LCS COMPLETE

MILESTONE™ Instruments
with MBT Tray Preparation

SURGICAL TECHNIQUE
CONTENTS

Preface 2

Surgical Concepts 3

Instruments 4

Surgical Technique Summary 6

Surgical Technique 8

Preparation 8

Incision and Exposure 8

Ligament Balancing 9

Tibial Resection 10

Femoral Sizing 14

Femoral Preparation 15

Femoral Rotation Determination & Flexion Balancing 16

A/P Femoral Resection 18

Distal Femoral Resection 19

Femoral Finishing Resection 22

Tibial Plateau Preparation 23

Central Stem Preparation 23

MBT Tray Preparation 25

MBT Keel Tray Preparation 25

Trial Reduction 26

Tibial Bearing Selection 28

Patellar Resection 29

Patellar Trial 30

Non-Cemented Implantation 32

Cemented Implantation 35

Ordering Information 39

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction

 PREFACE

Any new concept that is introduced usually
goes through a series of evolutionary
changes as it is perfected. Each change
hopefully improves the original concept.
The LCS® Total Knee System was first
implanted by the designer in 1977. The
system was subjected to a rigorous FDA
approved multicenter clinical investigation
to prove its safety and efficacy.1 It became
nationally available in the United States in
1985. The instruments that were initially
used reflected a very conservative surgical
approach. The objective was to ensure that
a precise and reproducible surgical
procedure could be performed and that
equal flexion and extension gaps could be
achieved in the process.
Since 1985, total knee arthroplasty (TKA)
instrumentation has evolved significantly. As
technique improvements have been made,
they have been evaluated and
This surgical technique has been
developed to provide the surgeon with a
clear explanation describing the use of the
MILESTONE Instruments. The technique
has gone through an evolutionary process
with input from a number of surgeons and
engineers. Shortcuts and technique tips
have been identified through the 24 years
of usage and many are included in the
following technique.
I am grateful to Louis Jordan, MD, for his
help in defining the patellar portion of the
technique and to Peter A. Keblish, MD, for
his review of the interim manuscript and
for his suggestions.
I am also grateful to Frederick F. Buechel,
MD, and Michael J. Pappas, PhD, who
started it all.
R. Barry Sorrells, MD

modifications made to the initial

Author of the MILESTONE
instrumentation. The first major
Surgical Technique
modification, the API (Advanced
Performance Instrumentation), proved to
be a significant improvement and is
currently in worldwide usage.2

The MILESTONE™ Instruments reflect the

state of the art in total knee arthroplasty.
The transmalleolar axis and palpable bony
landmarks are used to reliably orient the
tibial cut. Preset angles and dimensions are
used where possible. The isthmus of the
femoral canal is referenced to help define
the distal femoral valgus correction angle,
and the femoral finishing cuts are made
through one instrument.

2    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

SURGICAL CONCEPTS

Total knee arthroplasty represents a
major advance in the management of
severe, crippling arthritis. Success of
the procedure is dependent on the
skills of the surgeon and the surgical
team, coupled with the design of the
implant and instrumentation. A
scientifically sound design must be
complemented by easily used
instruments and a technique that
assures accuracy and reproducibility.
The surgical procedure to follow
provides the surgeon with the
necessary information to achieve
accurate and reproducible results
using the LCS Total Knee System with
the MILESTONE Instruments. The
technique incorporates the basic
surgical philosophies of balanced
flexion and extension gaps developed
by Michael Freeman, FRCS, and John
Insall, MD.
In the normal knee, the majority of
rotation occurs laterally with less
motion seen medially; both condyles
pivot about the intercondylar
eminence as the center of rotation.
This surgical technique is based on
the principle that reproducing normal
knee rotation is desirable when the
anterior and/or posterior cruciate
ligaments are sacrificed.
If the posterior cruciate is absent or
substituted, the axis of rotation
remains central and equally shared by
both compartments. The design of
the implant allows for this and
eliminates the need for right and left
tibial components or bearings. In this
technique, the objective is to produce
a knee that has equal soft tissue
tension medially and laterally in both
flexion and extension. This results in
a stable total knee throughout the
range of active and passive motion.
Such stability maintains contact
pressure on the mobile bearings and
protects against subluxations and
dislocations.
Femoral component sizing is chosen
to approximate the original A/P and
M/L anatomy. A tibial-cut-first
approach is used to provide a logical,
time-tested method that first
establishes the flexion gap, and then
an extension gap to match. Since the
sagittal tibial cut is non-variable,
subsequent femoral cuts are
referenced from the resected tibia.
The proximal tibia is cut with a
posterior inclination parallel to the
patient’s anatomic inclination angle.
This provides better flexion, creates
compressive loading of the tibial
components and avoids shearing
effects associated with perpendicular
plane resections.
Primary femoral bone cuts preserve
a maximum of bone stock using the
anterior femoral cortex and the
isthmus of the femoral canal for
surgical reference. Slight external
rotation of the femoral component
results from referencing the resected
proximal tibia. This allows the
femoral resections to parallel the
proximal tibia with the collateral
ligaments tensioned. This also
provides a stable tracking position for
the patella that helps avoid
subluxation.
A measured resection of the patellar
articular surface, usually at the level
of the quadriceps and patellar tendon
insertion, allows sufficient bone stock
and blood supply to implant a 3-peg
fixturing element. This stabilizes a
rotating bearing or all polyethylene
fixed patellar replacement.

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    3

MILESTONE, MBT INSTRUMENTS

Tibial Instruments

Tibial Resection Guide SP2 Tibial Tray Alignment Handle

Ankle Clamp SP2 Universal Handle

Tibial Resection Block

Varus/Valgus Tibial Resection Block

Femoral Instruments

Tibial Stylus
Anterior/Posterior Cutting Block

MBT Tray Trial

Guide Yoke

MBT Keel Punch

Initiator Drill (9 mm)

MBT Keel Punch Extractor

I.M. Rod (9 mm)

MBT Keel Punch Bushing

Femoral Guide Positioner

MBT Central Drill

I.M. Rod (40 cm)

MBT Stem Punch

Distal Cutting Guide

MBT Drill Bushing

Distal Femoral Cutting Block

MBT RP Plateau Trial Post

Femoral Finishing Guide

MBT Tray Impactor

Femoral Extractor

MBT Tray Trial Fixation Pins

Femoral Sizing Template

MBT Punch Bushing

Femoral Impactor

Modular Depth Stop Ring

4    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

Patellar Instruments General Instruments

Caliper Spacer Block

Modular Clamp Femoral Spacer Adapter

Modular Face Plate Tibial Spacer Adapter

Modular Clamp Head Lug/Peg Drill

Patellar Resection Guide

LCS Patellar Reference Arm

3-Peg Patellar Templates, Modular

3-Peg Patellar Templates, Thin

General Instruments

Saw Capture

Alignment Tower and Rod

Slap Hammer

Flatness Gauge

Pin Extractor

Pin Holder

Alignment Rod

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    5

SURGICAL TECHNIQUE SUMMARY

1. Resect proximal tibia and balance 2. Size femur, position A/P block and drill intramedullary guide hole.
soft tissues in extension.

