Journey II BCS Final Exam (Qld)

The JOURNEY II Knee system offers six design parameters no other knee system can offer. These include

• Physiological Joint Line

• Asymmetric Posterior Cam

• Anterior Cam

• All of the above

Some of the great features of the JOURNEY II BCS system over competitive systems include which of the following?

• Chisel through template

• Ream through femoral trial

• Box Conserving Design

• B & C

Satisfaction levels and return to functional activity following TKA are the same as that of THA

• True

• False

Some of the supportive technologies that will be available with the JOURNEY II BCS  knee system include which of the following?

• VISIONAIRE cutting guides

• OrthAlign – KneeAlign technology

• VISIONAIRE digital templating

• All of the above

A key characteristic to understand in relation to the native knee anatomy is that it is… 

• Asymmetrical

• Symmetrical

• Dependent on individual anatomy

• B & C

In extension an angle is formed between the quadriceps and patella tendon, this angle is known as the ___ angle (fill in the blank)  

The JOURNEY II BCS knee system delivers stability through range of motion

• True

• False

Through PHYSIOLOGICAL Matching Technology the JOURNEY II BCS restores the anatomic  ____ degree joint line.

JOURNEY II BCS is available in VERILAST technology which is the combination of…

• OXINIUM + UHMWPE

• OXINIUM + XLPE

• CoCr + XLPE

• None of the above

Which TKA system was the first ‘guided-motion’ kinematically accurate knee design on the market?

• TRIATHLON CR

• VANGUARD PS

• JOURNEY BCS

• MEDIAL PIVOT

According to Ries et al (2010) which of the following tibial component issues contribute to increased tension in the ITB?

• Aseptic loosening of the tibial component

• Excessive external rotation of the tibial component

• Excessive posterior position of the tibial component

• B & C

The Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) Annual Report identified the  JOURNEY BCS Knee as having a higher than expected revision rate.The Incidence of ITB pain is likely to have contributed to the Journey BCS revision rate in the AOA NJRR.

• True

• False

The ___MATCHING™ Technology of the JOURNEY II BCS Knee System incorporates proprietary virtual technology (LifeMOD) that simulates how the implant interacts with the knee’s soft tissue envelope to allow for a boost in function while providing improved reproducibility.

There have been no reported cases of ITB syndrome or revisions for the 67 JOURNEY II BCS knees implanted in Australia

• True

• False

The JOURNEY II BCS knee system is positioned as a product for orthopaedic surgeons seeking treatment solutions beyond traditional knee replacements.

• True

• False

Why has the JOURNEY II BCS PS box increased in size?

• Reduce early rollback

• Reduced strain of popliteal tendon

• Reduced strain of IT and IT patella band

• To accept a constrained insert (bail out option)

In conventional knees which muscle group shows consistently greater muscular effort versus a non-operated leg?

• Biceps

• Hamstrings

• Quadriceps

• Gastrocnemius

The flexed posterior cut is not a unique design feature of JOURNEY II BCS i.e. other competitive knee systems share this same design feature.

• True

• False

Luyckx et al (2010) reported outcomes for 1,070 JBCS knees at a mean follow up of 2.5 years. Device survival of 98% was reported, with partial or total revision as the primary endpoint. However, symptoms of iliotibial band (ITB) syndrome were observed in ___ % of patients at a mean of six months follow-up. After further rehabilitation, pain during flexion persisted in 2% of these patients resulting in surgical ITB release. (Fill in the blank)

What changes to the original JBCS insert have been made to address the complication of dislocation?  

• Post height increased (on average 2-3mm) and top of post “squared off”

• Post height decreased (on average 2-3mm) and top of post “rounded off”

• Post widened (on average 1-2mm)

• B & C

In relation to customer segmentation the JOURNEY II BCS system should be targeted to which of the following surgeon groups?

• Early Adopters

• Laggards

• Early Majority

• A & C

Which of the following competitive knee systems do not have an anatomical baseplate like the JOURNEY II BCS system?

• Attune

• Triathlon

• Persona

• A & B

What is the name of the Smith and Nephew IPAD application that can be utilised as a selling aid for JOURNEY II BCS?

• SNAPP

• SNIPP

• SNUG

• None of the above

Which factors provide the rationale for a kinematic knee?

• Conventional knee designs do not replicate the normal anatomy of the knee and thus they are unable to restore normal kinematics and muscular efficiency

• Conventional knee designs do not provide the same levels of satisfaction and return to function as seen in THA

• The prevalence of younger more demanding patients

• All of the above

In extension the knee adopts the screw home position, which is a position of stability. In this position which of the following can be observed?Select the box(s) that apply (There may be more than one answer).  

• Femur internally rotated 5° (achieved by ACL pull)

• Femur externally rotated 5° (achieved by ACL pull)

• Knee joint is more congruent and quadriceps activity is not required

• Quadriceps activity increases utilized to stabilize the knee

The JOURNEY II BCS system delivers unmatched stability through which of the following features.Choose all correct responses.

