Vanguard Complete Knee System Design Rationale

Vanguard
Complete Knee System

Design Rationale
Table of Contents
Vanguard Cruciate Retaining (CR) Knee Design Features

Introduction............................................................................................................... 4
Advanced Technology............................................................................................... 4
E1 Antioxidant Infused Bearing Technology
Regenerex Porous Titanium Construct
Signature Personalized Patient Care
Femoral Design Features........................................................................................... 5

Rounded Sagittal Profile
Deeper/Swept-back Trochlear Groove
Wider Proximal Trochlear Groove
Sizing
Removable Femoral Lugs/Augments........................................................................ 6
Articulation Features................................................................................................. 7
Coronal Geometry
Sagittal Geometry
Curved Articulation
CR Bearing Options................................................................................................... 8
Bearing Technologies................................................................................................ 9
ArCom Polyethylene
E1 Antioxidant Infused Technology
Polyethylene Thickness
Component Fixation................................................................................................ 11
Interlok Finish
PPS Porous Plasma Spray Coating
Tibial Tray Design Features...................................................................................... 12

Locking Mechanism
Sizing
Tibial Baseplate Options
Stem Options
Patellar Articulation................................................................................................. 15
Series A Patella
Regenerex Patella
2|Vanguard Complete Knee SystemDesign Rationale
Table of Contents (cont.)
Signature Personalized Patient Care..................................................................... 16

Signature Planning Landmarks
Signature Total Knee Planning Software
Signature Positioning Guides
Instrumentation Platforms...................................................................................... 17
Microplasty Total Knee Instrumentation
Premier Total Knee Instrumentation
Microplasty Elite Total Knee Instrumentation
Vanguard Tensor Instrumentation
Premier Anterior Referencing Instrumentation
Vanguard Posterior Stabilizied (PS) Knee Design Features

Introduction............................................................................................................. 19
Advanced Technology............................................................................................. 19
E1 Antioxidant Infused Bearing Technology
Femoral Design Features......................................................................................... 20

Deeper/Swept-back Trochlear Groove
Extended Trochlear Groove
Sizing
PS Femoral Box Design............................................................................................ 21
Cam and Post Design............................................................................................... 22

Extended Cam
Cam and Post Engagement
High Dislocation Height
Articulation Features............................................................................................... 23
Coronal Geometry
Sagittal Geometry
Curved Articulation
PS Bearing Options.................................................................................................. 24
PS Bearing Design
PS Plus Bearing Design
Table of Contents (cont.)
Bearing Technologies.............................................................................................. 25
ArCom Polyethylene
Polyethylene Thickness
Component Fixation................................................................................................ 27
Interlok Finish
Tibial Tray Design Features...................................................................................... 28

Locking Mechanism
Sizing
Stem Options
Patellar Articulation................................................................................................. 30
Series A Patella
Regenerex Patella
Signature Personalized Patient Care....................................................................... 31

Instrumentation Platforms...................................................................................... 32
References............................................................................................................... 34
Vanguard Cruciate Retaining (CR) Knee Design Features

Introduction Regenerex Porous Titanium Construct
The proven clinical heritage of AGC, Maxim, and Regenerex Porous Titanium Construct unites the
Ascent Total Knee Systems13 and combined state- proven clinical history of titanium alloy6 with an
of-the-art design features have allowed Zimmer enhanced interconnecting pore structure, resulting
Biomet to produce the most comprehensive total knee in a revolutionary material that provides for biologic
replacement system on the market. The Vanguard fixation4,7 (Figure 2).
Knee System offers the flexibility to change from
See page 12 for more information regarding Regenerex
cruciate retaining (CR) to posterior stabilized (PS)
material.
within a single system. The transition between each
constraint level can be made with ease, allowing the
physician to evaluate soft tissue and bone deficiencies
intraoperatively without making a preoperative
commitment to the level of constraint. The Vanguard
Knee is supported by five instrumentation platforms:
Microplasty, Premier, Microplasty Elite, Vanguard
Tensor, and Premier Anterior Referencing Systems,
Figure 2
accommodating a number of workflows and Regenerex Porous Titanium Construct
techniques.
Advanced Technology Signature Personalized Patient Care

The Vanguard Complete Knee System continues Signature Personalized Patient Care utilizes MRI and
to advance total knee arthroplasty with innovative CT based patient-specific femoral and tibial positioning
technologies to provide personalized patient care. guides to offer an individualized approach to total knee
These technologies include: replacement. The Signature System, which fits the
femoral and tibial components independently, when
E1 Antioxidant Infused Bearing Technology used with the Vanguard Complete Knee System, offers
Regenerex Porous Titanium Construct a comprehensive solution for personalized patient
Signature Personalized Patient Care care (Figure 3).
See page 16 for more information regarding the

E1 Antioxidant Infused Bearing Technology Signature System.
E1 Antioxidant Infused Tibial Bearing Technology
defines a new class of bearings and overcomes the
limitations of remelted and annealed polyethylenes
by uniting true oxidative stability, high mechanical
strength, and ultra-low wear4,5 (Figure 1).
See pages 9-10 for more information regarding E1

Tibial Bearings.
Figure 3

Figure 1
E1 Antioxidant Infused Tibial Bearing
Femoral Design Features Deeper/Swept-back Trochlear Groove

When designing the Vanguard Complete Knee System, The trochlear groove is a critical design feature for
every aspect of the femur, tibia, and patella was patella performance. Translation of the trochlear
reviewed for potential performance enhancements groove posteriorly in the femur has shown to resist
in all patient populations. Many clinically successful patella crepitus and clunk.9
features found in earlier Zimmer Biomet Total Knee
The Vanguard trochlear groove has been designed
Systems can be found in the Vanguard Complete Knee
to sweep back posteriorly for better patellar
System. However, many unique features were added.
performance10 (Figure 5).
The Vanguard Femoral Component has four main
design features:
Rounded sagittal profile

Deeper, swept-back trochlear groove
Wider proximal trochlear groove
Sizing

Two distinct femoral designs have evolved over time Figure 5
(Figure 4): Standard Trochlear Groove (Green) vs. Vanguard Deeper/
Swept-back Trochlear Groove
Anatomic (box-like) femoral profile
Swept-back (rounder) femoral profile
Patellar capture during flexion must be balanced with
the need for less patellar constraint in extension. The
trochlear floor of the Vanguard Knee has been widened
to reduce the constraining forces in extension. The
patella track provides a 6.5 degree valgus angulation
and a 2 mm lateralized trochlear groove. Valgus
angulation has been shown to reduce the patellar
shear stresses.8
The wider proximal trochlear groove offers excellent

patellar tracking (within 0 to 15 degrees of valgus)
Figure 4
Anatomic (Green) vs.
regardless of the patients Q-angle4 (Figure 6).
Vanguard Swept-back Sagittal Profile (Gray)
015
A round sagittal profile, as found in the Vanguard

Knee, allows for greater range of motion than anatomic
femoral components and may be more forgiving to the
retinaculum by not over tensioning the soft tissues.8
Figure 6
Q-Angle Variability (within 015 degrees) Permitted
by Vanguard Trochlear Groove
Sizing Removable Femoral Lugs/Augments