6. Check extension gap. 7. Finish femoral resections.

6    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

 3. Set femoral rotation; 4. Check flexion gap. 5. Resect distal femur.
resect A/P femoral condyles.

4-7
2-3
1-1.5

8. Finish tibia. 9. Measure, resect, orient

and drill the patella.

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    7

PREPARATION, INCISION AND EXPOSURE
Anatomic Axis
Mechanical Axis
Valgus Angle
Alternate skin
incision for
varus exposure
(figure 1)
Skin Incision
Pre-operatively, obtain a standing
A/P x-ray of both the femur and
tibia centered on the knee joint. On
the x-ray, draw a line through the
center of each femoral canal to the
center of the knee joint (anatomic
axis). Draw a line through the
center of each femoral head to the
center of the knee joint (mechanical
axis). The angle between these two
lines is the “valgus angle”
(Figure 1). Measure the valgus angle
of both knees. The normal angle
varies from 3 to 8 degrees and
should be individualized for each
patient in the distal femoral
resection. Draw a transverse tibial
line perpendicular to
8    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
(figure 2) (figure 3)
Neutral or Fixed Varus Knee
the I.M. line at the level of the
anticipated resection. It is
recommended by the author that
the following valgus angles be used
based on the patient’s height:
Height < 5’11” 5 degrees
Height 5’11” – 6’1” 4 degrees
Height > 6’1” 3 degrees
Pre-operatively assess component
sizing and resection depths in both
the A/P and M/L planes using the
x-ray templates.
(figure 4)
Valgus Knee
With the knee slightly flexed, make
a straight midline incision from 3 to
4 in. above the patella, over the
patella, and ending at the tibial
tubercle (Figure 2). With neutral
alignment or with varus deformity,
make a median parapatellar incision
through the retinaculum, capsule
and synovium (Figure 3). The
subvastus approach may be used. If
significant valgus deformity exists, a
lateral parapatellar deep incision as
part of a lateral release may be
preferred (Figure 4).3, 4

(figure 5)
Following a median parapatellar
incision, reflect the patella laterally
to expose the entire tibiofemoral
joint (Figure 5). Should tension
prevent adequate lateral
displacement of the patella, detach
the medial one-fourth to one-third
of the patellar tendon from the
tibial tubercle. To further mobilize
the extensor mechanism, continue
the sharp incision of the medial
portion of the quadriceps tendon
proximally.
Following a lateral parapatellar
incision in the valgus knee, incise
the anterior compartment fascia
longitudinally 1 cm from the tibial
tubercle. Elevate the tibial tubercle
LIGAMENT BALANCING
LCL and PT
elevated with
periosteal attachment
ITB elevated
subperiosteally
(figure 6)
Valgus Knee Releases
with an osteo-periosteal flap if
necessary for patellar reflexion.
Reflect the patella
and periosteal attachments
medially.3, 4 Excise hypertrophic
synovium and a portion of the
infrapatellar fat pad to allow access
to the medial, lateral and
intercondylar spaces. Excise
redundant synovium to prevent
possible impingement or post-
operative overgrowth. Some
surgeons prefer a complete
synovectomy.
For better exposure, a preliminary
patellar resection may be performed
at this stage. (see Patellar Resection
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    9
MCL and
pes anserinus
elevated
subperiosteally
(figure 7)
Varus Knee Releases
on page 29) By reducing patellar
bulk, eversion may not be necessary.
The patellar remnant can simply be
displaced to the side, lessening
tension on its tubercle insertion.
Remove femoral and tibial
osteophytes, especially any deep to
the collateral ligaments. Lateral soft
tissue release and, occasionally,
osteotomy and removal of the
fibular head (severe valgus) will
enable correction of valgus
contracture (Figure 6). Medial
release will be necessary for a fixed
varus deformity (Figure 7). An
extensive medial tibial subperiosteal
sleeve may be necessary in severe
varus angulation.
TIBIAL RESECTION
(figure 8)
After the proximal tibia and distal
femur are cleared of soft tissue
debris, sharply develop the soft
tissue planes between the collateral
ligaments and the joint surfaces.
Expose approximately 1 in. of
proximal tibia anteriorly, medially
and laterally. Slide retractors deep
to the collateral ligaments and
anterior to the posterior capsule to
protect the posterior neurovascular
structures during resection of the
tibial articular surface. An “S” or
“Z” shaped retractor works well
(Figure 5).
11    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
Tibial cutting guide
Tibial cutting block
Ankle clamp
(figure 9) (figure 10)
Make a longitudinal mark from a Flex the knee to 90 degrees,
point 6 - 8 mm medial to the position the tibia in about 10
midpoint between the prominence degrees external rotation and clearly
of the medial and lateral malleoli, mark the center of the tibia with
extending to the second toe reference to the intercondylar notch
(Figure 8). Select the tibial cutting of the femur (Figure 10).
block (7 or 10 degrees) compatible
with the posterior slope of the
patient’s tibia and attach it
proximally to the tibial cutting
guide. Attach the ankle clamp to
the rod distally (Figure 9).
 (figure 11)
(figure 12)
Introduce the long spike of the
alignment guide into the proximal
tibial spines (Figure 11). Attach the
ankle clamp by wrapping the spring
around the ankle. Establish proper
rotational alignment by positioning
the appropriate malleoli wings
parallel to the transmalleolar axis
(Figure 12). Place the alignment rod
proximally over the center mark on
(figure 13)
the tibia, usually slightly medial to
the tibial tubercle. It should be
directly over the longitudinal mark
distally, just lateral to the tibialis
anterior tendon (Figure 13).
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    11
(figure 14)
When the rod is parallel to the
intramedullary axis of the tibia as
viewed laterally, the posterior slope
of the tibia should parallel the
chosen resection block (7 or 10
degrees). The slope may be further
adjusted by loosening the ankle
clamp knob and sliding the rod
anteriorly or posteriorly. When
proper positioning is achieved,
impale the second spike (Figure 14)
and lock the ankle clamp knob.
 (figure 15)
Attach the stylus (0 or 2 mm) to the
tibial cutting block on the side of
the lower tibial compartment
(Figure 15). Lower the cutting block
and stylus by turning the knurled
cylinder to the left until the tip
of the stylus contacts the tibial
plateau. Ensure that a minimum of
10 mm (total) of bone and cartilage
is resected from the unaffected side
of the tibia. Determine that the level
of tibial resection is satisfactory,
then predrill and place two
3 in. long fixation pins in the
marked row of holes. Remove the
11    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
(figure 16)
stylus. (A 6 mm stylus is also
provided. The 6 mm measurement
is used when referencing the
unaffected plateau.)
Disconnect the spring from the
ankle clamp and turn the knurled
cylinder to the left until it drops
free. Using a mallet or slap-hammer,
gently remove the tibial cutting
guide, taking care not to misalign
the cutting block (Figure 16). Slide
the cutting block flush to the tibia
and further impact the two fixation
pins.
12
(figure 17A)
Check alignment by attaching the
alignment tower and rod to the
tibial cutting block. The distal end
of the rod should lie over the
longitudinal ankle mark, in line with
the second toe and just lateral to
the anterior tibialis tendon insertion
(Figure 17A). If alignment is found
to be in variance, the cutting block
can be removed from the pins and
 2 degree varus/valgus cutting block
Standard tibial cutting block
(figure 17B)
(figure 18)
the 2 degree varus/valgus block
applied to the pins for correction
(Figure 17B). Use corresponding
holes. Since the fixation pin holes of
all tibial cutting blocks are parallel
to the cutting surface, this block
will only alter the varus/valgus angle
by 2 degrees and will not affect the
posterior slope.
Apply the saw capture and
(Figure 18) resect the proximal tibia
(Figure 19). With the RP insert, the
PCL is generally sacrificed, but can
be recessed based on surgeon
preference. Remove the block.
Leave the fixation pins in place.
Once the proximal tibial bone has
(figure 19)
been removed, further ligament The electrocautery cord or suction
balancing becomes easier. With pre- tubing can be stretched from the
existing flexion contracture, center of the femoral head
preliminary removal of the tibial (approximately two finger breadths
plateau usually allows full extension medial to the ASIS) to the center
of the knee to facilitate ligament mark on the ankle. The line should
balancing. pass through the center of the knee
joint. This confirms that the
Before proceeding further, assure ligaments are balanced in extension.
that the extremity can be brought
into normal medial-lateral alignment
in extension. Place traction on the
foot or introduce medial and lateral
spreaders to tension the collaterals,
and perform additional soft tissue
balancing until the normal
mechanical axis is obtained.
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    11
FEMORAL SIZING
Articular
Cartilageˇ
Lateral View
(figure 20)
Select a femoral sizing template.
The inside of each template
corresponds to the inside geometry
of the selected size of femoral
component. The outside of the
template corresponds to the outside
surface of the femoral component.
When sizing, it is important to keep
the anterior flange of the femoral
component in the same plane as
the anterior cortex.
11    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
Center Line
(figure 21)
With the knee in flexion, place the
femoral template against the lateral
condyle to visually determine the
best fit. Check to ensure the bony
resection depths look reasonable
(Figure 20). This will define the best
A/P component fit and should be
the primary sizing method.
The M/L width of the femur can be
measured at its maximal width with
the knee flexed and can be used as
a secondary reference for sizing
(Figure 21).
The best fitting femoral component
in the M/L plane will be as follows:
Width of femur at widest point:
Size mm
Small 54
Small+ 59
Medium 62
Standard 65
Standard+ 70
Large 75
Large+ 81
It is advisable to mark the center
line for the femur at this point as it
will subsequently help define the
location of the femoral I.M. hole.
FEMORAL PREPARATIONˇ
(figure 22)
Attach the guide yoke to the
appropriate size A/P femoral
resection guide (Figure 22).
(figure 23) (figure 24)
Slip the yoke beneath the muscle Center the guide between the
anteriorly on the periosteum. epicondyles (Figure 24).
Establish the center of the I.M.
canal by positioning the yoke
centrally on the anterior femoral
shaft (Figure 23).
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    11

