Zimmer NexGen® ®

Complete Knee
Solution
Extramedullary/
Intramedullary
Tibial Resector
Surgical Technique

IMAGE TO
COME
Provides a choice of techniques for tibial resection.
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 1

Zimmer NexGen Complete Table of Contents

Knee Solution EM/IM
Tibial Resector Surgical Introduction 2
Technique Extramedullary Technique Using the Spike Arm 2
Step One: Assemble Alignment Guide 2
Step Two: Position Alignment Guide 3
Step Three: Set Resection Level 4
Step Four: Resect the Proximal Tibia 5
Optional Technique 6
Cut Guide Extramedullary Technique 7
Step One: Assemble Alignment Guide 7
Step Two: Position Alignment Guide 8
Step Three: Set Resection Level 9
Step Four: Resect the Proximal Tibia 11
Optional Technique 11
Intramedullary Technique 12
Step One: Position IM Alignment Guide 12
Step Two: Set Resection Level 15
Step Three: Resect the Proximal Tibia 16
Optional Technique 17
Spike Arm Intramedullary Technique 18
Step One: Insert IM Rod 18
Step Two: Position Cut Guide 19
Step Three: Set Resection Level 20
Step Four: Resect the Proximal Tibia 21
Optional Technique 22
2 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Introduction Extramedullary Technique Slide the Spike Arm onto the dovetail at the top
of the Spike Arm Telescoping Rod and temporailty
Using the Spike Arm secure it by turning the knob at the top of the rod
The Extramedullary/Intramedullary Tibial
Resector provides a choice of techniques for tibial (Fig. 2).
resection. Each of the techniques offers a number
Step One
of options to accomodate various anatomical Assemble Alignment Guide
conditions and surgeon preferences. To facilitate
the handling of bone defects in the proximal Slide the Ankle Clamp onto the dovetail at the
tibia, both the extramedullary and intramedullary bottom of the Distal Telescoping Rod. Turn the
techniques allow the depth of the tibial resection knob opposite the dovetail to temporarily hold the
to be adjusted after the alignment guide has clamp in place (Fig. 1). The mediolateral position
Fig. 2
been positioned. In addition, an extramedullary of the rod can be adjusted by loosening this knob.
alignment check can be performed after the When the final position is determined, the knob
alignment guide has been removed. can be fully tightened to secure it in place.

The same cutting guide is used for both

intramedullary and extramedullary approaches.
It is provided in both left and right configurations The system includes four different Cut Guides: a
to facilitate alignment while accomodating the 7-degree guide and a 0-degree guide both in left
patellar tendon. The cutting guides have multiple and right configurations. The 0-degree guide is for
holes to provide four different depth-of-cut use with the A/P Wedge Tibial Plates.
adjustments (-2, 0, +2, and +4) after the guide
Lower the adjustment knob in the middle of the
has been positioned and fixed to the bone with
Spike Arm Telescoping Rod to the bottom of the
headless holding pins. These four positioning
threaded portion. Insert the Cut Guide over the
options are important in maintaining a high level
threaded portion of the rod above the adjustment
of surgical latitude throughout the tibial resection
knob and slide it all the way up on the dovetail
procedure. The resection can be made using either Fig. 1
(Fig. 3). To hold the Cut Guide in place, advance
the slot or the top surface of the cutting guide. The
the adjustment knob to the upper end of its range
top surface is 4mm above the slot, and appropriate
of travel. This will allow for space adjustment after
adjustments must be made.
the alignment guide assembly has been secured
in position.
The Extramedullary/Intramedullary Tibial
Resector can be used with any of the NexGen®
Instrumentation Systems.
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 3

Step Two Position the Cut Guide at the proximal tibia. Loosen
the knob in the middle of the telescoping rod and
Position Alignment Guide adjust the length of the rod until the long spike on
the Spike Arm just contacts the tibial plateau. The
To improve exposure of the tibial surface, use the
Cut Guide should be proximal to the tibial tubercle.
Tibial Retractor to lever the tibia anteriorly. This
Center the long spike mediolaterally on the bone
instrument should be carefully positioned against
surface anterior to the tibial spine. This should
the posterior cortex of the tibia subperiosteally
align the rod with the medial third of the tibial
to prevent neurovascular injury. Use the Patella
tubercle. Stabilize the Alignment Guide by tapping
Retractor to retract the patella laterally.
the Spike Arm until only the long spike engages the
tibial plateau. Do not drive the long spike in too
Adjust the telescoping rod to the approximate
far (Fig. 6).
length of the tibia and turn the knob on the shaft to
Fig. 3
temporarily maintain the length.

