LEGION™

Total Knee System

Proven Performance,
Continuous Innovation
Durability
Flexibility
Clinical Heritage
Give your patient the potential to regain an active
lifestyle. With the LEGION™ Total Knee System you
can offer a customized solution to meet your patient’s
high expectations. This system is designed to
empower surgeons to address diverse challenges
and simplify decision-making intraoperatively.
Peace of Mind
LEGION™ Total Knee System is a comprehensive, state-of-the-art system that empowers surgeons to
provide personalized joint care. The system includes simple solutions for addressing the increasingly
diverse needs of your patients.

Exceptional durability
The LEGION Total Knee System offers biocompatible implant technology with unmatched wear
performance. Smith & Nephew is the only company to offer VERILAST™ Technology. With the combination
of OXINIUM™ alloy and highly cross-linked polyethylene (XLPE), VERILAST Technology offers the full solution
in knee implant materials.

System flexibility
Today’s knee implant patients present increasingly diverse scenarios. The versatility of the LEGION Total
Knee System allows surgeons to simplify decision making intraoperatively and deliver personalized joint care.

Rich clinical heritage

Smith & Nephew has a rich history in the medical field dating back over 150 years. The company has
produced many products that demonstrate proven performance. Built upon the world-class GENESIS™ II
design and its over 20 years of clinical data, the LEGION Total Knee System is carrying on the legacy.
Durability: Wear Performance
As today’s patients seek more active lifestyles, knee implants will be expected to endure more stress without succumbing to
wear. However, the functional lifetime demand of younger and active patients is 10-fold greater than the estimated functional
lifetime of traditional implant bearings.1 VERILAST™ Technology from Smith & Nephew is the only bearing technology with
published results of 45 Million Cycles of in-vitro knee wear simulation testing with the LEGION™ Primary Knee System. This
means the replacement may provide improved wear performance. More importantly, if implanted earlier, it may restore
patients to their active lifestyles.

The implants identified below were tested by their manufacturers using different testing protocols and, therefore, the results
are not directly comparable.

50
45 43.40
Volumetric wear rate (mm3/Mcycle)

40
34.60
35

30
24.40
25 23.00 23.45
20.20
20
15 13.00

10 7.30
5.40 6.41 6.50 6.10
4.10
5
0.58
0
2

1
a TM

M
o TM

TM
TM

TM

a TM

S
rd
II

II

on

en
rd T

TK
pi
ne
on

en
S™

S™

ua
gm

xG
hl
gm
pi

or
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SI

SI
tu
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hl

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iat

ng
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Ne
NE

NE
Si

iat

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At
Sc

Tr
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Va

GI
C

Tr
GE

GE
C
Va
PF

LE
PF

CoCr and CPE CoCr and XLPE VERILAST Technology

Mean volumetric wear rates of CoCr against conventional polyethylene (CPE), CoCr against crosslinked polyethylene
(XLPE) and OXINIUM against XLPE as published by the respective companies with their respective implants.
Please see references for testing information.
Durability
Just as metal ions are a well described problem for many hip replacement patients, cobalt, chromium and
nickel are commonly cited allergens for knee replacement patients.

Surgeons should be aware that all metal implants contain varying amounts of cobalt, chromium, and nickel.
When selecting the appropriate implant, surgeons should consider the composition of each implant before
use. To help with this decision, VERILAST™ Technology incorporates proprietary OXINIUM™ alloy. Compared
to cobalt chrome, OXINIUM alloy has much less cobalt (<0.002%), chromium (<0.02%) and nickel
(<0.0035%) content.

Metal content of implants

13

Clinical studies
14

Maximum nickel content Prevalence of patients demonstrating metal sensitivity

<0.0035%

0.1%

0.5%

0.0% 0.2% 0.4% 0.6% 0.8%

Ni content % by weight

Maximum chromium content Maximum cobalt content

<0.02% <0.002%

<0.02% <0.01%

27-30% 58-68%

0.0% 10% 20% 30% 40% 0.0% 10% 20% 30% 40% 50% 60%
Cr content % by weight Co content % by weight
System Flexibility
LEGION™ has the flexibility to address diverse surgical challenges and simplify decision making
intraoperatively. The LEGION instrumentation gives you the ability to move from a cruciate retaining implant
all the way to a hinged component.

Seamless
system

Same A-P Resection

Add PS Box Same A-P Resection Same A-P Resection with Build-up
Add Augments Add Revision Components Add Hinge Components
Add Constraint

Updated instruments

LEGION is not only offered with updated traditional instrumentation but also with a more cost-effective and
simplified approach to total knee arthoplasty. VISIONAIRE™ FastPak includes VISIONAIRE Cutting Guides and
size-specific disposable instruments.

VISIONAIRE FastPak
Patient Flexibility
Today’s knee implant patients present increasingly diverse scenarios. Even with thorough preoperative
planning some factors may not be visible until surgery is underway. You have to make decisions fast, and
you need a knee system that can react quickly and work with you each step of the way.

