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JOURNEY◊ II AKS implant wear

How long do you want your knee implant to last?

Just like the surfaces of your natural knee joint, friction created when the surfaces of a knee implant rub together can cause these surfaces to wear down over time. This type of implant wear is a leading cause of knee replacement failure.

Conventional wisdom indicates that most knee implants should be expected to last 10 to 15 years before implant wear becomes an issue. At Smith & Nephew, we've always thought we could do better. And since today's more active knee patients are having surgery younger and living longer, we knew we had to do better.1

Enter a remarkable combination of advanced, low-friction materials that addresses implant wear on both surfaces of the implant. This combination, formerly known as VERILAST Technology includes the award-winning OXINIUM◊ Oxidized Zirconium, a ceramicised metal alloy for the femoral side (thigh bone), and a highly "cross-linked" plastic for the tibial side (shin bone). When these two surfaces work together in the joint, they do amazing things:

  • In rigorous lab testing, Smith & Nephew's LEGION◊ CR Knee made with the combination of our OXINIUM Technology and XLPE was subjected to 45 million cycles, or simulated steps. That's equal to around 30 years of physical activity.2
  • The data showed that after 5 million cycles, the LEGION CR Knee made with the combination of our OXINIUM Technology and XLPE showed 98% less wear than did the same knee made using traditional implant materials. And when LEGION CR knee with the combination of our OXINIUM Technology and XLPE kept "walking" out to 45 million cycles, it was again compared to the traditional knee's 5 million cycle data. Even with 40 million more cycles, the LEGION knee with the combination of our OXINIUM Technology and XLPE showed 81% less wear.2-8

So while we cannot say we've eliminated implant failure due to wear, we believe our 20 years of dedicated research is paying off for patients who want to rediscover their active lives.

Important safety notes

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

References

  1. Elena Losina, Ph.D., co-director, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston; William J. Robb III, M.D., chairman, Department of Orthopaedic Surgery, NorthShore University Health System, Evanston, Ill; Feb. 10, 2012, presentation, American Academy of Orthopaedic Surgeons, annual meeting, San Francisco.
  2. Testing concluded at 45 million cycles. ISO 14243-3 defines test completion at 5 million cycles.
  3. Goldsmith AA et al., "Comparative study of the activity of the total hip arthroplasty patients and normal subjects". J Arthrop, (16)5:613-619, 2001.
  4. Morbidity and mortality weekly report, 55(40):1089-1092, October 13, 2006.(//www.cdc.gov/mmwr/preview/mmwrhtml/mm5540a2.htm?s_cid=mm5540a2_e. Accessed on October 30, 2009).
  5. Gioe TJ et al., "Knee Arthroplasty in the young patient - Survival in a community registry". Clin Orthop Relat Res, 464:83-87, 2007.
  6. Wallbridge N and Dowson D. "The walking activity of patients with artificial hip joints". Eng Med 11:95, 1982
  7. Wimmer M A et al., "Joint motion and daily activity profile of total knee patients in comparison with the ISO knee wear simulator". Paper 0159, 48th ORS, 2002.
  8. Huddleston J I et al., "How often do patients with high-flex total knee arthroplasty use high flexion?",Clin Orthop Relat Res, 467:1898-1906, 2009.
  9. Naal F D et al., "How active are patients undergoing total joint arthroplasty? A systematic review", Clin Orthop Relat Res, DOI 10.1007/s11999-009-1135-9, published online: 28 October 2009.
  10. R. Papannagari, G. Hines, J. Sprague and M. Morrison, "Long-term wear performance of an advanced bearing knee technology," ISTA, Dubai, UAE, Oct 6-9, 2010.

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References

  1. Hall, et al. Unicompartmental knee arthroplasty (alias uni-knee): an overview with nursing implications. Orthopaedic Nursing. 2004;23(3):163-171. Accessed April 25, 2019.
    • Based on pre-surgical pain levels in UKA patients.
  2. Mayman DJ, Patel AR, Carroll KM. Hospital related clinical and economic outcomes of a bicruciate knee system in total knee arthroplasty patients. Poster presented at: ISPOR Symposium; May 19-23, 2018; Baltimore, Maryland, USA.
  3. Nodzo SR, Carroll KM, Mayman DJ. The Bicruciate Substituting Knee Design and Initial Experience. Techniques in Orthopaedics. 2018;33(1):37-41
    • Compared to non-JOURNEY II knees; Based on BCS evidence
  4. 1Short-term Range of Motion is Increased after TKA with an asymmetric bicruciatestabilized implant.AcceptedPoster Presentation, AAOS 2018 New Orleans. Kaitlin M. Carroll, Peter K. Sculco, Brian CMichaels,RichardL. Murphy, Seth A, Jerabek, David J. Mayman
  5. 2J Orthop. 2017 Jan 7;14(1):201- 206. doi: 10.1016/j.jor.2016.12.005. eCollection 2017. Bi-cruciate substituting total knee arthroplasty improved medio-lateral instability in mid-flexion range
  6.  In Vivo Kinematic Comparison of a Bicruciate Stabilized Total Knee Arthroplasty and the Normal Knee Using Fluoroscopy Trevor F. Grieco, MS a, *, Adrija Sharma, PhD a, Garett M. Dessinger, BS a, Harold E. Cates, MD b, Richard D. Komistek, PhD. The Journal of Arthroplasty, September 2017
  7. Testing concluded at 45 million cycles, ISO 14242-1 and 14243-3 define test completion at 5 million cycles. The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.
  8. Iriuchishima T, Ryu K. Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019. doi:10.4103/ortho.IJOrtho_392_18.
  9. Smith JR, Picard F, Lonner J, et al. The accuracy of a robotically-controlled freehand sculpting tool for unicondylar knee arthroplasty. Congress of the International Society of Biomechanics. August 4-9, 2013. Natal, Brazil.
  10. Zardiackas, Lyle D., Kraay, Matthew J., Freese, Howard L, editors. Titanium, Niobium, Zirconium, and Tantalum for Medical and Surgical Applications ASTM special technical publication; 1471. Ann Arbor, MI: ASTM, Dec. 2005