee Surgical Technique

Appendix B (cont.)

Extension
Flexion Tight OK Loose

Tight 1 2 3

OK 4 5 6

Loose 7 8 9

Figure 105

Spacer Block Technique (cont.)

Balance Flexion and Extension Gaps
Technique Tip: Prior to addressing flexion/ 2. If the knee is tight in flexion but acceptable in
extension imbalances, make sure that desired extension, three options exist. One option is to
varus/valgus alignment has been attained. release the PCL either by island osteotomy or
ligament release, both of which lengthen the
Technique Tip: If femoral or tibial recuts are ligament. If the PCL is absent, change constraint
performed subsequent femoral finishing and tibial to MC or UC. A second option is to cement
finishing steps need to be repeated to provide for the femoral component distal to the bone cut.
proper provisional and component fit. This augmentation with cement distally fills the
 ith the knee in extension, attach the alignment rod
W extension space when used with a thinner tibial
to the alignment rod with coupler. Check ligament bearing. The third option is to downsize the femoral
balance and limb alignment in extension. Refer to component.
Figure 105 for potential solutions for flexion/extension 3. If the joint is loose in extension and tight in flexion
mismatches. one option is to use a smaller sized femoral
1. If a knee is too tight in both flexion and extension, component possibly with a thicker polyethylene
resecting additional tibial bone or reducing the component.
height of the tibial bearing may be sufficient to 4. If the joint is acceptable in flexion but tight in
balance the construct. extension, several options exist. One is to release
the posterior capsule from the femur. Another
alternative is to resect more distal femoral bone.
This moves the femoral component proximally on
the femur at the expense of elevating the joint line.

Alignment Rod with Coupler Alignment Rod MIS Spacer/Alignment Guide

00-5785-080-00 00-5785-079-00 00-5983-070-10
 51 | Persona The Personalized Knee Surgical Technique

Appendix B (cont.)

Extension
Flexion Tight OK Loose

Tight 1 2 3

OK 4 5 6

Loose 7 8 9

Figure 106

Spacer Block Technique (cont.)

Balance Flexion and Extension Gaps (cont.)
5. If both components are acceptable, no further 8. If the joint is loose in flexion and acceptable in
modification is necessary. extension, increasing the femoral size may equalize
the gaps. Alternatively, moving the femoral
6. If the joint is acceptable in flexion and loose in component proximally and applying a thicker tibial
extension, consider downsizing the femoral bearing will equalize the gaps. Another option is
component with a thicker tibial bearing. If the to fill the flexion gap with the appropriate poly
femoral component cannot be downsized, cement and perform a posterior release to increase the
the femoral component distal to the bone cut. extension gap.
This augmentation with cement distally fills the
extension space. 9. If a joint is symmetrically loose in both flexion and
extension, a thicker tibial bearing will usually solve
7. If the joint is loose in flexion and tight in extension, both problems.
a larger femoral component may suffice. A second
option is a thicker tibial bearing with a more In situations where two options exist to help solve the
proximal femoral position. A third option is a soft tissue mismatch, the position of the patella or the
thicker tibial component combined with a posterior joint line helps the surgeon decide which option to
release. select.

Note: After applying one of these solutions, perform

another trial reduction. This will identify any new
problem or a variation of the initial problem that
may exist.
52 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments

1. Pull Figure 108

2. Insert
Figure 107

Figure 109

Resect Distal Femur – Fixed Distal

Resection Instrument
Assemble Fixed Distal Resection Instrumentation
 ull the lever on the modular handle and insert the IM
P I nsert the fixed resection tower into the face of the
rod (Figure 107). Orientation of the IM rod will align fixed valgus guide indicating the angle and side of the
with the polished line on the sides of the modular knee (left or right).
handle.
Note: The valgus alignment guide will resect
Technique Tip: Alternately, the IM rod may be 10 mm of distal bone. The distal resection can be
inserted into the top of the modular handle to changed to 1 mm through 9 mm resection depth, in
accommodate surgical preference. 1 mm increments, by assembling the corresponding
resection plate to the valgus guide. Figure 109
Insert the IM rod into the fixed valgus guide. illustrates this with the 9 mm resection plate.
The 9 mm and 8 mm resection plates may facilitate
Note: If desired, align the depth markings on the
IM rod with the flat plate of the fixed valgus guide correction of recurvatum and the 1 mm – 3 mm
to set the IM rod at a specific length (Figure 108). resection plates can be used for recutting the distal
femur, if needed.