Pathology
Same A-P Resection Sa
Same A-P Resection
• Primary to Revision and Hinge Add Revision
Components
wit
with posterior build-up
Hin components
Add Hinge
• Offsets, wedges and augments

Range of motion
• Constrained, standard and high flexion inserts

Age Anatomy
• Cemented and porous options • Bone-preserving PS box LEGION™ Other knee systems
• CoCr and VERILAST™ Technology • Anatomically designed base plate
• Offset capability for optimal component position

Activity level
Anatomic baseplate
• CoCr and VERILAST Technology offers full coverage
• Standard polyethylene and highly cross-linked poly

Biocompatible implants Optimal Sizing

• OXINIUM™ Oxidized Zirconium • Ideal sizing for male and female anatomy
• All-polyethylene tibial components • 1mm increment inserts
• Titanium tibial base plates
 Rich Clinical Heritage
Proven performance, continuous innovation
Smith & Nephew has a rich history in the medical field dating back over 150 years. The company has
produced many products that demonstrate proven performance. Built upon the world-class GENESIS™ II
design and its over 20 years of clinical data, the LEGION™ Total Knee System is carrying on the legacy.

GENESIS II clinical results:

15 – 17 year Clinical Results15

• “Excellent” survivorship of 98.1% at a minimum
follow-up of 15 years
• 89 consecutive GENESIS II knee procedures GENESIS II: A Systematic Literature
were studied
• “Minimum 15-year follow-up reports after TKA are Review of Clinical Outcomes16
not abundant”
• 99.5% cumulative mean survival rate at 5 years 99.9%
at 7 years; 98.8% at nine years
• Low revision rate (up to 11.9 year follow-up)
• Includes 19 studies and 2656 knees
• Mean post op Knee Society score of 90.6

LEGION and GENESIS II achieve equivalent articulation but do so via different surgical
approaches to femoral external rotation.

GENESIS II CR GENESIS II PS LEGION CR LEGION PS LEGION RK LEGION HK

Cruciate Retaining Knee Posterior Stabilized Knee Cruciate Retaining Knee Posterior Stabilized Knee Revision Knee Hinged Knee

Built-in Femoral Rotation Surgeon-directed Femoral Rotation

LEGION GENESIS II
M L M L
LEGION has symmetric posterior condyles while GENESIS II has a
thinner medial posterior condyle due to the built in external rotation.

LEGION encompasses the same design features that have demonstrated excellent long-term survivorship with GENESIS II.
LEGION CR and PS knees provide the same kinematic motion and articulation as GENESIS II with the addition of updated
instrumentation and a seamless total knee system able to handle all stages of knee reconstruction.17
 e of Apex Knee CR Apex Knee 2 586 0.2 (0.0, 1.2) 0.6 (0.1, 2.5)
PROSTHESIS TYPES Revision Revision

Apex Knee PS Apex Knee 4 1116 0.4 (0.1, 1.2)

There are 502 femoral and tibial prosthesis There are 39 cementless femoral and tibial
Reason for Revision Number Percent Type of Revision Number Percent
combinations used in primary total knee prosthesis combinations with more than 400
Loosening/Lysis 4990 28.1 TKR (Tibial/Femoral) 4508 25.4 replacement recorded by the Registry, 16 more procedures. Of those with a 15 year cumulative

There are 502 femoral and 17 tibial prosthesis There are 39 cementless femoral and tibial
Infection 3985 22.5 Insert Only 3736 21.1 than 2014. The cumulative percent revision of percent revision, the Nexgen CR/Nexgen is the

cent Attune CR Attune 3199 0.5 (0.3, 0.9)

Patellofemoral Pain 2059 11.6 Patella Only 3690 20.8 the 139 combinations with more than 400 lowest at 4.5% (Table KT10).
Pain 1535 8.7 Tibial Component 1786 10.1 procedures per combination are listed in Tables

combinations used in primary total knee

Instability
prosthesis combinations with more than 400
1194 6.7 Insert/Patella 1734 9.8 KT9 – KT11. Although the listed combinations are

Attune PS Attune 7 1632 0.4 (0.2, 0.9)

Patella Erosion 772 4.4 Femoral Component 1081 6.1 a small proportion of all possible combinations,

25.4
they represent 95.9% of all primary total knee “The Nexgen CR/Nexgen has the lowest 15

replacement recorded by the Registry, 16 more results. procedures. Of those with a 15 year cumulative
Arthrofibrosis 611 3.4 Cement Spacer 1017 5.7

LEGION™ is carrying on the legacy of excellent clinical

year cumulative percent revision.”
replacement. The ‘Other’ group is the
Fracture 486 2.7 Removal of Prostheses 105 0.6

BalanSys BalanSys 20 1417 0.2 (0.0, 0.6) 1.5 (0.8, 2.5) 1.9 (1.1, 3.2) 2.6 (1.5, 4.5) 3.9 (2.2, 7.1)
combined outcome of the remaining 363

21.1
Malalignment 403 2.3 Minor Components 47 0.3
prosthesis combinations with less than 400

than 2014. The cumulative percent revision of

Wear Tibial Insert
percent revision, the Nexgen CR/Nexgen is the
290 1.6 Cement Only 9 0.1 procedures reported per combination. There are 40 combinations of primary total knee