The Vanguard Complete Knee System offers ten The Vanguard CR Femoral Lugs are removable and can
femoral sizes specifically designed for optimal bone be used in conjunction with distal augments (Figures
coverage of all patient populations. 8 and 9). This feature allows for posterior and distal
augmentation in a primary total knee arthroplasty or
Femoral sizes increase A/P by an average of
the use of a primary component in the revision of a
2.4 mm and M/L by 2.6 mm across all ten sizes
unicompartmental knee arthroplasty.
(Figure 7)
Narrow anterior flange maintains a small profile
to reduce the likelihood of femoral overhang
Rounded anterior flange corners to further
address femoral overhang
Posterior condyles grow proportionally in size to
reduce overstuffing of the flexion gap in smaller
femurs and the potential for undersizing the
posterior condyles in larger femurs
Figure 8
Better coverage of the posterior condyles aids in Removable CR Lugs
achieving high flexion and restoring femoral offset. The
posterior condyle geometry has also been optimized
to provide larger contact areas in deep flexion to
dissipate forces on the bearing more effectively.11
Figure 9
Augment Attached to CR Knee
Figure 7
Ten Femoral Sizes
Articulation Features The coronal geometry features softened intercondylar

M/L edges. This radius enhancement provides
The Vanguard Complete Knee System features
increased contact area when the patella articulates
optimized tibiofemoral articulation based on the
on the condyles in flexion. A Finite Element Analysis
enhanced design of the following elements:
has demonstrated a 25 percent reduction in patella
Coronal Geometry contact pressure compared to the Maxim Total Knee4
(Figure 11).
Sagittal Geometry
Curved Articulation
Coronal Geometry
The Vanguard Complete Knee System provides a fully
congruent (coronally), moderately dished articulation
to reduce polyethylene stresses, while still allowing
physiological motion. The 1:1 condylar geometry
provides surgical flexibility by allowing complete tibial-
femoral interchangeability* (Figure 10).
Figure 11
Finite Element Analysis Demonstrates a Gradual Dispersion
of Forces Along the Patella
Sagittal Geometry
The Vanguard Knee has been designed to allow up
to 145 degrees of flexion without additional posterior
condyle resections (Figure 12), with early results
showing postoperative mean rage of motion of 125
degrees at three year follow-up.4
Figure 10
Tibiofemoral Contact
Figure 12
145 Degrees Range of Motion with Primary Bone Cuts
*with the exception of the Vanguard Anterior Stabilized (AS) Bearing

The Vanguard Tibial Bearings have a deep anterior CR Bearing Options

relief to accommodate the patella tendon during high
Vanguard CR Tibial Bearings are available in both,
flexion (Figure 13).
ArCom Direct Compression Molded Polyethylene
and E1 Antioxidant Infused Technology. Three bearing
design options are available for use with the CR knee
(Figure 15).
Standard CR
CR Lipped
Anterior Stabilized (AS)
These options provide intraoperative flexibility to meet
patient needs and surgeon preference.
Figure 13
High Flexion Patellar Tendon Relief
Curved Articulation
To increase contact area with axial rotation, the
Vanguard Knee features a rotated articulation
bearing surface (Figure 14). As compared to a linear
articulation, a rotated articulation increases the Standard CR:
3 degrees posterior slope
contact area by 13 percent.4
15 degrees internal/external rotation
No varus/valgus constraint
CR Lipped:
Enhanced posterior lip
Figure 14 15 degrees internal/external rotation
Rotated Articulation Bearing Surface
AS Bearing:
Ultracongruent deep dish design
6 degrees internal/external rotation
Figure 15
CR Bearing Options
Bearing Technologies Zimmer Biomet has continued the commitment to

Direct Compression Molded (DCM) tibial bearings
Zimmer Biomets proven polyethylene clinical heritage
within the Vanguard Complete Knee System to
and commitment to improving bearing technologies
minimize the potential for oxidative breakdown of the
to address the effects of oxidation, has produced some
polyethylene. Zimmer Biomets ability to provide a
of the industrys most advanced bearing technologies.
clinically proven polyethylene1317 along with a clinically
These technologies include:
proven method of consolidation for the Vanguard
ArCom Polyethylene Complete Knee System punctuates Zimmer Biomets
commitment to long term clinical success with its
bearing technologies. DCM polyethylene has been
clinically proven to be resistant to wear, delamination
ArCom Polyethylene
and oxidation with 97.8 percent survivorship reported
Oxidation negatively impacts the mechanical at 20 years, with no implants being revised for
properties of polyethylene by causing pitting and polyethylene wear.1
delamination in knee bearing surfaces. Following
Zimmer Biomets traditional engineering approach,
it was the first company to use inert gas (argon)
to replace oxygen during the sterilization and E1 Antioxidant Infused Tibial Bearing Technology
packaging process. The use of argon reduces the defines a new class of bearings and overcomes the
degradative effects of oxygen in polyethylene limitations of remelted and annealed polyethylenes
bearings.5 Furthermore, gamma sterilization in an by uniting true oxidative stability, high mechanical
argon atmosphere has been shown to decrease wear strength, and ultra-low wear.4,5 The foundation of
over EtO sterilized polyethylene by 44 percent12 this advancement in bearing technologies is ArCom
(Figure 16). Polyethylene.
Hip Simulator Wear Testing

EtO vs. Gamma 12
EtO Sterilized
Weight Loss (grams)
ArCom Gamma
Sterilized
Cycles (millions)
Figure 16
Wear Testing
E1 Antioxidant Infused Bearings are neither annealed An internal Zimmer Biomet study demonstrated that
nor remelted. Instead, oxidative stability is achieved CR E1 tibial bearings had an 86 percent reduction in
by the infusion of Vitamin-E. Environmental Stress wear over CR DCM tibial bearings4 (Figure 19).
Crack Testing (ESC) mimics cyclic loading in vivo Volumetric Wear Rates
which is a major reason or mode for bearing of Largest Cruciate Retaining (CR)
Tibial Bearing Profile4
breakdown. ESC testing has shown E1 material 50
Tested at Zimmer Biomet Biomaterials Laboratory
to be more oxidatively stable than sequentially 43.4
crosslinked and annealed polyethylene4 (Figure 17). 40
This manufacturing process allows E1 material to

achieve oxidative stability without remelting the
Volumetric Wear Rate

30
(mm3/MC)
bearing material, which ultimately allows the bearing 86% CR wear
reduction
to retain its mechanical strength4,5 (Figure 18). 20 over Direct
Compression
Molded
Oxidation Profile4,18
After ESC testing 10
0.8 6.1
0.7
0.6 0
Oxidation Index (Absorbance Units)
DCM E1
0.5 UHMWPE Material
0.4
Figure 19
0.3
CR E1 Wear Rate
0.2
0.1
0.0
E1 Antioxidant Infused Technology FDA Cleared Claims:4
-0.1
Top
Surface
Center Bottom
Surface Prevents oxidative degradation of polyethylene
Sequentially Crosslinked and Annealed Loaded
Sequentially Crosslinked and Annealed Control
Protects polyethylene from oxidation
E1 Material Loaded
and cracking during environmental stress
E1 Material Control
crack testing
Figure 17
Oxidation Profile Maintains the mechanical strength
of conventional UHMWPE under small
Ultimate Tensile and Yield Strengths
for Multiple Polyethylenes4,19
punch testing
48.1 40.8 45.8 46.1

Maintains mechanical strength
50
after accelerated aging
40
33.3
(Strength MPa)
30
20.1 21.3 22.6 22.8
20 19.0
10
0
DCM Unaged1 DCM Aged1 E1 Material Unaged1 E1 Material Aged1 100kGy Remelted5
Tensile Strength (MPa) Yield Strength (MPa)
Figure 18
Polyethylene Thickness PPS Porous Plasma Spray Coating

