Journey II

The JOURNEY II BCS Knee

Recent advances in biomedical engineering software have opened a new chapter on high performance knee implants.

One remarkable breakthrough has been the creation of the JOURNEY II BCS knee, a second-generation knee replacement that combines the stability and natural motion of the human knee with new low-friction materials that may extend the life of the implant.

While the lifespan of a knee implant is heavily influenced by the materials used to make it, the natural feeling of the implant during physical activity is dependent upon the way the patient's muscles, ligaments and tendons are addressed during surgery and by the implant's shape within the body after surgery.

As discussed previously in this booklet, the knee is a hinge joint, but it does not swing like a simple door hinge. It has a complex rotational motion that you don't notice is there - but many patients know when it's not there after total knee replacement. Traditional implants attempt to recreate this subtle swing-and-rotate action with either a rotating platform (a simple pivot point) within the implant or by requiring an angled alignment of the implant during surgery.

With these traditional knee replacement designs, the muscles and ligaments around your new joint have to work harder because the implant's slightly unnatural shapes and resulting motion make these soft tissues move in unfamiliar, stressful ways. This leads to joint pain, muscle fatigue and the unnatural feeling patients experience while walking or bending in the months after their procedure.

The JOURNEY II BCS knee, on the other hand, is designed to reproduce the original internal shapes and angled forces of the human knee through its full range of motion - accommodating the swing-and-rotate of the joint with the same engineering principles your real knee currently uses. Because of this, your soft tissues don't have to readjust to new shapes and forces after surgery and your stride can return to its natural rhythm.

The JOURNEY II BCS knee also reproduces the stability provided by your anterior cruciate ligament (ACL) and your posterior cruciate ligament (PCL). Your ACL and PCL are key to the stability of your real joint and contribute to natural motion when your knee is fully extended and fully bent. No other knee implant reproduces both functions.

Implant Components

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In the knee replacement procedure, each prosthesis is made up of four parts.

The tibial component has two elements - a metal base and a plastic insert - and replaces and the top of the tibia (shin bone). This prosthesis is made up of a metal tray attached directly to the bone and a high-density plastic spacer that provides the bearing surface.

The femoral component replaces the bottom of the thigh bone or femur. This component also replaces the groove where the patella or kneecap rides.

The patellar component replaces the surface of the knee cap, which rubs against the femur. The patella protects the joint, and the resurfaced patellar button will slide smoothly on the front of the joint. In some cases, surgeons do not resurface the patella.

Bearing Surfaces

One of the keys to a successful implant is its ability to withstand the rigors of daily activity, and central to that is the quality of the artificial surfaces that slide against each other, or articulate, in the new joint.

In knee implants, bearing surface options have been somewhat limited over the last few decades. The standard substance used for the femoral component is cobalt chrome, a metal alloy typified by its toughness and biocompatibility. However,even this high-quality industry standard has its shortcomings. Over time, this metal surface can become roughened by bone and bone cement particles trapped between the femoral component and the plastic tibial insert.

This roughened surface, when rubbing against the plastic component up to two million times per year, can more quickly wear out your implant. When that happens, you will have to undergo surgery to replace the plastic piece, the femoral component, and possibly even the tibial component. For this reason, implants have been shown to last between ten and fifteen years in the human body.

An exciting material to enter orthopaedics in recent years is OXINIUM Oxidized Zirconium. This remarkable material combines the strengths of ceramic and metal, such as wear-reduction and strength, but does not have the weaknesses, such as limited implant options and the possibility of fracture.

Zirconium is a biocompatible metal, similar to titanium. When the zirconium alloy undergoes a unique heating process, the surface of the metal transforms into a ceramic. Even though the new ceramic surface is 4,900 times more abrasion resistant than cobalt chrome, it retains the toughness and flexibility of the underlying metal.

Because it can achieve this remarkable reduction in implant wear without sacrificing strength as actual ceramic components do, oxidized zirconium implants have the potential to last significantly longer.

The Procedure

Knee replacement surgery typically takes between one and two hours to complete. This section will provide you with a brief, easy-to-understand description of the surgical procedure. (Please consult with your physician for details regarding your specific procedure.)

