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Cruciate Retaining Knee System



Designed to be a kinematically correct cruciate retaining TKA


The solution is PHYSIOLOGICAL MATCHING Technology through function, motion and durability



Anatomic, articular surfaces are designed to restore native anatomy and yield a normal anatomic A/P position throughout the range of motion.

  • Anterior stability is provided by a high posterior medial lip which mimics ACL function in full extension and early gait.
  • Provides a proper femoro-tibial A/P position yielding a virtual elimination of paradoxical motion, anterior sliding of the femur during flexion.6-13


  • More normal muscle firing patterns are expected due to the proper A/P positioning, thereby helping to prevent muscle fatigue during activities of daily living.
  • Restoration of both the anatomic A/P alignment and the normal kinematic patterns of the knee should produce more normal neuromuscular firing patterns throughout the range of motion—as demonstrated in the original JOURNEY BCS design.10, 15

Satisfaction (Proprioception)

Restoration of more normal neuromuscular firing patterns throughout the range of motion should improve a patient’s ability to perform the activities they are demanding—as demonstrated in the original JOURNEY BCS design.18, 1


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.19, 20


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


  • 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.22, 23, 24, 25

  • Provides improved contact which should improve wear performance 22
  • Provides improved patella tracking which should minimize anterior pain 22, 23
  • Provides more freedom of baseplate positioning without maltracking concerns 26


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

  • Engineered to provide for up to 155° of flexion, following in the superior anatomic, high flexion kinematics proven in the first generation JOURNEY BCS. 6, 9, 11, 13, 14, 28, 29

For more information, visit the JOURNEY II TKA page. 


*Please see reference tab for the full list of references. 



1. US Department of Health and Human Services Agency (HHSA) for Healthcare Research and Quality (AHRQ) Knee Replacements Up Dramatically Among Adults 45 to 64 Years Old. AHRQ News and Numbers, November 3, 2011. Agency for Healthcare Research and Quality, Rockville, MD.
2. Phil Noble et al; Does total knee replacement restore normal knee function? 2005; CORR. (431): 157-65.
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. Functional comparison of posterior cruciate-retained versus cruciate-sacrificed total knee arthroplasty. Dorr LD, Ochsner JL, Gronley J, Perry J. Clin Orthop Relat Res. 1988 Nov; (236):36-43.
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. 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.
15. Lester DK and Shantharam R. Objective Sagittal Instability of CR-TKA by Functional EMG During Normal Walking. AAOS. 2012; Presentation No. 810.
16. Pritchett JW. Patient preferences in knee prostheses. J Bone Joint Surg Br. 2004 Sep; 86(7):979-82.
17. Pritchett JW. Anterior cruciate-retaining total knee arthroplasty. J Arthroplasty. 1996 Feb; 11(2):194-7.
18. Rajgopal A; Dahiya V; Kochhar H. Bi-Cruciate Substituting Total Knee Arthroplasty Early Experience. International Society for Technology in Arthroplasty: 22 Congress. 2009; Poster No. 107.
19. Haas S. Kinematics of the Knee & JOURNEY BCS. Insall Club Annual Meeting. June 2010
20. 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.
21. Mahfouz MR, Komistek RD, Dennis DA, Hoff WA. In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am. 2004;86-A Suppl 2:56-61.
22. 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
23. Brilhault J, Ries MD. Measuring patellar height using the lateral active flexion radiograph: Effect of total knee implant design. Knee. 2010 Mar;17(2):148-51. doi: 10.1016/j.knee.2009.07.008. Epub 2009 Aug 31.
24. 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.
25. 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. [Epub ahead of print] (
26. 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
27. Nha KW, Papannagari R, Gill TJ, Van de Velde SK, Freiberg AA, Rubash HE, Li G. In vivo patellar tracking: clinical motions and patellofemoral indices. J Orthop Res. 2008 Aug;26(8):1067-74.
28. 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.
29. 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.
30. 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.
31. 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.
32. 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.
33. 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.
34. 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.
35. Biomet publication, FDA Cleared Claims for E1 Antioxidant Infused Technology”
36. Ref: DePuy Attune 510 K Document K101433 Dec 10, 2010
37. Ref: Smith & Nephew OR-12-129
38. Hunter, G., and Long, M. Abrasive Wear of Oxidized Zr-2.5Nb, CoCrMo, and Ti-6Al-4V Against Bone Cement. 6th World Biomaterials Cong. Trans., Society for Biomaterials, Minneapolis, MN, 2000, p. 835.
39. Long, M., Riester, L., and Hunter, G. no-hardness Measurements of Oxidized Zr-2.5Nb and Various Orthopaedic Materials. Trans. Soc. Biomaterials, 21, 1998, p. 528.
40. Poggie RA, Wert J, Mishra A, et al (1992). Friction and wear characterization of UHMWPE in reciprocating sliding contact with Co-Cr, Ti-6Al-4V, and zirconia implant bearing surfaces. Wear and Friction of Elastomers, Denton R and Keshavan MK, Eds., West Conshohocken, PA: ASTM International.
41. Nasser, S.: Biology of Foreign Bodies: Tolerance, Osteolysis and Allergy in Total Knee Arthroplasty, Edited by J. Bellemans, M.D. Ries and J. Victor; Springer -Verlag, Heidelberg, 2005.
42. Cartier P, Khefacha A, Sanouiller JL, Frederick K. Unicondylar knee arthroplasty in middle-aged patients: a minimum 5-year follow-up. Orthopedics. 2007 Aug; 30 (8 Suppl):62-.
43. 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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Caution: US Federal law restricts the sale of these devices to or on the order of a physician.