(figure 25)
The centering mark that was
previously drawn will be helpful.
In this position, the only contact
between the resection guide and
the distal femoral condyles may be
on the posterior medial condyle.
The position of the femoral guide
hole is generally 3 to 5 mm medial
to the apex of the intercondylar
notch (Figure 25). Place one
temporary pin in any of the femoral
resection guide holes for stability.
11    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
FEMORAL ROTATION DETERMINATION
AND FLEXION BALANCING
(figure 26)
Drill the femoral I.M. guide hole
using a 9 mm diameter initiator drill
(Figure 26). Remove the temporary
pin and yoke. Insert the 7 in. long,
9 mm diameter rod.
(figure 27)
Slide the femoral guide positioner
into the joint space, engaging the
slot of the femoral A/P resection
guide (Figure 27). Slightly flex or
extend the knee until the positioner
lies flat on the previously resected
proximal tibia. If the positioner will
not fit into the joint space, use the
tibial fixation pins to realign the
tibial resection block by selecting a
more proximal row of holes on the
block, lowering the block and
removing additional proximal tibial
bone.

(figure 28)
If the positioner does not fit snugly
into the joint space, add tibial
spacer shims and reassess until
equal medial and lateral collateral
ligament tension is achieved
(Figure 28). Evaluate tibial alignment
once more by sliding the external
alignment rod through the femoral
positioner (Figure 29).
12.5 mm
15.0 mm
17.5 mm
20.0 mm
(figure 29)
Evaluate femoral rotation prior to Pin the femoral A/P resection guide
pinning the resection guide in place. in two places, using the middle
It is customary to implant the holes in the lower set of holes.
femoral component in relative Remove the femoral guide
external rotation. In this system, positioner.
however, specific external rotation is
defined by the femoral guide
positioner, which also establishes
equal compartmental tension. The
goal is to establish a quadrilateral
space with the resected posterior
femoral condylar surfaces parallel to
the resected tibial surfaces when
the collateral ligaments are
tensioned.
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    11
A/P FEMORAL RESECTION

(figure 30) (figure 31)

Attach the saw capture and cut the
anterior and posterior femoral
condyles. The anterior resection is
flush with the anterior cortex of the
femur (Figure 30).
Once the resections are completed,
remove the guide and pins. Insert
the spacer block assembly into the
flexion gap. The assembly mimics
the thickness of the femoral, tibial
and 10 mm bearing components.
Assure equal medial and lateral
compartmental tension. If necessary,
add a tibial shim to the spacer block
to fill the gap.
The fixation pin hole pattern on the
A/P femoral resection guides is the
same distance from the anterior
cutting surface regardless of
component size. Thus, the anterior
femoral resection will remain flush
with the shaft if downsizing is
performed. Therefore, resection
of additional posterior condylar
bone is simplified.
Note: If one compartment is still
too tight in flexion, release
additional soft tissue to achieve
equal compartmental tension.
Note that this will affect
extension alignment. Insert the
external alignment rod through
the spacer block handle to again
check the frontal and lateral
plane alignment on the tibia
(Figure 31). Make note of the
thickness of the spacer block
utilized to fill the flexion gap.
This will subsequently determine
the extension gap.

11    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

DISTAL FEMORAL RESECTION

Calibrated stop

(figure 32)

Intercondylar
notch contact
point

(figure 33)

Select a distal femoral cutting block
that corresponds to the pre-
operatively determined valgus
correction angle (3, 4, 5 or 6
degrees). Attach the cutting block
to the distal femoral cutting guide
with the correct indication, “Right”
or “Left,” facing up. Move the
block until it abuts the calibrated
stop on the alignment guide. The
arrow at the top of the block will
point to the corresponding arrow
on the alignment guide. Lock the
cutting block into place by turning
the wing nut 45 degrees clockwise.
The 5 degree cutting block will
allow a cut of 5 degrees of valgus
that is approximately 3 mm
proximal to the intercondylar notch.
The 3 mm matches the thickness of
the femoral component in that area.
It is recommended by the author
that the following valgus angles be
used based on the patient’s height:
Height < 5’11” 5 degrees
Height 5’11” – 6’1” 4 degrees
Height > 6’1” 3 degrees
The depth of the distal cut can be
fine-tuned by turning the wing nut
45 degrees counterclockwise to the
neutral position, flipping up the
calibrated stop and sliding the block
proximally or distally on the arm of
the alignment guide (Figure 32).
Incremental markers of 2 mm are
provided for this adjustment.
With the cutting block locked into
place, insert the 8 mm femoral I.M.
rod into the distal femoral cutting
guide assembly (Figure 33).