The size 1 and 2 femoral components are 1 mm

thinner distally than sizes 3-12. Consider adjusting
the resection depth on these sizes to accommodate
for this difference.

Persona 8 mm IM Rod Persona Modular Handle Persona 5° Valgus Persona 9 mm Distal

42-5099-002-00 42-5099-014-00 Alignment Guide Resection Plate
42-5099-005-05 42-5099-015-09
 53 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Lock
2. Insert 1. Unlock

Figure 110a Figure 110b

Resect Distal Femur – Fixed Distal

Resection Instrument (cont.)
Assemble Fixed Distal Resection
Instrumentation (cont.)
 otate the lock lever on the fixed resection tower to
R Flip the lock lever to the locked, or “vertical”, position
the unlocked, or “in-line”, position and fully insert into to secure it to the cut guide (Figure 110b).
the cut guide (Figure 110a).
Technique Tip: The fixed resection tower is
compatible with the adjustable valgus guide and
the adjustable resection tower is compatible with
the fixed valgus guide. These instruments can be
interchanged to accommodate surgical preference.

Persona 8 mm IM Rod Persona Modular Handle Persona 5° Valgus Persona Fixed Resection Tower Persona 0° Distal Cut Guide
42-5099-002-00 42-5099-014-00 Alignment Guide 42-5099-006-00 42-5099-010-00
42-5099-005-05
54 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Figure 111 Figure 112 Figure 113

Resect Distal Femur – Fixed Distal

Resection Instrument (cont.)
Establish Femoral Alignment
Drill the IM canal using the 8 mm IM step drill Note: Setting rotation of the fixed valgus guide
(Figure 111). Suction the canal to remove medullary is important for creating a distal resection that
contents. matches the desired valgus angle selected. It does
not set the rotation of the femoral component.
Insert the IM rod and assembled distal resection
instrumentation into the IM canal far enough to ensure T o secure orientation, impact the captured pin on the
the most accurate replication of the anatomic axis. medial side of the fixed valgus guide until the head of
the captured pin is flush with the plate (Figure 113).
S et the orientation of the fixed valgus guide by placing
it against the most prominent distal condyle and
rotating it about the IM rod so that it is aligned with
the epicondylar axis (Figure 112).

8 mm IM Step Drill Persona 8 mm IM Rod Persona Modular Handle Persona 5° Valgus Persona Fixed Resection Tower Persona 0° Distal Cut Guide
00-5978-014-00 42-5099-002-00 42-5099-014-00 Alignment Guide 42-5099-006-00 42-5099-010-00
42-5099-005-05
 55 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

1. Unlock

2. Pull

Figure 114 Figure 115 Figure 116

Resect Distal Femur – Fixed Distal

Resection Instrument (cont.)
Resect Distal Femur
Verify the fixed valgus guide is set to the proper side Note: If the captured pin was deployed it may be
(left or right) and the fixed valgus guide shows the necessary to first remove it from the bone using the
appropriate valgus angle. pin puller. Alternatively, removing the IM rod from
the fixed valgus guide may facilitate removal of the
Technique Tip: Confirm valgus alignment by captured pin from the bone.
inserting the drop rod adapter into the large holes
on the anterior face of the cut guide and insert an Technique Tip: Additional 2 mm adjustments may
alignment rod into the drop rod adapter (Figure 114). be made by using the sets of holes marked -2, +2,
and +4. These sets of holes indicate, in millimeters,
I nsert a trocar tipped pin through each of the standard the amount of additional bone resection each will
pin holes marked ‘0’ on the anterior surface of the cut yield relative to the 10 mm resection accommodated
guide (Figure 115). by the fixed resection tower (however, if the 9 mm
F lip the lock lever on the fixed resection tower to the resection plate is used, the depth adjustments are
unlocked, or “in-line”, position and pull the handle to relative to a 9 mm resection).
remove the IM rod and assembled distal resection
instrumentation leaving only the cut guide attached to
the femur (Figure 116).

