ADVANCE. Knee System Family. Medial-Pivot Kinematics. Sound Clinical History. Superior Instrumentation.

Transcription

1 ADVANCE Family Medial-Pivot Kinematics. Sound Clinical History. Superior Instrumentation.

2 Family The Leader in Knee Implants with Stability Two different design philosophies, the progressive and the traditional, have been combined to form the. ENHANCED TIBIOFEMORAL CONTACT AREA 4,5 CONTACT AREA (mm 2 ) 0 Progressive Philosophy (Natural Kinematic Design) The Medial-Pivot, Double-High, and Unicompartmental Knee Systems are pioneering the future of knee replacement. They are based on contemporary medial-pivoting kinematic studies by prominent researchers such as Rick Komistek, PhD; David Blaha, MD; and Michael Freeman MAR. 1,2,3» Superior patient stability» Highest contact through range of motion (Figure 1)» Minimal polyethylene wear Medial-Pivot Knee GENESIS II LCS Natural Ultra Congruent PFC Sigma Profix Conforming Traditional Philosophy (Insall Berstein Design Legacy) The Posterior Stabilized and Revision Systems are clinically-proven implants designed in conjunction with the Hospital for Special Surgery; a preeminent institution for total knee development.» Long-term clinical history» Literature-supported security» Predictable performance FIGURE The History of the Medial-Pivot PCL-Substituting Stemmed Medial-Pivot Unicompartmental Double-High PCL-Retaining PROGRESSIVE TRADITIONAL Posterior-Stabilized Revision STATURE s

3 Medial-Pivot Knee Medial-Pivot/Double-High Femoral Component with Constant Radius Due to the high stability and rotation provided by the partial ball-in-socket articulation, the Medial-Pivot Knee functions like a normal knee. In fact, studies have shown it is preferred by 8 out of 10 patients with an Medial-Pivot Knee in one leg and a competitive design in the other. 7,8 2 CONSTANT RADIUS In the normal knee, the medial femoral condyle exhibits less roll than the lateral condyle during motion. The Medial-Pivot Knee was the first major system to address and replicate these kinematics. Medial-pivoting kinematics is a critical design rationale, which has grown through the acceptance of modern kinematic studies and clinical success. 1,2,3,7,8,9 Intra-operative Options without Additional Resections 0 30 Constant radius from 0-90 (1)» High contact area throughout ROM» Maintains constant ligamentous tension throughout range of motion PCL SACRIFICING YOUR C Patella track at anatomic angle and depth Medial-Pivot Insert Med Ball-in-S Does not require a large intercondylar resection Raised anterior lip (2)» Replaces the spine of a traditional posterior stabilized knee» Allows PCL-substitution 2 Lateral trough» Allows 15 of natural rotation for deep flexion» Allows freedom of rotational alignment Medial Poste Provides Stab SAME TIB Ball-in-socket articulation» Provides patient stability through range of motion 7,8» Highest contact area through range of motion Tibial Bases Available in porous coated or non-porous Modular stem options Locking mechanism resists micromotion Medial-Pivot Knee

4 Double-High Knee OICE OF INSERTS ial ocket Medial Ball-in-Socket Constant Radius Femur (0-90 ) Used for PCL-retaining or sacrificing Matches medial conformity on insert Maintains constant contact area PCL RETAINING Double-High Insert The Leader in PCL-retaining Knees The Double-High Knee received its name because it provides high flexion and high stability in PCL-retaining knees. To manage more dynamic function, the articular surface features a raised anterior lip like the Medial-Pivot Knee and a PCL-guided flexion path to provide anterior stability and deep natural flexion. The Double-High Knee utilizes the same femoral, tibial and patellar components as the Medial-Pivot Knee. An insert exchange (with no additional bone cuts) is required to convert from PCL-retaining to sacrificing intraoperatively. Raised Anterior Lip» Reduces anterior sliding (paradoxical motion) by maintaining the femoral placement through flexion 5,10» May share anterior stresses with the posterior cruciate ligament (PCL), allowing longer, more effective PCL function» Designed to minimize PCL loosening 11,12,13 PCL-guided Flexion Path» Designed to allow the PCL-dictated translation and rotation demonstrated in deep flexion 4,14» Medial side Features low-profile articular surfaces to allow PCL-guided flexion 4» Lateral Side Allows the anterior/posterior translation found in the normal knee rior Lip ility IAL BASE OPTIONS Reduced Medial Posterior Lip to allow PCL-Guided Flexion Double-High Knee

