Can you make your knees more hip?

Anatomic AP positioning of the femur in extension virtually eliminates mid-flexion instability (paradoxical sliding) 6-14

FunctionDesigned to achieve normal stability throughout the range of motion

*Patented

Anatomic mid-line sulcus

Posterior medial lip/horn

Assymetrical posterior cam*

PCL allowanceACL substitutinganterior cam*

Mid-flexion stability

Normal ModernJOURNEY II BCS TraditionalJOURNEY™ II CR

Restoring the normal kinematic patterns of the knee produces more normal muscular firing patterns throughout the range of motion - as demonstrated in lab simulation in the original JOURNEY BCS design.16

Strength

Restores Normal Quad Function3X Increase Quad ActivityMuscular Function EMG Data15

0.0

27.5

55.0

82.5

110.0

Millivolts

Patient A Patient B

Anatomic AP positioning of the femur in extension virtually eliminates mid-flexion instability (paradoxical sliding) 6-14

Function Motion DurabilityNormal motionThe JOURNEY™ II BCS Knee System has a virtually identical kinematic pattern as the normal knee throughout its range of motion.16

0° – Screw-home, anterior AP position 0° – 90° – Rollback medial pivot 90° – 155° – Posterior translation

High flexionAllow for an anatomic, deep flexion performance up to 155º.17-23

VERILAST™ TechnologyCombining the award-winning, pioneering materials of OXINIUM™ Oxidized Zirconium and highly cross-linked polyethylene (XLPE), Smith & Nephew was able to create VERILAST™ Technology, a highly durable and long-lasting material combination.

Mean volumetric wear rates of CoCr against conventional polyethylene (CPE), CoCr against crosslinked polyethylene (XLPE) and OXINIUM™ against XLPE as published by the respective companies with their respective implants.

Volu

met

ric w

ear r

ate

(m3 /

Mcy

cle)

References can be found in the 00394 V2 VERILAST Technology Messaging Brochure 11/14.* ISO 14243-1 testing protocol used. Other results obtained using ISO 14243-3 protocol

When comparing Smith & Nephew’s conventional technology to its XLPE technology, the XLPE technology provides an expected, significant reduction in wear rates. Moreover, when comparing Smith & Nephew’s XLPE technology to VERILAST Technology, there is another significant reduction in wear rates. Understanding these tests were conducted using pristine components, the differences in these wear rates would be even more pronounced with roughened components due to the resistance to micro-scratches of the VERILAST couple.

The implants identified above were tested by their manufacturers using different testing protocols and, therefore, the results are not directly comparable.

Metal ContentOXINIUM™ Oxidized Zirconium, exclusively from Smith & Nephew, has less than 0.0035% nickel content, compared to a maximum content of 0.5% in cobalt chrome and 0.1% in titanium.

Surgeons should be aware that all metal implants contain varying amounts of cobalt, chromium, and nickel.

Metal content of implants32

Maximum nickel contentMetal content of implants1

Maximum chromium content

0.0% 10% 20% 30% 40%

27-30%

<0.02%

<0.02%

Cr content % by weight

Maximum nickel content

0.0% 0.2% 0.4%

<0.0035%

0.6%

0.5%

0.1%

Ni content % by weight

Maximum cobalt content

0.0% 10% 20% 30% 40% 50% 60%

58-68%

<0.01%

<0.002%

Co content % by weight

70%

DurabilityVERILAST™ TechnologyCombining the award-winning, pioneering materials of OXINIUM™ Oxidized Zirconium and highly cross-linked polyethylene (XLPE), Smith & Nephew was able to create VERILAST™ Technology, a highly durable and long-lasting material combination.

Mean volumetric wear rates of CoCr against conventional polyethylene (CPE), CoCr against crosslinked polyethylene (XLPE) and OXINIUM™ against XLPE as published by the respective companies with their respective implants.

