Nexgen Lps Flex Fixed Bearing Knee Surgical Technique
Nexgen Lps Flex Fixed Bearing Knee Surgical Technique
Nexgen Lps Flex Fixed Bearing Knee Surgical Technique
Surgical Technique
Table of Contents
Introduction............................................................................................................... 2
Patient Selection
Preoperative Conditioning
Preoperative Planning
PCL Resection............................................................................................................ 7
Tibial Preparation.................................................................................................... 10
Femoral Preparation................................................................................................ 10
Flexion/Extension Gaps.......................................................................................... 12
Patella Preparation.................................................................................................. 14
Trial Reduction......................................................................................................... 15
Implantation............................................................................................................ 15
Assembly................................................................................................................. 17
For Back Table Assembly:
For in vivo Assembly:
Closure..................................................................................................................... 19
Rehabilitation Protocol............................................................................................ 19
2|NexGen LPS-Flex Fixed Bearing KneeSurgical Technique
Figure 1 Figure 2
Introduction
The NexGen LPS-Flex Fixed Bearing Knee is a posterior and pulled tightly against the anterior tibia and distal
stabilized prosthesis designed to accommodate greater femur. The LPS-Flex fixed bearing knee is designed to
range of motion for appropriate patients, such as those help relieve these stresses through a larger, deeper
who are physically capable or whose cultural customs or anterior cutout on the bearing (Figure 2). This cutout
recreational/work activities require deep flexion. accommodates the extensor mechanism in deep
flexion.
The development of the LPS-Flex fixed bearing knee
is the result of an analysis of a knee prosthesis as it Additionally, the cam/spine mechanism has been
undergoes deep flexion beyond 120 degrees. For modified to provide greater jump height as the
example, the interaction of the posterior condyles on knee prosthesis undergoes deep flexion between
the bearing was carefully studied. As a result, efforts 120 and 155 degrees. The cam/spine mechanism
have been made to optimize the contact area as the induces mechanical rollback while inhibiting
posterior condyles roll back to flexion angles up to 155 posterior subluxation of the tibia.
degrees (Figure 1). This is addressed by thickening the
posterior condyles, thereby extending the radius. These design features accommodate high-flexion
activities and, together with proper patient selection,
The tibial bearing was also considered in the design. surgical technique, and rehabilitation, increase the
In deep flexion, the extensor mechanism experiences potential for greater range of motion.
a high level of stress as the soft tissues are stretched
3|NexGen LPS-Flex Fixed Bearing KneeSurgical Technique
Introduction (cont.)
The LPS-Flex fixed bearing knee components can be will help provide a consistent flexion gap. Regardless
implanted using any of the NexGen Knee Instrument of the instrumentation system used, the spacer
Systems. These include: blocks should always be used to check the flexion
and extension gaps after the initial femoral and tibial
Multi-Reference 4-in-1 Femoral Instrumentation cuts have been made. Also, the V-STAT Variable Soft
System Tissue Alignment Tensor can be used with any of
MICRO-MILL Instrumentation System-Milling or the instrument systems except the intramedullary
5-in-1 saw blade options instrumentation system to aid in proper flexion/
Intramedullary instrumentation system extension gap balancing. When the flexion gap is
equal to the extension gap, the posterior recut guide
Epicondylar instrumentation system is used to prepare the posterior condyles for the LPS-
If the Multi-Reference 4-in-1 Femoral Instrumentation Flex femoral component.
System is used, the posterior referencing technique
4|NexGen LPS-Flex Fixed Bearing KneeSurgical Technique
>90
Does not meet
selection criteria
Figure 3
Thigh-calf angle
Patient Selection
The LPS-Flex fixed bearing knee should be used with sitting cross-legged, and squatting are common.
patients capable of higher flexion to optimize its Also, certain hobbies and recreational activities,
potential benefits. A common view among potential such as gardening, bowling, or golfing, may
orthopaedic surgeons is that preoperative range of require high-flexion capabilities.
motion is a good indicator of postoperative range of 3. The patient should have a thigh-calf index of less
motion. In determining the appropriateness of this than 90 degrees (Figure 3).
implant for any patient, careful consideration should
be given to the following criteria for patient selection. 4. The patient should have stable and functional
collateral ligaments.
1. The patient should be capable of reaching 5. If the patient has an angular deformity, it should
120 degrees of flexion preoperatively, with be less than 20 degrees. Keep in mind that it
a reasonable probability, in the surgeons is more difficult to achieve ligament balance
judgment, of achieving a range greater than 130 in these patients. And, in patients with severe
degrees postoperatively. deformity, consider the patient expectation for
2. The patient should have a need and desire to achieving high flexion.
perform deep-flexion activities. This need is 6. The patient should not be obese.
often dictated by cultural background where
practices such as frequent kneeling for prayer, It is also important to consider the length of time the
patient has not performed high-flexion activities.
5|NexGen LPS-Flex Fixed Bearing KneeSurgical Technique
Preoperative Conditioning
To help prepare the patient for surgery, it may be techniques can be used: the Multi-Reference 4-in-1
helpful for the patient to perform mobility exercises Femoral Instrumentation System, the MICRO-MILL
to prepare the ligaments and muscles for the Instrumentation System with Milling or 5-in-1 Saw
postoperative rehabilitation protocol. Blade Options, the Intramedullary Instrumentation
System, or the Epicondylar Instrumentation System.
