Consecutive series of 226 journey bicruciate substituting total knee replacements: early complication and revision rates

Abstract

BackgroundThe Journey bicruciate substituting (BCS) total knee replacement (TKR) is intended to improve knee kinematics by more closely approximating the surfaces of a normal knee. The purpose of this analysis was to address the safety of Journey BCS knees by studying early complication and revision rates in a consecutive case series.MethodsBetween December 2006 and May 2011, a single surgeon implanted 226 Journey BCS total knee prostheses in 191 patients (124 women, 67 men) who were eligible for study. Mean age at surgery was 68 years (41–85 years).Outcome measures were early complications and minor and major revision rates. All complications were considered, irrespective of whether conservative treatment or revision was required.ResultsThe average implantation time was 3.5 years (range 1.3-5.8 years). Thirty-three complications (14.6% of 226 knees) required minor or major revision surgery in 25 patients. The remaining eight patients were treated conservatively. Sixteen minor revisions were performed in 12 patients. Thirteen major revisions were required in 13 patients, which results in a rate of 1.65 major revisions per 100 component years. The linear trend of the early complication rate by treatment year was not significant (p = .22).Multivariate logistic regression showed no significant predictors for the occurrence of a complication or for revision surgery. A tendency towards higher complication rates was observed in female patients, although it was not significant (p = .066).ConclusionsThe complication and revision rates of the Journey BCS knee implant are high in comparison with those reported for other established total knee systems. Caution is advised when using this implant, particularly for less experienced knee surgeons.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-395) contains supplementary material, which is available to authorized users.

Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

“…This in contrast to stiffness rates with the original BCS I design of 22.6% [7], 2.7% [6], and 2.2% [4] reported in the literature. It remains unclear whether the absence of stiffness in our series was supported by the kinematic rotational alignment obtained using an extension-first surgical technique.…”

“…The extension-first technique we employed may be more forgiving with guided-motion implants in comparison with the measured resection or tibia-first technique, the latter of which has been associated with midflexion instability in a recently published study in 226 consecutive knees [4]. The tibia-first technique may lead to femoral component malrotation in patients with preoperative deformities that result in ligamental instabilities [9, 18] and is furthermore associated with postoperative joint line elevation [4]. Both component malrotation and joint line elevation are risk factors for midflexion instability [15, 19].…”

“…It aims to improve knee kinematics by more closely approximating a normal knee with an asymmetric femoral component, polyethylene replicating 3° of tibial varus, and a medially concave and laterally slightly convex shape [4]. Guided motion is obtained via the asymmetric tibiofemoral surface geometry and cam-post design, the latter of which guides the femur to external rotation in flexion in relation to the tibia and in full extension to the screw-home mechanism.…”

“…Other authors have reported a high rate of early complications following implantation of the Journey BCS [4, 5, 7]. Of specific concern was a study reporting an increased risk of postoperative iliotibial band (ITB) friction syndrome (7.2%) with this device after a mean follow-up time of 2.5 years (range, 1 – 5 years), which eventually led to a surgical release of the ITB in 2% of these subjects [5].…”

Comparison of Muscle Recovery Following Bi-cruciate Substituting versus Posterior Stabilized Total Knee Arthroplasty in the Asian Population

“…[1][2][3][4] However, it has also been reported that normal knee kinematics and function are not accurately reproduced in traditional TKA designs. [5][6][7][8][9][10] As the demand and frequency of TKA grow, the degree of satisfaction reported is relatively low. 4, 6,11 One potential cause may be that conventional TKA designs cannot reproduce normal knee kinematics and function due to the lack of the anterior cruciate ligament (ACL).…”