40

50

30

20

10

35

45

25

15

5

0

PFC Sigm

aTM

GENES

IS™ II

Scorpio

TM

Triath

lonTM

NexGen

TM

Vangu

ardTM

PFC Sigm

aTM

Scorpio

Triath

lon

NexGen

Vangu

ard

Attune

TM

Volu

met

ric w

ear r

ate

(mm

3 /M

cycl

e)

23.00 23.45

34.60

20.20

24.40

43.40

5.40

13.00

6.417.30

6.504.10

6.10

CoCr and CPE CoCr and XLPE VERILAST Technol ogy

0.58

JOURN

EY II

TKA

Not-detectible *0.97

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

24-31

GENES

IS II

References can be found in the 00394 V2 VERILAST Technology Messaging Brochure 11/14.* ISO 14243-1 testing protocol used. Other results obtained using ISO 14243-3 protocol

When comparing Smith & Nephew’s conventional technology to its XLPE technology, the XLPE technology provides an expected, significant reduction in wear rates. Moreover, when comparing Smith & Nephew’s XLPE technology to VERILAST Technology, there is another significant reduction in wear rates. Understanding these tests were conducted using pristine components, the differences in these wear rates would be even more pronounced with roughened components due to the resistance to micro-scratches of the VERILAST couple.

The implants identified above were tested by their manufacturers using different testing protocols and, therefore, the results are not directly comparable.

Metal ContentOXINIUM™ Oxidized Zirconium, exclusively from Smith & Nephew, has less than 0.0035% nickel content, compared to a maximum content of 0.5% in cobalt chrome and 0.1% in titanium.

Surgeons should be aware that all metal implants contain varying amounts of cobalt, chromium, and nickel.

Metal content of implants32

Maximum chromium contentMaximum nickel content Maximum cobalt contentMetal content of implants1

Maximum chromium content

0.0% 10% 20% 30% 40%

27-30%

<0.02%

<0.02%

Cr content % by weight

Maximum nickel content

0.0% 0.2% 0.4%

<0.0035%

0.6%

0.5%

0.1%

Ni content % by weight

Maximum cobalt content

0.0% 10% 20% 30% 40% 50% 60%

58-68%

<0.01%

<0.002%

Co content % by weight

70%

LEGIO

N™ TKS

JOURN

EY™ B

CS

Function Motion Durability

Function Motion Durability Function Motion Durability

EMGMuscleLachman Euroquol

In-Vivo FluoroKinematics

-In Vivo MRIKinematics

FluoroKSS

Bench Test

Case Reports

Stability StrengthSatisfaction FlexionTF Kinematics PF Kinematics Wear Metal Sens.

Function Motion Durability Function Motion Durability

EMGMuscleLachman Euroquol

In-Vivo FluoroKinematics

-In Vivo MRIKinematics

FluoroKSS

Bench Test

Case Reports

Stability StrengthSatisfaction FlexionTF Kinematics PF Kinematics Wear Metal Sens.

Stability Satisfaction StrengthHigh Flexion

Normal motion

Anatomic patellar tracking Wear

Metal Sensitivity

Stability Satisfaction StrengthHigh Flexion

Normal motion

Anatomic patellar tracking

WearMetal Sensitivity

References1. Phil Noble et al; Does total knee replacement restore normal knee function? 2005; CORR. (431): 157-65.2. Scott CE, Howie CR, MacDonald D, Biant LC; Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010

Sep;92(9)3. Huch K, Müller KA, Stürmer T, Brenner H, Puhl W, Günther KP. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study. Ann Rheum

Dis. 2005 Dec; 64 (12):1715-20.4. Comparing patient outcomes after THA and TKA: is there a difference? Bourne RB, Chesworth B, Davis A, Mahomed N, Charron K. Clin Orthop Relat Res. 2010 Feb;

468(2):542-6. Epub 2009 Sep 4.5. Halewood C1, Risebury M, Thomas NP, Amis AA. Kinematic behaviour and soft tissue management in guided motion total knee replacement. Knee Surg Sports

Traumatol Arthrosc. 2014 Dec;22(12):3074-82.6. Victor J, Mueller JK, Komistek RD, Sharma A, Nadaud MC, Bellemans J. In vivo kinematics after a cruciate-substituting TKA. Clin Orthop Relat Res. 2010 Mar;