Meding, et al. demonstrated excellent long-term Since its introduction in 1981, Zimmer Biomets PPS
results with 4.4 mm minimum thickness DCM tibial Coating has been used by surgeons throughout the
bearings.14 The Vanguard Complete Knee System world to achieve better fixation on a multitude of
provides a minimum of 6 mm of polyethylene products including the AGC, Maxim, and Ascent
thickness in all components (Figure 20). Knee Systems. Long-term follow-up studies show
that surgeons are observing extremely low rates of
Size Thickness osteolysis and 97 percent survivorship at 20 years with
10 12 14 16 18 20 22 24
(mm) PPS coated prostheses20 (Figure 22).
Polyethylene
Articulating 6 8 10 12 14 16 18 20
Thickness (mm)
Figure 20
Polyethylene Size/Thickness
Component Fixation
The Vanguard Complete Knee System incorporates
three types of fixation:
Figure 22
Interlok Finish PPS Coating
In addition, PPS Coating has been proven to:
Provide for more biologic fixation than CoCr
Interlok Finish material and has proven superior with regard to
biocompatibility and component fit over titanium
The Interlok Finish allows for proper cement
fiber mesh21
interdigitation into the surface for a more secure bond
in cemented applications (Figure 21). Maintain the implants inherent fatigue
strength4, 2224
Provide early stage fixation, helping to prevent
micromotion20
Provide late stage fixation, helping to offload
stresses between implant and bone20
Figure 21
Interlok Finish
Regenerex Porous Titanium Construct Locking Mechanism

Regenerex Porous Titanium Construct unites the Effective polyethylene thickness is determined by
proven clinical history of titanium alloy6 with an evaluating not only thickness at the center of the tibial
enhanced interconnecting pore structure, resulting condyle but also by measuring the periphery of the
in a revolutionary material that provides for biologic polyethylene insert. Many competitive components
fixation4,7 (Figure 23). provide adequate thickness at the center, but
compromise thickness around the edges due to the
design of the locking mechanism.
Features of the locking mechanism design include

(Figure 24):
Peripheral polyethylene thickness is maintained

by locating the locking mechanism anteriorly and
Figure 23 within the intercondylar area
Regenerex Porous Titanium Technology
Vanguards Locking Mechanism compresses the
Regenerex material provides for: polyethylene bearing against the tray by utilizing
an oversized titanium locking bar that forces the
Average porosity of 67 percent4 bearing against a 10 degree posterior boss
Average pore size of 300 microns4 The Coventry Award-winning study by Parks and
High strength and flexibility4 Engh, and a study published by Sosa, have shown
Fixation in as early as two weeks was reported in the Vanguard Locking Mechanism to be the
canine studies 4,7 most stable overall. 25,26,28
The large potential surface area for biologic fixation

makes this tray an optimal option for patients with
good bone quality.
Tibial Tray Design Features

Concerns have been raised about modularity and
bearing micromotion as a contributor to osteolysis and
early failure.2529 Feng, et al. have found that the most
severe polyethylene wear occurs at the periphery,
where the tibial component had a raised metal edge.30
These concerns have been addressed with the Zimmer Figure 24
Biomet modular tibial tray design. Anterior Compressive Locking Mechanism
The modular design of the Vanguard Tibial Tray is

based on clinically successful features of earlier
Zimmer Biomet Total Knee Systems, including:
Locking Mechanism
Sizing
Stem Options
Sizing Tibial Baseplate Options

Many knee systems offer a variety of tibial tray sizes. Primary tibial trays are made from both titanium
However, few systems offer consistent sizing. Based on and cobalt chrome alloys. Modular titanium primary
the work of Mensch and Amstutz,31 the Vanguard Knee baseplates are available with an Interlok Finish for
System offers nine symmetrical tibial baseplates that cemented applications, or PPS Coating and Regenerex
change in consistent 4 mm M/L intervals (Figure 25). Porous Titanium Construct to enhance bone fixation in
cementless applications.
Micro Macro Macro
M/L 59 63 67 71 75 79 83 87 91
PPS coated baseplates accept up to four 6.5 mm
A/P 38 41 43 46 48 51 53 56 58
cancellous bone screws (Figure 27), while Regenerex
Figure 25 Baseplates feature four solid titanium pegs that exhibit
Zimmer Biomet Tibial Baseplate Sizing a rough texture (Figure 28) for enhanced fixation when
a cementless tibial component is utilized.
Incavo, et al. examined eight tibial tray designs,
consisting of six symmetrical and two asymmetrical
baseplates. The study demonstrated that the sizing
rationale for the AGC Total Knee System, which is
closely paralleled by the Vanguard Knee System,
offers optimal coverage as compared to competitive
asymmetrical designs32 (Figure 26).
Figure 27 Figure 28
PPS Baseplate Regenerex Baseplate
Figure 26
Vanguard Symmetrical Tibial Tray Design
Of all the tibial trays tested in one study, the modular

tray design of the AGC Knee was ranked as the best
in total tibial plateau coverage, covering 81 percent of
the tibial surface.32
The Regenerex Tibial Tray is compatible with four Stem Options

primary articulations within the Vanguard Complete
The modular titanium primary baseplate allows for
Knee System:
intraoperative stem selection to match specific patient
CR needs. An I-beam primary stem is available in 40 mm
length, while cruciate fin and splined primary stems
CR Lipped
are available in 40 mm and 80 mm lengths. In addition
AS to the 40 mm and 80 mm splined, and cruciate fin
PS stems, a taper cap is available for the Regenerex
Primary Tibial Tray (Figure 30).
The Vanguard Complete Knee System is compatible with
the following cobalt chrome baseplate options: I-beam,
cruciate finned, or Microplasty Tray with an Interlok
Finish (Figure 29).
Figure 30
Modular Tibial Tray Stems
I-beam Tray Cruciate Finned Tray
The combination of a Morse-type taper and screw

fixation helps maintain a solid connection between the
stem and baseplate. When more fixation is desired,
the stemmed or offset tray will accept a 40, 80, 120,
160, or 200 mm stem extension (Figure 31). Stem
Microplasty Tray extensions are available in splined, smooth and grit-
Figure 29 blasted finishes. Bowed, splined, smooth and grit-
Cobalt Chrome Baseplate Options blasted stem extensions are offered in 160 and
180 mm lengths.
I-beam and cruciate finned baseplates feature a 40 mm
stem design while the 20 mm cruciate stem design of
the Microplasty Tibial Tray allows for a less invasive
procedure and arcs posteriorly to increase resistance
against pull-out.
Interlok Offset Tibial Baseplate, Interlok Stemmed

Baseplate, and the PPS Baseplate can be used with
block or wedge augments. All augments are fixed to
the baseplates by bolts, allowing a mechanical lock
between the tray and augments.
Figure 31
Stem Extensions
Patellar Articulation Regenerex Patella

The Vanguard Complete Knee System offers multiple The Regenerex Primary Three Peg Patella
patella options: incorporates Zimmer Biomets Regenerex Porous
Titanium Construct with the Series A true dome
Series A shape and the standard poly thickness. The
Single Peg (1-Peg) octagonal pegs provide for initial fixation on the
resurfaced bone (Figure 34).
Three Peg (3-Peg)
Regenerex Construct
Three Peg (3-Peg)
Series A Patella
Ritter, Lombardi, Insall, Ranawat, et al. have shown
excellent long-term results with domed patellar
designs.9,11,33,34 The domed patella is more forgiving in Figure 34
placement than other designs and can reliably provide Regenerex Three Peg Patella
congruent contact10 (Figure 32). Series A and Regenerex Patella size and thickness
offering listed below (Figure 35):
Diameter (mm)
Patella Sizing
Chart 25 28 31 34 37 40
Series A Low Profile 6.2 6.2 6.2 7.8 8.5 N/A
1-Peg Standard 8.0 8.0 8.0 8.5 10.0 10.0
3-Peg Standard 8.0 8.0 8.0 8.5 10.0 10.0
Regenerex
Standard N/A 8.0 8.0 8.5 10.0 N/A
3-Peg
Figure 32
Domed Patella Figure 35
Patella Sizing Chart
Series A patellas are available in one and three peg

options (Figure 33), and are available in standard
thickness as well as a low profile which is on average
1.5 mm thinner than the standard patella.
Figure 33
Series A Standard One and Three Peg Patellas
Signature Personalized
A
Patient Care
Signature Personalized Patient Care utilizes patient
B
specific femoral and tibial positioning guides A
B C
developed from MRI and CT imaging modality to D E
offer an individualized approach to total knee

replacement. The Signature System fits the femoral F F
and tibial components independently. When used

H
with the Vanguard Complete Knee System, it offers a G I
comprehensive solution for personalized patient care.

