CORI Robotic Hip and Knee Replacement

LEGION^◊ CR Knee with VERILAST^◊ technology was lab-tested for 30 years of wear performance.¹ (See Important Testing Note below)

We understand that “30 years of wear performance” is a pretty significant statement for any implant manufacturer to make. That’s why we want you to see how we can back it up.

Initial testing

Using an internationally accepted testing protocol, our LEGION Knee with VERILAST Technology was placed alongside identical implants made from cobalt chrome and a standard plastic liner and cobalt chrome and an XLPE liner into a sophisticated machine that continually simulates the cycle of movement required by a normal walking motion. Each cycle is equivalent to the range of movement required for an average person to take a step.²

During the first phase of testing, all three implant types were placed under a load of 899 pounds, or 4.9 times the typical body weight of a knee replacement patient (185 pounds), while the machine completed 5 million cycles. The machine was then stopped and all of the implants were carefully measured to determine how much wear had occurred to the metal and plastic components. The results from this first phase of wear testing very encouraging.

Continued testing

Armed with the data from the first 5 million cycles, we decided to continue “walking” the LEGION CR Knee with VERILAST Technology Implant out to 45 million cycles – the equivalent of 30 years of an active adult’s life under typical conditions.^3-9

After a total of nearly three years of continuous laboratory wear testing, the results surpassed even our high expectations.

After 45 million cycles, the LEGION CR Knee with VERILAST Technology showed 81% less wear – even when compared to the cobalt chrome knee that was stopped after only 5 million cycles.

Why 45 million cycles?

Based on scientific literature reviews, a person who undergoes knee replacement surgery at the relatively young age of 45 years old would subject the implant to between 36 and 44 million cycles over a 30-year period, depending on how active the person’s lifestyle is. Smith & Nephew chose the high end of this range – 45 million cycles – as the simulated 30-year mark.

Important testing note

VERILAST knee wear testing and results apply only to the VERILAST LEGION CR Primary Knee System only. Extended lab-testing for other VERILAST knee systems have not been performed. 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.

Important safety notes

Knee replacement surgery is intended to relieve knee pain and improve knee functions. However, implants may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon’s limitations on activity level. Early failure can happen if you do not guard your knee joint from overloading due to activity level, failure to control body weight or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

References

1. ASTM F2384.19404-1 and ASTM F75.17485-1
2. ISO 14243-3
3. 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.
4. 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.
5. 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).
6. Gioe TJ et al., “Knee Arthroplasty in the young patient – Survival in a community registry”. Clin Orthop Relat Res, 464:83-87, 2007.
7. Wallbridge N and Dowson D. “The walking activity of patients with artificial hip joints”. Eng Med 11:95, 1982
8. 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
9. 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.
   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.

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2020 Smith & Nephew, All Rights Reserved.

JOURNEY^◊ II XR

Rediscover your active life with the high performance

A New Chapter in Knee Implants

Recent advances in biomedical engineering software have opened a new chapter in high performance knee implants.

One remarkable breakthrough has been the creation of the JOURNEY^◊ II XR Active Knee System, which combines an implant designed to restore the stability and natural motion of the human knee with low-friction materials that may help extend the longevity of the implant itself.

While the longevity of a knee implant is heavily influenced by the materials used to make it, the natural feeling of the implant during physical activity is dependent upon the way the patient’s muscles, ligaments and tendons are addressed during surgery and by the implant’s shape within the body after surgery.

Every knee implant design is faced with two important challenges; how to recreate the normal swing-and-rotate motion of your natural knee, and how to restore stability to your joint after surgery.

For the first challenge, conventional knee implant designs have attempted to recreate the natural, fluid motion of the knee with either a rotating platform (a simple pivot point) within the implant or by requiring an angled alignment of the implant during surgery. Both of these options force the muscles around your knew joint to work harder as they adjust to the joint’s new and unnatural shapes and movement patterns.

For the second challenge, most implants rely on design aspects within the plastic insert to provide the stability that is sacrificed after the anterior and posterior cruciate ligaments (ACL/PCL) within your joint are removed to accommodate the new implant.

JOURNEY II XR is Different

Fortunately, the JOURNEY II XR Knee Implant is different from most knee implants.

First, the JOURNEY II XR implant features an anatomically shaped femoral component and two plastic inserts designed to work together to reproduce the original internal shapes and forces of your natural knee as it goes through its full range of motion. This attention to anatomic detail means that the muscles and other soft tissues around your joint don’t have to adjust to unfamiliar stresses and you may be able to return to a natural pattern of motion after surgery.

Second, the JOURNEY II XR uses a U-shaped tibial base plate that fits around your healthy ACL and PCL, allowing them to remain in place and function normally after surgery. In short, the function of these important ligaments doesn’t have to be re-engineered because they were never removed.