Place the spring arms of the Ankle Clamp around

Arrows are etched onto both the Spike Arm
Telescoping Rod and the Distal Telescoping Rod to the ankle proximal to the malleoli (Fig. 5) and
indicate the correct orientation during assembly loosen the knob that provides mediolateral
(Fig. 4). Insert the Spike Arm Telescoping Rod into adjustment at the ankle.
the Distal Telescoping Rod.

Fig. 6

Fig. 5

Fig. 4
4 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Adjust the slide at the foot of the rod mediolaterally Set the final position of the extramedullary The stylus will snap into the hole (Figs. 9a & 9b).
so the guide is aligned with the mechanical axis alignment guide assembly by tapping the Spike Confirm that it is fully seated and properly oriented.
of the tibia. The longitudinal axis of the rod will Arm until both the long and short spikes are fully The 2mm tip should rest on the tibial condyle (Fig.
usually lie just medial to the mid-point of the tibial impacted in the proximal tibia (Fig. 8). Then tighten 10). This positions the slot of the Cut Guide to
tubercle and be centered over the intercondylar the knob in the middle of the telescoping rod remove 2mm of bone below the tip of the stylus.
eminence. The foot of the rod should be positioned assembly.
about 5mm-10mm medial to the midpoint between
the palpable medial and lateral malleoli. The tip Fig. 9a
should point to the second toe. When the proper
mediolateral position is achieved, tighten the knob
to secure the Ankle Clamp to the rod.

In the sagittal plane, align the rod so it is parallel

to the anterior tibial shaft by using the slide
adjustments at both the proximal and distal ends
of the rod (Fig. 7). Then tighten the knobs for both
Fig. 9b
adjustments. If there is a bulky bandage around
Fig. 8
the ankle, adjust the rod to accommodate the
bandage. This will help ensure that the tibia will be
cut with the proper slope.

Step Three
Set Resection Level

Each tip of the Tibial Depth Resection Stylus

indicates a different depth. The 2mm tip is used to
check the depth from the defective tibial condyle
for a minimal cut. The 10mm tip is used to check
the depth from the least involved tibial condyle for
an anatomic cut.
Fig. 10
Insert the Tibial Depth Resection Stylus into the top
of the Cut Guide, using the hole that corresponds
to the defective tibial condyle (Fig. 9).

Alternatively, rest the 10mm tip of the stylus on the

cartilage of the least involved condyle (Fig. 11).
Fig. 7

Fig. 9
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 5

To confirm alignment, insert the Extramedullary Step Four

Alignment Arch into the Cut Guide and insert the
Alignment Rod with Coupler through the arch,
Resect the Proximal Tibia
passing it distally toward the ankle (Fig. 27). The
Loosen the adjustment knob below the Cut Guide
distal end of the rod should point to the second
until the knob is at the bottom of the threaded
toe (Fig. 13).
portion of the rod. Then loosen the knob on the
telescoping rod. Use a slaphammer to disengage
the spikes on the Spike Arm. Raise the telescoping
rod until the dovetail disengages the Cut Guide.
Then open the arms of the Ankle Clamp and
remove the entire assembly, leaving the Cut Guide
Fig. 11 in place on the bone.

If desired, the Alignment Arch and Alignment Rod

with Coupler can be used on the Cut Guide again to
check alignment.

This will allow the removal of the same amount 2mm adjustments may be made by using the sets
of bone that the thinnest tibial component would of holes marked -2, +2, and +4. The markings on
replace. the Cut Guide indicate, in millimeters, the amount
of bone resection each will yield relative to the
These two points of resection will usually not standard tibial resection set by the Cut Guide and
coincide. The surgeon must determine the Tibial Depth Resection Stylus.
appropriate level of resection based on patient
age, bone quality, and the type of prosthetic
fixation planned.