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Bone Cuts

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Implant Components

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Implanted

  1. An incision is made extending from the thigh, past the inside edge of the kneecap, and down to the shinbone.

  2. The end of the femur is shaped in preparation for sizing the femoral trial component.

  3. The top of the tibia is shaped for proper sizing of the tibial trial component.

  4. The trial units are put in place and the appropriate implant size is selected.

  5. The knee is assessed for alignment, stability, and range of motion.

  6. The underside of the kneecap is prepared and patella trial is selected.

  7. The trial units are removed and the final femoral, tibial, and patella components are implanted.

  8. The incision is closed, a drain is put in, and the post-operative bandaging is applied.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.

Aren't all total knee implants the same?

montagebcs_journey In theory, yes, all total knee implants are intended for the same purpose: the elimination of painful bone-on-bone contact, and the restoration of motion and function to the joint. In reality, however, the way each implant is designed, built and implanted not only makes them different, but can have an impact on how well they perform for each patient. Commonly described as a hinge joint, your knees actually do much more than simply swing back and forth. In fact, every time your knee bends, forces in and around the joint work together to produce a subtle and complex rotational movement that you most of us don't even realize is there. However, if this rotational movement is removed, the change can be felt in the muscles and ligaments through the entire leg. One of the most remarkable breakthroughs in design of total knee replacements has been the creation of the JOURNEY II Active Knee Solutions. Designed using the latest in human simulation software, and built using some of the most wear-resistant materials available, this unique implant was designed to address two of the most common concerns associated with knee replacement implants: implant wear and implant feel.

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.

Physiological Matching◊

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The rationale behind the concept of Physiological Matching is simple: any change you make to the knee joint will ultimately impact the entire leg. Of course, as is so often the case, simple rarely means easy.

The primary hurdle to overcome in a knee replacement is the knee itself. Described as a hinge joint, the knee actually does much more than bend back and forth. In fact, every time your knee bends, forces in and around the knee cause it to move with a complex rotational motion that most of us never realize. However, when that motion is removed after knee replacement, the result can be disappointing.

Traditionally, most knee implants have attempted to replace the natural swing-and-rotate of the knee by building a simple pivot point into the implant (known as a rotating platform) or by using a slightly angled alignment of the implant during surgery. Unfortunately, both of these options can force the muscles and ligaments around the new joint to work harder and move in unfamiliar, stressful ways; resulting in pain, muscle fatigue and an unnatural feeling while walking or bending the knee.

The JOURNEY II implant was designed using Smith & Nephew's proprietary LifeMOD◊ human simulation software. This advanced software system allows engineers to examine in a virtual 3-D environment the exact internal shapes and angled forces that act on the knee throughout each phase of motion. As a result, the JOURNEY II implant has been designed to physiologically match how the hard structures of a normal knee joint move and rotate in an effort to maintain normal muscle activity and return the patient's stride to it's a natural rhythm.

Important Safety Note

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Talk to your doctor to determine what treatment may be best for you.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.

JOURNEY◊ II Active Knee Solutions - Implant Feel

The right "feel" often starts with the right design

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To most of us, total knee implants all look very similar. With the exception of color (the OXINIUM◊ alloy used in JOURNEY II implants is black while the cobalt chrome used in other implants is silver), it can take an experienced eye to see the subtle differences in size and shape between two implants. However, as subtle as the differences may seem, they can often have a profound impact on how an implant feels to the patients after surgery.

Fortunately, JOURNEY II implants were designed using a concept called Physiological Matching◊. This unique process begins with proprietary human simulation software that virtually recreates the exact internal shapes and angled forces that act on the knee through each phase of motion. This detailed information helped Smith & Nephew engineers create an implant that replicates as closely as possible the complex, natural rotation of the knee.

Important Safety Note

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Talk to your doctor to determine what treatment may be best for you.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.

JOURNEY II Active Knee Solutions - Implant Wear

Implant materials can impact durability

Virtually all total knee replacement systems use a combination of metal and plastic components to replace the surfaces of a damaged knee. Metal is typically used to replace the surfaces of the bone, while plastic is most commonly used to replace the joint's cartilage.

Unfortunately, the metal and plastic surfaces of an implant can wear down over time. The primary cause of this "implant wear" is the friction created when the upper, metal, part of an implant - called the femoral component - rubs against the plastic insert. Even with pristine implants, over time, this friction can cause tiny particles of the insert to wear away. If the metal component becomes scratched for any reason, this destructive process can be increased dramatically. In fact, this type of implant wear is a leading cause of premature knee replacement failure.

Fortunately, implant wear can be offset by using advanced, wear-reducing materials during the creation of the implant.