Added Durability

The JOURNEY II XR implant addresses durability with VERILAST◊ Technology, a combination of two wear reducing materials – the proprietary OXINIUM◊ metal alloy and a highly cross-linked plastic insert – that were designed to address wear on both surfaces of the implant.

Because it is twice as hard as cobalt chrome, the most commonly used metal in knee implants, implants made with OXINIUM material have been shown in lab testing to reduce joint wear by more than 80% when compared to cobalt chromium components.¹

VERILAST Technology was designed to address “wear and tear,” which is only one of several reasons why a knee implant may need to be replaced. Each patient should listen carefully when his or her orthopedic surgeon reviews other risks that can shorten the life of a new knee – such as infection, weight gain or high impact sports.

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 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.

Not all patients are candidates for the JOURNEY II XR Knee Implant. Discuss your condition and implant options with your surgeon.

Disclaimer

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. jHunter, G., and Long, M., Abrasive Wear of Oxidized Zr-2.5Nb, CoCrMo, and Ti-6Al-4V Against Bone Cement. 6th World Biomaterials, Minneapolis, MN 2000, p. 835

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2020 Smith & Nephew, All Rights Reserved.

The rationale behind the concept of PHYSIOLOGICAL MATCHING^◊ is simple: any change you make to the knee joint will ultimately impact the entire leg. Of course, as is so often the case, simple rarely means easy.

The primary hurdle to overcome in a knee replacement is the knee itself. Described as a hinge joint, the knee actually does much more than bend back and forth. In fact, every time your knee bends, forces in and around the knee cause it to move with a complex rotational motion that most of us never realize. However, when that motion is removed after knee replacement, the result can be disappointing.

Traditionally, most knee implants have attempted to replace the natural swing-and-rotate of the knee by building a simple pivot point into the implant (known as a rotating platform) or by using a slightly angled alignment of the implant during surgery. Unfortunately, both of these options can force the muscles and ligaments around the new joint to work harder and move in unfamiliar, stressful ways; resulting in pain, muscle fatigue and an unnatural feeling while walking or bending the knee.

The JOURNEY^◊ II implant was designed using Smith & Nephew’s proprietary LifeMOD^◊ human simulation software. This advanced software system allows engineers to examine in a virtual 3-D environment the exact internal shapes and angled forces that act on the knee throughout each phase of motion. As a result, the JOURNEY II implant has been designed to physiologically match how the hard structures of a normal knee joint move and rotate in an effort to maintain normal muscle activity and return the patient’s stride to it’s a natural rhythm.

Important safety note

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.

Talk to your doctor to determine what treatment may be best for you.

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2020 Smith & Nephew, All Rights Reserved.

The right “feel” often starts with the right design

To most of us, total knee implants all look very similar. With the exception of color (the OXINIUM^◊ alloy used in JOURNEY^◊ II implants is black while the cobalt chrome used in other implants is silver), it can take an experienced eye to see the subtle differences in size and shape between two implants. However, as subtle as the differences may seem, they can often have a profound impact on how an implant feels to the patients after surgery.

Fortunately, JOURNEY II implants were designed using a concept called PHYSIOLOGICAL MATCHING^◊. This unique process begins with proprietary human simulation software that virtually recreates the exact internal shapes and angled forces that act on the knee through each phase of motion. This detailed information helped Smith & Nephew engineers create an implant that replicates as closely as possible the complex, natural rotation of the knee.

Important safety note

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.

Talk to your doctor to determine what treatment may be best for you.

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2020 Smith & Nephew, All Rights Reserved.

Implant materials can impact durability

Virtually all total knee replacement systems use a combination of metal and plastic components to replace the surfaces of a damaged knee. Metal is typically used to replace the surfaces of the bone, while plastic is most commonly used to replace the joint’s cartilage.

Unfortunately, the metal and plastic surfaces of an implant can wear down over time. The primary cause of this “implant wear” is the friction created when the upper, metal, part of an implant – called the femoral component – rubs against the plastic insert. Even with pristine implants, over time, this friction can cause tiny particles of the insert to wear away. If the metal component becomes scratched for any reason, this destructive process can be increased dramatically. In fact, this type of implant wear is a leading cause of premature knee replacement failure.

Fortunately, implant wear can be offset by using advanced, wear-reducing materials during the creation of the implant.

VERILAST^◊ Technology

Unlike other implants that only available with cobalt chrome for their metal femoral components, the JOURNEY II Active Knee implant can also be made with a proprietary metal alloy called OXINIUM^◊ Oxidized Zirconium. While cobalt chrome has been used successfully for years, laboratory tests have shown that the “ceramicized” OXINIUM metal alloy is twice as hard as cobalt chrome and can be twice as resistant to the type of scratching that can cause implant wear.¹ First introduced in 1997, OXINIUM implants have been used in more than 1 million surgeries around the world.

And since each implant is a combination of metal and plastic, JOURNEY II implants also use a harder, highly cross-linked polyethylene known as XLPE for the plastic insert.