Adjust the Cut Guide to the desired depth by

adjusting the length of the alignment guide
assembly. Then retighten the telescoping rod,
and insert a 48mm Headless Screw Pin or 75mm
Headless Holding Pin into the hole marked “0” on
the lateral side of the guide (Fig. 12).

Pin 2 Fig. 13

Insert a second 75mm Headless Holding Pin

Pin 1 into the medial hole marked “0.” Once the tibial
Pin 3
resection has been determined, use the Hex-head
Holding Pins, or 48mm Headed Screw Pins, or
Silver Spring Pins to further stabilize the guide.

The extramedullary alignment arch can be left

attached to the tibial cut guide for added stability.
A 0.050” reciprocating saw blade can be used to
make the medial and lateral tibial plateau cuts.
Then remove alignment tower to finish tibial cuts.

Fig. 12
6 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Use a .050-inch oscillating saw blade through the Alternatively, the adjustment can be made after
slot on the Cut Guide to cut the proximal surface of the alignment guide assembly is removed by
the tibia flat (Fig. 14). Then remove the Cut Guide. lifting the Cut Guide off the headless pins, which
were inserted through the holes marked “0,” and
reinserting the guide through the holes marked
“+4” (Fig. 17).

Fig. 15
Fig. 17

Fig. 14

Optional Technique
2mm
If desired, the cut can be made from the top
surface of the Cut Guide. The top surface of the
guide is 4mm above the slot (Fig. 15), so the
position of the guide must be adjusted to account
for this difference. The adjustment can be made
when the Cut Guide is first positioned by using the
etch lines, which are in 2mm increments, at the top
of the Spike Arm Telescoping Rod (Fig. 16).

Fig. 16
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 7

Cut Guide Extramedullary Place the desired Cut Guide onto the dovetail of the
proximal portion of the Cut Guide Telescoping Rod.
Technique Tighten the knob to secure the position (Fig. 19).

Step One Arrows are etched onto both the Cut Guide
Assemble Alignment Guide Telescoping Rod and the Distal Telescoping Rod to
indicate the correct orientation during assembly
Slide the Ankle Clamp onto the dovetail at the (Fig. 20). Insert the Cut Guide Telescoping Rod into
bottom of the Distal Telescoping Rod. Turn the the Distal Telescoping Rod.
knob opposite the dovetail to temporarily hold the
clamp in place (Fig. 18). The mediolateral position
of the rod can be adjusted by loosening this knob.
When the final position is determined, the knob
can be fully tightened to secure it in place.

Fig. 20

Fig. 18

Fig. 19
The system includes six different Cut Guides: a
7-degree guide, 3-degree guide, and a 0-degree
guide, all in left and right configurations. The
0-degree guide is for use with the A/P Wedge Tibial
Plates.
8 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Step Two Position the Cut Guide at the proximal tibia. Loosen
the knob in the middle of the telescoping rod and
Position Alignment Guide adjust the length of the rod until the Cut Guide is
proximal to the tibial tubercle. Align the rod with
To improve the exposure of the tibial surface, use
the medial third of the tibial tubercle (Fig. 22) or
the Tibial Retractor to lever the tibia anteriorly. This
just medial to the tubercle.
instrument should be carefully positioned against
the posterior cortex of the tibia subperiosteally
Adjust the slide at the foot of the rod mediolaterally
to prevent neurovascular injury. Use the Patellar
so the guide is aligned with the mechanical axis
Retractor to retract the patella laterally.
of the tibia (Fig. 23). The longitudinal axis of the
rod will usually lie just medial to the mid-point of
Adjust the telescoping rod to the approximate
the tibial tubercle and be centered in line with the
length of the tibia and turn the knob on the shaft of
intercondylar eminence. The foot of the rod should
the rod to temporarily maintain the length.
be posi-tioned about 5mm-10mm medial to the
midpoint between the palpable medial and lateral
Place the spring arms of the Ankle Clamp around
malleoli. The tip should point to the second toe.
the ankle proximal to the malleoli (Fig. 21) and Fig. 22
When the proper mediolateral position is achieved,
loosen the knob that provides mediolateral
tighten the knob to secure the Ankle Clamp to the
adjustment at the ankle.
rod. The posterior cortex of the tibia can also be
used as a rotational check.