Features of the Signature System include:

J
Figure 36
Signature Planning Landmarks Signature Planning Landmarks
The Signature System features proprietary planning Signature Total Knee Planning Software
algorithms to generate an initial preoperative
plan incorporating traditional resection guides and Software built into the Signature System allows
allowing intraoperative position verification by the surgeons to visualize and specify an implant position
surgeon. for each patient plan.
These landmarks include (Figure 36): Automated planning algorithms generate

preoperative plan based off mechanical axis
A Anterior/Posterior Axis
User-friendly software for surgeon fine-tuning
B Epicondylar Axis Positioning guides incorporate preoperative
C Distal Femoral Mechanical Axis surgeon alteration
D Lateral Distal Femoral Condyle The result of the preoperative surgical planning is
a more focused intervention with the instruments
E Medial Distal Femoral Condyle required for surgery as well as the operative plan.
F Posterior Condylar Axis
G Lateral Plateau
H Proximal Tibial Mechanical Axis Landmark
I Medial Plateau
J Medial One-third of the Tibial Tubercle

Signature Positioning Guides Instrumentation Platforms

Preoperative surgeon planning is integrated into The Vanguard Complete Knee System is supported
Signature Positioning Guides (Figure 37). by five instrumentation platforms, allowing the
commitment to the level of constraint.
These instrumentation platforms include:
Microplasty Instrumentation
Premier Instrumentation
Microplasty Elite Instrumentation
Figure 37 Microplasty Total Knee Instrumentation

Microplasty Total Knee Instrumentation is designed
for use with minimally invasive surgical techniques
Femoral positioning guides register on femoral and includes Zimmer Biomets Slidex Technology
bearing to establish: which allows for minimal disruption to soft tissues
Distal femoral resection during total knee arthroplasty (Figure 38).
Distal femoral valgus angle

Distal femoral flexion angle
Femoral component rotation
A/P position
Femoral component sizing
Tibial positioning guides register on the anteromedial
tibial plateau to establish: Figure 38
Tibial resection
Varus/valgus angle
Tibial slope angle
Tibial rotation
Premier Total Knee Instrumentation Vanguard Tensor Instrumentation

Premier Total Knee Instrumentation is designed for Utilizing Premier Total Knee Instrumentation, the
conventional total knee replacement. Enhanced Vanguard Tensor is designed to assist in balancing
instrument functionality allows for reproducible and soft tissues during total knee arthroplasty (Figure 41).
reliable results (Figure 39).
Figure 39
Figure 41
Microplasty Elite Total Knee Instrumentation Vanguard Tensor Instrumentation

is designed for use with both traditional surgical Premier Anterior Referencing Instrumentation
methods as well as minimally invasive techniques. Anterior Referencing Instrumentation is available for
This instrumentation is designed for minimization use with the Vanguard Complete Knee System. This
of soft tissue trauma that occurs during total knee instrumentation allows for anterior referencing during
arthroplasty (Figure 40). femoral preparation to accommodate the preferred
approach of individual surgeons (Figure 42).
Figure 40
Figure 42
Vanguard PS Knee Design Features

Introduction Regenerex Porous Titanium Construct
The proven clinical heritage of AGC, Maxim, and Ascent Regenerex Porous Titanium Construct unites the
Total Knee Systems13 and combined state-of-the-art proven clinical history of titanium alloy 6 with
design features have allowed Zimmer Biomet to produce an enhanced interconnecting pore structure,
the most comprehensive total knee replacement system resulting in a revolutionary material that provides for
on the market. The Vanguard Knee System offers the biologic fixation4,7 (Figure 44).
flexibility to change from cruciate retaining (CR) to
See pages 2728 for more information regarding
posterior stabilized (PS) within a single system. The
Regenerex material.
transition between each constraint level can be made
with ease, allowing the physician to evaluate soft tissue
and bone deficiencies intraoperatively without making a
preoperative commitment to the level of constraint. The
Vanguard Knee is supported by five instrumentation
platforms: Microplasty, Premier, Microplasty Elite,
Vanguard Tensor, and Premier Anterior Referencing
Systems, accommodating a number of workflows and
techniques.
Figure 44
Advanced Technology Regenerex Porous Titanium Construct
The Vanguard Complete Knee System continues to

advance total knee arthroplasty with innovative Signature Personalized Patient Care
technologies to provide personalized patient care. Signature Personalized Patient Care utilizes MRI and
These technologies include: CT based patient-specific femoral and tibial positioning
guides to offer an individualized approach to total
E1 Antioxidant Infused Bearing Technology knee replacement. The Signature System, which fits
Regenerex Porous Titanium Construct the femoral and tibial components independently,
Signature Personalized Patient Care when used with the Vanguard Complete Knee System,
offers a comprehensive solution for personalized
E1 Antioxidant Infused Bearing Technology patient care (Figure 45).
E1 Antioxidant Infused Tibial Bearing Technology See pages 3132 for more information regarding the
defines a new class of bearings and overcomes the Signature System.
by uniting true oxidative stability, high mechanical
strength, and ultra-low wear 4,5 (Figure 43).
See page 26 for more information regarding E1 Tibial

Bearings.
Figure 45
Figure 43
E1 Antioxidant Infused Tibial Bearing
Femoral Design Features Deeper/Swept-back Trochlear Groove

When designing the Vanguard Complete Knee The trochlear groove is a critical design feature for
System, every aspect of the femur, patella, and tibia patella performance. Translation of the trochlear
was reviewed for potential performance enhancement groove posteriorly in the femur has shown to resist
in all patient populations. Many clinically successful patella crepitus and clunk.9
features found in earlier Zimmer Biomet Total Knee
The Vanguard trochlear groove has been designed
Systems can be found in the Vanguard Complete
to sweep back posteriorly for better patellar
Knee System. However, many unique features were
performance.10
added.
The Vanguard femoral component has five main Extended Trochlear Groove
design features:
The trochlear groove has been lengthened to further
Rounded sagittal profile support the patella in deep flexion and provide more
support of the quadriceps tendon (Figure 47). The
Deeper/swept-back trochlear groove junction of the trochlear groove and PS box articulates
Extended trochlear groove with the quadriceps tendon at 105120 degrees of
Wider proximal trochlear groove flexion.
Sizing

Two distinct femoral designs have evolved over time
(Figure 46).
Anatomic (box-like) femoral profile

Swept-back (rounder) femoral profile
Figure 47
Standard Trochlear Groove (Green) vs. Vanguard Deeper and
Extended Trochlear Groove (Gray)