Persona 8 mm IM Rod Persona Modular Handle Persona 5° Valgus Persona Fixed Persona 0° Distal Cut Guide
42-5099-002-00 42-5099-014-00 Alignment Guide Resection Tower 42-5099-010-00
42-5099-005-05 42-5099-006-00

Persona Drop Rod Adapter Alignment Rod with Coupler 3.2 mm x 75 mm Trocar Tipped Pin/Screw Inserter
42-5399-006-00 00-5785-080-00 Drill Pin (2.5 mm hex) 00-5901-021-00
00-5901-020-00
56 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Side Designation

Figure 117 Figure 118

Size Femur – Anterior

Referencing Sizer
Size Femur and Establish External Rotation
Rotate the feet of the anterior referencing sizer so the Note: Sizer geometry is rotated 3 degrees to align
appropriate “left” or “right” markings are visible as the to the A/P and epicondylar axes of the femur. The
anterior referencing sizer is placed on the bone (Figure 3 degrees drill holes are rotated 3 degrees from
117). External rotation can be set at 3 degrees or 5 the posterior feet and are neutral to the central
degrees from the posterior condylar axis. sizer geometry. This enables use of the A/P and
epicondylar axis to set rotation.
Technique Tip: Remove any osteophytes that
interfere with instrument positioning. If the 3 degrees external rotation holes are to be used
to set external rotation, the etched line on the anterior
Apply the anterior referencing sizer so that the flat referencing sizer should be positioned so it is in line
surface of the anterior referencing sizer is flush against with Whiteside’s line (Figure 118) to optimize the M/L
the resected surface of the distal femur and the feet position of the drill holes for subsequent anterior
of the anterior referencing sizer are flush against the referencing 4-in-1 cut guide placement.
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.

Persona Anterior Referencing Sizer 2.5 mm Male Hex Driver

42-5099-088-00 42-5099-025-00
 57 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Figure 119

Size Femur – Anterior

Referencing Sizer (cont.)
Size Femur and Establish External Rotation (cont.)
If the 5 degrees external rotation holes are to be Slightly extend the knee and retract soft tissues to
used, the sizer can be positioned with the etched expose the anterior femoral cortex. Clear any soft
line on the anterior referencing sizer 4 mm laterally tissue from the anterior cortex. Ensure that the leg
from Whiteside’s line to better center the drill holes is in less than 90 degrees of flexion (70 degrees
for subsequent anterior referencing 4-in-1 cut guide – 80 degrees). This will decrease the tension of
placement, due to the M/L offset of the holes. Hold the patellar tendon to facilitate placement of the
the anterior referencing sizer in place and if necessary, anterior referencing sizer boom. The position of the
secure the anterior referencing sizer to the femur anterior referencing sizer boom tip approximates the
using 25 mm x 3.2 mm (2.5 mm female hex) screws proximal position of the anterior flange of the femoral
(Figure 119) in one or both of the holes on the lower component. The anterior referencing sizer boom can
portion of the anterior referencing sizer to help draw be rotated to facilitate insertion under the soft tissue
the anterior referencing sizer adjacent to the distal envelope. A palpable indication as well as a vertical
femur, particularly in MIS situations. orientation of the end of the anterior referencing
sizer boom (Figure 122) ensures that the anterior
Note: Do NOT use 48 mm screws for fixation of referencing sizer boom is rotated to the correct
the anterior reference sizer. 48 mm screws are not position.
recommended due to potential bone perforation.
Technique Tip: Do not impact the anterior
referencing sizer onto the femur.

Persona Anterior Referencing Sizer 2.5 mm Male Hex Driver

42-5099-088-00 42-5099-025-00
58 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Figure 121