468(3):807-14.7. Zingde SM, Sharma A, Komistek RD, Dennis, DA, Mahfouz, MR. In vivo comparison of kinematics for 1891 non-implanted and implanted knees. AAOS. 2009; Scientific

Exhibit No. 22.8. Zingde SM, Mueller J, Komistek RD, MacNaughton JM, Anderle MR, Mauhfouz MR. In vivo comparison of tka kinematics for subjects having a PS, PCR, or Bi-Cruciate

Stabilizing design. Orthopedic Research Society. 2009; Paper No. 2067.9. Bicruciate-stabilised total knee replacements produce more normal sagittal plane kinematics than posterior-stabilised designs.Ward TR, Burns AW, Gillespie MJ,

Scarvell JM, Smith PN J Bone Joint Surg Br. 2011 Jul;93(7):907-13.10. Catani F, Ensini A, Belvedere C, Feliciangeli A, Benedetti MG, Leardini A, Giannini S. In vivo kinematics and kinetics of a bi-cruciate substituting total knee arthroplasty:

a combined fluoroscopic and gait analysis study. J Orthop Res. 2009 Dec;27(12):1569-75.11. Morra EA, Rosca M, Greenwald JFI, Greenwald AS. The influence of contemporary knee design on high flexion: a kinematic comparison with the normal knee. JBJS

Am. 2008; 90: 195-201.12. The Mark Coventry Award: Articular contact estimation in TKA using in vivo kinematics and finite element analysis. Catani F, Innocenti B, Belvedere C, Labey L, Ensini A,

Leardini A. Clin Orthop Relat Res. 2010 Jan; 468(1):19-28. doi: 10.1007/s11999-009-0941-4. Epub 2009 Jun 23.13. Van Duren BH, Pandit H, Price M, Tilley S, Gill HS, Murray DW, Thomas NP. Bicruciate substituting total knee replacement: how effective are the added kinematic

constraints in vivo? Knee Surg Sports Traumatol Arthrosc. 2012 Oct; 20 (10):2002-10. Epub 2011 Nov 29.14. Lester DK1, Shantharam R, Zhang K. Dynamic electromyography after cruciate-retaining total knee arthroplasty revealed a threefold quadriceps demand compared with

the contralateral normal knee. J Arthroplasty. 2013 Apr;28(4):557-62. doi: 10.1016/j.arth.2012.08.024. Epub 2012 Dec 21.15. Lester DK and Shantharam R. Objective Sagittal Instability of CR-TKA by Functional EMG During Normal Walking. AAOS. 2012; Presentation No. 810.16. LifeMOD KneeSim (California).17. Victor J, Mueller JK, Komistek RD, Sharma A, Nadaud MC, Bellemans J. In vivo kinematics after a cruciate-substituting TKA. Clin Orthop Relat Res. 2010 Mar;

468(3):807-14.18. Bicruciate-stabilised total knee replacements produce more normal sagittal plane kinematics than posterior-stabilised designs.Ward TR, Burns AW, Gillespie MJ,

Scarvell JM, Smith PN J Bone Joint Surg Br. 2011 Jul;93(7):907-13.19. Morra EA, Rosca M, Greenwald JFI, Greenwald AS. The influence of contemporary knee design on high flexion: a kinematic comparison with the normal knee. JBJS

Am. 2008; 90: 195-201.20. Van Duren BH, Pandit H, Price M, Tilley S, Gill HS, Murray DW, Thomas NP. Bicruciate substituting total knee replacement: how effective are the added kinematic

constraints in vivo? Knee Surg Sports Traumatol Arthrosc. 2012 Oct; 20 (10):2002-10. Epub 2011 Nov 29.21. Arbuthnot JE, Brink RB. Assessment of the antero-posterior and rotational stability of the anterior cruciate ligament analogue in a guided motion bi-cruciate stabilized

total knee arthroplasty. J Med Eng Technol. 2009;33(8):610-5.22. Victor J, Ries M, Bellemans J, Robb WM, Van Hellemondt G. High-flexion, motion-guided total knee arthroplasty: who benefits the most? Orthopedics. 2007 Aug; 30 (8

