Zimmer

Segmental
System

Distal Femoral
Surgical Technique
INTRO Zimmer Segmental System Distal Femoral Surgical Technique

Introduction
The Zimmer Segmental System is designed to address
significant bone loss resulting from oncology, trauma, and/or
the salvage of previously failed arthroplasty. The Segmental
Distal Femoral Component features the same condylar-loading
geometry as the Zimmer NexGen Rotating Hinge Knee (RH Knee),
but will also allow both medial and lateral access to the hinge pin
locking assembly. The Segmental One-piece Hinge Post, which
is packaged with the corresponding size Segmental Articular
Surface, ensures a minimum 40mm jump-height of the post for
all sizes of Segmental Articular Surface. The system also includes
specific instruments designed to facilitate the surgical procedure.

Femoral Replacement Options

The Zimmer Segmental System offers solutions for both
distal femoral replacement and total femoral replacement,
in addition to proximal tibial replacement (Fig. 1).

System Compatibility
The Segmental Distal Femoral Component may be implanted
with all Segmental Distal Femoral Components, the Segmental
Trabecular Metal Proximal Tibial Component, Segmental Stems,
Segmental Stem Collars, and Segmental Segments as well as the Fig. 1
NexGen RH Knee Tibial Components, VerSys Hip System 12/14
Heads and the legacy 12/14 Heads (Fig. 2). The Segmental
Distal Femoral Component may be used with both Fluted
Stems (cemented) and Variable Stiffness Stems (press-fit) in
many stem lengths and diameters. All Stems are compatible
with both Trabecular Metal Collars and Tivanium Ti-6Al-4V Alloy
Collars (Fig. 2). Variable Stiffness Stems are not indicated for
use in the knee with the Segmental Distal Femoral Components
in the United States.

INTRO. 1
 Zimmer Segmental System Distal Femoral Surgical Technique INTRO

Segmental Segmental
Trabecular Metal Trabecular Metal Segmental Proximal
38mm 46mm
Proximal Femoral Proximal Femoral Femoral Component
offset offset
Tissue Attachment Kits Components (38mm offset)

Segmental Segments,
Stems and Collars NexGen Stem
Components
(Variable Stiffness Stems are
not indicated for use in the
knee with the Segmental
Distal Femoral Components
in the United States)

Trabecular Metal
Femoral Cones

Segmental Knee Distal RH Knee Distal Femoral

Femoral and Segmental and RH Knee Cement
Knee Polyethylene Shield Polyethylene
Insert Components Insert Components

Segmental Knee Hinge

NexGen Patellar
Post and Articular
Segmental Components
Surface Components
Intercalary
Segments

Segmental
RH Knee Segmental
Proximal
Tibial Baseplate Trabecular Metal
Tibia Tissue
Components Proximal Tibial
Attachment
Components
Kit
Segmental System
Male-Female Segments,
Trabecular Metal
Fluted Stems, Variable
Tibial Cones
Stiffness Stems,
and Stem Collars Segmental Segments,
Straight Stems and Collars
(Variable Stiffness Stems are
not indicated for use in the
knee with the Segmental
Trabecular Metal Proximal Tibial
Components in the United States)

NexGen Stem
Components
NexGen Knee
Segmental System
RH Knee

Fig. 2

INTRO. 2
INTRO Zimmer Segmental System Distal Femoral Surgical Technique

Table of Contents
SECTION PAGE SECTION PAGE
Distal Femur Replacement Using the
1 Segmental Distal Femoral Component
1 3 Total Femur Replacement 22

Distal Femur Replacement

Using the Segmental Distal 1 Total Femur Replacement 22
Femoral Component

Step One: Prepare the Femur 2 Proximal Femur Options 24

Step Two: Prepare the Tibia 6 Distal Femoral 24

Step Three: Prepare the Patella 6 Proximal Tibia 25

Step Four: Assemble Provisional

Components and Perform 6
APPENDIX PAGE
Trial Reduction
Appendix A: NexGen RH Knee &
Step Five: Assemble Implants 13 A Segmental Articular Surface/Hinge 26
Kit Compatibilities
Step Six: Insert Implants 16

Disassembly 20 APPENDIX PAGE

Appendix B: Servicing the
Closure 20 B hinge of a well-fixed Segmental 28
Distal Femoral

SECTION PAGE
Using the Segmental One-piece
2 Hinge Post with the NexGen RH Knee
21

Using the Segmental One-piece

Hinge Post with the NexGen 21
RH Knee

TOC. 1
 SECTION

Distal Femur Replacement Using the Segmental Distal Femoral Component

1

Premature failure of the Segmental Distal Femoral

hinge may be caused by:
1) Stretching of the knee to insert the Segmental Distal Femoral
Hinge Post (after back table hinge-post assembly). In vivo
assembly is required (Fig. 3).
2) Not replacing the tibial bushing when servicing the hinge at
revision (Fig. 4). The tibial bushing is packaged in the Hinge
Servicing implant kit and the Tibial Bushing Remover tool 00-
5881-055-00 (Fig.4) is in the NexGen RH Knee instrument kits
KT-5979-005-00 or 00-5979-005-00.

These conditions may place excessive demand/

severe loading on the polyethylene insert (box) Fig. 3
component of the Segmental Distal Femoral Construct:
Neuropathic Athropathy (Charcots knee)
Muscle deficiencies (quadriceps insufficiency or previous patellar
tendon/tibial tubercle rupture)
Refusal to modify postoperative physical activities
Morbid obesity (Body Mass Index >39)

Tibial Bushing

Fig. 4

1
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1 Distal Femur Replacement Using the Segmental Distal Femoral Component

TECHNIQUE TIP 1.A Distal Femur** Stem/Collar Segments Total Length*

None 90mm
Consider marking Femoral Rotation outside of the resection area
30mm 122mm
prior to resection for later reference.
35mm 127mm
40mm 132mm
TECHNIQUE TIP 1.B 45mm 137mm
50mm 142mm
To ensure proper leg length, consider marking both the tibia
55mm 147mm
and femur outside of the resection area. Measure and record the
60mm 152mm
distance between the two lines for later reference during trialing.
35+30mm 159mm
40+30mm 164mm

Step One: Prepare the Femur 40+35mm 169mm

80mm 172mm
After exposing the distal femur and proximal tibia, extend 40+45mm 179mm
the leg in a reproducible position (typically full extension).
60+30mm 184mm
Distal Femoral Resection 60+35mm 189mm


Measuring from the articular surface of the distal femur, use a 100mm 192mm
marker, osteotome, or electrocautery to make a horizontal line 60+45mm 199mm
marking the proposed resection level based on preoperative 80+30mm 204mm
planning and the implant configuration (Table 1 & Fig. 5). Size B 80+35mm 209mm
30mm
Resect the distal femur at or slightly distal (0.5mm-1.0mm) 58mm** 120mm 212mm
to the marked resection level. Resecting the femur slightly 80+45mm 219mm
below the mark will account for slightly oblique cuts and 100+30mm 224mm
help accommodate femoral resection planing. 100+35mm 229mm
140mm 232mm
100+45mm 239mm
120+30mm 244mm
120+35mm 249mm
160mm 252mm
120+45mm 259mm
140+30mm 264mm
140+35mm 269mm
180mm 272mm
140+45mm 279mm
30mm
Stem/Collar 30 + 160mm 284mm
200mm 292mm
2mm Taper
Connection 30 + 180mm 304mm
90mm 220mm 312mm
30 + 200mm 324mm
58mm (Size B)
Distal Femur** Table. 1
Distal Femoral Resection with Stems, Collars and Segments
*Each large taper connection adds 2mm to the total length.
**Size C Segmental Distal Femoral is 60mm tall. Resect an additional 2mm
Fig. 5 beyond the total length of resection listed in the table above for the Size C.