Working together, these materials form a bearing surface combination known as VERILAST Technology, which is unique to global medical device maker, Smith & Nephew.

Important testing note

VERILAST Technology has been designed to address “wear and tear,” which is only one reason why a knee implant may need to be replaced. Listen carefully when your orthopedic surgeon reviews other risks that can shorten the life of your new knee – such as infection, excessive weight gain or high impact sports.

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 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.

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.

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2020 Smith & Nephew, All Rights Reserved.

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

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

Enter VERILAST^◊ Hip Technology – a remarkable combination of advanced, low-friction materials that was designed to address implant wear on both surfaces of the implant: the award-winning OXINIUM^◊ Oxidized Zirconium, a ceramicised metal alloy for the ball, and a highly “cross-linked” plastic for the socket. In fact, laboratory testing has shown that VERILAST Technology is capable of reducing hip implant wear by 67% when compared to traditional materials (cobalt chrome implants and highly cross-linked plastic) – even after 45 million cycles of laboratory wear simulation testing.2 That testing is 9 times longer than the industry standard for hip replacements! (See Important Testing Note below)

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 testing note

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.

Important safety notes

Hip replacement surgery is intended to relieve hip pain and improve hip function. However, implants may not produce the same feel or function as your original hip. There are potential risks with hip replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon’s limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

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. A. Parikh, P. Hill, V. Pawar and J. Sprague, “Long-term simulator wear performance of an advanced bearing technology for THA,” Orthop Res Soc, San Antonio, TX, Jan 26-29, 2013, 1028.
3. ASTM F2384.19404-1 and ASTM F75.17485-1

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2020 Smith & Nephew, All Rights Reserved.

What is XLPE or highly cross-linked plastic?

As remarkable as OXINIUM^◊ Oxidized Zirconium is, it is the combination of the OXINIUM material on XLPE that makes VERILAST^◊ Technology.

XLPE is created by altering chemical bonds in the polyethylene we use to create our plastic inserts. By doing so, we are able to create a tighter weave at the molecular level, thus reducing the amount of wear experienced when the metal component rubs against it. Perhaps the easiest way to think of it is like a fabric with a higher thread count.

Important safety notes

Hip replacement surgery is intended to relieve hip pain and improve hip function. However, implants may not produce the same feel or function as your original hip. There are potential risks with hip replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon’s limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2020 Smith & Nephew, All Rights Reserved.

What is the risk of hip implant fracture, chipping or squeaking?

As one of the largest joints in the body, the hip is subjected to tremendous pressures even during simple, everyday activities. For example, the weight pressing against these joints during a simple walk can be 5 to 6 times your natural body weight.

Because the hip ball component of a VERILAST^◊ Hip implant uses a metal as its base, it can withstand forces far greater than those of a ceramic hip – another material often used in in hip implants.¹

Unfortunately, while ceramic heads are biocompatible and may provide good resistance to implant wear, they can fracture under impact.²

As you will learn on the OXINIUM^◊ Oxidized Zirconium page of this site, the surface of the VERILAST Hip implant is transformed into a ceramicised metal, retaining all of the durability of the underlying metal and offering the smooth, wear-reducing surface of a ceramic.³

And because this ceramicised surface is not a coating, it cannot chip off or flake away. Finally, because the VERILAST Hip ball rotates against a highly cross-linked plastic liner, there is less concern of squeaking than there is in “hard-on-hard” implant couples like ceramic-on-ceramic or metal-on-metal implants.⁴

So whether it is fracture, chipping or squeaking that concerns you, VERILAST Hip technology addresses each of these concerns.

Important safety notes

Hip replacement surgery is intended to relieve hip pain and improve hip function. However, implants may not produce the same feel or function as your original hip. There are potential risks with hip replacement surgery such as loosening, fracture, dislocation, wear and infection that may result in the need for additional surgery. Longevity of implants depends on many factors, such as types of activities and weight. Do not perform high impact activities such as running and jumping unless your surgeon tells you the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if you do not follow your surgeon’s limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Talk to your doctor to determine what treatment may be best for you.

References

1. Data on file.
2. G. Hadley Callaway, MD, William Flynn, MD, Chitranjan S. Ranawat, MD,and Thomas R Sculco, MD. Fracture of the Femoral Head After Ceramic-on-polyethylene Total Hip Arthroplasty. Journal of Arthroplasty; Vol. 10 No. 6: 1995.
3. 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.
4. Claire L. Brockett, PhD, Sophie Williams, PhD, Zhongmin Jin, PhD, Graham H. Isaac, PhD, and John Fisher, D.Eng. Squeaking Hip Arthroplasties: A Tribological Phenomenon. Journal of Arthroplasty; Volume 28, Issue 1 , Pages 90-97, January 2013.

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2020 Smith & Nephew, All Rights Reserved.