Patellar capture during flexion must be balanced with
the need for less patellar constraint in extension. The
trochlear floor of the Vanguard Knee has been widened
to reduce the constraining forces in extension. The
patella track provides a 6.5 degree valgus angulation
and a 2 mm lateralized trochlear groove. Valgus
Figure 46 angulation has been shown to reduce the patellar
Anatomic (Green) vs. Swept-back Sagittal Profile (Gray) shear stresses.8
A round sagittal profile, as found in the Vanguard

Knee, allows for greater range of motion than anatomic
femoral components and may be more forgiving to the
retinaculum by not over tensioning the soft tissues.8
The wider proximal trochlear groove offers excellent

patellar tracking (within 015 degrees of valgus)
regardless of the patients Q-angle4 (Figure 48).
015
Figure 49
Ten Femoral Sizes
Figure 48
PS Femoral Box Design
Q-Angle
The Vanguard Complete Knee System offers a closed
Sizing box and open box femoral component.
The Vanguard Complete Knee System offers ten femoral
Vanguard Instrumentation offers three resections
sizes specifically designed for optimal bone coverage
that accomodate both closed and open box femoral
of all patient populations.
component designs (Figure 50). The closed box (CL)
Femoral sizes increase A/P by an average of resection level is utilized when implanting a closed box
2.4 mm and M/L by 2.6 mm across all ten sizes femoral component. The open box femoral component
(Figure 49) can be implanted utilizing either the open box (OP) or
the bone conserving (BC) resection level.
Narrow anterior flange maintains a small profile
to reduce the likelihood of femoral overhang
Conserving
Closed
Rounded anterior flange corners to further Bone

Open
address femoral overhang

Posterior condyles grow proportionally in size to
reduce overstuffing of the flexion gap in smaller
femurs and the potential for undersizing the
posterior condyles in larger femurs
Better coverage of the posterior condyles aids in

achieving high flexion and restoring femoral offset. The
posterior condyle geometry has also been optimized
to provide larger contact areas in deep flexion to Figure 50
dissipate forces on the bearing more effectively.11 PS Box Resections
The open box design allows for additional preservation Extended Cam
of distal bone. Utilizing the bone conserving resection
The Vanguard PS features an extended cam (Figure 52)
with the open box design will conserve bone anteriorly
for increased resistance to dislocation in deep flexion.
while additional box resection is made for closed box
design (Figure 51). If needed, IM nails can be utilized
in the intercondylar notch with the open box femoral
component.
Box Volume
BC
OP
CL
Box Volume (cm^3)
Figure 52
Extended Cam

The cam, of the Vanguard PS Femoral Component, is
55 57.5 60 62.5 65 67.5 70 72.5 75 80
Femoral Size designed to engage the post of the tibial bearing at
Figure 51 45 degrees of flexion (Figure 53).
Maximum Box Volume for Vanguard PS Knee
Cam and Post Design

The Vanguard PS Femoral Component has been
specifically designed to enhance performance. Key
elements in the Vanguard PS design include:
Extended Cam
Dislocation Height
Figure 53
45 Degrees Cam and Post Engagement
Gait analysis demonstrates that the weight bearing

phase occurs from 045 degrees.32 After weight
bearing phase occurs, the cam engages the post to
provide stability and increase quadriceps efficiency,
specifically during activities such as ascending and
descending stairs.35
Mid-flexion cam engagement avoids cam and post

contact during cycle activities but provides for stability
during load activities.
High Dislocation Height

The cam engages relatively low on the tibial bearing
post and remains low throughout full range of motion.
The forces at the tibial bone interface and locking
mechanism are decreased, while maintaining a high
bearing dislocation height. The dislocation height
of the Vanguard PS is never less than 17.3 mm at
90 degrees of flexion or greater (Figure 54). The
Vanguard PS component allows for 10 degrees of Figure 55
Tibial-Femoral Contact
hyperextension before anterior post impingement.
The coronal geometry features softened intercondylar
M/L edges. This radius enhancement provides
increased contact area when the patella articulates
on the condyles in flexion. A finite element analysis
45
60
75 has demonstrated a 25 percent reduction in patella
17.3 90
contact pressure compared to a conventional total
knee4 (Figure 56).
Figure 54
Cam and Post Contact Points
Articulation Features
The Vanguard Complete Knee System features optimized
tibiofemoral articulation based on the enhanced
design of the following elements:
Figure 56
Coronal Geometry Finite Element Analysis Demonstrates a Gradual Dispersion of
Forces Along the Patella
Sagittal Geometry
Curved Articulation Sagittal Geometry
Coronal Geometry The Vanguard Knee has been designed to allow up to
145 degrees of flexion without additional posterior
The Vanguard Complete Knee System provides condyle resections (Figure 57), with early results
a fully congruent (coronally), moderately showing postoperative mean rage of motion of
dished articulation to reduce polyethylene 125 degrees at three year follow-up.4
stresses, while still allowing physiological
motion. The 1:1 condylar geometry provides
surgical flexibility by allowing complete
tibiofemoral interchangeability* (Figure 55).
Figure 57
*with the exception of the Vanguard Anterior Stabilized (AS) Bearing
145 Degrees Range of Motion with Primary Bone Cuts
The Vanguard Tibial Bearings have a deep anterior PS Bearing Options

relief to accommodate the patella tendon during high
Vanguard PS Tibial Bearings are available in both
flexion (Figure 58).
ArCom Direct Compression Molded Polyethylene and
E1 Antioxidant Infused Technology.
Two bearing design options are available for use with

the PS knee.
PS
PS Plus
PS Bearing Design
The Vanguard PS post geometry is rounded to
Figure 58 minimize forces on the post due to femoral rotation
High Flexion Patellar Tendon Relief (Figure 60). According to a mechanical wear simulation
test, the Vanguard PS Bearing had a 71 percent
Curved Articulation reduction in gravimetric wear at 5.5 million cycles,
To increase contact area with axial rotation, the as compared to standard square post design
Vanguard Knee features a rotated articulation geometry.4
bearing surface (Figure 59). As compared to a linear
articulation, a rotated articulation increases the
contact area by 13 percent.4
Figure 60
Vanguard Rounded PS Post
Figure 59
Rotated Articulation Bearing Surface
PS Plus Bearing Design Bearing Technologies

The prominent anterior lip of the PS Plus bearing Zimmer Biomets proven polyethylene clinical
helps resist paradoxical anterior femoral slide during heritage and commitment to improving bearing
gait (Figure 61). This cradling effect controls the technologies to address the effects of oxidation,
femoral component on the articulating surface without has produced some of the industrys most advanced
sacrificing freedom of rotation. The combination of 45 bearing technologies. These technologies include:
degrees cam engagement with a prominent anterior
lip limits premature wear of the tibial post and provides ArCom Polyethylene
mid-flexion stability. E1 Antioxidant Infused Technology
ArCom Polyethylene
Oxidation negatively impacts the mechanical
properties of polyethylene by causing pitting and
delamination in knee bearing surfaces. Following
Zimmer Biomets traditional engineering approach, it
was the first company to use inert gas (argon) to replace
oxygen during the sterilization and packaging process.
The use of argon reduces the degradative effects
Figure 61
Prominent Anterior Lip
of oxygen in polyethylene bearings.5 Furthermore,
gamma sterilization in an argon atmosphere has
been shown to decrease wear over EtO sterilized
The PS Plus bearing is more constrained than the
polyethylene by 44 percent12 (Figure 63).
standard PS bearing (Figure 62). The PS Plus bearing is
indicated for use in a primary situation when more
stability and initial constraint is desired to resist rotation Hip Simulator Wear Testing
EtO vs. Gamma 12
and varus/valgus lift-off. The PS Plus bearing limits

rotation to +/-2 degrees and varus/valgus lift-off to 2 EtO Sterilized
degrees. The standard PS bearing does not constrain