Preoperative Planning The spacer blocks available with these instrument
Use the template overlay (available through your systems should always be used to check the flexion
Zimmer Biomet representative) to help determine the and extension gaps.
angle between the anatomic axis and the mechanical
axis. This angle should be reproduced intraoperatively. In addition, the V-STAT Variable Soft Tissue
Alignment Tensor can be used with any of the
Use the various templates to approximate the instrumentation choices except the Intramedullary
appropriate component sizes. The final sizes must Instrumentation System.
be determined intraoperatively; therefore, larger and
smaller sizes should be available during surgery.
Figure 4
Lax
Tensed
Contracture
Figure 5
Lax Tensed
Contracture
Figure 6
Tibial Preparation
Using the selected instrumentation system, and is a posterior stabilized design, surgeons should first
following the appropriate technique for that system, consider upsizing. By doing this, they maintain the
establish the tibial cutting platform and resect the option to downsize if the knee is too tight in flexion
proximal tibia. Some PS surgeons may prefer to cut with the larger size.
the tibia with a 35 degrees posterior slope that
matches the preoperative slope of the tibia. Excessive Prepare the femur as per the MIS Mini-Incision Multi-
posterior slope can increase the likelihood of the Reference 4-in-1 technique or the MIS Mini-Incision
femoral component contacting the anterior portion of IM technique. Alternatively, the MIS Quad-Sparing
the bearing spine. technique may also be utilized. When choosing the 3
degrees flexion cut in the 4-in-1 technique, excessive
Femoral Preparation flexion in the distal femoral cut can increase the
likelihood of the femoral component contacting the
When sizing the femoral component, it is preferable
anterior portion of the bearing spine. If a size A or B
to select the closest size. With the large selection of
femoral component is chosen, do not drill the distal
available femoral component sizes for the LPS-Flex
femoral post holes at this time. Size A and B femoral
knee, it is possible to choose a size that is within 2 mm
components have smaller pegs. The holes should be
of the measured anatomy. However, depending on the
drilled using the size A/B femoral peg drill and the
situation, selecting the closest size could mean either
posterior recut guide.
upsizing or downsizing. Because the LPS-Flex knee
11|NexGen LPS-Flex Fixed Bearing KneeSurgical Technique
Figure 7 Figure 8
Figure 9 Figure 10
Flexion/Extension Gaps
While the basic box cuts are the same for both cruciate 4-in-1 instruments an option exists to resect the
retaining and posterior stabilized designs, there are distal femur in 3 degrees of flexion to help avoid
some important differences in the technique, and it anterior notching. This option can be helpful when
is important that those surgeons who have typically between femoral sizes.
followed the cruciate retaining philosophy understand
With the knee flexed 90 degrees, start with the
these differences. First, be aware that when the PCL
thickest spacer/alignment guide that will easily fit
is removed, there may be a change in the symmetry
between the posterior femoral condyles and the
of the flexion and extension gaps. Therefore, the
resected tibia. Use progressively thicker spacers
joint balancing is different with a posterior stabilized
until the proper soft tissue tension is obtained. The
prosthesis. In the posterior stabilized technique, the
resultant flexion space should be balanced and
flexion and extension gaps are balanced with spacer
symmetrical. The tibial resection can also be checked
blocks and/or tensor devices. Posterior referencing
at this point by placing the alignment rod through the
instrumentation systems, like the Multi-Reference
handle of the spacer/alignment guide (Figure 10).
4-in-1 Instruments, are designed to help balance the
gaps with the initial bone cuts (Figure 9). With the
13|NexGen LPS-Flex Fixed Bearing KneeSurgical Technique
Figure 11
Figure 12
Prolong LPS-Flex
Net-Shaped Molded
LPS-Flex
Figure 13
Assembly
For back table assembly: For in vivo assembly:
1. Assemble the stem extension or the taper plug If preferred, a 17 mm or thicker bearing can be inserted
onto the tibial plate by striking it with a mallet after the tibial plate has been implanted.
once for the stem extension or several times for
1. Assemble the stem extension or the taper plug
the taper plug to allow the ring on the taper plug
onto the tibial plate by striking it with a mallet
to deform.
once for the stem extension or several times for
2. Place the tibial plate on the holding fixture, which the taper plug to allow the ring on the taper plug
is an integral part of the instrument case. to deform.
3. Use the bearing inserter to insert the bearing on It is recommended to secure the taper plug/stem
the tibial plate. extension using a replacement stem extension
4. With the bearing in place, insert the secondary locking screw: 00-5980-090-00 (available as a
locking screw (packaged with the bearing). separate sterile item) before implanting the tibial
component. This screw will hold the taper plug/
5. Use the LCCK deflection beam torque wrench
stem extension in place when the tibial plate is
with the 4.5 mm hex driver bit attached to torque
impacted.
the screw to 95 in.-lbs. Alternatively, if using a
stem extension, use the tibial plate wrench to
assist when torquing the screw. Do not over or
under torque.
18|NexGen LPS-Flex Fixed Bearing KneeSurgical Technique
*For cemented applications, apply a layer of bone cement to the underside of the
tibial plate, around the keel, on the resected tibial surface and in the tibial IM canal.
Remove the excess cement.
19|NexGen LPS-Flex Fixed Bearing KneeSurgical Technique
Figure 14 Figure 15
Notes
References
1. Whiteside, L. Factors Affecting Range of Motion in Total Knee
Arthroplasty. Journal of the Japanese Orthopaedic Association.
65: 1934, 1991.
2. Insall, J. Surgery of the Knee, 3rd ed. NY, NY: Churchill Livingston.
1553, 2001.
Legal Manufacturer
Zimmer, Inc
1800 West Center Street
Warsaw, IN 46581-0708
USA
97-5964-102-00-REV0616 zimmerbiomet.com