2
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Distal Femur Replacement Using the Segmental Distal Femoral Component

1

Ream the Femoral Canal


Ream the femoral canal until the reamer contacts cortical Stem Diameter (mm)
bone in the isthmus. For a straight stem, use the straight
9 10 11 12 13 14 15 16 17 18 19
reamers from the VerSys Hip System. For a bowed stem,
130mm Straight (Fluted & Variable Stiffness)
flexible reamers from the Pressure Sentinel Intramedullary

Stem Type
Stem IM
Length
Reaming System are recommended: use the Pressure 190mm Straight (Fluted)
Sentinel Reamer Expanded Hip Set (00-2228-000-03) 190mm Bowed (Variable Stiffness)
or the ZMR Flexible Reamer Set (00-9975-000-11). 250mm Bowed (Fluted)

If preferred, the flexible reamers can also be used for a
straight Variable Stiffness Stem to allow for point contact Table. 2a
in the canal. The intramedullary lengths of the stems Stem Types and Lengths
are listed in the chart to the right (Table 2a). Ream to a
depth greater than the intramedullary length to allow Stem Size Minimum Ream Minimum Ream
proper seating of the stem collar on the cortical bone and Diameter Diameter
(Fluted) (Variable Stiffness)
placement of a cement restrictor if using a fluted stem.
9mm 11mm 8.5mm
Variable Stiffness Straight Stems
10mm 12mm 9.5mm
For optimal fit, the Segmental 3/4mm Reamers may be used. 11mm 13mm 10.5mm

Flexible reamers may be used to allow for point contact in 12mm 14mm 11.5mm
the canal.
13mm 15mm 12.5mm

If insertion is difficult, consider reaming an additional time
14mm 16mm 13.5mm
with the final reamer diameter used.
15mm 17mm 14.5mm
Notes: 16mm 18mm 15.5mm
The diameters indicated for the Segmental Variable Stiffness 17mm 19mm 16.5mm
Stems represent the actual outer diameters of the stems, 18mm 20mm 17.5mm
which include the height of the splines. The diameter of the 19mm 21mm 18.5mm
reamed hole should be 0.5mm smaller than the labeled stem
size to provide for apposition of the distal splines with the Table. 2b
femoral canal (Table 2b).
Recommended reamer diameters
When using a bowed variable stiffness stem it may be
necessary to ream the intramedullary canal to a diameter
equal to or slightly greater than the diameter of the stem to
accommodate any difference between the bow of the stem
prosthesis and the anatomy of the patient.
The diameters indicated for the Segmental Fluted Stems
represent the actual outer diameters of the stem. Therefore,
the diameter of the definitive stem should be 2mm smaller
than that of the largest reamer used to ream the canal to
allow for an adequate cement mantle (Table 2b).

Instruments

VerSys Hip Reamer Pressure Sentinel ZMR System Segmental

(See ZSS Profiler) IM Reamer Flexible Reamer 3/4mm Reamer
KT-5853-013-00 (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler)
00-7899-073-00 00-2228-000-03 00-9975-000-11 KT-5853-014-00
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1 Distal Femur Replacement Using the Segmental Distal Femoral Component

Plane the Femoral Bone


Thread the appropriately sized Segmental Planer Pilot
(130mm long) for the stem diameter selected onto the Planer
Femoral/Tibial Planer (Fig. 6).

Planer Pilot
Fig. 6

Stem Size Planer Pilot Planer Pilot

Diameter Diameter
(Fluted) (Variable Stiffness)

If the anatomy requires the use of a shorter planer pilot,
9mm 9mm 8mm
use the 75mm length Segmental Planer Pilots. If the canal
is bowed, use the shorter Planer Pilots from the Segmental 10mm 10mm 9mm
Variable Stiffness Stem instrument kit (KT-5853-008-00). 11mm 11mm 10mm
A Planer Pilot 1-2mm smaller than the stem diameter 12mm 12mm 11mm
chosen can be used to facilitate insertion into a curved
13mm 13mm 12mm
medullary canal (Table 3). Attach the assembly to a power
14mm 14mm 13mm
driver with a Zimmer adapter. Then plane the resected
distal femur until the cortical bone is smooth and flat. 15mm 15mm 14mm


To aid in removing the Planer Pilot from the Planer, insert 16mm 16mm 15mm
the pin on the Segmental Collar Provisional Sizer through 17mm 17mm 16mm
the cross-hole and, while securing the noncutting end of 18mm 18mm 17mm
the planer, turn the shank counterclockwise. 19mm 19mm 18mm

Table. 3
Recommended Planer Pilot Diameters

Instruments

Segmental Segmental Segmental Collar

Planer Pilot Planer Provisional Sizer
(See ZSS Profiler) 5100-00-052 00-5853-056-10
00-5851-070-XX
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Distal Femur Replacement Using the Segmental Distal Femoral Component

1
Counterbore
Reamer Stop Plate
Counterbore the Femoral Canal
(Variable Stiffness Stems Only)

The full diameter of a Variable Stiffness Stem proximal
to the splines will be 0.5mm greater than the reamed
diameter of the femoral canal. Counterboring this proximal Counterbore
portion is required for proper insertion of the stem in the Reamer Tip
intramedullary canal.
Thread the appropriate size Counterbore Reamer Tip into
the Counterbore Stop Plate (Fig. 7).

Fig. 7

Counterbore Reamer Tip

Then insert the assembly into a power driver. Insert the pin
on the Segmental Collar Provisional Sizer through the cross-
hole of the Counterbore Reamer Tip and turn the collar to
tightly secure it to the Counterbore Stop Plate (Fig. 8). Segmental Collar
Provisional Sizer
Fig. 8

Insert the assembly into the reamed canal and counterbore

the proximal canal (Fig. 9). The Counterbore Stop Plate will
serve as a stop when the appropriate depth is achieved.
Do not over ream or elongate the hole.