Suppl): 77–9.23. Kuroyanagi Y, Mu S, Hamai S, Robb WJ, Banks SA. In vivo knee kinematics during stair and deep flexion activities in patients with bicruciate substituting total knee

arthroplasty. J Arthroplasty. 2012 Jan; 27(1):122-8. doi: 10.1016/j.arth.2011.03.005. Epub 2011 Apr 19.24. H. M. J. McEwen, P. I. Barnett, C. J. Bell, R. Farrar, D. D. Auger, M. H. Stone and J. Fisher, The influence of design, materials and kinematics on the in vitro wear of total

knee replacements, J Biomech, 2005;38(2):357-365.25. A. Parikh, M. Morrison and S. Jani, Wear testing of crosslinked and conventional UHMWPE against smooth and roughened femoral components, Orthop Res Soc, San

Diego, CA, Feb 11-14, 2007, 0021.26. AA. Essner, L. Herrera, S. S. Yau, A. Wang, J. H. Dumbleton and M. T. Manley, Sequentially crosslinked and annealed UHMWPE knee wear debris, Orthop Res Soc,

Washington D.C., 2005, 71.27. L. Herrera, J. Sweetgall, A. Essner and A. Wang, “Evaluation of sequentially crosslinked and annealed wear debris, World Biomater Cong, Amsterdam, May 28-Jun 1,

2008, 583.28. C. Schaerer, K. Mimnaugh, O. Popoola and J. Seebeck, “Wear of UHMWPE tibial inserts under simulated obese patient conditions,” Orthop Res Soc, New Orleans, LA,

Feb 6-10, 2010, 2329.29. Biomet publication, FDA Cleared Claims for E1 Antioxidant Infused Technology”30. Ref: DePuy Attune 510 K Document K101433 Dec 10, 201031. Ref: Smith & Nephew OR-12-12932. ASTM International Standard Specification for Wrought Zirconium-2.5Niobium Alloy for Surgical Implant Applications (UNS R60901) Designation: F 2384 – 05 and

Standard Specification for Cobalt-28 Chromium-6 Molybdenum Alloy Castings and Casting Alloy for Surgical Implants (UNS R30075): Designation: F 75 – 07.

Total Knees are not performing as well as Total Hips:• 20 – 30% Dissatisfied1,2 • Poorer return to sports3 • Lower Patient Reported Outcomes (PRO)4

The challenge

PHYSIOLOGICAL MATCHING is the pioneering technology powering JOURNEY II TKA to provide complete anatomic restoration through PHYSIOLOGICAL MATCHING.

The solution isPHYSIOLOGICAL MATCHING™ Technology

Controlsubjects

TKA patients

0 20 40 60 80 100

dancing

racquet sports

golf

carrying heavy objects

gardening

kneeling

squatting

Graph 1 2

Percent reporting no difficultyGraph 2 3

Sports activity

THA TKA

34%Post-op

42%Preop

52%Post-op

36%Preop

Return to sports activity post surgery

Conventional total knee designs are symmetric and unanatomic in shape and motion. The result of this is an unnatural ligament strain and conflicting kinematics. The anatomic restoration of JOURNEY II TKA is designed to provide higher level of patient satisfaction and activity.5

You, the surgeon, are left tempering your patients’ expectations and tolerating the limited capabilities of traditional knee replacements.

Normal

3º

Conventional

3º joint line maintained

6º

mec

hani

cal

axis an

atom

ic

axis

3º

6º

3º

JOURNEY II TKA

0º

Function Motion Durability

Function Motion Durability Function Motion Durability

EMGMuscleLachman Euroquol

In-Vivo FluoroKinematics

-In Vivo MRIKinematics

FluoroKSS

Bench Test

Case Reports

Stability StrengthSatisfaction FlexionTF Kinematics PF Kinematics Wear Metal Sens.

Function Motion Durability Function Motion Durability

EMGMuscleLachman Euroquol

In-Vivo FluoroKinematics

-In Vivo MRIKinematics

FluoroKSS

Bench Test

Case Reports

Stability StrengthSatisfaction FlexionTF Kinematics PF Kinematics Wear Metal Sens.