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    11


(figure 34)
The rod is fluted and 1 mm smaller
than the pilot hole to minimize
pressure build-up in the canal and
to allow the isthmus to dictate rod
placement. Slowly advance the
femoral I.M. rod into the distal
femur. Full seating is not necessary
as the rod may reach the isthmus.
The blunt tip will easily pass into the
I.M. canal while minimizing the
chances of perforation (Figure 34).
22    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
Two Finger Breadths
The modular cutting block should
rest flush on the anterior femoral
cut. Secure it in place by predrilling
and inserting two pins through the
marked center row of holes.
Disengage the alignment guide
from the cutting block by turning
the wing nut to the neutral
position. Remove both the I.M. rod
and the alignment guide, leaving
the block in place (Figure 34).
Verify varus/valgus alignment by
using the external alignment tower
(Figure 35). With the femur in
extension and in neutral rotation,
correct alignment is indicated when
(figure 35)
the proximal end of the external
alignment rod is centered over the
head of the femur, or approximately
two finger breadths medial to the
anterior superior iliac spine. If
alignment is found to be other than
desired, the valgus angle can be
altered by two degrees with the use
of a two degree varus/valgus cutting
block.
If more correction is necessary, then
choose another cutting block,
mount it on the I.M. guide and
reposition it on the anterior cut.
 Traction
(figure 36)
(figure 37)
To ensure the correct depth of the
distal-femoral cut, have an assistant
place traction on the ankle with the
knee in extension. Place a spacer
block parallel with the tibial cut and
the anticipated femoral cut
(Figure 36).
To ensure accuracy, the tibial cutting
block may be repositioned on the
retained tibial pins, flush against the
resected tibia. Apply a shim to the
spacer block if it was used in
determining the flexion gap. The
extension gap must equal the
flexion gap. If the spacer block is
(figure 38)
parallel and aligns with the tibial cut
while medial and lateral tissues are
equally tensioned, the distal femoral
cutting block is correctly located.
The cutting block can be positioned
in a different row of holes (2.5 mm
apart) to resect a greater or lesser
amount of distal femur to assure
the spacer block will fit in the
extension gap.
Note: Before proceeding, if
necessary, correct either the
distal-femoral or proximal-tibial
cut to assure equal flexion and
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    22
(figure 39)
extension gaps. The distal
femoral cut will affect the
extension gap; the tibial resection
will affect both flexion and
extension gaps. The extension gap
must equal the flexion gap.
Attach the saw capture and cut the
distal femur (Figure 37). Extend the
knee and insert the spacer block
(with the shim if it was used for the
flexion gap). It should fit snugly in
the gap with equal MCL and LCL
tension (figs 38 and 39). Remove
the spacer block and fixation pins.
FEMORAL FINISHING
RESECTION
(figure 40)
(figure 41)
Flex the knee. Center the finishing
guide between the epicondyles and
impact it until fully seated. The
finishing guide is the exact width of
the corresponding femoral
component size. Use fixation pins to
secure the guide to the femur
(Figure 40). Ensure the anterior and
distal surfaces are flush. Cut the
anterior and posterior chamfers
with the oscillating saw (Figure 41).
Using the 1/4 in. diameter stop drill,
create two 3/4 in. deep holes
through the distal guide holes
(Figure 42).
22    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
(figure 42)
(figure 43)
(figure 44)
Using an osteotome or a narrow After all femoral cuts have been
oscillating saw, make the recessing made, check again for maximal
cut from the proximal end of the bone prosthesis contact using the
finishing guide. Save this bone to femoral template (Figure 44).
fashion a cone to plug the femoral
I.M. hole. Use a power saw or
osteotome to resect the posterior
femoral condyle remnants to assure
adequate flexion clearance
(Figure 43). Remove the finishing
guide.
TIBIAL PLATEAU PREPARATION CENTRAL STEM
PREPARATION

Drill Bushing

(figure 45)

(figure 46) (figure 47) (figure 48)

 onnect the tibial tray alignment

C Note: Excessive malrotation of
handle to the MBT tray trial by
retracting the lever, inserting the
two pins into the anterior portion of
the tray trial and releasing the lever
(Figure 45). With the knee in full
flexion and the tibia subluxed
anteriorly, place the tray trial onto
the resected tibial surface. Select
the tray size that maximizes
proximal tibial coverage without
tibial overhang (Figure 46).
ANY size tray can be used with any
size tibial insert since the insert
cone is the same for all sizes.
the tibial tray, relative to the
femoral component, can result in
insert overhang and potential
impingement on soft tissue.Refer
to the femoral/tibial sizing matrix
on page 28 to assure adequate
rotation with the chosen tibial
and insert components. Mark
rotational alignment of the MBT
tray trial with electrocautery on
the anterior tibial cortex to aid in
permanent tibial tray
implantation (Figure 47).
Note: Tibial tray rotation is
usually centered on the junction
between the medial and central
one-third of the tibial tubercle.
Secure the tray with two fixation
pins inserted through the
recessed holes. Alternatively, the
tray trial may be fixed to the
proximal tibia using the two
posterior spikes on the MBT drill
bushing (Figure 48).
Seat the MBT drill bushing into the
tibial tray trial by lightly tapping the
top of the drill bushing.

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    22

 4-7
2-3
Selected Tray Size
1-1.5
(figure 49)
In cases where the proximal tibial
bone is sclerotic, drill two small
holes posteriorly to facilitate the
placement of the spikes on the drill
bushing onto the tray trial.
Use of MBT Stem Punch For
Non Cemented Application:
Advance the MBT stem punch into
the drill bushing and impact it into
the cancellous bone until the
appropriate tray size marking is
reached (Figure 49). In the case of
sclerotic proximal tibial bone,
introduce the drill into the drill
guide first to begin the hole to
facilitate the stem punch.
22    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
Selected Tray Size
Note: The MBT drill creates a
cavity that is line-to-line with the
punch bushing and final implant.
Cement will interdigitate as the
tray is implanted. If a larger
cement mantle is desired, see
Table A. The porous tray will
create an interference fit of 1.6
mm around the entire central
stem when fully impacted.
(figure 50)
Use of MBT Stem Drill: drill through the MBT drill bushing
Assemble the drill stop onto the and into the cancellous bone until it
MBT drill and position it at the hits the drill stop (Figure 50).
selected tray size. Advance the MBT
Table A: Creating Central Stem Cement Mantle
Tray Size Drill Stop Setting Cement Mantle
1 - 1.5 1 - 1.5 None (line-to-line fit)
2-3 0.5 mm per side / 4 mm distal
2 - 3 2 - 3 None (line-to-line fit)
4-7 0.5 mm per side / 4 mm distal
4-7 4-7 None (line-to-line fit)
Drill “bottoms out” on tray trial 0.5 mm per side / 4 mm distal
Note: If over-reaming is desired, remove the tray trial to avoid impingement of the
reamer on the tray trial. To compact cancellous bone, advance the drill in reverse.
MBT TRAY PREPARATION MBT KEEL TRAY
PREPARATION