Fig. 9

Instruments

Counterbore Counterbore Segmental Collar

Reamer Tip Reamer Stop Plate Provisional Sizer
(See ZSS Profiler) 00-5851-073-01 00-5853-056-10
00-5851-073-XX
5
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1 Distal Femur Replacement Using the Segmental Distal Femoral Component

Stem Smooth Collar Trabecular Metal Collar

Diameter (Item #) (Item #) (Dimension A)

Step Two: Prepare the Tibia

25mm for 9-16mm Stems

For the steps required to prepare the tibia for use with the
(00-5852-040-25)
NexGen RH Knee, refer to the Zimmer NexGen RH Knee
Primary/Revision Surgical Technique (97-5880-002-00,
30mm for 9-16mm Stems
revision 4 or later). 9-16mm
(00-5852-042-09) 30mm for 9-16mm Stems
(00-5852-040-30)
Step Three: Prepare the Patella
If the patella will be resurfaced, refer to the steps required to
prepare the patella, in the Zimmer NexGen RH Knee Primary/ 35mm for 9-16mm Stems
Revision Surgical Technique (97-5880-002-00, revision 4 (00-5852-040-35)
or later). Other surgical techniques that may be helpful are
those for the Zimmer Patella Reamer, the Augmentation
Patella, and the Trabecular Metal Primary Patella. 30mm for 17-19mm Stems
30mm for 17-19mm Stems (00-5852-041-30)
17-19mm
(00-5851-042-17)

35mm for 17-19mm Stems

(00-5852-041-35)
Stem Collar Compatibility Table

Step Four: Assemble Provisional Components Provisional Stem

and Perform Trial Reduction Provisional Stem Diameter
Stem Size Diameter (Fluted) (Variable Stiffness)
Stem Extension Provisional Assembly
9mm 9mm 8mm
Use the Segmental Collar Provisional Sizer to select the collar
10mm 10mm 9mm
size that provides the best coverage of the bone surface.
If using a nonporous collar, only the 30mm diameter collar 11mm 11mm 10mm
is available. As an option, the collar sizer may be threaded 12mm 12mm 11mm
onto the selected Planer Pilot to facilitate collar selection. 13mm 13mm 12mm
Select the appropriate stem provisional (Table 4). 14mm 14mm 13mm
15mm 15mm 14mm
16mm 16mm 15mm
17mm 17mm 16mm
20mm Dimension A 18mm 18mm 17mm
19mm 19mm 18mm

30mm
Table. 4
Recommended stem provisional diameters

Instruments

Segmental Collar Segmental

Provisional Sizer Planer Pilot
00-5853-056-10 (See ZSS Profiler)
00-5851-070-XX
6
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Distal Femur Replacement Using the Segmental Distal Femoral Component

1
Hole for
Threading Collar

Confirm that the stem and stem collar sizes are compatible Anterversion
Pockets
(Table 4). Then thread the Segmental Collar Provisional
onto the selected Segmental Stem Provisional (Fig. 10).

Threaded
Threaded Provisional Provisional Collar
TECHNIQUE TIP 1.C Extraction Hole Stem
Fig. 10
Check the fit of the Stem Extension Provisional Assembly by inserting
it into the reamed canal. For a bowed canal, it may be necessary to
perform additional reaming, possibly causing the next smaller
stem size to be utilized.

Notes:
The diameters of the Segmental Stem Provisionals
represent the actual diameters of the stems, i.e. a 14mm
stem provisional has a nominal 14mm outer diameter.
The same Segmental Straight Stem Provisionals (130mm)
are used for both the 130mm Segmental Fluted Straight
Stem and the 130mm Variable Stiffness Straight Stem,
although, when trialing, a diameter 1mm less than the
stem to be implanted is recommended for the Segmental
Variable Stiffness stems.

Instruments

Segmental Stem Segmental Stem Collar Provisional

Provisional Bowed Provisional Straight (See ZSS Profiler)
(See ZSS Profiler) (See ZSS Profiler) 00-5853-056-XX
00-5853-054-XX 00-5853-05X-XX
7
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1 Distal Femur Replacement Using the Segmental Distal Femoral Component

Femoral Provisional Assembly and Insertion

After verifying that all sizes are correct, assemble the
provisional femoral components. The components can be
assembled either on the back table or in vivo. For back-table
assembly, place the Segmental Distal Femoral Provisional
into the Segmental Condyle Impactor. If using a segment
provisional, place the male taper into the female taper of the
distal femoral provisional. Using the appropriate Segmental
Implant/Provisional Male or Female Impactor and the Universal
Impactor Handle, impact the segment provisional onto the
distal femur. Next attach the stem provisional to the segment
Fig. 11
provisional or femoral provisional using the appropriate
impactor. Ensure that all tabs on the provisional components
are properly engaged in the corresponding pockets. Use gauze
to protect the stem tip and impact with a mallet.
Alternatively, the femoral provisionals may be assembled
sequentially in vivo. If necessary, the Universal Impactor
Handle can be threaded into the base of the Segmental
Condyle Impactor (Fig. 11). Anteversion Pockets
Insert the femoral provisional assembly into the femoral
canal and evaluate the fit. If necessary to achieve full seating,
use the Segmental Condyle Impactor, the Universal Impactor
Handle, and a mallet to lightly impact the distal end of the
Segmental Distal Femoral Provisional (Fig. 12). Evaluate the
fit of the stem collar on the bone surface to determine if the
stem is fully seated. Assess the orientation of the distal femoral
Alignment Slot
provisional and determine whether a rotation adjustment
will be necessary. If desired, the femoral component can be
slightly externally rotated based on the anterior femur and
linea aspera to facilitate patellar tracking.
If a bowed stem is being used, mark the femoral bone in Fig. 12
line with the alignment slot on the mediolateral side of the
Segmental Bowed Stem Provisional to provide a locator for
proper orientation of the implant (Fig. 12).

Instruments

Segmental Stem Segmental Stem Segmental Implant/ Segmental Implant/ Segmental Distal Segmental Condyle Segment Universal Handle
Provisional Bowed Provisional Straight Provisional Male Provisional Female Femoral Provisional Impactor Provisional 6216-01-125
(See ZSS Profiler) (See ZSS Profiler) Taper Impactor Taper Impactor (See ZSS Profiler) 00-5851-074-00 (See ZSS Profiler)
00-5853-054-XX 00-5853-05X-XX (Stem Impactor) (Segment Impactor) 00-5851-01X-XX KT-5853-004-00
00-5851-080-00 00-5851-074-02

Collar Provisional Mallet

(See ZSS Profiler) 00-0155-002-00
00-5853-056-XX

8
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Distal Femur Replacement Using the Segmental Distal Femoral Component

1

Femoral Version Adjustment

If a rotation adjustment is necessary, use the Segmental
Taper Separator to disassemble the provisional taper.
Pockets
The anteversion pockets and tabs on the provisional
components allow the component rotation to be adjusted Tab
in a controllable manner in 20-degree increments (Fig. 13).