VERILAST Technology

Unlike other implants that only available with cobalt chrome for their metal femoral components, the JOURNEY II Active Knee implant can also be made with a proprietary metal alloy called OXINIUM Oxidized Zirconium. While cobalt chrome has been used successfully for years, laboratory tests have shown that the "ceramicized" OXINIUM metal alloy is twice as hard as cobalt chrome and can be twice as resistant to the type of scratching that can cause implant wear.1 First introduced in 1997, OXINIUM implants have been used in more than 1 million surgeries around the world.

And since each implant is a combination of metal and plastic, JOURNEY II implants also use a harder, highly cross-linked polyethylene known as XLPE for the plastic insert.

Working together, these materials form a bearing surface combination known as VERILAST Technology, which is unique to global medical device maker, Smith & Nephew.

Important Testing Note

VERILAST Technology has been designed to address "wear and tear," which is only one reason why a knee implant may need to be replaced. Listen carefully when your orthopedic surgeon reviews other risks that can shorten the life of your new knee - such as infection, excessive weight gain or high impact sports.

The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.

Important Safety Note

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Talk to your doctor to determine what treatment may be best for you.


  1. G. Hunter and M. Long, "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.

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.

Rediscover your active life with the high performance

A New Chapter in Knee Implants

Recent advances in biomedical engineering software have opened a new chapter in high performance knee implants.

One remarkable breakthrough has been the creation of the JOURNEY II XR Active Knee System, which combines an implant designed to restore the stability and natural motion of the human knee with low-friction materials that may help extend the longevity of the implant itself.

While the longevity of a knee implant is heavily influenced by the materials used to make it, the natural feeling of the implant during physical activity is dependent upon the way the patient's muscles, ligaments and tendons are addressed during surgery and by the implant's shape within the body after surgery.

Every knee implant design is faced with two important challenges; how to recreate the normal swing-and-rotate motion of your natural knee, and how to restore stability to your joint after surgery.

For the first challenge, conventional knee implant designs have attempted to recreate the natural, fluid motion of the knee with either a rotating platform (a simple pivot point) within the implant or by requiring an angled alignment of the implant during surgery. Both of these options force the muscles around your knew joint to work harder as they adjust to the joint's new and unnatural shapes and movement patterns.

For the second challenge, most implants rely on design aspects within the plastic insert to provide the stability that is sacrificed after the anterior and posterior cruciate ligaments (ACL/PCL) within your joint are removed to accommodate the new implant.

JOURNEY II XR is Different

Fortunately, the JOURNEY II XR Knee Implant is different from most knee implants.

First, the JOURNEY II XR implant features an anatomically shaped femoral component and two plastic inserts designed to work together to reproduce the original internal shapes and forces of your natural knee as it goes through its full range of motion. This attention to anatomic detail means that the muscles and other soft tissues around your joint don't have to adjust to unfamiliar stresses and you may be able to return to a natural pattern of motion after surgery.

Second, the JOURNEY II XR uses a U-shaped tibial base plate that fits around your healthy ACL and PCL, allowing them to remain in place and function normally after surgery. In short, the function of these important ligaments doesn't have to be re-engineered because they were never removed.

Added Durability

The JOURNEY II XR implant addresses durability with VERILAST Technology, a combination of two wear reducing materials - the proprietary OXINIUM metal alloy and a highly cross-linked plastic insert - that were designed to address wear on both surfaces of the implant.

Because it is twice as hard as cobalt chrome, the most commonly used metal in knee implants, implants made with OXINIUM material have been shown in lab testing to reduce joint wear by more than 80% when compared to cobalt chromium components.1

VERILAST Technology was designed to address "wear and tear," which is only one of several reasons why a knee implant may need to be replaced. Each patient should listen carefully when his or her orthopedic surgeon reviews other risks that can shorten the life of a new knee - such as infection, weight gain or high impact sports.

The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.

Not all patients are candidates for the JOURNEY II XR Knee Implant. Discuss your condition and implant options with your surgeon.

Disclaimer

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

1. jHunter, G., and Long, M., Abrasive Wear of Oxidized Zr-2.5Nb, CoCrMo, and Ti-6Al-4V Against Bone Cement. 6th World Biomaterials, Minneapolis, MN 2000, p. 835


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.


All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

All materials copyright © 2019 Smith & Nephew, All Rights Reserved.

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