Stability Satisfaction StrengthHigh Flexion

Normal motion

Anatomic patellar tracking Wear

Metal Sensitivity

Stability Satisfaction StrengthHigh Flexion

Normal motion

Anatomic patellar tracking

WearMetal Sensitivity

Smith & Nephew, Inc. www.smith-nephew.com1450 Brooks RoadMemphis, TN 38116USA

Telephone: 1-901-396-2121Information: 1-800-821-5700Orders and Inquiries: 1-800-238-7538

03557 V1 06/15©2015 Smith & Nephew.

™Trademark of Smith & Nephew. Certain marks registered US Patent and Trademark Office. All Trademarks acknowledged.

References1. Phil Noble et al; Does total knee replacement restore normal knee function? 2005; CORR. (431): 157-65.2. Scott CE, Howie CR, MacDonald D, Biant LC; Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010

Sep;92(9)3. Huch K, Müller KA, Stürmer T, Brenner H, Puhl W, Günther KP. Sports activities 5 years after total knee or hip arthroplasty: the Ulm Osteoarthritis Study. Ann Rheum

Dis. 2005 Dec; 64 (12):1715-20.4. Comparing patient outcomes after THA and TKA: is there a difference? Bourne RB, Chesworth B, Davis A, Mahomed N, Charron K. Clin Orthop Relat Res. 2010 Feb;

468(2):542-6. Epub 2009 Sep 4.5. Halewood C1, Risebury M, Thomas NP, Amis AA. Kinematic behaviour and soft tissue management in guided motion total knee replacement. Knee Surg Sports

Traumatol Arthrosc. 2014 Dec;22(12):3074-82.6. Victor J, Mueller JK, Komistek RD, Sharma A, Nadaud MC, Bellemans J. In vivo kinematics after a cruciate-substituting TKA. Clin Orthop Relat Res. 2010 Mar;

468(3):807-14.7. Zingde SM, Sharma A, Komistek RD, Dennis, DA, Mahfouz, MR. In vivo comparison of kinematics for 1891 non-implanted and implanted knees. AAOS. 2009; Scientific

Exhibit No. 22.8. Zingde SM, Mueller J, Komistek RD, MacNaughton JM, Anderle MR, Mauhfouz MR. In vivo comparison of tka kinematics for subjects having a PS, PCR, or Bi-Cruciate

Stabilizing design. Orthopedic Research Society. 2009; Paper No. 2067.9. Bicruciate-stabilised total knee replacements produce more normal sagittal plane kinematics than posterior-stabilised designs.Ward TR, Burns AW, Gillespie MJ,

Scarvell JM, Smith PN J Bone Joint Surg Br. 2011 Jul;93(7):907-13.10. Catani F, Ensini A, Belvedere C, Feliciangeli A, Benedetti MG, Leardini A, Giannini S. In vivo kinematics and kinetics of a bi-cruciate substituting total knee arthroplasty:

a combined fluoroscopic and gait analysis study. J Orthop Res. 2009 Dec;27(12):1569-75.11. Morra EA, Rosca M, Greenwald JFI, Greenwald AS. The influence of contemporary knee design on high flexion: a kinematic comparison with the normal knee. JBJS

Am. 2008; 90: 195-201.12. The Mark Coventry Award: Articular contact estimation in TKA using in vivo kinematics and finite element analysis. Catani F, Innocenti B, Belvedere C, Labey L, Ensini A,

Leardini A. Clin Orthop Relat Res. 2010 Jan; 468(1):19-28. doi: 10.1007/s11999-009-0941-4. Epub 2009 Jun 23.13. Van Duren BH, Pandit H, Price M, Tilley S, Gill HS, Murray DW, Thomas NP. Bicruciate substituting total knee replacement: how effective are the added kinematic

constraints in vivo? Knee Surg Sports Traumatol Arthrosc. 2012 Oct; 20 (10):2002-10. Epub 2011 Nov 29.14. Lester DK1, Shantharam R, Zhang K. Dynamic electromyography after cruciate-retaining total knee arthroplasty revealed a threefold quadriceps demand compared with

the contralateral normal knee. J Arthroplasty. 2013 Apr;28(4):557-62. doi: 10.1016/j.arth.2012.08.024. Epub 2012 Dec 21.15. Lester DK and Shantharam R. Objective Sagittal Instability of CR-TKA by Functional EMG During Normal Walking. AAOS. 2012; Presentation No. 810.16. LifeMOD KneeSim (California).17. Victor J, Mueller JK, Komistek RD, Sharma A, Nadaud MC, Bellemans J. In vivo kinematics after a cruciate-substituting TKA. Clin Orthop Relat Res. 2010 Mar;