Fig. 13

Using the Segmental Taper Separator

Before employing the Segmental Taper Separator, make
sure that the inside wedging portion of the instrument is
fully retracted and centered within its housing. To orient Anteversion
Pockets
the instrument correctly, insert the tabs of the separator
into the anteversion pockets with the flat of the separator
Segmental Taper Anteversion
toward the anatomical joint as etched on the instrument Separator Tab
(Fig. 14). Slowly turn the handle clockwise until the tapers
are disengaged, taking care not to pinch fingers against the
rotating impactor cap. If necessary, lightly tap the impactor
cap on the instrument to facilitate taper disassembly.

Note: To protect the taper integrity of the femoral provisional

components, use only the Segmental Taper Separator with
the turning handle when disassembling the femoral Flat towards
anatomical
provisional construct.
Fig. 14 joint

Instruments

Segmental Taper Segmental Stem Segmental Stem Segment Collar Provisional

Separator Provisional Bowed Provisional Straight Provisional (See ZSS Profiler)
00-5851-020-00 (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) 00-5853-056-XX
00-5853-054-XX 00-5853-05X-XX KT-5853-004-00
9
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1 Distal Femur Replacement Using the Segmental Distal Femoral Component

Tibial Provisional Assembly and Insertion

Assemble the NexGen RH Knee Tibial Provisional
Segmental
Components and NexGen Stem Extension Provisional,
Distal Femoral
if applicable. Use the provisionals from the RH Knee
Articular Surface Provisional Instrument Set (Kit# 5979-04).
Remember that the size on the femoral provisional must
exactly match the size of the articular surface provisional. Segmental
Articular Surface
The size on the tibial provisional must be appropriate
for the size of the femoral provisional and tibial articular
surface provisional (Table 5). RH Knee Tibial

Note: When using a large tibia component paired with a small

Segmental Distal Femoral Size
femoral component, some portion of the tibia base plate will
B C
be visible under the articulating surface. This is normal.
1 B/123456 C/123456
Insert the tibial provisional construct into the tibial canal, 2 B/123456 C/123456
and then insert the appropriate size articular surface RH Knee 3 B/123456 C/123456
provisional. Place the knee through a full range of motion Tibial
Size 4 B/123456 C/123456
to evaluate soft tissue tension and knee stability. A thicker
articular surface provisional should be used if necessary to 5 B/123456 C/123456
correctly balance the knee. 6 B/123456 C/123456

Note: The Segmental Distal Femoral Component and the RH Table. 5

Knee Tibial Components are linked, forcing the tibia to be in Interchangeability Chart: Segmental Knee System (using an RH Knee
alignment directly under the femur (on the mechanical axis) Tibial Component)
by virtue of the one-piece hinge post that links the femoral
and tibial components.

Instruments

Segmental Distal NexGen RH Knee Straight Stem Offset Stem RH Knee Articular Segmental Hinge Segmental Stem Segmental Stem
Femoral Provisional Tibial Provisional Extension Provisional Extension Provisional Surface Provisional Post Provisional Provisional Bowed Provisional Straight
(See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler)
00-5851-01X-0X 00-5987-020-11 00-5851-01X-12 00-5853-054-XX 00-5853-05X-XX
00-5881-XXX-XX 00-5989-010-10 00-5881-0XX-XX

Collar Provisional
(See ZSS Profiler)
00-5853-056-XX

10
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Distal Femur Replacement Using the Segmental Distal Femoral Component

1

Trial Reduction
When assessing hyperextension during trial reduction,
use only the Segmental One-piece Hinge Post Provisionals,
which have gold color on their superior ends, with the
Segmental Distal Femoral Provisional. This is important
because these hinge post provisionals incorporate the
thickness of the Segmental Polyethylene Insert into the
design. Using a one-piece hinge post provisional, without
the gold color on its end, will not provide an accurate
assessment of hyperextension during trial reduction.
Insert the Segmental One-piece Hinge Post Provisional into
the articular surface provisional and tibial provisional before
attaching it to the femoral provisional.
The hinge post provisional must match the femoral
provisional size. Use the Segmental Hinge Pin Aligner to
align the hole in the hinge post provisional with those on
each side of the femoral provisional. Then, while maintaining
the position, remove the aligner, and insert the Segmental
Distal Femoral Bolt Provisional using the 4.5mm Hex Driver
to secure the bolt into the femoral provisional.

Instruments

Segmental Distal NexGen RH Knee Straight Stem Offset Stem RH Knee Articular Segmental Hinge Segmental Stem Segmental Stem
Femoral Provisional Tibial Provisional Extension Provisional Extension Provisional Surface Provisional Post Provisional Provisional Bowed Provisional Straight
(See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler)
00-5851-01X-0X 00-5881-XXX-XX 00-5989-010-10 00-5987-020-11 00-5881-0XX-XX 00-5851-01X-12 00-5853-054-XX 00-5853-05X-XX

Collar Provisional Segmental Hinge Segmental Distal Screw Driver

(See ZSS Profiler) Pin Aligner Femoral Bolt (4.5mm)
00-5853-056-XX 00-5851-084-00 Provisional 00-5881-026-00
00-5851-012-07
11
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1 Distal Femur Replacement Using the Segmental Distal Femoral Component

The femoral provisional rotation should be evaluated and

adjusted, if necessary. Leg holders should not be used
during the assembly process.

Insert the appropriate patellar provisional if patellar

resurfacing is being performed. Conduct a complete
evaluation of range of motion. Evaluate the patellar tracking,
and palpate the posterior soft tissues to ensure that there
is not excessive tension. To avoid causing damage to nerve
and vascular structures, do not pull too hard on the leg.
Assess the rotation of the limb and, if necessary, adjust the
Provisional Slaphammer Implant Slaphammer
rotation of the components. Then perform any necessary soft Adapter (two grooves) Adapter (one groove)
tissue releases.
Fig. 15
Provisional Disassembly
Remove the patellar provisional, if used, Segmental
Distal Femoral Bolt Provisional, Segmental One-piece
Hinge Post Provisional, and articular surface provisional.
Manually attempt to remove the femoral provisional,
segment provisional, if used, and the stem provisional.
If these components cannot be removed manually,
use the Segmental Taper Separator to loosen the taper
between the stem and the femoral provisional or segment
provisional, if used. Thread the Provisional Slaphammer
Adaptor (Fig. 15) onto the slaphammer and thread it into
the stem provisional. Impact the slaphammer to remove
the stem provisional. Then remove the tibial base plate
provisional and associated extension provisional, if used.