Weight Loss (grams)
ArCom Gamma
Sterilized
the femur in rotation or varus/valgus lift-off.
Cycles (millions)
Figure 63
Wear Testing
Zimmer Biomet has continued the commitment to

Direct Compression Molded (DCM) tibial bearings
within the Vanguard Complete Knee System to
minimize the potential for oxidative breakdown of the
polyethylene. Zimmer Biomets ability to provide a
Figure 62
clinically proven polyethylene1317 along with a clinically
PS Bearing and PS Plus Bearing (Green)
proven method of consolidation for the Vanguard
Complete Knee System punctuates Zimmer Biomets
commitment to long term clinical success with its Ultimate Tensile and Yield Strengths
for Multiple Polyethylenes4,19
bearing technologies. ArCom Polyethylene has been
clinically proven to be resistant to wear, delamination 50
48.1 40.8 45.8 46.1
and oxidation with 97.8 percent survivorship reported 40

33.3
at 20 years, with no implants being revised for
(Strength MPa)
30
20.1 21.3 22.6 22.8
polyethylene wear.1 20 19.0
10
0
DCM Unaged1 DCM Aged1 E1 Material Unaged1 E1 Material Aged1 100kGy Remelted5
Tensile Strength (MPa) Yield Strength (MPa)
E1 Antioxidant Infused Tibial Bearing Technology
Figure 65
defines a new class of bearings and overcomes the
by uniting true oxidative stability, high mechanical A second, independent study conducted through the
strength, and ultra-low wear.4,5 The foundation of University of Nebraska, reported that PS E1 tibial
this advancement in bearing technologies is ArCom bearings had an 87 percent reduction in wear over PS
Polyethylene. DCM tibial bearings (Figure 66).4
E1 Antioxidant Infused Bearings are neither Volumetric Wear Rates

of Largest Posterior Stabilized (PS)
annealed nor remelted. Instead, oxidative stability Tibial Bearing Profile4
Tested at University of Nebraska
is achieved by the infusion of Vitamin-E. Zimmer 25
Biomet Environmental Stress Crack Testing (ESC) 21.33
mimics cyclic loading in vivo which is a major reason 20
or mode for bearing breakdown. ESC testing has

Volumetric Wear Rate
15
shown E1 material to be more oxidatively stable than 87% PS wear
(mm3/MC)
sequentially crosslinked and annealed polyethylene 4 reduction

10 over Direct
(Figure 64). This manufacturing process allows Compression
Molded
E1 material to achieve oxidative stability without
5
remelting the bearing material, which ultimately 2.87
allows the bearing to retain its mechanical strength4,5

0
(Figure 65). DCM
UHMWPE
E1
Material
Figure 66
Oxidation Profile4,18
PS E1 Wear Rate
After ESC testing
0.8
0.7
E1 Antioxidant Infused Technology FDA Cleared Claims:4
0.6
Oxidation Index (Absorbance Units)
0.5 Prevents oxidative degradation of polyethylene

0.4
Protects polyethylene from oxidation and
0.3
0.2
cracking during environmental stress crack
0.1
testing
0.0 Maintains the mechanical strength of conventional
-0.1
Top Center Bottom
UHMWPE under small punch testing
Surface Surface
Sequentially Crosslinked and Annealed Loaded

Maintains mechanical strength after accelerated
Sequentially Crosslinked and Annealed Control aging
E1 Material Loaded
E1 Material Control
Figure 64
Oxidation Profile
Polyethylene Thickness Knee Systems. Long-term follow-up studies show

that surgeons are observing extremely low rates of
Meding, et al. demonstrated excellent long-term
osteolysis and 97 percent survivorship at 20 years with
results with 4.4 mm minimum thickness DCM tibial
PPS coated prostheses9, 20 (Figure 69).
bearings.14 The Vanguard Complete Knee System
provides a minimum of 6 mm of polyethylene thickness
in all components (Figure 67).
Size Thickness
10 12 14 16 18 20 22 24
(mm)
Polyethylene
Articulating 6 8 10 12 14 16 18 20
Thickness (mm)
Figure 67
Polyethylene Size/Thickness
Figure 69
PPS Coating
Component Fixation In addition, PPS Coating has been proven to:
The Vanguard Knee system incorporates three types
of fixation: Provide for more biologic fixation than CoCr
material and has proven superior with regard to
Interlok Finish biocompatibility and component fit over titanium
PPS Porous Plasma Spray Coating fiber mesh21
Regenerex Porous Titanium Construct Maintain the implants inherent fatigue
strength4, 2224
Interlok Finish Provide early stage fixation, helping to prevent
The Interlok Finish allows for proper cement micromotion20
interdigitation into the surface for a more secure bond Provide late stage fixation, helping to offload
in cemented applications (Figure 68). stresses between implant and bone20

Regenerex Porous Titanium Construct unites the
proven clinical history of titanium alloy 6 with an
enhanced interconnecting pore structure, resulting
in a revolutionary material that provides for biologic
fixation4,7 (Figure 70).
Figure 68
Interlok Finish

Since its introduction in 1981, Zimmer Biomets PPS
Coating has been used by surgeons throughout
the world to achieve better fixation on a multitude Figure 70
of products including the AGC, Maxim, and Ascent Regenerex Porous Titanium Technology
Regenerex material provides for: Features of the locking mechanism design include
(Figure 71):
Average porosity of 67 percent4
Average pore size of 300 microns4 Peripheral polyethylene thickness is maintained
by locating the locking mechanism anteriorly and
High strength and flexibility4 within the intercondylar area
Fixation in as early as two weeks was reported in Vanguards Locking Mechanism compresses
canine studies 4,7 the polyethylene bearing against the tray by
The large potential surface area for biologic fixation utilizing an oversized titanium locking bar that
makes this tray an optimal option for patients with forces the bearing against a 10 degree posterior
good bone quality. boss
The Coventry Award-winning study by Parks
Tibial Tray Design Features and Engh, and a study published by Sosa, have
Concerns have been raised about modularity and shown the Vanguard Locking Mechanism to be
bearing micromotion as a contributor to osteolysis the most stable overall. 25,26,28
and early failure.2529 Feng, et al. have found that
the most severe polyethylene wear occurs at the
periphery, where the tibial component had a raised
metal edge.30 These concerns have been addressed
with the Zimmer Biomet modular tibial tray design.
The modular design of the Vanguard Tibial Tray is

based on clinically successful features of earlier
Zimmer Biomet Total Knee Systems, including:
Figure 71
Locking Mechanism
Anterior Compressive Locking Mechanism
Sizing
Sizing
Many knee systems offer a variety of tibial tray sizes.
Stem Options However, few systems offer consistent sizing. Based on
the work of Mensch and Amstutz,31 the Vanguard Knee
Locking Mechanism System offers nine symmetrical tibial baseplates that
Effective polyethylene thickness is determined by change in consistent 4 mm M/L intervals (Figure 72).
evaluating not only thickness at the center of the Micro Macro Macro
tibial condyle but also by measuring the periphery M/L 59 63 67 71 75 79 83 87 91

