Kinematics

JOURNEY II is designed to replicate kinematics of a normal knee1.

PHYSIOLOGICAL MATCHING Technology inspired by research

When designing JOURNEY II, Smith & Nephew conducted in-depth analyses of the geometry, kinetics, kinematics and ligament behaviour of normal knees.

The findings led to the creation of PHYSIOLOGICAL MATCHING, technology intended to help provide anatomic restoration through: 

  • Function
  • Motion
  • Durability

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Tibiofemoral (TF) kinematics

The kinematic patterns of the femur and tibia of a knee design have a direct impact on patients’ reported levels of satisfaction with the outcomes of their knee replacements.1,2

Extension

  • Femur internally rotated to achieve a natural anatomic screw-home position
  • Minimal posterior femoral overhang in the sagittal plane (Proper A/P position)


Mid-flexion

  • Femur external rotation to maximize quadriceps mechanism efficiency
  • Virtual elimination of paradoxical motion to prevent mid-flexion instability


Deep flexion

  • Femur remains externally rotated to retain maximal quadriceps efficiency
  • Significant posterior femoral rollback occurs to gain clearance for deep flexion in high demand activities

Patellofemoral (PF) kinematics

The kinematic pattern in the PF joint is critically important to decrease anterior knee pain post operatively and the associated revisions.3, 4, 5, 6

  • Designed to provide improved contact which should improve wear performance3
  • Designed to provide improved patella tracking which should minimize anterior pain 3,4
  • Designed to provide more freedom of baseplate positioning without maltracking concerns 7 

Flexion

The normal kinematic patterns of movement provide the correct environment to allow an anatomic, deep flexion performance.

  • JOURNEY PFJ and JOURNEY UNI – Designed to preserve the normal anatomy of the knee, intended to promote a more natural range of motion.
  • JOURNEY II TKA – Engineered to provide for up to 155° of flexion, following in the anatomic, high flexion kinematics proven in the first generation JOURNEY BCS. 8, 9, 10, 11, 12, 13, 14

 

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References

1.   Haas S. Kinematics of the Knee & JOURNEY BCS. Insall Club Annual Meeting. June 2010.
2.   Banks SA; Fregly BJ; Boniforti F; Reinschmidt C; Romagnoli S. Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc. 2005 Oct; 13(7):551-6. Epub 2005 Jan 20.
3.  Carpenter RD, et al, Magnetic resonance imaging of in vivo patellofemoral kinematics after total knee arthroplasty, The Knee (2009), doi:10.1016/j.knee.2008.12.016
4.  Brihault J. Ries MD. Measuring patellar height using the lateral active flexio radiograph: Effect of total knee implace design. Knee. 2010 March; 17(2):148-51. doi:10.1016/j.knee.2009.07.008 Epub 009 Aug.31
5.  Leopold SS, Silverton CD, Barden RM, Rosenberg AG. Isolated revision of the patellar component in total knee arthroplasty. J Bone Joint Surg Am 2003; 85-A:41–7.
6.  Breugem SJ, van Ooij B, Haverkamp D, Sierevelt IN, van Dijk CN. No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years. Knee Surg Sports Traumatol Arthrosc. 2012 Nov 3. http://www.ncbi.nlm.nih.gov/pubmed/23124601)
7. Lee GC, Garino JP, Kim RH, Lenz N. Contributions of Femoral, Tibial and Patellar Malposition to Patellar Maltracking in Total Knee Arthroplasty. AAOS. 2013; Poster No. 114
8.  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.
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. 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.
11. 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.
12. 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. JMed Eng Technol. 2009; 33(8):610-5.
13. 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.
14. 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.