Implantation and Closure

Tibial Implantation

1. Apply cement on the proximal tibia and seat the tibial implant with the tibial impactor. Remove excess cement.
2. If using the porous tray and screws, orient the tibial screw drill guide over the holes and drill using the tibial screw drill. Determine the appropriate screw size using the screw depth gauge. Insert screws with alternating tightening to avoid liftoff.

Femoral Implantation

1. Flex the knee to 90° keeping the thin bent Hohmann laterally and removing the Aufranc retractor.
2. Apply cement only on the femoral component.
3. Place the femoral implant onto the femur and use the femoral impactor to fully seat the implant.
4. Remove excess cement. Extend the knee to remove cement anteriorly without retracting the proximal soft tissue.
5. Place the tibial insert trial onto the tibial implant and extend the leg to pressurize the cement.

Patellar Implantation

1. Assemble the patellar cement clamp to the patellar reamer guide.
2. Apply bone cement to the patella.
3. Place the patellar implant onto the patella and clamp into the bone. Remove excess cement.

Insert Placement

1. Determine the correct articular insert thickness.
2. Clear any debris from the locking mechanism and slide the insert into the tibial baseplate engaging the locking mechanism. For the P/S insert, begin insertion in flexion and extend the leg to engage the locking mechanism.
3. Attach the articular inserter/extractor to the tibial tray. Lift the inserter superiorly until the anterior lip of the articular insert is fully seated.

Closure

1. Close the arthrotomy by placing three O-Vicryl sutures at the superior border of the patella just distal to the VMO. A stitch is placed to close the VMO fascia. The remainder of the arthrotomy is closed in the standard fashion.
2. Perform routine subcutaneous and skin closure.