Instruments

Segmental Distal Segment NexGen RH Knee Straight Stem Offset Stem Segmental Hinge Segmental Distal Screw Driver
Femoral Provisional Provisional Tibial Provisional Extension Provisional Extension Provisional Post Provisional Femoral Bolt (4.5mm)
(See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) (See ZSS Profiler) Provisional 00-5881-026-00
00-5987-020-11 00-5851-01X-12
00-5851-01X-0X KT-5853-004-00 00-5881-XXX-XX 00-5989-010-10 00-5851-012-07

Segmental Taper Provisional Slaphammer

Separator Slaphammer 00-6551-006-00
00-5851-020-00 Adapter
00-5851-097-12
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1

Step Five: Assemble Implants Segmental Femoral Size

Notes: B C
Remove any debris from tapers prior to assembly of tapered 1 B/123456 C/123456
components. 2 B/123456 C/123456
If implanting the Variable Stiffness Stem/Collar/Segment/ RH Knee 3 B/123456 C/123456
Distal Femoral assembly separately, DO NOT impact the Tibial
Size 4 B/123456 C/123456
segment or stem to the distal femur at this time. Please
5 B/123456 C/123456
proceed to the next section Stem Extension Assembly.
6 B/123456 C/123456
Distal Femoral Assembly
Before assembling the final components, verify the accuracy Table. 6
of the implants selected and the compatibility of all Interchangeability Chart: Segmental Knee System (using an RH Knee
component sizes (Intro 2 Compatibility Chart & Table 6). Tibial Component)
Assemble the femoral and tibial components as described
in the provisional assembly step before mixing the cement.
If segments will be used, rest the distal condyles of the Anteversion Tabs
femoral component on the Segmental Condyle Impactor
(Fig. 16). Align the anteversion tabs, and then use the
Segmental Implant/Provisional Male or Female Impactor,
the Universal Impactor Handle, and a mallet to solidly
impact the segment into the femoral component.

Note: Avoid notching, scratching, or directly striking the

Femoral Condyle Impactor
implants during assembly Fig. 16

With the femoral component resting on the Segmental

Condyle Impactor on the back table, ensure that all
anteversion tabs are properly aligned. For a Fluted stem, Collar Alignment Tab
protect the end of the stem with gauze during impaction.
Then use a mallet to solidly impact the stem into the
femoral component or segment.

When impacting the Variable Stiffness Stem into the distal
femoral component or segment, the Variable Stiffness Stem
Impaction Sleeve must be used to avoid damaging the
prongs on the Variable Stiffness Stem tip.
Slide the Variable Stiffness Stem Impaction Sleeve over
the stem until the notches on the sleeve capture the collar
alignment tabs on the stem base. Use a two-pound mallet
to solidly strike the impaction head of the sleeve. This will Pocket on
Trabecular Metal Collar
impact the stem into the femoral component or segment. Fig. 17
Use cementing technique described for Fluted stems
(Fig. 17) to cement the collar to the Variable Stiffness Stem.

Instruments

Segmental Implant/ Segmental Implant/ Segmental Condyle Universal Handle Mallet Variable Stiffness
Provisional Male Provisional Female Impactor 6216-01-125 00-0155-002-00 Stem Impaction
Taper Impactor Taper Impactor 00-5851-074-00 Sleeve
(Stem Impactor) (Segment Impactor) 00-5853-074-05
00-5851-080-00 00-5851-074-02 13
SECTION

1 Distal Femur Replacement Using the Segmental Distal Femoral Component

A/P

Notes:
Impacting the taper more than once may loosen the
taper connection.
Do not strike the tip of the Variable Stiffness Stem with
any instrument, as this may damage the distal tines.
Position the segment anteversion tabs in either the A/P or
M/L direction to facilitate access for the Segmental Taper
Separator (Fig. 18).

Stem Extension Assembly

M/L
All Segmental Stems must be used with collars, and all
collars must be cemented to the stems. Refer to Table 7
for an overview of stem and collar combinations. Be sure
to verify compatibility of the collar with the stem size being
used on the product label before the implant packages
are opened. Fig. 18

Stem Smooth Collar Trabecular Metal Collar

Diameter (Item #) (Dimension A) (Item #) (Dimension A)

TECHNIQUE TIP 1.D

Consider using two mixes of bone cement. The first can be used to
25mm for 9-16mm Stems
cement the collar to the stem. Once the cement has set, the stem/ (00-5852-040-25)
collar assembly can be inserted as a unit. The second mix can be
used to cement the stem/collar assembly (if using a Fluted Stem),
tibial component, and patellar component. 30mm for 9-16mm Stems
9-16mm
(00-5852-042-09)
30mm for 9-16mm Stems
(00-5852-040-30)

TECHNIQUE TIP 1.E 35mm for 9-16mm Stems

(00-5852-040-35)
If using a Fluted (cemented) stem, before cementing the collar,
insert the stem implant into the intramedullary canal to confirm that
the stem will fully seat. Clean off the stem prior to cementing the collar.

30mm for 17-19mm Stems

30mm for 17-19mm Stems (00-5852-041-30)
17-19mm
(00-5851-042-17)

35mm for 17-19mm Stems

20mm Dimension A (00-5852-041-35)

30mm
Table. 7
Stem Collar Compatibility Chart

14
 SECTION

Distal Femur Replacement Using the Segmental Distal Femoral Component

1


For a Fluted stem, apply cement in the doughy state to the
base/taper end of the stem. Then slide the stem collar over Collar Alignment Tab
the stem and advance it to the shank area where cement was
applied. Clean off excess cement as the collar is advanced.
Care should be taken to prevent cement from contacting
the taper, the anteversion adjustment pockets, and the
external surfaces of Trabecular Metal Material. Collars must
be assembled to the stem with the pockets toward the
anatomical joint and engaged into the tabs on the stem
(Fig. 19). Allow the cement to fully harden before inserting
into the Distal Femoral Component.

Proximal Tibial Assembly

Pocket on
To assemble the NexGen RH Knee Tibial Component,
Trabecular Metal Collar
refer to the Zimmer NexGen RH Knee Primary/Revision Fig. 19
Surgical Technique (97-5880-002-00, revision 4 or later).
If the Segmental Proximal Tibial Component will be used,
refer to the Zimmer Segmental System Trabecular Metal
Proximal Tibial Component Surgical Technique
(97-5850-006-00).

15
SECTION

1 Distal Femur Replacement Using the Segmental Distal Femoral Component

Step Six: Insert Implants

Implanting the Fluted Stem/Collar/Segment/Distal Femoral
as a Single Unit
Before final implantation, verify that properly sized
components (Segmental Polyethylene Insert, Segmental
Hinge Pin, Segmental One-piece Hinge Post, Segmental
Articular Surface, Segmental Stem, and Segmental
Segments) have been used in the assemblies, as
determined when using provisionals.

