Femoral Preparation

Femoral Rotational Alignment
Rotation of the valgus alignment guide is set neutral to the posterior femoral condyles by using the landmarks described above either with or without rotational alignment paddles.

Without Paddles

1. Flex the knee to 70-90°.
2. Align:
1. The posterior aspect of the valgus alignment guide parallel to the posterior condyles.
2. The line laser-etched across the distal surface of the valgus alignment guide parallel to the epicondylar axis. (The line on the valgus alignment guide is drawn such that placing it parallel to the epicondylar axis aligns the guide in neutral rotation.)
3. The femoral alignment template (Figure 5a) with the A-P axis. (The femoral alignment template is designed such that setting it parallel to the A-P axis aligns the valgus alignment guide in neutral rotation.) The femoral alignment template is placed over the valgus angle bushing to guide rotational alignment. Make sure that the template is positioned so that "left" is facing out when operating on a left knee and "right" is facing out when operating on a right knee. The valgus alignment guide is placed in neutral orientation by aligning the outrigger of the template with the A-P line. (Figure 5b)

With Paddles

1. Flex the knee to ›100° with the patella retracted laterally when inserting the valgus alignment guide with the modular paddles.
2. Unlock the capture mechanism on the modular paddles. The arm on the paddles distracts posteriorly and rotates to either side to unlock so the anterior lip can engage the slot in the posterior aspect of the valgus alignment guide.
3. Insert the anterior lip of the paddles into the slot in the valgus alignment guide. Rotating the arm back centrally into the recess will lock the paddles onto the valgus alignment guide. (Figure 6)
4. Position the paddles under the posterior condyles.

Note: Posterior condylar referencing may be less reliable in knees with deficient posterior condyles (e.g. severe valgus deformity). If the posterior condyles are deficient, the AP or epicondylar axis should be used.