In the sagittal plane, align the rod so it is parallel

to the anterior tibial shaft by using the slide
adjustment at the distal end of the rod. Tighten
the knob for the adjustment. If there is a bulky
bandage around the ankle, adjust the rod to
accommodate the bandage. This will help ensure
that the tibia will be cut with the proper slope.

Fig. 21

Fig. 23
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 9

Step Three
Set Resection Level

Each tip of the Tibial Depth Resection Stylus

indicates a different depth. The 2mm tip is used to
check the depth from the defective tibial condyle
for a minimal cut. The10mm tip is used to check the
depth from the least involved tibial condyle for an
anatomic cut.

Insert the Tibial Depth Resection Stylus into the top

of the Cut Guide, using the hole that corre-sponds
to the defective tibial condyle (Fig. 24).

Fig. 25
Fig. 24

The stylus will snap into the hole (Figs. 24a & 24b).
Confirm that it is fully seated and properly oriented.
The 2mm tip should rest on the tibial condyle (Fig.
25). This positions the slot of the Cut Guide to
remove 2mm of bone below the tip of the stylus.

Fig. 24a

Fig. 24b
10 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Alternatively, rest the 10mm tip of the stylus on the This will allow the removal of the same amount Insert a second 75mm Headless Holding Pin into
cartilage of the least involved condyle (Fig. 26). of bone that the thinnest tibial component would the other hole marked “0” (Fig. 28).
replace.

These two points of resection will usually not

coincide. The surgeon must determine the
appropriate level of resection based on patient
age, bone quality, and the type of prosthetic
fixation planned.

Adjust the Cut Guide to the desired depth by

adjusting the length of the alignment guide
assembly. Then retighten the telescoping rod,
and insert a 48mm Headless Screw Pin or 75mm
Headless Holding Pin into the hole marked “0” on
the lateral side first of the Cut Guide.

To confirm alignment, insert the Extramedullary Fig. 28

Alignment Arch into the Cut Guide and insert the
Alignment Rod with Coupler through the arch,
passing it distally toward the ankle (Fig. 27). The
distal end of the rod should point to the second
toe.
Fig. 26

Fig. 27
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 11

Step Four
Resect the Proximal Tibia

Loosen the knob that has secured the Cut Guide

onto the Cut Guide Telescoping Rod and remove
the entire assembly, leaving the Cut Guide in place
on the bone. The entire assembly can be left in
place for additional fixation during resection.

Additional 2mm adjustments may be made by Fig. 30

using the sets of holes marked -2, +2, and +4. The
markings on the Cut Guide indicate, in millimeters,
the amount of bone resection each will yield
relative to the standard tibial resection set by the
Cut Guide and Tibial Depth Resection Stylus. Once
the tibial resection has been determined, use the
hex-head Holding Pins, 48mm Headed Screw Pins,
or Silver Spring Pins to further stabilize the guide.
Fig. 31
Use a .050-inch oscillating saw blade through the
slot on the Cut Guide to cut the proximal surface of
the tibia flat (Fig. 29). Then remove the Cut Guide.