Unitized Punch Bushing Keel Punch Bushing

(figure 51) (figure 52) (figure 53)

MBT Tray Preparation: MBT Keeled Tray Preparation

Assemble the universal handle to (optional):
the appropriately sized MBT punch Assemble the universal handle to
bushing (Figure 51). Impact this the appropriately sized MBT keel
assembly into the cancellous bone punch bushing. Impact this
until the shoulder of the bushing is assembly into the cancellous bone
in even contact with the MBT tray until the shoulder of the bushing is
trial. Disconnect the universal in even contact with the MBT tray
handle, leaving the MBT punch trial. Disconnect the universal
bushing in place (Figure 52). handle, leaving the MBT keel punch
bushing in place (Figure 53).

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    22

 TRIAL
REDUCTION

Keel Punch

(figure 54) (figure 55) (figure 56)

Assemble the universal handle to Note: If the bone of the medial or Select the tibial insert trial that
the appropriately sized MBT keel lateral plateau is sclerotic, it is matches the chosen femoral size
punch and insert it into the MBT helpful to initially prepare the and thickness (as determined by
keel punch bushing, being careful keel slot with an oscillating saw spacer blocks) and slide it onto the
to avoid malrotation (Figure 54). or high speed burr. MBT bushing on top of the tray trial
Impact this composite into the (Figure 56).
cancellous bone until the shoulder
of the punch is in even contact with
the MBT keel punch bushing
(Figure 55). Disconnect the universal
handle, leaving the MBT keel punch
in place.

22    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

 (figure 57)
Flex the knee 100 to 120 degrees
and slide the femoral trial into
position using the two peg holes
and anterior surface for guidance
(Figure 57). Avoid the tendency to
place the trial in flexion. Extend the
knee to 60 to 80 degrees of flexion
and seat the femoral trial using the
femoral impactor (Figure 58).
Note the anterior/posterior stability,
medial/lateral stability and overall
alignment in the A/P and M/L plane.
If there is any indication of
instability, substitute a tibial insert
trial with the next greater thickness
and repeat reduction. Select the
insert that gives the greatest
stability in flexion and extension
while still allowing full extension.
The appropriate thickness bearing
has been chosen when it cannot be
removed with the femoral
component in place and in 90
degrees of flexion. The rotating
platform should not allow
malrotation with the knee in flexion
and with the femoral component in
place.
Flex and extend the knee while
evaluating component function and
stability.
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    22
27
(figure 58)
Check for:
• Adequate range of motion
• Equal flexion and extension gaps
• Proper ligamentous tension in
extension and in flexion
• Correct mechanical alignment
of the extremity
• Correct rotation of the tibial
component
• Natural motion without
restrictions
 TIBIAL BEARING SELECTION

Mobile Bearing Tibial (MBT) Tray - Sizing AP/ML (mm)

Size 1 Size 1.5 Size 2 Size 2.5 Size 3 Size 4 Size 5 Size 6 Size 7
39/59 41/62 43/65 44/67 46/70 49/75 53/81 57/87 60/92

Small 35/53 COMPLETE RP

Small+ 39/58
LCS COMPLETE RP Tibial Inserts - Sizing AP/ML (mm)

COMPLETE RP

Medium 41/61 COMPLETE RP

Standard 43/64 COMPLETE RP

Standard+ 46/69 COMPLETE RP

Large 49/74 COMPLETE RP

Large+ 53/80 COMPLETE RP

Tibial insert and tibial tray compatibility.

Rotating platform tibial inserts must match femoral components size-to-size.

Bearing size is critical. The bearing size must match the femoral size to maintain congruency.

22    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

PATELLAR RESECTION

(figure 59)

(figure 60A) (figure 60B)

Free the synovial tissue and There should be equal amounts of LCS 3-Peg Patellar Thickness Chart
retinaculum from the periphery of bone remaining in the medial/lateral Implant Thickness
the patella down to the plane of the and superior/inferior portions of the Size
(mm)
quadriceps tendonand patellar patellar remnant. A remnant of at
All
tendon reflection. Measure the least 13 mm thickness is suggested. Metal-Backed
Polyethylene
patellar thickness. Small 9.5 9.0
Resection of the patella can also be
Resect the patellar articular surface accomplished by using the patellar Small+ 10.2 9.7
parallel to and at the level of the resection guide (figs 60A/B). Medium 10.6 10.2
quadriceps tendon attachment Standard 10.9 10.4
(Figure 59). Resect articular bone Set the reference arm of the
Standard+ 11.6 11.1
thickness approximately equal to resection guide to the appropriate
Large 12.3 11.8
the implant’s overall thickness. size, which will allow for the proper
resection for the patellar implant. Large+ 13.0 12.5

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    22

PATELLAR TRIAL
(figure 61)
Place the thin patellar template that
matches the femoral component’s
size over the trial femoral
component and perpendicular to
the long axis of the extremity with
pegs pointing upward (Figure 61).
Reduce and press the resected
patella onto the template, engaging
the pegs in the resected patellar
surface.
33    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
Flex the knee and assure that the
patellar template remains
perpendicular to the long axis of the
extremity and parallel to the
prosthetic joint line.
(figure 62)
With the knee extended, evert the
patella while pressing the template
to the patellar remnant. The handle
of the template will usually lie
approximately 20-30 degrees
downward from the perpendicular
(Figure 62). Mark the three pegs for
the trial patellar component with
the cautery or a marking pen.
 (figure 63) (figure 64)

Remove the template and press the
trial patellar component onto the
resected patellar surface in the
same location as the patellar
template (Figure 63).
Reduce the patella. While flexing
and extending the knee, evaluate
patellar tracking. The metal portion
of the patella should remain parallel
with the knee joint. Make
adjustments as necessary. Align the
appropriate size thick patellar
template over the mark on the
patellar remnant, representing
proper alignment.
Prepare the three pegs using the
femoral lug drill. Ensure that the
peg holes are sufficiently deep to
avoid any resistance to the three
pegs of the final patellar component
(Figure 64).

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    33

NON-CEMENTED IMPLANTATION

(figure 65) (figure 66) (figure 67)

Remove the trials and implant the
final components in the following
order:
• MBT Tray
• LCS Complete RP Tibial Insert
• LCS Complete Femoral
Component
• LCS Patellar Component
If the keeled MBT tray is selected,
attention is required to ensure the
implant keel aligns with the
prepared bone. When the tray is
fully inserted, impact the top of the
universal handle with several mallet
blows to seat the implant fully
(Figure 66).
Insert Implantation
Carefully clear and remove any
loose fragments or particulate from
the implanted tibial tray. Anteriorize
the proximal tibial for improved
visualization and insert the
appropriate size tibial insert into the
MBT tray (Figure 67).