5 Stature Specific Knees Designed for the Man or Woman with a Narrow Femur. The Medial-Pivot and Double-High Knees are designed to reproduce normal motion and anatomy. However, determining correct femoral size is difficult in men or women with a narrow distal femur. 18 An implant that fits anterior/posterior may overhang medial/ lateral. 1 To prevent overhang, a smaller implant with a shorter anterior/posterior dimension may be utilized. 19 Respectively, this can lead to soft tissue interference or mid-flexion instability due to excessive posterior condyle resection. Narrow Femur ADVANCE STATURE Femoral Components (represented in teal) are designed to accommodate those male or female femora with a larger anterior/posterior dimension than medial/lateral. This helps ensure your patients will receive the best implant fit possible. Standard Femoral Component Normal Femur STATURE Femoral Component Stature Specific Knees

6 Stemmed Medial-Pivot Knee The Leader in Bone Conserving Revision The Stemmed Medial-Pivot Knee offers the same kinematic benefits as the primary Medial-Pivot Knee, yet accepts a full line of augments, stems, and tibial bases. Unlike other revision systems, the Stemmed Medial-Pivot Knee significantly reduces femoral bone loss by not requiring a full housing resection. Constant radius from 0-90 (A)» Highest contact through range of motion (Figure 1)» Deepened and extended anatomic patellar groove (B)» Maintains constant ligamentous tension throughout motion Raised anterior lip (C)» Replaces the spine of a traditional posterior stabilized knee» Allows PCL-substitution» Does not require a large intercondylar resection A E C F B D Lateral trough (D)» Allows 15 of natural rotation for deep flexion» Allows freedom of rotational alignment Ball-in-socket articulation (E)» Provides patient stability 7,8» May limit paradoxical motion 15 Available in porous and nonporous femoral options» Nonporous option accepts stem extensions and augments» Canal-filling stems in 100mm and 140mm lengths Coronal slot conforms to endosteal bone changes» Cemented stems in 30mm, 65mm, and 100mm lengths» Femoral augments in 5mm and 10mm Tibial bases available in porous, nonporous, and offset options» Tibial block augments in 5mm,10mm, and 15mm; 15 wedges Anterior femoral stem position (F)» Maximizes contact with anterior cortex» Restores flexion gap Stemmed Medial-Pivot Knee

7 Posterior-Stabilized Knee The Leader in Clinical History The Posterior Stabilized (PS) Knee is the third generation of Insall/ Burstein knee; designed by the Hospital For Special Surgery. The I/B knees are considered the gold standard for PS knees, with a reported 98% survivorship at 14 years. 16 A B C D Patellar track (A)» Deepened to minimize anterior patella displacement» Extended to maintain patellofemoral contact» Transition radius minimizes patellar clunk (B) Patented HSS spine/cam mechanism (C)» Spine placed posteriorly for increased flexion» Spine length increased to prevent subluxation» Provides patient stability Increased M/L conformity for greater contact area (D) Same femoral cuts as the Medial-Pivot with the addition of a separate housing resection C The Posterior-Stabilized Knee employs a patented spine/cam mechanism for greater patient stability. PS

8 Revision The Leader in Clinical History and Simplicity The Revision Knee was designed in conjunction with the Hospital For Special Surgery to provide a complete revision system with exemplary clinical history. Its instrumentation simplifies revision surgery while providing options for any situation. A B C D Accepts stem extensions and augments (A)» Canal-filling stems in 100mm and 140mm lengths Coronal slot conforms to endosteal bone changes» Cemented stems in 30mm, 65mm, and 100mm lengths» Femoral augments in 5mm and 10mm» Tibial block augments in 5mm,10mm, and 15mm; 15 wedges Reduced flange width minimizes M/L overhang (B) HSS spine/cam mechanism (C)» 1 up/1 down size interchangeability Tibial bases available in porous, nonporous, and offset options (D) Accepts standard Posterior Stabilized and Constrained (CCK) inserts» CCK & CCK Minus inserts Allows 1 internal/external rotation Allows.5 varus/valgus movement E Anterior stem position (E)» Maximizes contact with anterior cortex» Restores flexion gap Same femoral cuts as the Stemmed Medial-Pivot with the addition of a separate housing resection Revision

9 Unicompartmental Knee The Leader in Resurfacing Unicompartmental Knees A The Unicompartmental is based on many of the same philosophies that have led to the success of the Medial-Pivot Knee. It incorporates a constant radius of curvature and offers a constant contact area. In addition, the instrumentation brings reproducibility to resurfacing the knee.» Constant radius from (A) Anatomic shape mimics posterior condyles Bone conserving Same radius as the Medial-Pivot femoral component» Constant contact area beyond 10 flexion» 7 angled anterior flange replicates the curvature of distal femur and promotes central tracking (B)» Low profile distal tip minimizes patellar impingement (C)» Conservative fin/peg (D) Provides optimal fixation with minimal bone loss 17» Dual pegs and peripheral cement capture improve tibial base fixation (E)» Easily Converts to an Total Knee Replacement D C B E Unicompartmental Knee