of the polyethylene insert. Many competitive A/P 38 41 43 46 48 51 53 56 58
components provide adequate thickness at the center,
Figure 72
but compromise thickness around the edges due to the
Zimmer Biomet Tibial Baseplate Sizing
design of the locking mechanism.
Incavo, et al. examined eight tibial tray designs, The Regenerex Tibial Tray is compatible with four
consisting of six symmetrical and two asymmetrical primary articulations within the Vanguard Complete
baseplates. The study demonstrated that the sizing Knee System.
rationale for the AGC Total Knee System, which is
closely paralleled by the Vanguard Knee System, CR
offers optimal coverage as compared to competitive CR Lipped
asymmetrical designs32 (Figure 73). AS
PS
The Vanguard Complete Knee System is compatible with
the following cobalt chrome baseplate options: I-beam,
cruciate finned, or Microplasty tray with an Interlok Finish
(Figure 76).
Figure 73
Symmetrical Tibial Tray Design of the Vanguard
Of all the tibial trays tested in one study the modular tray I-beam Tray Cruciate Finned Tray
design of the AGC Knee was ranked as the best in total

tibial plateau coverage, covering 81 percent of the tibial
surface.32

Microplasty Tray
Primary tibial trays are made from both titanium Figure 76
and cobalt chrome alloys. Modular titanium primary Cobalt Chrome Baseplate Options
baseplates are available with an Interlok Finish
for cemented applications, or PPS coating and I-beam and cruciate finned baseplates feature a 40 mm
Regenerex Porous Titanium Construct to enhance stem design while the 20 mm cruciate stem design of
bone fixation in cementless applications. the Microplasty Tibial Tray allows for a less invasive
PPS coated baseplates accept up to four 6.5 mm procedure and arcs posteriorly to increase resistance
cancellous bone screws (Figure 74), while Regenerex against pull-out.
baseplates feature four solid titanium pegs that exhibit Interlok offset tibial baseplate, Interlok stemmed
a rough texture (Figure 75) for enhanced fixation when baseplate, and the PPS baseplate can be used with
a cementless tibial component is utilized. block or wedge augments. All augments are fixed
to the baseplates by bolts, allowing a mechanical lock
between the tray and augments.
Figure 74 Figure 75
PPS Baseplate Regenerex Baseplate
Stem Options Patellar Articulation

The modular titanium primary baseplate allows The Vanguard Complete Knee System offers multiple
for intraoperative stem selection to match specific patella options:
patient needs. An I-beam primary stem is available in
40 mm length, while cruciate fin and splined primary Series A
stems are available in 40 mm and 80 mm lengths. In Single Peg (1-Peg)
addition to the 40 mm and 80 mm splined and cruciate Three Peg (3-Peg)
fin stems, a taper cap is available for the Regenerex
Primary Tibial Tray (Figure 77). Regenerex Construct
Three Peg (3-Peg)
Series A Patella
Ritter, Lombardi, Insall, Ranawat, et al. have shown
excellent long-term results with domed patellar
designs.9,11,33,34 The domed patella is more forgiving in
placement than other designs and can reliably provide
congruent contact10 (Figure 79).
Figure 77
Modular Tibial Tray Stems
The combination of a Morse-type taper and screw

fixation helps maintain a solid connection between the
stem and baseplate. When more fixation is desired,
the stemmed or offset tray will accept a 40, 80, 120,
160, or 200 mm stem extension (Figure 78). Stem
extensions available in splined, smooth and grit-blasted Figure 79
Domed Patella
finishes. Bowed splined, smooth and grit-blasted stem
extensions are offered in 160 and 180 mm lengths.
Series A patellas are available in one and three peg
options (Figure 80), and are available in standard
thickness as well as a low profile which is on average
1.5 mm thinner than the standard patella.
Figure 80
Series A Standard One and Three Peg Patellas
Figure 78
Stem Extensions
Regenerex Patella Signature Planning Landmarks

The Regenerex Primary Three Peg Patella incorporates The Signature System features proprietary planning
Zimmer Biomets Regenerex Porous Titanium algorithms to generate an initial preoperative plan
Construct with the Series A true dome shape and incorporating traditional resection guides and allowing
standard poly thickness. The octagonal pegs provide intraoperative position verification by the surgeon.
for initial fixation on the resurfaced bone (Figure 81).
These landmarks include (Figure 83):
A B
B C
D E
Figure 81
Regenerex Three Peg Patella
F F
Series A and Regenerex Patella size and thickness
offering listed below (Figure 82). G H
I
Diameter (mm)
Patella Sizing
Chart 25 28 31 34 37 40
1-Peg Standard 8.0 8.0 8.0 8.5 10.0 10.0
J
3-Peg Standard 8.0 8.0 8.0 8.5 10.0 10.0
Regenerex
Standard N/A 8.0 8.0 8.5 10.0 N/A
3-Peg
Figure 83
Figure 82
Patella Sizing Chart
A Anterior/Posterior Axis
Signature Personalized
Patient Care B Epicondylar Axis
Signature Personalized Patient Care utilizes patient C Distal Femoral Mechanical Axis
specific femoral and tibial positioning guides developed
from MRI and CT imaging modality to offer an D Lateral Distal Femoral Condyle
individualized approach to total knee replacement. The
E Medial Distal Femoral Condyle
Signature System fits the femoral and tibial components
independently. When used with the Vanguard F Posterior Condylar Axis
Complete Knee System, it offers a comprehensive
solution for personalized patient care. Features of the G Lateral Plateau
Signature System include:
H Proximal Tibial Mechanical Axis Landmark
I Medial Plateau
J Medial One-third of the Tibial Tubercle
Signature Total Knee Planning Software Tibial positioning guides register on the anteromedial
tibial plateau to establish:
Software built into the Signature system allows
surgeons to visualize and specify an implant position Tibial resection
for each patient plan.
Varus/valgus angle
Automated planning algorithms generate Tibial slope angle
preoperative plan based off mechanical axis
Tibial rotation
User-friendly software for surgeon fine-tuning
Positioning guides incorporate preoperative
Instrumentation Platforms
surgeon alteration The Vanguard Complete Knee System is supported
by five instrumentation platforms, allowing the
The result of the preoperative surgical planning is
a more focused intervention with the instruments
required for surgery as well as the operative plan.
commitment to the level of constraint. These
instrumentation platforms include:
Microplasty Instrumentation
Preoperative surgeon planning is integrated into
Signature positioning guides (Figure 84). Premier Instrumentation
Microplasty Elite Instrumentation

Microplasty Total Knee Instrumentation is designed
for use with minimally invasive surgical techniques and
includes Zimmer Biomets Slidex Technology which is
designed for minimal disruption to soft tissues during
total knee arthroplasty (Figure 85).
Figure 84
Femoral positioning guides register on femoral

bearing to establish:
Figure 85
Distal femoral resection Microplasty Total Knee Instrumentation
Distal femoral valgus angle

Distal femoral flexion angle
Femoral component rotation
A/P position
Femoral component sizing
Premier Total Knee Instrumentation Vanguard Tensor Instrumentation