MBT Tray Implantation

Assemble the universal handle onto
the tray impactor and carefully
insert the MBT tray into the
proximal tibia, avoiding malrotation
(Figure 65).

33    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

 (figure 68) (figure 69)

Femoral Component Fully seat the component with the

Implantation femoral impactor and bring the
Plug the femoral medullary canal knee into full extension to produce
with cancellous bone. Assemble the maximum axial pressure on the
femoral component to the prepared bone-implant interface (Figure 69).
distal femur, taking care that the
lead edges are advanced in equal
measure in alignment with bone
cuts (Figure 68).

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    33


(figure 70)
Patellar Implantation
Insert the fixation pegs of the
patellar component into the drill
holes in the resected patellar
surface (Figure 70).
33    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique
(figure 71)
(figure 72)
Assemble the patellar clamp with
the appropriate size patellar head
(Figure 71). Press the patellar
anchoring plate flat against the
anterior patella surface using the
patellar clamp (Figure 72).
CEMENTED IMPLANTATION
(figure 73)
MBT Tray Implantation
Thoroughly cleanse the entire site
with pulsatile lavage. Prepare
methyl methacrylate cement and
apply it in its low viscous state by
syringe or with digital pressure to
assure maximum penetration into
the trabecular bone.
Assemble the universal handle onto
the tray impactor and carefully
insert the MBT tray into the
proximal tibia avoiding malrotation
(Figure 73). If the keeled MBT tray is
selected, attention is required to
ensure the implant keel aligns with
the prepared bone.
(figure 74)
When the tray is fully inserted,
impact the top of the universal
handle with several mallet blows to
seat the implant fully (Figure 74).
At this point, the surgeon may elect
to assemble the RP trial plateau post
and the tibial insert trial onto the
seated MBT tray and the trial
femoral component onto the
prepared femur (Figure 75). Place
the knee in 20 – 30 degrees of
flexion and apply axial compression
to maintain equal pressure at the
bone-to-tibial implant interface until
the cement has set.
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    33
(figure 75)
(figure 76)
Then place the knee in full flexion,
remove the trials and carefully
excise all extruded cement.
Tibial Insert Implantation
Carefully clear and remove any
loose fragments or particulate from
the permanent tibial tray.
Anteriorize the proximal tibial for
improved visualization and insert
the appropriate size tibial insert into
the MBT tray (Figure 76).
 (figure 77) (figure 78)

Femoral Component
Implantation
Plug the femoral medullary with Fully seat the femoral component
cancellous bone. Apply methyl with the femoral impactor and clear
methacrylate cement to all cut any extruded cement (Figure 78).
surfaces and press it into the Bring the knee into full extension to
cancellous bone at the anterior, produce maximum axial pressure on
anterior chamfer and distal chamfer the bone-cement interface until the
surfaces and onto the femoral cement has polymerized. Then place
component at the posterior chamfer the knee in flexion and excise all
and posterior condylar recesses. remaining extruded cement with an
Care is taken to avoid the articular osteotome.
surface of the implant. As the
component is implanted, ensure
that the lead edges are advanced in
alignment with the bone cuts
(Figure 77).

33    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique


(figure 79)
Patellar Implantation
Apply methyl methacrylate cement
to the prepared patellar surface.
Insert the fixation pegs of the
patellar component into the drill
holes in the resected patellar
surface (Figure 79).
(figure 80)
(figure 81)
Assemble the patellar clamp with
the appropriate size patellar head
(Figure 80). Press the patellar
anchoring plate flat against the
anterior patella surface using the
patellar clamp (Figure 81).
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    33
 (figure 82)

Final Implant Evaluation Closure, Drains, Dressing Post-operative Management

Reduce the patella and evaluate the
implants. Ensure that unrestricted
range of motion, free bearing
movement and proper patellar
tracking are occurring (Figure 82).
Use the surgeon’s preferred Use the surgeon’s preferred
procedure. Closure in moderate procedure.
flexion is recommended.