Fig. 29

Optional Technique

If desired, the cut can be made from the top

surface of the Cut Guide. The top surface of the
guide is 4mm above the slot (Fig. 30), so the
position of the guide must be adjusted to account
for this difference. The adjustment can be made
after the alignment guide assembly is removed by
lifting the Cut Guide off the headless pins, which
were inserted through the holes marked “0,” and
reinserting the guide through the holes marked
“+4” (Fig. 31).
12 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Intramedullary Technique Drill a hole using the 8mm IM Drill. Suction the
canal to remove medullary contents.
To improve exposure of the tibial surface, use the
Tibial Retractor to lever the tibia anteriorly. This Slowly insert the Tibial IM Rod (5977-44) into the
instrument should be carefully positioned against canal. The flutes on the rod will aid decompression
the posterior cortex of the tibia subperiosteally of the canal during insertion.
to prevent neurovascular injury. Use the Patella
Retractor to retract the patella laterally. Attach either the 7-degree Revision Tibial Boom
(5787-10), 3-degree Boom, or the 0-degree
A preoperative radiograph of the tibia is necessary Augment Tibial Boom (5125-60) to the rod (Fig.
to make sure that the tibial shaft is straight and will 33). The selection of the boom will deter-mine the
accept the Tibial IM Rod. Some tibias are bowed or posterior slope of the tibial resection.
have too small a canal and will not accept the rod.
The acetate template used for femoral planning can
be inverted and used on the tibia.

Step One
Position the Alignment Guide

Use the Universal Handle to start a hole in the

proximal tibia just anterior to the anterior cruciate
ligament insertion and centered mediolaterally
(Fig. 32). This may seem too far anterior; however,
it is the straight proximal extension of the tibial
medullary canal. If a hole is started further
posteriorly, excessive posterior slope may be cut
into the proximal tibia.

Fig. 33

Fig. 32
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 13

Lower the adjustment knob on the IM Alignment Slide the barrel of the IM Alignment Guide onto
Guide to the bottom of the threaded portion. Insert the boom, making sure that the locking knob
the 0-degree Cut Guide over the threaded portion has been adjusted to allow free access (Fig. 35).
of the alignment guide above the adjustment knob Rotate the boom on the rod until the Cut Guide is
and slide it up until it just engages the dovetail properly positioned mediolaterally on the anterior
(Fig. 34). This will allow for final adjustment after tibia. Use the medial third of the tibial tubercle as
the alignment guide has been secured in position. a landmark. Then slightly secure the knob on the
To hold the Cut Guide in place, advance the boom.
adjustment knob until it contacts the underside of
the guide.

Fig. 34

Fig. 35
Only the 0-degree Cut Guide will fit onto the IM
Alignment Guide. The 7-degree Cut Guide will not fit
onto the IM Alignment Guide. Using the 0-degree
Cut Guide with the 7-degree Revision Tibial Boom
will give you a 7-degree cut. Using the 0-degree
Cut Guide with the 3-degree Boom will give you a
3-degree cut.
14 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

To determine varus/valgus alignment, insert the If the surgeon would like to set the Cut Guide at
Extramedullary Alignment Arch onto the Cut Guide a 90-degree angle to the Tibial IM Rod, tighten
and insert the Alignment Rod with Coupler through the knob at the top of the IM Alignment Guide
the arch, passing it distally toward the ankle (Fig. clockwise in the “90” direction as etched on top of
36). The distal end of the rod should point to the the knob (Fig. 37). Do not overtighten the knob.
second toe.
If the alignment check suggests a varus/valgus
adjustment, rotate the barrel of the IM Alignment
Guide on the boom to align the Alignment Rod
to the second toe. When the appropriate varus/
valgus alignment is achieved, tighten the knob at
the top of the IM Alignment Guide counterclock-
wise in the “Var-Valg” direction as etched on top of
the knob (Fig. 38). This will hold the varus/ valgus
position of the Cut Guide. Do not overtighten the
knob.

Fig. 36

Fig. 37

Fig. 38
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 15

Step Two The 2mm tip should rest on the tibial condyle (Fig. Alternatively, rest the 10mm tip of the stylus on the
40). This positions the slot of the Cut Guide to cartilage of the least involved condyle (Fig. 41). This
Set Resection Level remove 2mm of bone below the tip of the stylus. will allow the removal of the same amount of bone
that the thinnest tibial component would replace.
Each tip of the Tibial Depth Resection Stylus
indicates a different depth. The 2mm tip is used to
check the depth from the defective tibial condyle
for a minimal cut. The10mm tip is used to check the
depth from the least involved tibial condyle for an
anatomic cut.

Insert the Tibial Depth Resection Stylus into the top

of the Cut Guide, using the hole that corre-sponds
to the defective tibial condyle (Fig. 39). The stylus
will snap into the hole (Figs. 39a & 39b). Confirm
that it is fully seated and properly oriented.