• Anatomic Shapes

• Replication of both ACL & PCL function

• Non Anatomic Shapes

• None of the above

Through normal kinematic patterns the JOURNEY II BCS delivers an environment for anatomic deep flexion of up to how many degrees of flexion?

• 160 Degrees

• 155 Degrees

• 130 Degrees

• 150 Degrees

Although published clinical evidence supports the efficacy of the Journey BCS knee system (JBCS) in relation to kinematics, there are four key clinical papers that have highlighted complications associated with the JBCS. What are the complications identified in this literature? Please choose all correct response/s below.

• Paradoxical motion

• Iliotibial band syndrome

• Dislocation

• Stiffness requiring manipulation under anaesthesia

What did Luyckx et al (2010) suggest contributed to the ITB traction syndrome observed in some JBCS patients?

• Inadequate translation of the femur in flexion leading to increased eccentric loading of the ITB in some patients

• The normal screw home position of the JBCS which allowed the knee to rest in its normal anatomical position

• Excessive translation of the femur in flexion leading to increased eccentric loading of the ITB in some patients

• A & B

 A study by Noble et al. (2005) concluded that patients who had TKA experience…

• Substantial functional impairment when compared with their age and gender matched peers

• Functional outcomes similar to that of their age and gender matched peers

• Substantial functional improvement when compared with their age and gender matched peers

• None of the above

The distal condylar radius of the lateral condyle of the femur is described as having a “flat” shape. The distal condylar radius of the medial condyle of the femur would be best described as having a __________ shape.

• Oval

• Flat

• Round

• Oblong

ITB friction or traction syndrome is a relatively common injury associated with running and is frequently reported in relation to total knee arthroplasty.

• True

• False

 The stiffness associated with the original JBCS knee system was attributed to the excessive stresses placed on the soft tissues as a result of limited roll back of the femoral component.

• True

• False

In Australia The JOURNEY II BCS System is now launched in the public system. 

• True

• False

What was the high level rationale behind evolving the original JOURNEY BCS (JBCS) System?

• Complete the system

• Improve functionality

• Increase repeatability

• All of the above

What paradoxical motion can occur as a result of conventional knee designs?

• The lack of ACL function leads to paradoxical anterior sliding of the femur during flexion

• During flexion the knee may pivot laterally, as opposed to the naturally occurring medial pivot

• During flexion the knee may pivot medially, as opposed to the naturally occurring lateral pivot

• A & B

Which key design changes improved kinematics by reducing early rollback (posterior cam & post engage later in flexion ~60-70⁰)? 

• Posterior cam elevated superiorly and cam reduced in size

• Post shifted 2mm anteriorly

• Post shifted 2mm posteriorly

• A & B

In published literature by Cantani et al (2009) Knee joint kinematics were assessed in 16 JBCS patients using video-fluoroscopy and electromyography (EMG) during activities of daily-living including stair climbing, chair rising and sitting and step up/down test. What did the results of this study show? Select all box(s) that apply (There maybe more than one answer).

• All JBCS patients demonstrated femoral external rotation and translation similar to that of other conventional knee designs

• This more physiological knee motion resulted in recovery of normal extensor and flexor muscle function which was attributed to the more anatomical knee design

• All patients demonstrated a combination of relatively normal locomotion and gait, coupled with clear femoral external rotation and translation

Although there are a number of design changes from the original JBCS to the JIIBCS knee system it is most important to understand those that have specifically addressed the complications as seen with the original JBCS. What are the Key changes that have addressed the ITB syndrome that was observed with the original JBCS?

• Post height decreased (on average 2-3mm)

• Thinned anterior flange and reduced lateral condyle

• Post shifted posteriorly & posterior cam lowered inferiorly

• Post shifted anteriorly & posterior cam elevated superiorly

Arnout et al (2011)³ reported on four cases (0.3%) of posterior dislocation of the tibia relative to the femur in a series of 1,350 JBCS cases. The authors concluded that consistent soft-tissue stretch occurred in these patients. Which factors were noted as potentially contributing to soft tissue stretching?Please choose all correct response/s below.

• High flexion - during flexion the cam rises onto the post towards maximal flexion and in the case of a loose flexion space the cam could in theory become dislocated over the post

• Low jump distance - due to the relative position of the cam, low height of the post combined with a rounded post design

• Excessive femoral rollback - may contribute to consistent stretch on soft tissues leading to laxity, especially in flexion

The first global implantation of the JOURNEY II BCS system took place in December of which year?

• 2010

• 2011

• 2012

• 2013

When reviewing the articular geometry of the tibia which of the following can be observed? Please check the correct box.

• The lateral tibial condyle is concave in shape and the medial tibial condyle is convex in shape (no constraint on AP motion)

• The medial tibial condyle is concave in shape and the lateral tibial condyle is convex in shape (no constraint on AP motion)