Figure 120 Figure 122

Size Femur – Anterior

Referencing Sizer (cont.)
Size Femur and Establish External Rotation (cont.)
Technique Tip: Positioning the anterior referencing A 3.2 mm pin may be placed in the first drilled hole
sizer boom tip on the “high” part of the femur by to maintain an “index” position prior to drilling the
lateralizing the location of the anterior referencing second hole. Remove the screws, then remove the
sizer boom tip can often lessen the likelihood of anterior referencing sizer.
notching the femur.
Technique Tip: The multi pin puller cannot be used
fter the anterior referencing sizer boom is
A to extract the screw(s).
appropriately positioned, read the femoral size from
the engraved lines on the anterior referencing sizer Technique Tip: This anterior referencing sizer
tower and select the closest size (Figure 120). There works only with these anterior referencing 4-in-1
are six even sizes labeled on the left side of the tower femoral cut guides and provisionals, and implants
and six odd sizes labeled on the right side of the tower, referenced in this technique.
with lines indicating the in-between sizes. The same
size markings are present on the anterior surface of
the anterior referencing sizer boom and approximate
the proximal position of the anterior flange of the
femoral component when telescoped to the same
size that has been determined by the vertical anterior
referencing sizer tower (Figure 121). The 3 degrees
or 5 degrees holes in the midline of the A/P portion
of the anterior referencing sizer are used to drill
3.2 mm holes for pegs on the anterior referencing
4-in-1 femoral cut guide (Figure 122).

25 mm x 2.5 mm Female Hex Screw 3.2 mm Drill

42-5099-025-25 00-5120-085-00
 59 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Figure 124

Figure 123 Figure 125

Shift Block
Prior to performing the four facet cuts with the 4-in-1 Technique Tip: The Persona Shift Block is only to
cut guide, determine whether the position of the block be used with the Persona 4-in-1 Cut Guides.
anterior to posterior and external rotation is sufficient.
If adjustment is needed, remove the 4-in-1 cut guide Technique Tip: Do not impact or torque the shift
block while inserting or drilling.
from the femur and insert the shift block using the
same holes in the distal face of the femur (Figure 123).

To select the method of adjustment, depress button

and rotate drill guide until the desired face is shown. If
a 2 degrees rotation is desired, rotate the guide to the
appropriate 2 degrees rotation face (Figure 124).

If an A/P shift is desired, rotate the guide to the

appropriate 1 mm shift face (Figure 125).

Persona Shift Block 3.2 mm Drill

42-5099-085-10 00-5120-085-00
60 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Figure 126 Figure 127

Shift Block (cont.)

After making sure the appropriate face is locked in Technique Tip: The shift block can be rotated 180
place, drill through the holes that have been selected degrees to create new drill holes in the opposite
using a 3.2 mm drill (Figure 126). M/L direction while providing the same A/P shift
or rotation adjustment. If a 180 degrees rotation
Technique Tip: Ensure drill guide is locked in place
for accurate shift or rotations. is performed, be careful to avoid overlapping
previously drilled holes.
I f additional adjustment with the shift block is desired,
remove it from the bone, using an osteotome if
necessary, and replace it in the newly drilled holes and
repeat the drilling process. Otherwise, place the 4-in-1
cut guide in the newly drilled holes (Figure 127) and
perform bone resections.

Persona Shift Block 3.2 mm Drill Persona Anterior Referencing 4-in-1 Cut Guide - Size 7
42-5099-085-10 00-5120-085-00 42-5099-085-62
 61 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Insert

Figure 129

Unlock

Figure 128 Figure 130

Resect Distal Femur –

PRI Distal Resection Instrument
Please refer to the appropriate surgical technique Insert the femoral IM rod into the modular T-handle
if other distal femoral alignment and distal (Figure 129) and insert the IM rod into the femur far
femoral resection instrumentation is to be used to enough to ensure the most accurate replication of
accomplish the distal femoral resection. the anatomic axis, then remove the modular T-handle
(Figure 130).
fter attaining the desired soft tissue exposure,
A
use the 8 mm IM step drill to make a starter hole Technique Tip: As the symbol on the modular
(Figure 128). T-handle indicates – do not impact the modular
T-handle.
Suction the canal to remove medullary contents.

Femoral IM Rod Modular T-Handle 8 mm IM Step Drill

00-5901-060-00 00-5901-061-00 00-5978-014-00
62 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Optional
Pinning
2. Rotate Holes

1. Retract 3. Release
Retraction

5 degrees Right Valgus Setting

Figure 131 Figure 132 Figure 133

Resect Distal Femur – PRI Distal

Resection Instrument (cont.)
Retract the spring-loaded button on the top of the Technique Tip: If the epicondyles are visible, the
femoral valgus alignment guide and rotate the valgus epicondylar axis may be used as a guide in setting
adjustment dial to the desired valgus angle and release the orientation of the femoral valgus alignment
the button to lock the valgus angle from 0 degrees to 9 guide. This does not set the rotation of the femoral
degrees, ensuring that the proper left or right setting component, but keeps the distal cut oriented
is attained (Figure 131). to the final component rotation. If desired, the
guide can be pinned to provide rotational stability
 lace the femoral valgus alignment guide on the IM
P
(Figure 133).
rod against the most prominent condyle and confirm
the desired valgus setting (Figure 132).