After cementing the collar onto the stem, and if desired,
use a plastic cement restrictor to permit the cement to Bigliani/Flatow
be manually pressurized. A Bigliani/Flatow Pressurizer Pressurizer Sponge
Sponge (item # 00-4301-035-01) may be used to prevent
cement from extruding out of the femoral canal and onto
the face of the Trabecular Metal Collar that contacts that
planed surface of the femoral cortex (Fig. 20). If using this
technique, after the cement that attaches the collar to
the stem has cured, slide the sponge onto the stem until
it contacts the base of the Trabecular Metal Collar. Inject
cement into the intramedullary canal. Apply cement to the
shank of the stem to ensure adequate cement coverage at
the implant/bone interface. Attach the Universal Impactor
Handle to the Segmental Condyle Impactor. Use this
impactor and a mallet to tap the implant until fully seated, Fig. 20
cleaning off excess cement as the femoral implant assembly
is inserted and being careful to keep cement off of the
external surfaces of the smooth or Trabecular Metal Collars,
the entire surface of the tapers, and the crevices of the
anteversion adjustment pockets. If using the Bigliani/Flatow
Pressurizer Sponge, remove the sponge just prior to the
collar sitting flush with the prepared cortex and prior to the
cement curing. Fully seat the stem, taking care not to leave
any foam material in the wound or on the Trabecular Metal
Materials surface. Do not implant the pressurizer sponge.

Note: Cement must be added to the base of the Smooth Collar

where it contacts the bone.

Instruments

Bigliani/Flatow Universal Handle Segmental Condyle Mallet

Pressurizer Sponge 6216-01-125 Impactor 00-0155-002-00
00-4301-035-01 00-5851-074-00

16
 SECTION

Distal Femur Replacement Using the Segmental Distal Femoral Component

1

Other Components
To implant the tibial component, refer to the NexGen
RH Knee Primary/Revision Surgical Technique Flat on box faces
anteriorly
(97-5880-002-00, revision 4 or later). To implant the
patellar component, refer to Step Three: Prepare the
Patella. The articular surface provisional may be inserted
and the knee placed in extension while the cement is Groove faces
setting to maintain compression on the components. anteriorly

Segmental Polyethylene Insert / Hinge Post Orientation

The size of the Segmental Polyethylene Insert must match
the femoral size selected. Attach the Segmental Polyethylene
Insert to the Segmental One-piece Hinge Post by spreading
the sides of the polyethylene insert out slightly and pressing
it over the hinge post until it snaps into place. The holes
in the polyethylene insert must match the bosses on the Proper Orientation
hinge pin bushing to assure proper orientation (Fig. 21). If
attached backwards, the Segmental Polyethylene Insert and Fig. 21
Segmental One-piece Hinge Post will not fit easily within the
Segmental Distal Femoral Component without interference.
Once the cement has set, remove the articular surface
provisional, if used. Insert the final Segmental Articular
Surface. The Segmental Articular Surface is packaged with
a mating hinge post that ensures a 40mm jump height.
Do not use a hinge post from another articular surface size.

Warning: Do not use Segmental System components (such as

the Segmental One-piece Hinge Post) with NexGen RH Knee
articular surfaces. They were not designed to be compatible.

Attach the hinge post assembly (with Segmental Polyethylene

Insert snapped on) to the Segmental Distal Femoral
Component. Follow the steps below to lock the hinge post to
the femoral component.
Then insert the hinge post into the tibial component.
Insert the hinge post assembly (with Segmental Polyethylene
Insert snapped on) into the tibial component before attaching
it to the femoral component. Then follow the steps below to
lock the hinge post to the femoral component.

Instruments

RH Knee Articular
Surface Provisional
(See ZSS Profiler)
00-5881-0XX-XX
17
SECTION

1 Distal Femur Replacement Using the Segmental Distal Femoral Component

Implanting the Variable Stiffness Stem/Collar/Segment/

Distal Femoral as Single Unit
After cementing the collar onto the stem (see previous
section Stem Extension Assembly for details), insert the
construct into the femoral canal and use the Segmental
Condyle Impactor (Fig. 22) with the Universal Impactor
Handle attached and a mallet to tap the implant until
fully seated.

Note: Cement must be added to the base of the Smooth Collar

where it contacts bone.

As the stem advances into the canal, use the vertical mark
on the bone to assess the rotational alignment. If the stem Femoral Condyle Impactor
fits too tightly in the bone, consider removing the stem and
passing the last reamer used through the canal several more
times. This can help to increase the hole diameter slightly, Fig. 22
which will permit the stem to be more easily impacted into
the bone.

Implanting the Variable Stiffness Stem/ Collar Assembly and

the Segment/Distal Femur Assembly Separately
After cementing the collar onto the stem, insert the stem/
collar assembly into the femoral canal and use the Segmental
Implant/Provisional Male Taper Impactor (assembled to the
Universal Impactor Handle) and a mallet to tap the stem
implant until fully seated.

Note: Cement must be added to the base of the Smooth Collar

where it contacts bone.

As the stem advances into the canal, use the vertical mark
on the bone to assess the rotational alignment. If the stem
fits too tightly in the bone, consider removing the stem and
passing the last reamer used through the canal several more
times. This can help to increase the hole diameter slightly,
which will permit the stem to be more easily impacted into
the bone.

Note: Remove any debris from tapers prior to assembly of

tapered components.

Instruments

Segmental Implant/ Segmental Condyle Universal Handle Mallet

Provisional Male Impactor 6216-01-125 00-0155-002-00
Taper Impactor 00-5851-074-00
(Stem Impactor)
18 00-5851-080-00
 SECTION

Distal Femur Replacement Using the Segmental Distal Femoral Component

1
Segmental Set Screw
If using a segment, assemble it to the Distal Femur using the
Segmental Condyle Impactor. Impact the assembly together
with the Segmental Implant/Provisional Female Taper
Impactor assembled to the Universal Impactor Handle.
Use a mallet to firmly tap the tapers to the seated position.

Place the Distal femoral assembly onto the stem taper, Segmental Hinge Pin
and use the Segmental Condyle Impactor (with Universal
Handle) and a mallet to tap the two assemblies together Segmental
until fully seated. Distal Femoral
Component
Locking the Hinge Post to the Femoral Component
Use the Segmental Hinge Pin Aligner to align the hole
in the hinge post with the holes of the femoral implant. Fig. 23
Then remove the aligner. Use the 4.5mm Hex Driver to
insert and thread the Segmental Hinge Pin through the
hole of the femoral implant (Fig. 23). Make sure that the
pin crosses through the hole in the hinge post bushing.
The hinge pin may be inserted either medially or laterally
into the femoral component. Use the RH Knee Torque
Wrench with the blue handle and 4.5mm Hex Driver to
tighten the hinge pin to 130in-lbs. While torquing, watch
the stylus on the wrench until it reaches the 130 line,
then stop within the patient (Fig. 24). Insert the Segmental
Hinge Pin Set Screw on the same side as the hinge pin
(Fig. 23) and use the RH Knee Torque Wrench with the blue
handle and 4.5mm Hex Driver to torque the set screw to
130in-lbs. While torquing, watch the stylus on the wrench
until it reaches the 130 line, then stop within the patient
(Fig. 24).

Caution: Do not torque the hinge-pin or set screw beyond

130in-lbs or damage to the hex-drive or driver will occur.
Note: Stretching the knee to insert the hinge post shank
into the tibia (back-table hinge post assembly) is not
recommended. In vivo assembly of the hinge pin to the hinge
post is required with the Segmental Distal Femorals.