Fig. 40 Fig. 41

Fig. 39

Fig. 39a

Fig. 39b
16 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

These two points of resection will usually not Step Three

coincide. The surgeon must determine the
appropriate resection based on patient age,
Resect the Proximal Tibia
bone quality, and the type of prosthetic fixation
Loosen the adjustment knob below the Cut Guide
planned.
until the knob is at the bottom of the threaded
portion of the rod. Loosen the varus/valgus
Adjust the Cut Guide to the desired depth by
adjustment knob on the IM Alignment Guide. Use
turning the adjustment knob. Then insert 48mm
a slaphammer to raise the IM Rod until the dovetail
Headless Pin, or 75mm Headless Holding Pins into
portion of the IM Alignment Guide disengages from
the holes marked “0” lateral side first (Fig. 42).
the Cut Guide. Remove the alignment assembly,
leaving the Cut Guide in place on the bone.

If desired, the Alignment Arch and Alignment Rod

with Coupler can be used on the Cut Guide again to
check alignment.

Additional 2mm adjustments may be made by

using the sets of holes marked -2, +2, and +4. The
markings on the Cut Guide indicate, in millime-
ters, the amount of bone resection each will yield
relative to the standard tibial resection set by the
Cut Guide and Tibial Depth Resection Stylus. Once
the tibial resection has been determined, use the
Hex-head Holding Pins, 48mm Headed Screw Pins,
or Silver Spring Pins to further stabilize the guide.

Fig. 42 Use a .050-inch oscillating saw blade through the

slot on the Cut Guide to cut the proximal surface of
the tibia flat (Fig. 43). Then remove the Cut Guide.

Fig. 43
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 17

Optional Technique Alternatively, the adjustment can be made after

the IM Alignment Guide is removed by lifting
If desired, the cut can be made from the top the Cut Guide off the headless pins, which were
surface of the Cut Guide. The top surface of the inserted through the holes marked “0,” and 2mm
guide is 4mm above the slot (Fig. 44), so the reinserting the guide through the holes marked
position of the guide must be adjusted to account “+4” (Fig. 46).
for this difference. The adjustment can be made
when the Cut Guide is first positioned by using the
etch lines, which are in 2mm increments, on the IM
Alignment Guide (Fig. 45).

Fig. 45

Fig. 44

Fig. 46
18 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Spike Arm Intramedullary Step One

Technique Insert IM Rod

To improve exposure of the tibial surface, use the Use the Universal Handle to start a hole in the
Tibial Retractor to lever the tibia anteriorly. This proximal tibia just anterior to the anterior cruciate
instrument should be carefully positioned against ligament insertion and centered mediolaterally
the posterior cortex of the tibia subperiosteally (Fig. 47). This may seem too far anterior; however,
to prevent neurovascular injury. Use the Patella it is the straight proximal extension of the tibial
Retractor to retract the patella laterally. medullary canal. If a hole is started further
posteriorly, excessive posterior slope may be cut
A preoperative radiograph of the tibia is necessary into the proximal tibia.
to make sure that the tibial shaft is straight and will
accept the Tibial IM Rod. Some tibias are bowed or Drill a hole using the 8mm IM Drill. Suction the
have too small a canal and will not accept the rod. canal to remove medullary contents.
The acetate template used for femoral planning can
be inverted and used on the tibia. Slowly insert the Tibial IM Rod (5977-44) into the
canal. The flutes on the rod will aid decompression
of the canal during insertion.

Fig. 47
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 19

Step Two Lower the adjustment knob in the middle of the Slide the Spike Arm assembly over the IM Rod
Spike Arm Telescoping Rod to the bottom of the (Figs. 50, 50a & 50b). Lower the assembly until the
Position Cut Guide threaded portion. Insert the Cut Guide over the long spike engages the tibial surface. Adjust the
threaded portion of the rod above the adjustment assembly to the correct rotation. Impact the Spike
The system includes six different Cut Guides: a
knob and slide it all the way up on the dovetail Arm until both the long and short spikes are fully
7-degree guide, a 3-degree guide, and a 0-degree
(Fig. 49). To hold the Cut Guide in place, advance engaged in bone. Loosen the knob at the top of the
guide, all in left and right configurations. The
the adjustment knob to the end of its range of Spike Arm Telescoping Rod, and slide the rod and
0-degree guide is for use with the A/P Wedge Tibial
travel. This will allow for final adjustment after the Cut Guide toward the anterior tibial surface. Then
Plates.
alignment assembly has been secured in position. tighten the knob.