Femoral Valgus 3.2 mm x 75 mm Trocar Pin/Screw Inserter

Alignment Guide Tipped Drill Pin (2.5 mm hex) 00-5901-021-00
00-5901-067-00 00-5901-020-00
 63 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Oblique
Hole

Adjustment Figure 136a

Dial

Figure 134
Figure 136b
Figure 135

Resect Distal Femur – PRI Distal

Resection Instrument (cont.)
Resect Distal Femur
Attach the 0 degrees captured/uncaptured Verify the desired resection setting on the distal
cutting head to the distal femoral resection guide femoral resection guide and/or rotate the adjustment
(Figure 134). The adjustment dial on the resection dial to attain the desired setting (Figure 136a). Insert
guide can be set from “-2” to “+4”. The “0” represents trocar tipped pins through the two standard pin holes
a 10 mm distal resection (Figure 135). The -1 setting marked “0” on the anterior surface of the cutting head
represents a 9 mm resection while the +4 setting (Figure 136b). Additional 2 mm adjustments may be
represents a 14 mm resection. Upon rotation, the dial made by removing the cutting head from the pins
has palpable stops and clear markings at each 2 mm and replacing the cutting head on the pins in the sets
location. One half rotation creates 1 mm of adjustment. of holes marked -2, +2, and +4. The markings on the
Insert the distal femoral resection guide with the cutting head indicate, in millimeters, the amount of
cutting head into the femoral valgus alignment guide bone resection each will yield relative to the initial
until the cutting head rests on the anterior femoral distal resection setting.
cortex.

Femoral Valgus Distal Femoral 0° Captured/Uncaptured

Alignment Guide Resection Guide Cutting Head
00-5901-067-00 00-5901-063-00 00-5901-064-00
64 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Squeeze to
Unlock

Remove

Figure 137 Figure 138

Resect Distal Femur – PRI Distal

Resection Instrument (cont.)
Resect Distal Femur (cont.)
Technique Tip: If more fixation is desired, insert the distal femoral resection guide at the same time. If
trocar tipped pins in the small oblique holes on the necessary, the round end of the slaphammer can be
cutting head. used in conjunction with the central hole in the modular
T-handle to remove the IM rod.
If pin(s) were used to maintain rotational alignment of
the alignment guide, use the multi pin puller to remove Cut the distal femur through the cutting slot in the
the pin(s). Alternatively, the pin/screw inserter can be cutting head, using a 1.27 mm (0.050 inch) oscillating
used to remove these pin(s). saw blade (Figure 138).

Squeeze the button on the distal femoral resection Technique Tip: Check the flatness of the distal
guide (Figure 137) to release and remove the femoral femoral cut with a flat surface, such as the top of
valgus alignment guide and distal femoral resection one of the tibial cut guides. If necessary, modify the
guide assembly from the cutting head. The modular distal femoral surface so that it is completely flat.
T-handle is used to remove the IM rod, prior to the This is extremely important for the placement of
distal femoral resection. subsequent guides and for proper fit of the implant.

Alternatively, the modular T-handle can be used to After completing the cut, remove pins and the
remove the IM rod while the button on the distal femoral cutting head.
resection guide is squeezed to facilitate rapid removal
of the IM rod, the femoral valgus alignment guide and

3.2 mm x 75 mm Trocar Tipped Pin/Screw Inserter Multi Pin Puller Persona Slaphammer Femoral IM Rod Modular T-Handle
Drill Pin (2.5 mm hex) 00-5901-021-00 00-5901-022-00 42-5099-037-00 00-5901-060-00 00-5901-061-00
00-5901-020-00
 65 | Persona The Personalized Knee Surgical Technique

Appendix C: Optional Instruments (cont.)