Fig. 24

Instruments

Segmental Hinge Screw Driver Torque Wrench Segmental Implant/ Universal Handle
Pin Aligner (4.5mm) 00-5881-027-00 Provisional Female 6216-01-125
00-5851-084-00 00-5881-026-00 Taper Impactor
(Segment Impactor)
00-5851-074-02 19
SECTION

2 Using the Segmental One-piece Hinge Post with the NexGen RH Knee

Disassembly
If disassembly is necessary during surgery, the Segmental
Taper Separator is designed to enable separation of the
junctions between segments, stems, and femoral implants
without damaging the tapers. Refer to Using the Segmental
Taper Separator under Femoral Version Adjustment in Step
Four for instructions related to the Segmental Taper Separator.
For stem removal, thread the Implant Slaphammer Adaptor
(Fig. 25) onto the slaphammer and thread it into the stem.
Impact the slaphammer to remove the stem.

Fig. 25

RH Knee Tibial
Polyethylene
Bushing

Segmental
Hinge Pin

Closure
Before closing, thoroughly cleanse the surgical site of bone
chips, bone cement, and any other debris. Foreign particles
at the articular interface may cause excessive wear.
Segmental
Segmental Hinge Servicing Kit: A Segmental Hinge
 Polyethylene
Insert Segmental
Servicing Kit (Fig. 26) is available if a component is Set Screw
dropped or damaged during surgery. This kit is also used
during revisions of the Segmental hinge. In addition,
the Segmental Polyethylene Insert is also available as a Fig. 26
separate package from the kit.

Instruments

Segmental Taper Slaphammer Implant

Separator 00-6551-006-00 Slaphammer
00-5851-020-00 Adapter
00-5851-097-11
20
 SECTION

Using the Segmental One-piece Hinge Post with the NexGen RH Knee
2

Using the Segmental One-piece Hinge Post

with the NexGen RH Knee
Refer to the NexGen Rotating Hinge Knee Surgical Technique
(97-5880-002-00, revision 4 or later) (Fig. 27).

Fig. 27

21
SECTION

3 Total Femoral Replacement

Total Femoral Replacement Proximal Distal Male-Male Male-Female Total

Femur Femoral*** Segments Segments Length*
For total femoral replacement, the Zimmer Segmental 80mm - 222mm
System is compatible with the Zimmer NexGen RH Knee.
(See compatibility chart on Intro 2.) 90mm - 232mm
80mm 30mm 254mm
Implant Configuration
80mm 35mm 259mm
In the event that a total femur is required, the procedures for
90mm 30mm 264mm
a proximal femur replacement and distal femur replacement
are essentially combined. The suggested procedures are 90mm 35mm 269mm
performed after a routine approach has been performed for 90mm 40mm 274mm
opening and exposing the acetabulum, femur, and proximal
90mm 45mm 279mm
tibia. It is critical that leg length be checked and noted
before any bone resection. Care should be taken during the 80mm 60mm 284mm
reconstruction to avoid stretch injury to the neurovascular 90mm 55mm 289mm
structures.
80mm 30 + 35mm 291mm
Note: if needed please reference again the Segmental 90mm 60mm 294mm
System scope compatibility chart on Intro 2 for system
90mm 30 + 35mm 301mm
cross-compatibilities.
80mm 80mm 304mm
Determine the implant configuration based on the estimated 90mm 30 + 40mm 306mm
length of the femur (Table 8).
80mm 40 + 45mm 311mm
58mm**
80mm 90mm 80mm 314mm
Size B
90mm 40 + 45mm 321mm
80mm 100mm 324mm
80mm 60 + 45mm 331mm
90mm 100mm 334mm
90mm 60 + 45mm 341mm
200mm - 342mm
80mm 120mm 344mm
90mm 80 + 35mm 351mm
90mm 120mm 354mm
90mm 80 + 45mm 361mm
80mm 100 + 40mm 366mm
80mm 100 + 45mm 371mm
200mm 30mm 374mm
90mm 100 + 60mm 376mm
200mm 35mm 379mm
200mm 40mm 384mm
continued on next page
Table. 8
Total femur with segments table
* Note: Each large taper connection adds 2mm to the total length.
** Size C Segmental Distal Femoral is 60mm tall. Resect an additional 2mm
beyond the total length of resection listed in the table above for the Size C.

22
 SECTION

Total Femoral Replacement

3
continued from previous page

Proximal Distal Male-Male Male-Female Total

Femur Femoral Segments Segments Length*
200mm 45mm 389mm
90mm 100 + 60mm 396mm
80mm 140 + 35mm 401mm
200mm 60mm 404mm
80mm 140 + 45mm 411mm
90mm 180mm 414mm
90mm 140 + 45mm 421mm
200mm 80mm 424mm
200mm 40 + 45mm 431mm
90mm 200mm 434mm
90mm 160 + 45mm 441mm
200mm 100mm 446mm
200mm 60 + 45mm 451mm

58mm ** 90mm 220mm 454mm

80mm
Size B 90mm 180 + 45mm 461mm
200mm 120mm 464mm
200mm 80 + 45mm 471mm
90mm 200 + 40mm 476mm
90mm 200 + 45mm 481mm
200mm 140mm 484mm
200mm 100 + 45mm 491mm
90mm 200 + 60mm 496mm
90mm 220 + 45mm 501mm
200mm 160mm 504mm
200mm 120 + 45mm 511mm
90mm 220 + 60mm 516mm
200mm 140 + 35mm 521mm
200mm 180mm 524mm

Table. 8
Total femur with segments table
* Note: Each large taper connection adds 2mm to the total length.
** Size C Segmental Distal Femoral is 60mm tall. Resect an additional 2mm
beyond the total length of resection listed in the table above for the Size C.

23
SECTION

3 Total Femoral Replacement

Proximal Femoral Options

The Zimmer Segmental System offers three solutions for
proximal femoral replacement (Fig. 28) with various tissue
attachment options (Fig. 29a, 29b & 29c), including Tissue
Attachment Washers for the Trabecular Metal Material
components.

The standard Proximal Femoral component has suture holes Fig. 28
on both the medial and lateral aspects of the prosthesis.

The Trabecular Metal Proximal Femoral component offers
solutions for attaching both trochanteric bone and/or soft
tissue to the prosthesis. Multiple Tissue Attachment Washer
options are available depending on the type and thickness
of remaining tissue. Soft tissue may also be attached to the
prosthesis via suture holes on both medial and lateral sides.

The Zimmer Segmental System Proximal Femoral
components are compatible with all Zimmer Segmental
System segments. The Segmental Proximal Femoral
components can be anteverted in 20-degree increments
to enhance proximal joint stability using the anteversion
alignment features between the either the Proximal Femoral Fig. 29a
component or the Distal Femoral component and the
Segmental Femoral/Tibial Segments (Refer to the Zimmer
Segmental Proximal Femoral Components and Intercalary
Segments Surgical Technique 97-5850-007-00 for
instructions and compatibility).

