Zimmer ® Gender Solutions™ Patello-Femoral Joint (PFJ) System Surgical Technique IMAGE TO COME Advancing the science of partial knee replacement.

Zimmer® Gender Solutions™ Patello-Femoral Joint (PFJ) System Description The Zimmer® Gender Solutions™ Patello-Femoral Joint Prosthesis (PFJ) is intended for replacement of the femoral trochlea of the patellofemoral joint that has been affected by the disease process and/or injury. The PFJ prosthesis may be used alone or with the Zimmer Unicompartmental Knee System or M/G® Unicompartmental Knee System to treat conditions of the patellofemoral or tibiofemoral regions of the knee. The PFJ prosthesis is compatible with either an unresurfaced patella, a NexGen® all-polyethylene, porous or augmentation...

Zimmer® Gender Solutions™ Patello-Femoral Joint (PFJ) System Zimmer® Gender Solutions™ Patello-Femoral Joint (PFJ) System Surgical Technique Table of Contents SECTION Exposure Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Resect Patella Resecting the Patella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mark Femoral Landmarks Marking Femoral Anatomic Landmarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Perform Femoral Anterior Cut 4.1 Drilling the IM Hole . . . . ....

Zimmer® Gender Solutions™ Patello-Femoral Joint (PFJ) System Implant Trochlea and Patella Prostheses 9.1 Cementing/Implanting the PFJ Implant . . . . . . . . . . . . . . . . . . . . . . . . . . 9.2 Cementing/Implanting the Patella and Checking Motion . . . . . . . . . . . Bicompartmental Arthroplasty: Using the Zimmer Gender Solutions PFJ with a Zimmer Unicompartmental Implant 10.1 Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.2 Sequence - Implanting the Gender Solutions Patello-Femoral Joint First . . . . . . . . . . . . . . . ....

Exposure The Gender Solutions PFJ instrumentation is compatible with MIS arthrotomies. Various exposures can be considered including medial parapatellar, lateral parapatellar, midvastus, subvastus, etc. Resection of the infrapatellar fat pad can facilitate exposure. During arthrotomy it is important to avoid inadvertently cutting the anterior horns of the menisci or intermeniscal ligament.

Surgical Technique Header Resect Patella Resect Patella • After selecting the appropriate Zimmer patellar system, one of the following options may be used to prepare the patella. - MIS Patella Resection Guide - Standard Patella Instruments - Patella Reamer System • Select the appropriate size patella which provides for the best support of the patella on the condyles after it transitions off of the trochlear component.

Mark Femoral Landmarks Surgical Technique Header Mark Femoral Landmarks • Mark the A/P axis (Whiteside’s line) from the lowest part of the trochlea to the highest part of the intercondylar notch (Fig1). • With a skin marker, mark a line perpendicular to the A/P axis (Fig2). Fig. 1 TECHNIQUE TIP Technique Tip: Alternatively, the transepicondylar axis may be used as reference. NOTE: These marks will serve as references in setting external rotation in subsequent steps. Fig. 2 Mark a line perpendicular to the A/P axis.

Surgical Technique Header Femoral Anterior Cut Femoral Anterior Cut 4.1 Drilling the IM Hole • Use the 6mm Intramedullary (IM) drill to drill the hole (Fig. 3). NOTE: Hole location is 10 mm anterior to the origin of the posterior cruciate ligament. 4.2 Assembling the Telescoping Boom to the IM Anterior Cut Guide • Unlock the Telescoping Boom by loosening the knurled knob. (Fig. 4). NOTE: The locking boom (00-5983-028-00) is compatible with the IM Anterior Cut Guide and is available separately. Fig.4 Unlock Telescoping Boom.

Femoral Technique Header Surgical Anterior Cut • Push down and hold adjustment knob on the IM Anterior Cut Guide (Fig.5) while sliding the Telescoping Boom onto the IM guide collar (Fig.6). Boom may be inserted from either medial or lateral side. • Release the IM guide adjustment knob. • Lock the Telescoping Boom by tightening the knurled knob on the boom. It may be necessary to slightly rotate adjustment knob while depressing to allow boom insertion. Fig.5 Push down and hold adjustment knob. Fig.6 Slide on Telescoping Boom.

Surgical Technique Header Femoral Anterior Cut 4.3 Inserting the IM Anterior Cut Guide With Telescoping Boom • Insert the IM Guide into the medullary canal until the proximal aspect of the guide slightly contacts the distal femoral sulcus. The guide may be inserted by hand (Fig. 7) or with the Inserter/Extractor handle (Fig. 8). To provide additional clearance for the Telescoping Boom to clear the anterior femur during insertion, adjust the IM guide to the “open” position (turning adjustment knob on top of IM guide counter-clockwise). - If impaction is required, impact using the Inserter/ Extractor...

Femoral Technique Header Surgical Anterior Cut 4.4 Setting External Rotation and Depth for Anterior Cut • Rotate the IM guide to the desired external rotation. - To align to the A/P axis, rotate the IM guide until the vertical reference lines on the guide are parallel with the A/P axis. - If using transepicondylar axis or line perpendicular to the A/P axis, rotate until the horizontal lines on the guide are parallel to the marked lines. (Fig. 10). TECHNIQUE TIP Fig. 10 Setting external rotation parallel to marked lines. Moving the knee closer to extension will improve visibility of the anterior...

Surgical Technique Header Femoral Anterior Cut • Adjust A/P height of the cut guide by turning the IM guide adjustment knob until the boom tip just contacts the cortex (Fig. 12). NOTE: Avoid excessive pressure on the boom tip. • Confirm anterior cut with the Resection Guide (Fig.13). Fig. 12 Adjusting height of cut guide.