468(3):807-14.18. Bicruciate-stabilised total knee replacements produce more normal sagittal plane kinematics than posterior-stabilised designs.Ward TR, Burns AW, Gillespie MJ,

Scarvell JM, Smith PN J Bone Joint Surg Br. 2011 Jul;93(7):907-13.19. Morra EA, Rosca M, Greenwald JFI, Greenwald AS. The influence of contemporary knee design on high flexion: a kinematic comparison with the normal knee. JBJS

Am. 2008; 90: 195-201.20. Van Duren BH, Pandit H, Price M, Tilley S, Gill HS, Murray DW, Thomas NP. Bicruciate substituting total knee replacement: how effective are the added kinematic

constraints in vivo? Knee Surg Sports Traumatol Arthrosc. 2012 Oct; 20 (10):2002-10. Epub 2011 Nov 29.21. Arbuthnot JE, Brink RB. Assessment of the antero-posterior and rotational stability of the anterior cruciate ligament analogue in a guided motion bi-cruciate stabilized

total knee arthroplasty. J Med Eng Technol. 2009;33(8):610-5.22. Victor J, Ries M, Bellemans J, Robb WM, Van Hellemondt G. High-flexion, motion-guided total knee arthroplasty: who benefits the most? Orthopedics. 2007 Aug; 30 (8

Suppl): 77–9.23. Kuroyanagi Y, Mu S, Hamai S, Robb WJ, Banks SA. In vivo knee kinematics during stair and deep flexion activities in patients with bicruciate substituting total knee

arthroplasty. J Arthroplasty. 2012 Jan; 27(1):122-8. doi: 10.1016/j.arth.2011.03.005. Epub 2011 Apr 19.24. H. M. J. McEwen, P. I. Barnett, C. J. Bell, R. Farrar, D. D. Auger, M. H. Stone and J. Fisher, The influence of design, materials and kinematics on the in vitro wear of total

knee replacements, J Biomech, 2005;38(2):357-365.25. A. Parikh, M. Morrison and S. Jani, Wear testing of crosslinked and conventional UHMWPE against smooth and roughened femoral components, Orthop Res Soc, San

Diego, CA, Feb 11-14, 2007, 0021.26. AA. Essner, L. Herrera, S. S. Yau, A. Wang, J. H. Dumbleton and M. T. Manley, Sequentially crosslinked and annealed UHMWPE knee wear debris, Orthop Res Soc,

Washington D.C., 2005, 71.27. L. Herrera, J. Sweetgall, A. Essner and A. Wang, “Evaluation of sequentially crosslinked and annealed wear debris, World Biomater Cong, Amsterdam, May 28-Jun 1,

2008, 583.28. C. Schaerer, K. Mimnaugh, O. Popoola and J. Seebeck, “Wear of UHMWPE tibial inserts under simulated obese patient conditions,” Orthop Res Soc, New Orleans, LA,

Feb 6-10, 2010, 2329.29. Biomet publication, FDA Cleared Claims for E1 Antioxidant Infused Technology”30. Ref: DePuy Attune 510 K Document K101433 Dec 10, 201031. Ref: Smith & Nephew OR-12-12932. ASTM International Standard Specification for Wrought Zirconium-2.5Niobium Alloy for Surgical Implant Applications (UNS R60901) Designation: F 2384 – 05 and

Standard Specification for Cobalt-28 Chromium-6 Molybdenum Alloy Castings and Casting Alloy for Surgical Implants (UNS R30075): Designation: F 75 – 07.

PHYSIOLOGICAL MATCHING™ Technology

Can you make your knees more hip?