10 Instrumentation Options for ADVANCE Knees ODYSSEY MIS ARC Instrumentation ODYSSEY MIS Knee Instruments: The Leader in Minimally-Invasive Approaches Reduced Incisions with Uncompromised Results In MIS, instrument accuracy is paramount. Instruments must help ensure the benefits of MIS without endangering long-term results. ODYSSEY MIS instruments are designed for stability, simplicity, and accuracy within a reduced surgical approach.» All instruments are low-profile to reduce soft-tissue interference» Simplified instruments affix rigidly to bone for greater accuracy» Resection slots hold saw blades more rigidly than standard instruments to provide more accurate resections» Measurement styli are sleek and rigid to slide under soft tissues without distortion» All resections may be easily adjusted to prevent anterior notching, excess condyle resection and mal-alignment Precision in Any Incision ODYSSEY instruments offer an advantage for traditional approaches as well. For patients with excess soft tissue, the accuracy and reduced size of the ODYSSEY instruments allow for easy maneuvering within substantial soft tissues. ODYSSEY instruments are available in Distal Cut First or Anterior Rough Cut philosophies to match the technique you find most comfortable. 9 SRP Knee Instruments Twenty-five years ago, our patented SRP instruments drastically increased the reproducibility of total knee instrumentation by featuring resection blocks linked to an intramedullary rod. This single reference point offered greater accuracy than other instrument systems of the day; allowing A/P guide adjustment and precision resections. Due to this impressive clinical history, SRP instruments have been adapted to our primary s. ODYSSEY and SRP Knee Instrumentation

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12 References Komistek, R.; Walker, SA: An in vivo kinematic determination of the F/S 1000 medial pivot knee. Wright Medical Technology, Inc., Test Request TR , S.G. Elias, MD, MAR; Freeman, MD, FRCS; and E.I. Gokcay, MD: A Correlative Study of the Geometry and Anatomy of the Distal Femur. Clinical Orthopedics Related Research: 260, Blaha JD, et al. In vivo determination of kinematics for subjects having either an anterior cruciate ligament retaining or medial pivot total knee arthroplasty. Scientific Exhibit AAOS, Stuchin S, Intermediate term follow-up of a new medial-pivot total knee. Poster presentation. AAOS Komistek RD, et al. In vivo fluoroscopic analyses of the normal human knee. Clin Orthop 410: Minoda M, et al. Polyethylene Wear Particles in Synovial Fluid After Total Knee Arthroplasty. Clin Orthop. 410: ,2003. Kurosaka M, et al. Maximizing flexion after total knee arthroplasty. The needs and the pitfalls. J Arthroplasty 17(4) suppl Lotke PA. The posterior cruciate ligament in total knee arthroplasty: a commentary. University of Pennsylvania Orthopaedic Journal. Vol 12: Wright Medical Technology Report. Clinical survey of patient satisfaction A study of bilateral knee recipients. MK Schmidt R, Blaha JD, Penenberg BL, Maloney WJ, Komistek RD, Fluoroscopic analyses of cruciate retaining and medial pivot knee implants. Clin Orthop 410: Mahoney OM, Noble PC, Rhoads DD, Alexander JW and Tullos HS. Posterior cruciate function following total knee arthroplasty: A biomechanical study. J Arthroplasty, 9: Laskin R, O Flynn H. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Clin Orthop 345: Nelson CL. Total knee arthroplasty with preservation of the posterior cruciate ligament. University of Pennsylvania Orthopaedic Journal. Vol 12: Pritchett JW, Patient preferences in knee prostheses. JBJS (BR): , Schmidt R, Komistek R, et al., Fluoroscopic Analyses of Cruciate-Retaining and Medial-Pivot Knee Implants. Clin Orthop Relat Res. 410: Font-Rodriguez DE, G. Scuderi, J. Insall, R. Windsor and M. Moran: Survivorship of Cemented total knee arthroplasty., Clin Orthop Relat Res. Dec;(345): Wright Engineering Report, ER Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE. Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res.1996 Oct;(331): K Hitt, et al. Anthropometric Measurements of the Human Knee: Correlation to the Sizing of Current Knee Arthroplasty Systems. JBJS 85: (2003). Wright Medical Technology, Inc Airline Road Arlington, TN phone toll-free Wright Medical Europe, SA Rue Pasteur BP Toulon Cedex 9 France phone Trademarks and Registered marks of Wright Medical Technology, Inc. Covered by one or more of the following US Patents: ; ; ; ; ; ; Patents pending Wright Medical Technology, Inc. All Rights Reserved. MK Rev.0807