33    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

ORDERING INFORMATION
DePuy MBT Trays
Cat No. Description
1294-31-110 Cemented, Size
1294-31-115 Cemented, Size
1294-31-120 Cemented, Size
1294-31-125 Cemented, Size
1294-31-130 Cemented, Size
1294-31-140 Cemented, Size
1294-31-150 Cemented, Size
1294-31-160 Cemented, Size
1294-31-170 Cemented, Size
1294-32-110 POROCOAT®, Size 1
1294-32-115 POROCOAT, Size 1.5
1294-32-120 POROCOAT, Size 2
1294-32-125 POROCOAT, Size 2.5
1294-32-130 POROCOAT, Size 3
1294-32-140 POROCOAT, Size 4
1294-32-150 POROCOAT, Size 5
1294-32-160 POROCOAT, Size 6
1294-32-170 POROCOAT, Size 7
DePuy MBT Trays - With Keel
Cat No. Description
1294-33-110 Cemented, Size
1294-33-115 Cemented, Size
1294-33-120 Cemented, Size
1294-33-125 Cemented, Size
1294-33-130 Cemented, Size
1294-33-140 Cemented, Size
1294-33-150 Cemented, Size
1294-33-160 Cemented, Size
1294-33-170 Cemented, Size
1294-34-110 POROCOAT®, Size 1
1294-34-115 POROCOAT, Size 1.5
1294-34-120 POROCOAT, Size 2
1294-34-125 POROCOAT, Size 2.5
1294-34-130 POROCOAT, Size 3
1294-34-140 POROCOAT, Size 4
1294-34-150 POROCOAT, Size 5
1294-34-160 POROCOAT, Size 6
1294-34-170 POROCOAT, Size 7
LCS COMPLETE Femoral Components 3-Peg Metal-Backed Patella
Cat No. Description Cat No. Description
1 1294-01-010 Cemented, Right, Small 1779-81-025 Cemented, Small
1.5 1294-01-020 Cemented, Right, Small+ 1779-82-025 Cemented, Small+
2 1294-01-030 Cemented, Right, Medium 1779-87-025 Cemented, Medium
2.5 1294-01-040 Cemented, Right, Standard 1779-83-025 Cemented, Standard
3 1294-01-050 Cemented, Right, Standard+ 1779-84-025 Cemented, Standard+
4 1294-01-060 Cemented, Right, Large 1779-85-025 Cemented, Large
5 1294-01-070 Cemented, Right, Large+ 1779-86-025 Cemented, Large+
6 1294-02-010 Cemented, Left, Small
1779-71-000 POROCOAT, Small
7 1294-02-020 Cemented, Left, Small+
1779-72-000 POROCOAT, Small+
1294-02-030 Cemented, Left, Medium
1779-77-000 POROCOAT, Medium
1294-02-040 Cemented, Left, Standard
1779-73-000 POROCOAT, Standard
1294-02-050 Cemented, Left, Standard+
1779-74-000 POROCOAT, Standard+
1294-02-060 Cemented, Left, Large
1779-75-000 POROCOAT, Large
1294-02-070 Cemented, Left, Large+
1779-76-000 POROCOAT, Large+
1294-03-010 POROCOAT, Right, Small
1294-03-020 POROCOAT, Right, Small+
3-Peg All-Polyethylene Patella
1294-03-030 POROCOAT, Right, Medium
Cat No. Description
1294-03-040 POROCOAT, Right, Standard
1497-71-025 Cemented, Small
1294-03-050 POROCOAT, Right, Standard+
1497-72-025 Cemented, Small+
1294-03-060 POROCOAT, Right, Large
1497-77-025 Cemented, Medium
1294-03-070 POROCOAT, Right, Large+
1497-73-025 Cemented, Standard
1294-04-010 POROCOAT, Left, Small
1 1497-74-025 Cemented, Standard+
1294-04-020 POROCOAT, Left, Small+
1.5 1497-75-025 Cemented, Large
1294-04-030 POROCOAT, Left, Medium
2 1497-76-025 Cemented, Large+
1294-04-040 POROCOAT, Left, Standard
2.5
1294-04-050 POROCOAT, Left, Standard+
3
1294-04-060 POROCOAT, Left, Large
4
1294-04-070 POROCOAT, Left, Large+
5
6
7
Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    33
 LCS COMPLETE RP Tibial Inserts Tibial Preparation
Cat No. Description Cat No. Description
1294-05-110 Small, 10 mm 2294-31-110 MBT Tray Trial, Size 1
1294-05-112 Small, 12.5 mm 2294-31-115 MBT Tray Trial, Size 1.5
1294-05-115 Small, 15 mm 2294-31-120 MBT Tray Trial, Size 2
1294-05-117 Small, 17.5 mm 2294-31-125 MBT Tray Trial, Size 2.5
1294-05-120 Small, 20 mm 2294-31-130 MBT Tray Trial, Size 3
1294-05-210 Small+, 10 mm 2294-31-140 MBT Tray Trial, Size 4
1294-05-212 Small+, 12.5 mm 2294-31-150 MBT Tray Trial, Size 5
1294-05-215 Small+, 15 mm 2294-31-160 MBT Tray Trial, Size 6
1294-05-217 Small+, 17.5 mm 2294-31-170 MBT Tray Trial, Size 7
1294-05-220 Small+, 20 mm 2178-30-102 MBT Keelpunch, Size 1-3
1294-05-310 Medium, 10 mm 2178-30-103 MBT Keelpunch, Size 4-7
1294-05-312 Medium, 12.5 mm 2178-30-104 Keelpunch Bushing Extractor
1294-05-315 Medium, 15 mm 2178-30-105 MBT Keelpunch Bushing, Size 1-1.5
1294-05-317 Medium, 17.5 mm 2178-30-106 MBT Keelpunch Bushing, Size 2-3
1294-05-320 Medium, 20 mm 2178-30-107 MBT Keelpunch Bushing, Size 4-7
1294-05-410 Standard, 10 mm 2178-30-108 MBT Punch Bushing, Size 1-1.5
1294-05-412 Standard, 12.5 mm 2178-30-109 MBT Punch Bushing, Size 2-3
1294-05-415 Standard, 15 mm 2178-30-110 MBT Punch Bushing, Size 4-7
1294-05-417 Standard, 17.5 mm
1294-05-420 Standard, 20 mm 2178-30-118 MBT Central Drill
2178-30-119 MBT Non-Cemented Stem Punch/Drill
1294-05-510 Standard+, 10 mm
1294-05-512 Standard+, 12.5 mm 2178-30-120 MBT Drill Bushing
1294-05-515 Standard+, 15 mm 2178-30-121 MBT Plateau Trial Post
1294-05-517 Standard+, 17.5 mm
96-5383 MBT Tray Impactor
1294-05-520 Standard+, 20 mm
2178-30-123 MBT Tray Trial Fixation Pins
1294-05-610 Large, 10 mm
96-6330 Tibial Tray Alignment Handle
1294-05-612 Large, 12.5 mm
1294-05-615 Large, 15 mm 96-6520 SPECIALIST® 2 Universal Handle
1294-05-617 Large, 17.5 mm 2178-30-132 MBT Evaluation Bullet, Size 1-3
1294-05-620 Large, 20 mm 2178-30-133 MBT Evaluation Bullet, Size 4-7
1294-05-710 Large+, 10 mm
1294-05-712 Large+, 12.5 mm
1294-05-715 Large+, 15 mm
1294-05-717 Large+, 17.5 mm
1294-05-720 Large+, 20 mm

44    DePuy Synthes Joint Reconstruction  LCS® COMPLETE  Surgical Technique

LCS COMPLETE Trial Femoral Components
Cat No. Description
2294-01-010 Right, Small 2294-05-610 Large, 10 mm
2294-01-020 Right, Small+ 2294-05-612 Large, 12.5 mm
2294-01-030 Right, Medium 2294-05-615 Large, 15.0 mm
2294-01-040 Right, Standard 2294-05-617 Large, 17.5 mm
2294-01-050 Right, Standard+ 2294-05-620 Large, 20.0 mm
2294-01-060 Right, Large 2294-05-710 Large +, 10 mm
2294-01-070 Right, Large+ 2294-05-712 Large +, 12.5 mm
2294-02-010 Left, Small 2294-05-715 Large +, 15.0 mm
2294-02-020 Left, Small+ 2294-05-717 Large +, 17.5 mm
2294-02-030 Left, Medium 2294-05-720 Large +, 20.0 mm
2294-02-040 Left, Standard
2294-02-050 Left, Standard+ 3-Peg Mobile-Bearing Patella Trials
2294-02-060 Left, Large Cat No. Description
2294-02-070 Left, Large+ 2289-04-001 With Pegs, Small
2289-04-002 With Pegs, Small+
LCS COMPLETE RP Insert Trials 2289-04-014 With Pegs, Medium
Cat No. Description 2289-04-003 With Pegs, Standard
2294-05-110 Small, 10 mm 2289-04-004 With Pegs, Standard+
2294-05-112 Small, 12.5 mm 2289-04-005 With Pegs, Large
2294-05-115 Small, 15.0 mm 2289-04-006 With Pegs, Large+
2294-05-117 Small, 17.5 mm 2779-51-050 With Pins, Small
2294-05-120 Small, 20.0 mm 2779-52-050 With Pins, Small+
2294-05-210 Small+, 10 mm 2779-57-050 With Pins, Medium
2294-05-212 Small+, 12.5 mm 2779-53-050 With Pins, Standard
2294-05-215 Small+, 15.0 mm 2779-54-050 With Pins, Standard+
2294-05-217 Small+, 17.5 mm 2779-55-050 With Pins, Large
2294-05-220 Small+, 20.0 mm 2779-56-050 With Pins, Large+