Distal Femoral Replacement

To replace the distal femur, begin with Step 4: Assembly
Provisional Components and Perform Trial Reduction on
page 6 of this surgical technique.

Fig. 29b

Fig. 29c

24
 SECTION

Total Femoral Replacement

3

Proximal Tibial Replacement

The Zimmer Segmental System includes a Trabecular Metal
Tibial Component that enables tissue attachment to the
implant via sutures and/or arms included in the optional
Tissue Attachment Kit (Fig. 30). Please refer to the Zimmer
Segmental System Proximal Tibial Surgical Technique
(97-5850-006-00).

Fig. 30

The Trabecular Metal Tibial Component may be implanted

with the NexGen Rotating Hinge Knee Distal Femoral
Component or the Segmental Distal Femoral Component
(Fig. 31). A total femoral replacement can also be performed
using the NexGen RH Knee Proximal Tibial components
(Fig. 31).

Option 1 Option 2* Option 3*

Fig. 31
Proximal Tibial Replacement Options:
Option 1: Segmental Trabecular Metal Proximal Tibial Component
Option 2: NexGen RH Knee Non-Modular Proximal Tibial Component*
Option 3: NexGen RH Knee Modular Proximal Tibial Component*
* Refer to NexGen RH Knee Surgical Technique (97-5880-002-00
revision 4 or later)
Note: Segmental Distal Femoral not pictured.

25
SECTION

A Appendix A: NexGen RH Knee & Segmental Articular Surface/Hinge Kit Compatibilities

Appendix A: NexGen RH Knee & Segmental Articular Surface/Hinge Kit Compatibilities

Item Description Picture/Item Number Use On/With Do Not Use With/Why
Segmental Articular Surface  egmental Distal Femoral
S Segmental One-piece Hinge
Segmental One-piece (00-5850-012_013-01/02) Post with NexGen RH Knee
Hinge Post Segmental Trabecular Metal Proximal Articular Surface Piece
Segmental Articular Tibial M ating components are
Surface Piece (00-5850-001_003-10) not compatible
NexGen RH Knee Distal Femoral RH Knee Modular Hinge
(00-5880-012_016-01/02) Post Extension + Segmental
NexGen RH Knee Tibial Plate Articular Surface + Segmental
1 Trabecular Metal Proximal
(00-5880-001_006-00/02)
Tibial
Segmental Articular Surface can be used
with the NexGen RH Knee Hinge Post O
 nly Segmental One-piece
Extension (from Item 2 below) EXCEPT Hinge Post is indicated
with the Trabecular Metal Proximal with the Segmental
Tibial (see page 27 for the Servicing Kit Trabecular Metal Proximal
Compatibility Chart ) Tibial
00-5850-020_060-12_26
NexGen RH Knee Articular Surfaces NexGen RH Knee Distal Femoral Segmental Distal Femoral
NexGen RH Knee Hinge NexGen RH Knee Tibial Plate Segmental Trabecular Metal
Post Extension Proximal Tibial
NexGen RH Knee Articular Segmental One-piece Hinge
2 Surface Piece Post
M ating components are
not compatible
00-5880-020_060-12_26
NexGen RH Knee Cement Shield  exGen RH Knee Distal Femoral with
N NexGen RH Knee Distal
Hinge Service Kit Segmental Articular Surface & Segmental Femoral with NexGen RH Knee
Poly Insert with Shield One-Piece Hinge Post (Item 1 above) Hinge Post Extension
Shoulder Bolt Hinge Pin M
 ating components are
3 not compatible
Hinge Pin Plug
Tibial Bushing

00-5850-075-12_16
Segmental Hinge Service Kit Segmental Distal Femoral NexGen RH Knee Distal
Segmental Poly Insert Femoral
 egmental Articular Surface with
S
Segmental Hinge Pin Segmental One-piece Hinge Post (Item 1 M
 ating components are
above) not compatible
4 Segmental Hinge Pin
Set Screw
Tibial Bushing

00-5850-070-12_13
NexGen RH Knee Hinge NexGen RH Knee Distal Femoral Segmental Distal Femoral
Service Kit
 exGen RH Knee Articular Surface and RH
N NexGen RH Knee Distal
Poly Box Insert Knee Hinge Post Extension (Item 2 above) Femoral with Segmental One-
Hinge Post piece Hinge Post
5 M ating components are
Shoulder Bolt Hinge Pin
not compatible
Hinge Pin Plug
Tibial Bushing
00-5880-090-12_16

26
 SECTION

A Appendix A: NexGen RH Knee & Segmental Articular Surface/Hinge Kit Compatibilities

A

Servicing Kit Compatibility Chart

RH Knee Hinge Servicing Kit Used Compatible Articular Surfaces and Hinge Components
Segmental Articular Surface
(with the Hinge Post)

DISCARD
DISCARD
OR
NexGen RH Knee Articular Segmental Articular Surface NexGen RH Knee Articular
NexGen RH Knee Hinge Surface (with the Hinge with the Segmental Surface (with the Hinge
Base Component System Servicing Kit Post Extension) One-Piece Hinge Post Post Extension)

Segmental Articular Surface

NexGen RH Knee Cement with the Segmental
Base Component System Shield Servicing Kit One-Piece Hinge Post

27
SECTION

B Appendix B: Servicing the Hinge of a Well-Fixed Segmental Distal Femoral

Removing the Hinge Pin and Components

Disconnect the hinge post by untorquing the set screw
and hinge pin, utilizing the 4.5mm Screw Driver (00-5881-
026-00) with the Torque Wrench (00-5881-027-00) or with
the Wrench (00-5881-054-00). Remove the articular surface
from the construct. Remove the tibial bushing from the tibial
plate stem with the Tibial Bushing Remover (Fig. 32) part
number 00-5881-055-00, found in instrument kits KT-5979-
005-00 and 00-5979-005-00. Be careful to avoid scratching
the tibial plate surface.

Fig. 32

Implanting the tibial bushing using the

Segmental Distal Femoral Hinge Servicing Kit
Insert the new tibial bushing from the Segmental Distal
Femoral Hinge Servicing Kit and press into place until the
top of the bushing lip is flush with the tibial plate surface
(Fig. 33). Fig. 33

Instruments

Screw Driver Torque Wrench

(4.5mm) 00-5881-027-00
00-5881-026-00

28
Disclaimer
This documentation is intended exclusively for physicians and is not intended for laypersons.
Information on the products and procedures contained in this document is of a general nature and does not represent
and does not constitute medical advice or recommendations. Because this information does not purport to constitute
any diagnostic or therapeutic statement with regard to any individual medical case, each patient must be examined and
advised individually, and this document does not replace the need for such examination and/or advice in whole or in part.
Please refer to the package inserts for important product information, including, but not limited to, contraindications,
warnings, precautions, and adverse effects.

Contact your Zimmer representative or visit us at www.zimmer.com

97-5850-004-00 Rev. 2 3-17-14 Printed in USA 2014 Zimmer, Inc.