Slide the Spike Arm onto the top of the Spike

Arm Telescoping Rod and secure it temporarily by
turning the knob at the top of the rod (Fig. 48).

Fig. 49

Fig. 48

Fig. 50
20 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Step Three
Set Resection Level

Each tip of the Tibial Depth Resection Stylus

indicates a different depth. The 2mm tip is used to
check the depth from the defective tibial condyle
for a minimal cut. The10mm tip is used to check the
depth from the least involved tibial condyle for an
anatomic cut.

Insert the Tibial Depth Resection Stylus into the top

of the Cut Guide, using the hole that corresponds
to the defective tibial condyle (Fig. 51). The stylus
will snap into the hole (Figs. 51a & 51b). Confirm
that it is fully seated and properly oriented. The Fig. 52
2mm tip should rest on the tibial condyle (Fig. 52).
Fig. 50a
This positions the slot of the Cut Guide to remove
2mm of bone below the tip of the stylus. Alternatively, rest the 10mm tip of the stylus on the
cartilage of the least involved condyle (Fig. 53). This
will allow the removal of the same amount of bone
that the thinnest tibial component would replace.

Fig. 51

Fig. 51a
Fig. 50b

To confirm alignment, insert the Extramedullary

Alignment Arch onto the Cut Guide and insert the
Alignment Rod with Coupler through the arch,
passing it distally toward the ankle. The distal end
of the rod should point to the second toe.

Fig. 51b
 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique 21

Step Four
Resect the Proximal Tibia

Loosen the adjustment knob below the Cut Guide

until the knob is at the bottom of the threaded
portion of the rod. Use a slaphammer to raise the
IM Rod and Spike Arm assembly until the dovetail
portion of the IM Alignment Guide disengages from
the Cut Guide. Remove the alignment assembly,
leaving the Cut Guide in place on the bone.

If desired, the Alignment Arch and Alignment Rod

with Coupler can be used on the Cut Guide again to
check alignment.
Fig. 53
Additional 2mm adjustments may be made by
using the sets of holes marked -2, +2, and +4. The
markings on the Cut Guide indicate, in millimeters,
These two points of resection will usually not the amount of bone resection each will yield
coincide. The surgeon must determine the relative to the standard tibial resection set by the
appropriate resection based on patient age, Cut Guide and Tibial Depth Resection Stylus. Once
bone quality, and the type of pros-thetic fixation the tibial resection has been determined, use the
planned. Hex-head Holding Pins, Silver Spring Pins, or 48mm
Headed Screw Pins to further stabilize the guide.
Adjust the Cut Guide to the desired depth by
turning the adjustment knob. Then insert 48mm Use a .050-inch oscillating saw blade through the
Headless Screw Pins or 75mm Headless Holding slot on the Cut Guide to cut the proximal surface of
Pins into the holes marked “0” lateral side first. the tibia flat (Fig. 54). Then remove the Cut Guide.

Fig. 54
22 Zimmer NexGen Complete Knee Solution EM/IM Tibial Resector Surgical Technique

Optional Technique Alternatively, the adjustment can be made after the

alignment assembly is removed by lifting the Cut
If desired, the cut can be made from the top Guide off the headless pins, which were inserted
surface of the Cut Guide. The top surface of the through the holes marked “0,” and reinserting the
guide is 4mm above the slot (Fig. 55), so the guide through holes marked “+4” (Fig. 57).
position guide must be adjusted to account for this
difference. The adjustment can be made when the
Cut Guide is first positioned by using the etch lines,
which are in 2mm increments, on the Spike Arm
Telescoping Rod (Fig. 56).

Fig. 57

Fig. 55

2mm

Fig. 56
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