2294-05-310 Medium, 10 mm
3-Peg Polyethylene Patella Trials
2294-05-312 Medium, 12.5 mm
2294-05-315 Medium, 15.0 mm Cat No. Description
2294-05-317 Medium, 17.5 mm 2289-04-007 With Pegs, Small
2294-05-320 Medium, 20.0 mm 2289-04-008 With Pegs, Small+
2289-04-013 With Pegs, Medium
2294-05-410 Standard, 10 mm
2289-04-009 With Pegs, Standard
2294-05-412 Standard, 12.5 mm
2289-04-010 With Pegs, Standard+
2294-05-415 Standard, 15.0 mm
2289-04-011 With Pegs, Large
2294-05-417 Standard, 17.5 mm
2289-04-012 With Pegs, Large+
2294-05-420 Standard, 20.0 mm
2497-61-000 With Pins, Small
2294-05-510 Standard+, 10 mm
2497-62-000 With Pins, Small+
2294-05-512 Standard+, 12.5 mm
2497-67-000 With Pins, Medium
2294-05-515 Standard+, 15.0 mm
2497-63-000 With Pins, Standard
2294-05-517 Standard+, 17.5 mm
2497-64-000 With Pins, Standard+
2294-05-520 Standard+, 20.0 mm
2497-65-000 With Pins, Large
2497-66-000 With Pins, Large+

Surgical Technique  LCS® COMPLETE  DePuy Synthes Joint Reconstruction    44

Important:
This Essential Product Information sheet does not include all of the information
necessary for selection and use of a device. Please see full labeling for all necessary
information.
Indications
Cemented Use:
The LCS® COMPLETE™ – PFC® SIGMA™ RP Mobile Bearing Total Knee System is
indicated for cemented use in cases of osteoarthritis and rheumatoid arthritis. The
RPF and RPS inserts and femoral components are indicated where a higher than
normal degree of post-operative flexion is required. The rotating platform
prosthesis and modular revision components are indicated for revision of failed
knee prostheses.
Uncemented Use:
The porous coated Keeled and Non Keeled MBT (Mobile Bearing Tibial) Tray
configurations of the LCS Total Knee System are indicated for noncemented use in
skeletally mature individuals undergoing primary surgery for reconstructing knees
damaged as a result of noninflammatory degenerative joint disease (NIDJD) or
either of its composite diagnoses of osteoarthritis and post-traumatic arthritis
pathologies. The Rotating Platform device configuration is indicated for use in
knees whose anterior and posterior cruciate ligaments are absent or are in such
condition as to justify their sacrifice. The PFC SIGMA RP Curved bearings when
used with the PFC SIGMA Cruciate Retaining femoral component can be used in
posterior cruciate ligament retaining procedures.
Contraindications for use with and without cement:
The use of the LCS COMPLETE – PFC SIGMA RP Mobile Bearing Total Knee System
is contraindicated in:
• the presence of osteomyelitis, pyrogenic infection or other overt infection of the
knee joint. Every effort should be made to rule out the possibility of pre-
operative sepsis in a patient who has one or more of the following
abnormalities:
• fever or local inflammation;
• rapid destruction or bone resorption apparent on x-rays;
• elevation of the erythrocyte sedimentation rate or white blood cell count
unexplained by other disease or a marked shift in the white blood cell
differential count.
• patients with any active infection at sites such as the genitourinary tract,
pulmonary system, skin or any other site. Should a patient have any infection
prior to implantation, the foci of the infection must be treated prior to, during
and after implantation.
• patients with loss of musculature or neuromuscular compromise leading to loss
of function in the involved limb or in whom the requirements for its use would
affect recommended rehabilitation procedures.
• patients with severe osteoporosis or other metabolic bone diseases of the knee;
• patients with any of the following conditions:
• lesions of the supporting bone structures (e.g. aneurysmal or simple bone
cysts, giant cell tumor or any malignant tumor),
• systemic and metabolic disorders leading to progressive deterioration of solid
bone support,
­References:
1. Davenport, J.M., Friddle, N.S., Hastings, C.K., Peoples, S.J. & Voorhorst, P.E.
(1992). Multi-center clinical results of cemented and cementless mobile-
bearing total knee replacement. DePuy, Inc.
2. Buechel, F.F. & Pappas, M.J. (1989). New Jersey low contact stress knee
replacement system - ten year evaluation of meniscal bearings. Orthopaedic
Clinics of North America, 147-177.
DePuy Orthopaedics, Inc.
700 Orthopaedic Drive
Warsaw, IN 46582
T. +1 (800) 366-8143
www.depuysynthes.com
© DePuy Synthes Joint Reconstruction, a division of DOI 2014
0611-63-050 (Rev. 3) EO 0514
• the presence of severe instability secondary to advanced loss of
osteochondral structure or the absence of collateral ligament integrity, fixed
deformities greater than 60 degrees of flexion, 45 degrees of genu varus or
valgus,
• known drug or alcohol addiction,
• skeletally immature individuals and the presence of allergic reaction to
implant metals or polyethylene are also contraindications for the
noncemented, porous coated, MBT and LCS COMPLETE – PFC SIGMA RP
Mobile Bearing device configurations, and for the cemented use of all device
configurations of the LCS COMPLETE – PFC SIGMA RP Mobile Bearing Total
Knee System.
Contraindications for use without cement:
Noncemented use of the Porous Coated Keeled or Non-Keeled MBT Tray device
configurations is contraindicated in patients with sufficient loss in quantity or
quality of bone stock (as determined on x-ray) such that successful noncemented
fixation is unlikely. Additional contraindications may become apparent at the time
of surgery. These include:
• vascular deficiency at the bone site;
• inadequate bone stock to assure both a firm press fit and close apposition of
the cut bone surfaces to the prosthesis;
• the inability to make bone cuts so as to assure both correct component position
and intimate apposition of bone and prosthetic surfaces;
• inadequate bone quality (e.g. severe osteoporosis) and lack of stability of the
implanted components.
In the presence of any of the above conditions, noncemented implantation of the
Porous Coated Keeled or Non-Keeled MBT Tray device configurations of the LCS
COMPLETE – PFC SIGMA RP Mobile Bearing Total Knee System is contraindicated,
and the components should be fixed with cement.
Warnings and Precautions:
The PFC stem extensions can only be used with MBT revision trays and LCS
COMPLETE Revision and Modular femoral components. LCS COMPLETE – PFC
SIGMA RP Mobile Bearing Total Knee components, instruments and trial
prostheses should not be used together with those of another manufacturer. The
implantation of the PFC SIGMA RPF insert and femoral component will not in
themselves guarantee a high level of post-operative flexion. The degree of post-
operative flexion is multi-factorial. These factors include, but are not limited to,
surgical technique, patient build, pre-operative flexion and age. The surgeon
should discuss all physical and psychological limitations inherent to the use of this
device with the patient pre-operatively.
Adverse Events:
The following are the most frequent adverse events after knee arthroplasty:
change in position of the components, loosening, bending, cracking, fracture,
deformation or wear of one or more of the components, infection, tissue reaction
to implant materials or wear debris; pain, dislocation, subluxation, flexion
contracture, decreased range of motion, lengthening or shortening of leg caused
by improper positioning, looseness or wear of components; fractures of the femur
or tibia.
3. Buechell, F.F. (1990). A sequential three-step lateral release for correcting
fixed valgus knee deformities during total knee arthroplasty. Clinical
Orthopaedics and Related Research, 170-175.
4. Keblish, P.A. (1991). The lateral approach to the valgus knee surgical
technique and analysis of 53 cases with over two-year follow-up evaluation.
Clinical Orthopaedics and Related Research, 52-62.