Figure 139 Figure 140 Figure 141 Figure 142 Figure 143

Implant Components
Attached Tibial Plate Inserter
Depress the lever of the tibial inserter to extend the To release the inserter from the implant, depress
metal distal tab (Figure 139). Insert the tab into the the lever on the tibial inserter. The handle will move
implant’s dovetails on the central portion of the tibial in a superior direction away from the tibial implant
implant. Slide the tibial inserter posteriorly until the tab (Figure 142). Tilt the handle posteriorly to disengage the
engages the dovetails (Figure 140). Release the lever to distal tab of the inserter from the plate (Figure 143).
secure the tibial inserter to the tibial implant. Ensure the
tibial inserter is seated flush to the proximal surface of Thoroughly remove any excess cement in a consistent
the tibial implant (Figure 141). manner. Allow the cement to fully cure before performing
a trial ROM or inserting the bearing.
Sublux the tibia anteriorly to allow adequate clearance
to insert the tibial implant into the prepared bone. Do
not apply substances other than bone cement to the
tibial implant (i.e. do not dip implant into antibiotics or
other substances). Keep the implant clean and free of
debris prior to cementing. Place a layer of cement on the
underside of the tibial baseplate, around the keel, on the
resected tibial surface, and in the tibial IM canal.

Position the tibial plate onto the tibia and use the tibial
inserter to impact it until fully seated.

Persona Cemented Stemmed Persona Tibial Inserter Size E–F

Tibial Plate Sizes F Right 42-5398-092-05
42-5320-075-02
66 | Persona The Personalized Knee Surgical Technique

Appendix D: Compatibility Charts

CR: Persona CR Femoral/Persona CR Bearing and Tibial Compatibility

Tibial TASP Top & Femoral Size
Size Bottom Color 1 2 3 4 5 6 7 8 9 10 11 12
A Orange
1-2 / A B 3-6 / A B
B
C Yellow
1-2 / C D 3-9 / C D
D
E Green
3-11 / E F
F
G Blue
7-12 / G H
H
J Gray 9-12 / J

MC: Persona CR Femoral/Persona MC Bearing and Tibial Compatibility

Femoral Size
Tibial TASP Top &
Size Bottom Color 1 2 3 4 5 6 7 8 9 10 11 12
A Orange
1-2 / A B 3-4 / A B
B
C Yellow
4-5 / C D 6-7 / C D 8-9 / C D
D
E Green
4-5 / E F 6-7 / E F 8-11 / E F
F
G Blue
8-11 / G H 12 / G H
H
J Gray 12 / J

UC: Persona CR Femoral/Persona UC Bearing and Tibial Compatibility

Femoral Size
Tibial TASP Top &
Size Bottom Color 1 2 3 4 5 6 7 8 9 10 11 12
A Orange
1-2 / A B 3-4 / A B
B
C Yellow
1-2 / C D 3-7 / C D
D
E Green
4-11 / E F
F
G Blue
7-12 / G H
H
J Gray 9-12 / J
 67 | Persona The Personalized Knee Surgical Technique

Appendix D: Compatibility Charts (cont.)

PS: Persona PS Femoral/Persona PS Bearing and Tibial Compatibility

Femoral Size
Tibial TASP Top &
Size Bottom Color 1 2 3 4 5 6 7 8 9 10 11 12
A Orange
1-2 / A B 3-5 / A B
B
C Yellow
1-2 / C D 3-5 / C D 6-9 / C D
D
E Green
3-5 / E F 6-9 / E F 10-11 / E F
F
G Blue
6-9 / G H 10-12 / G H
H
J Gray 10-12 / J

CPS: Persona PS Femoral/Persona Constrained Posterior Stabilized (CPS)

Bearing and Tibial Compatibility
Femoral Size
Tibial TASP Top &
Size Bottom Color 1 2 3 4 5 6 7 8 9 10 11 12
A Orange
1-2 / A B 3-5 / A B
B
C Yellow
1-2 / C D 3-5 / C D 6-9 / C D
D
E Green
3-5 / E F 6-9 / E F 10-11 / E F
F
G Blue
6-9 / G H 10-12 / G H
H
J Gray 10-12 / J
68 | Persona The Personalized Knee Surgical Technique

Appendix D: Compatibility Charts (cont.)

