The power of simplicity

The power of simplicity

The power of simplicity Consider the facts, and take a look at the future: Revision TKA procedures are projected to double between now and 2015. 1 Restoration of a normal joint line in a balanced and stable joint is critical to achieving good outcomes in knee revisions. 2 Bone loss necessitates the use of intramedullary fixation in knee revisions resulting in the need to place the femoral and tibial components onto the metaphysis independent of the IM canal. 3 Projected TKA Revision Procedures 200 150 100 Revision TKA Surgeons 50 0 2005 2010 2015 2020 2025 2030 Restoration of proper joint line position in revision total knee arthroplasty is essential in promoting 2 recovery of function. Approximately 60% of patients with failed or poorly functioning implants are metal hypersensitive compared to only 10% of the general population. 4 This data suggests that the changing nature of the revision knee arthroplasty will require a higher level of functional outcomes for patients. The growing number of orthopaedic surgeons who will perform these procedures will require a system versatile enough to handle any contingency while being efficient and reproducible.

Versatility Fit the implant to the patient...every time! The LEGION Revision Knee System allows you to: obtain optimal stem fixation while balancing the flexion and extension gaps fit the implant to the patient, not the patient to the implant independently position the femoral and tibial components from the stem Flexion and extension balancing Traditional femoral placement LEGION system femoral placement Canal fixation and bone loss may dictate poor placement of components resulting in the inability to balance revision knees with the ideal sized femoral/tibial components. This results in sub-optimal patella function and joint instability. Stability resulting from reestablishment of the joint line in relationship to the patella, combined with a well-balanced knee in both flexion and extension, can be accomplished with a broad assortment of femoral and tibial screw-on augments and the LEGION system s versatile offset couplers. Traditional Stem Placement LEGION System Stem Placement Cemented Cementless Stem fixation may be lost due to non-centered stem placement resulting in poor cement mantles or partial engagement of pressfit stems. Cemented Cementless Stem location is not compromised in order to achieve optimal femoral/tibial placement. The LEGION system s versatile offset couplers allow optimal placement of both femoral and tibial components while centering stems within the IM canal.

Endurance Reduced wear and particle generation Aseptic loosening represents the most common cause of late failure of prosthetic implants. 5 Particulate debris including bone and bone cement causes third-body wear of implants. These particles, combined with wear debris, are accepted as key mechanisms responsible for accelerated wear and osteolysis leading to early failure. OXINIUM Oxidized Zirconium Femorals Abrasion-resistant advanced bearing material: Reduces wear by up to 96% in knees compared to CoCr in lab testing 6,7 8, 9, 10 Clinically proven material: up to 10 year follow-up data Award-winning material: Only ASM award winning material in orthopaedics 11 VERILAST Technology OXINIUM oxidized material combined with highly cross-linked polyethylene is the only TKA-bearing coupling designed to provide outstanding wear performance, even under abrasive conditions. Wear Rate (mm 3 /MC) 40 35 30 25 20 15 10 5 0 Pristine Roughened Pristine Roughened Pristine Roughened Pristine Roughened Pristine Roughened 5 MRad 6.5 MRad 7.5 MRad 9 MRad VERILAST Technology A solution for metal hypersensitivity OXINIUM Oxidized Zirconium has undetectable nickel content and has been shown clinically as a viable option for patients with diagnosed metal hypersensitivity 12 Maximum nickel content Not detectable Oxidized Zirconium (<.0035) 0.1% PS High Flexion to Constrained Allows surgeon to decide appropriate level of constraint Choose from PS High Flexion to Constrained Level of constraint is independent of femoral or stem selection needs Titanium 0.5% Cobalt Chrome 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% Maximum percentage of nickel Same A-P resection add constraint and stems PS High Flexion* PS Constrained

Ease Designed by surgeons for surgeons Designed to meet the needs of surgeons performing from one to one hundred knee revisions a year, the LEGION system instrumentation reduces surgical time and simplifies intraoperative decision-making. 5 Refer to LEGION Revision Knee System surgical technique for additional information. The technique is essentially the same for both the femur and the tibia, shortening the learning the curve and the procedure. The power of simplicity. 1. The block attaches rigidly to reamer for stability 2. Offset from canal is simply measured using the collets 3. Once the trial goes on, it never has to come off Tibial overview Ream and resect Size, assess offset and counterbore Trial Cut for wedges and punch for fins Femoral overview Ream and resect Size, assess offset and counterbore Prepare for PS Box Trial

Special thanks to Dr. Hilde Vandenneucker, UZ Leuven, Belgium References 1 Rapp S. Help wanted in 2030: TJR will soar, severe surgeon shortage possible. Orthopedics Today, May 2006. 2 Mahoney OM, Kinsey TL. Modular Femoral Offset Stems Facilitate Joint Line Restoration in Revision Knee Arthroplasty. Clin Orthop Relat Res. 2006 May; 446:93-8. 3 Abraham R, Malkani AL, Lewis J, Beck D. An anatomical study of tibial metaphyseal/diaphyseal mismatch during revision total knee arthroplasty. Journal of Arthroplasty. 2007 Feb;22(2):241-4. 4 Hallab N, Merritt K, Jacobs, JJ. Metal Sensitivity in Patients with Orthopaedic Implants. J Bone Joint Surg Am. 2001;83:428. 5 Nadaud M, Synder MA, Brown D, McPherron A. New trends and early clinical outcomes with a modern knee revision system. Orthopedics. 2007 Vol. 30 No. 8., pp. 97-101 6 Ries MD, Salehi A, Widding K, Hunter G. Polyethylene wear performance of oxidized zirconium and cobaltchromium knee components under abrasive conditions. J Bone Joint Surg Am. 2002;84-A Suppl 2:129-35 7 Spector BM, Ries MD, Bourne RB, Sauer WS, Long M, Hunter G. Wear performance of ultra-high molecular weight polyethylene on oxidized zirconium total knee femoral components. J Bone Joint Surg Am. 2001;83- A Suppl 2 Pt 2:80-6 8 Masonis JL, Kuremsky MA, Thompson C, Odum SM, Mokris JG, Springer BD. Mid-Term Outcomes of Oxidized Zirconium Femoral Components for Total Knee Arthroplasty. Poster. AAOS 2008 San Francisco, CA. 9 Sah AP, Ready JE. Use of oxidized zirconium hemiarthroplasty in hip fractures: clinical results and spectrum analysis. J Arthroplasty. 2007 Dec;22(8):1174-80. 10 Laskin RS. An oxidized Zr ceramic surfaced femoral component for total knee arthroplasty. Clin Orthop Relat Res. 2003 Nov;(416):191-6. 11 2005 recipient of ASM International s annual Engineering Materials Achievement Award for, the development of Oxinium Oxidized Zirconium for use as a joint replacement material to improve the performance and increase the service life of total joint replacement systems. 12 Nasser S. Orthopedics. Orthopedic metal immune hypersensitivity. 2007 Aug;30(8 Suppl):89-91. Orthopaedic Reconstruction & Trauma Smith & Nephew, Inc. 1450 Brooks Road Memphis, TN 38116 USA www.smith-nephew.com Telephone: 1-901-396-2121 Information: 1-800-821-5700 Orders and Inquiries: 1-800-238-7538 Trademark of Smith & Nephew. Reg. US Pat. & TM Off. All Trademarks acknowledged. 2008 Smith & Nephew, Inc. All rights reserved 7128-1437 40830516 10/08