Premier Total Knee Instrumentation is designed for Utilizing Premier Total Knee Instrumentation, the
conventional total knee replacement. Enhanced Vanguard Tensor is designed to assist in balancing
instrument functionality allows for reproducible and soft tissues during total knee arthroplasty (Figure 88).
reliable results (Figure 86).
Figure 86

is designed for use with both traditional Figure 88
surgical methods as well as minimally invasive Vanguard Tensor Instrumentation
techniques. This instrumentation is designed for
minimization of soft tissue trauma that occurs during Premier Anterior Referencing Instrumentation
total knee arthroplasty (Figure 87). Anterior Referencing Instrumentation is available for
use with the Vanguard Complete Knee System. This
instrumentation provides for anterior referencing during
femoral preparation to accommodate the preferred
approach of individual surgeons (Figure 89).
Figure 87
Figure 89
References
1. Ritter, M. The Anatomical Graduated Component Total Knee 20. Ritter, M. Twenty-year Survivorship of Cementless Anatomic
Replacement: A Long-Term Evaluation with 20-year Survival Graduated Component Total Knee Arthroplasty. The Journal of
Analysis. The Journal of Bone and Joint Surgery. 91-B(6):74549, Arthroplasty. 25(4):507-13, 2010.
2009.
21. Hofmann, A., et al. A Response of Human Cancellous Bone to
2. Lombardi, A. et al. An Algorithm for the Posterior Cruciate Ligament Identically Structured Commercially Pure Titanium and Cobalt
In Total Knee Arthroplasty. Clinical Orthopaedics and Related Chromium Alloy Porous-Coated Cylinders. Clinical Materials.
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3. Bassett, R. Results of 1,000 Performance Knees Cementless Versus 22. Yue, S. et al. The Fatigue Strength of Porous-coated Ti-6% Al-4% V
Cemented Fixation. The Journal of Arthroplasty. 13(4):409-13, 1998. Implant Alloy. Journal of Biomedical Materials Research. 18:104358,
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5. Kurtz, S. et al. The UHMWPE Handbook: Ultra High Molecular 176:42-51, 1983.
Weight Polyethylene in Total Joint Replacement. Elsevier Academic
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Strength of a Cast, Porous-coated Co-Cr-Mo Alloy. Journal of
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7. Testing done on animal models.
26. Engh, G. et al. In Vivo Deterioration of Tibial Baseplate Locking
8. Peterslidge, W. et al. The Effect of Trochlear Design on Patellofemoral Mechanisms in Contemporary Modular Total Knee Components.
Shear and Compressive Forces in Total Knee Arthroplasty. Clinical Journal of Bone and Joint Surgery. 83-A:16605, 2001.
Orthopaedics and Related Research. 309:13645, 1994.
27. Wasielewski, R. et al. Tibial Insert Undersurface as a Contributing
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Incidence of Patella Clunk Syndrome. International Orthopaedics. Research. 345:539, 1997.
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28. Sosa, M. et al. Micromotion Between the Tibial Tray and the
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Legacy Total Knee Arthroplasty Systems with Respect to Patella Canada, May, 1996.
Complications. The Journal of Arthroplasty. 23(6):822-25, 2008.
29. Pagnano, M. et al. Tibial Osteolysis Associated with the Modular
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Stresses in Ultra-High Molecular Weight Components for Total Joint Bone and Joint Surgery. 83-A(10):154548, 2001.
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Total Knee Replacements with Flat Bearings. Scientific Exhibit, 59th
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33. Ranawat, C. et al. Impact of Modern Technique on Long-term
14. Meding, J. et al. Total Knee Arthroplasty with 4.4mm of Tibial Results of Total Condylar Knee Arthroplasty. Clinical Orthopaedics
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34. Lombardi, A. et al. The PCL: To Save or Not to Save. A Mid-to-
15. Robertson, O. et al. The Swedish Knee Arthroplasty Register, A Long-Term Survivorship Comparison within a Single Total Knee
Nation-Wide Study of 30,003 Knees 1976-1992, Department Arthroplasty System. Scientific Exhibit, 69th Annual AAOS Meeting,
of Orthopaedics, University Hospital, Lund, Sweden. Acta Dallas, Texas, February, 2002.
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35. Banks, S. et al. Function of Total Knee Replacements During Activities
16. Paavaolainen, P. Long-Term Results of Total Joint Arthroplasty. of Daily Living. Scientific Exhibit at AAOS, Orlando, Florida, 2000.
Results of a 15-year Follow-up on a Nationwide Registration
Programme in Finland with 67,714 TJAs. National Agency for
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Years. Journal of Arthroplasty. 15(4): 418423, 2000.
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19. Bhambri, S. et al. The Effect of Aging on Mechanical Properties
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Notes
Notes
*A collaborative partnership with Materialise.
All trademarks herein are the property of Zimmer Biomet or its
subsidiaries unless otherwise indicated.
This material is intended for the sole use and benefit of the Zimmer
Biomet sales force and physicians. It is not to be redistributed, duplicated
or disclosed without the express written consent of Biomet.
For product information, including indications, contraindications,
warnings, precautions and potential adverse effects, see the package
insert and Zimmer Biomets website.
2016 Zimmer Biomet
Legal Manufacturer
Biomet Orthopedics
P.O. Box 587
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Vanguard

Complete Knee System

Vanguard Cruciate Retaining (CR) Knee Design Features

Femoral Design Features........................................................................................... 5

Removable Femoral Lugs/Augments........................................................................ 6

Tibial Tray Design Features...................................................................................... 12

Table of Contents (cont.)

Signature Personalized Patient Care..................................................................... 16

Vanguard Posterior Stabilizied (PS) Knee Design Features

Femoral Design Features......................................................................................... 20

PS Femoral Box Design............................................................................................ 21

Cam and Post Design............................................................................................... 22

Table of Contents (cont.)

Tibial Tray Design Features...................................................................................... 28

Signature Personalized Patient Care....................................................................... 31

Vanguard Cruciate Retaining (CR) Knee Design Features

Advanced Technology Signature Personalized Patient Care

See page 16 for more information regarding the

See pages 9-10 for more information regarding E1

Femoral Design Features Deeper/Swept-back Trochlear Groove

Rounded sagittal profile

Rounded Sagittal Profile

The wider proximal trochlear groove offers excellent

A round sagittal profile, as found in the Vanguard

Sizing Removable Femoral Lugs/Augments

Articulation Features The coronal geometry features softened intercondylar

*with the exception of the Vanguard Anterior Stabilized (AS) Bearing

The Vanguard Tibial Bearings have a deep anterior CR Bearing Options

Bearing Technologies Zimmer Biomet has continued the commitment to

Hip Simulator Wear Testing

to be more oxidatively stable than sequentially 43.4

crosslinked and annealed polyethylene4 (Figure 17). 40

This manufacturing process allows E1 material to

Volumetric Wear Rate

48.1 40.8 45.8 46.1

Tensile Strength (MPa) Yield Strength (MPa)

Polyethylene Thickness PPS Porous Plasma Spray Coating

Regenerex Porous Titanium Construct Locking Mechanism

Features of the locking mechanism design include

Peripheral polyethylene thickness is maintained

The large potential surface area for biologic fixation

Tibial Tray Design Features

The modular design of the Vanguard Tibial Tray is

Sizing Tibial Baseplate Options

Of all the tibial trays tested in one study, the modular

The Regenerex Tibial Tray is compatible with four Stem Options

The combination of a Morse-type taper and screw

Interlok Offset Tibial Baseplate, Interlok Stemmed

Patellar Articulation Regenerex Patella

Series A patellas are available in one and three peg

offer an individualized approach to total knee

and tibial components independently. When used

comprehensive solution for personalized patient care.

Signature Planning Landmarks

These landmarks include (Figure 36): Automated planning algorithms generate

H Proximal Tibial Mechanical Axis Landmark

J Medial One-third of the Tibial Tubercle

Signature Positioning Guides Instrumentation Platforms

These instrumentation platforms include:

Figure 37 Microplasty Total Knee Instrumentation

Distal femoral valgus angle

Premier Total Knee Instrumentation Vanguard Tensor Instrumentation

Microplasty Elite Total Knee Instrumentation

Vanguard PS Knee Design Features