CR: Persona CR Femoral/NexGen CR/CR-Flex Bearing

and Tibial Compatibility

Persona CR Femur Used On NexGen CR/CR Flex Bearing (Modular, Fixed Bearing)
Persona CR Femoral Size

NexGen Tibial Size 1 2 3 4 5 6 7 8 9 10 11 12

1
A-E Micro / 1-2 C-H / 1-2
2
3
A-E Micro / 3-4 C-H / 3-4
4
5
A-E Micro / 5-6* C-H / 5-6
6
7
8
C-H / 7-10
9
10

All compatibility above applies only to the following NexGen CR/CR-Flex Bearings: 90-5970-XXX-XX, 00/90-5952-XXXX-XX
*The A-E Micro / 5-6 NexGen CR/CR-Flex Bearing is only available in Japan, and only in the 00-5952-041-XX family.
This information is also available in the Persona Femoral Component package insert.

Persona CR Femur Used On NexGen CR Monoblock Tibia (Trabecular Metal™ Monoblock)

Persona CR Femoral Size

NexGen Tibial Size 1 2 3 4 5 6 7 8 9 10 11 12

1
2
3 C-H / 3
4 C-H / 4
5 C-H / 5
6 C-H / 6
7 C-H / 7
8 C-H / 8
9
10

All compatibility above applies only to the following NexGen Trabecular Metal Monoblocks: 00-5886-04X-XX
This information is also available in the Persona Femoral Component package insert.
 69 | Persona The Personalized Knee Surgical Technique

Appendix D: Compatibility Charts (cont.)

Persona PS Femoral/NexGen LPS-Flex Bearing and Tibial Compatibility

Persona PS Femur Used On NexGen LPS-Flex Bearing (Modular, Fixed Bearing)

Persona PS Femoral Size

NexGen Tibial Size 1 2 3 4 5 6 7 8 9 10 11 12

1
AB / 1-2 CD / 1-2 E / 1-2*
2
3
AB / 3-4 CD / 3-4 EF / 3-4 G / 3-4*
4
5
CD / 5-6 EF / 5-6 GH / 5-6
6
7
8
EF / 7-10 GH / 7-10
9
10

All compatibility above applies only to the following NexGen LPS-Flex Bearings: 00-5960-XXX-XX, 00-5962-XXX-XX, 00-5964-XXX-XX
*The E / 1-2 & G / 3-4 bearings are only available in the 00-5962-XXX-XX family.
This information is also available in the Persona Femoral Component package insert.
70 | Persona The Personalized Knee Surgical Technique

Appendix D: Compatibility Charts (cont.)

Persona PS Femur Used On NexGen LPS Monoblock Tibia (Trabecular Metal Monoblock)
Persona PS Femoral Size

NexGen Tibial Size 1 2 3 4 5 6 7 8 9 10 11 12

1
2
3 CD / 3 EF / 3
4 CD / 4 EF / 4
5 CD / 5 EF / 5 GH / 5
6 EF / 6 GH / 6
7 EF / 7 GH / 7
8 GH / 8
9
10

All compatibility above applies only to the following NexGen Trabecular Metal Monoblocks: 00-5886-05X-XX, 00-5886-06X-XX, 00-5886-07X-XX
This information is also available in the Persona Femoral Component package insert.
 71 | Persona The Personalized Knee Surgical Technique

Notes
72 | Persona The Personalized Knee Surgical Technique

Notes
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.
This material is intended for health care professionals. Distribution to any
other recipient is prohibited.
For product information, including indications, contraindications,
warnings, precautions, potential adverse effects and patient counseling
information, see the package insert and zimmerbiomet.com.
Zimmer Biomet does not practice medicine. This technique was
developed in conjunction with [a] health care professional[s]. This
document is intended for surgeons and is not intended for laypersons.
Each surgeon should exercise his or her own independent judgment in
the diagnosis and treatment of an individual patient, and this information
does not purport to replace the comprehensive training surgeons have
received. As with all surgical procedures, the technique used in each case
will depend on the surgeon’s medical judgment as the best treatment
for each patient. Results will vary based on health, weight, activity and
other variables. Not all patients are candidates for this product and/or
procedure.
Check for country product clearances and reference product specific
instructions for use. Not for distribution in France.
©2018 Zimmer Biomet

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Legal Manufacturer
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is not valid unless there is a CE
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