Duracon Duracon
with424 8968 1.0 (0.8, 1.2) 2.4 (2.1, 2.8) 3.3 (2.9, 3.7) 3.9 (3.5, 4.3) 4.8 (4.3, 5.3) 7.0 (5.9, 8.2)
Metal Related Pathology 286 1.6 Total Femoral 9 0.1
replacement with hybrid fixation with more

20.8
Incorrect Sizing 222 1.3 Reinsertion of Components 8 0.0

the 139 combinations more than 400 lowest at 4.5% (Table KT10).
There are 60 cemented femoral and tibial than 400 procedures. The Nexgen CR/Nexgen
Other 897 5.1 TOTAL 17730 100.0 prosthesis combinations with more than 400 has the lowest 15 year cumulative percent

E.Motion E.Motion 18 446 1.9 (0.9, 3.7) 4.8 (3.0, 7.6)

TOTAL 17730 100.0 procedures. Of those with a 15 year cumulative revision (4.2%) (Table KT11).

10.1 procedures per combination are listed in Tables

percent revision, the Nexgen CR/Nexgen is the
lowest at 5.3% (Table KT9).

LEGION Primary Knee Evolis

System Evolis
– KT11. -Although
Safety and 12 combinations
Efficacy Clinical 0.3 (0.1,are
730 Study 1.1) 1.1 (0.5, 2.3) 1.6 (0.8, 3.1) 2.9 (1.5, 5.3)
18
9.8 KT9 the listed Table KT9 Cumulative Percent Revision of Primary Total Knee Replacement with Cemented Fixation

aEvolution
smallfive Evolution
proportion of all 8
possible 1636 0.5 (0.2, 1.3) 1.5 (0.7, 3.3)
combinations,
Figure KT8 Cumulative Incidence Revision Diagnosis of Primary Total Knee Replacement
Femoral Tibial N N

6.1 • A ten year study spanning sites and 138 patients. AOANJRR | 2016 ANNUAL REPORT
Total Knee
Component Component Revised Total
1 Yr 3 Yrs 5 Yrs 7 Yrs 10 Yrs 15 Yrs

“The Nexgen CR/Nexgen has the lowest 15 AGC AGC 176 3493 0.5 (0.4, 0.9) 2.4 (2.0, 3.0) 3.5 (2.9, 4.2) 4.1 (3.5, 4.9) 5.4 (4.6, 6.3) 8.9 (7.1, 11.1)

GMK
they Primary
represent GMK Primary
95.9% of all 10
primary 549
total 0.8 (0.3,
knee 2.1) 2.4 (1.2, 4.7) 4.2 (1.7, 10.2)
5.0% Active Knee Active Knee 40 1430 1.0 (0.6, 1.6) 2.4 (1.6, 3.4) 3.6 (2.6, 5.0) 4.4 (3.0, 6.3) 4.9 (3.3, 7.2)

5.7
Loosening/Lysis

• Two year interim results show just two revisions; one for infection and one year cumulative percent revision.”
Infection Advance Advance II 54 918 1.5 (0.9, 2.6) 4.1 (3.0, 5.6) 4.8 (3.6, 6.4) 6.0 (4.5, 8.0) 7.2 (5.4, 9.6)
Patellofemoral Pain Apex Knee CR Apex Knee 2 586 0.2 (0.0, 1.2) 0.6 (0.1, 2.5)

replacement.
GMK Sphere The ‘Other’ group is the
4.0%
Pain
Apex Knee PS Apex Knee 4 1116 0.4 (0.1, 1.2)

0.6
Instability

GMK Primary
of the23remaining 1602 1.6 (1.0, 2.6)
for patella clunk.

Cumulative Incidence
Attune CR Attune 17 3199 0.5 (0.3, 0.9)

Primary
combined
OUTCOME outcome
FOR OSTEOARTHRITIS - PATIENT 363 CHARACTERISTICS
3.0% Attune PS Attune 7 1632 0.4 (0.2, 0.9)
BalanSys BalanSys 20 1417 0.2 (0.0, 0.6) 1.5 (0.8, 2.5) 1.9 (1.1, 3.2) 2.6 (1.5, 4.5) 3.9 (2.2, 7.1)

0.3 • LEGION Primary demonstrated excellent clinical survivorship of 98.6%. 2.0% Duracon Duracon 424 8968 1.0 (0.8, 1.2) 2.4 (2.1, 2.8) 3.3 (2.9, 3.7) 3.9 (3.5, 4.3) 4.8 (4.3, 5.3) 7.0 (5.9, 8.2)

prosthesis
Genesis II CRcombinations
Genesis II with
421 less13019
than 400 0.9 (0.8, 1.1) 2.4 (2.2, 2.7) 3.1 (2.8, 3.5) 4.0 (3.6, 4.4) 4.3 (3.9, 4.7) 5.6 (4.7, 6.7)
E.Motion E.Motion 18 446 1.9 (0.9, 3.7) 4.8 (3.0, 7.6)

0.1 Primary total knee replacement has the lowest Loosening/lysis is the most common reason for
Evolis Evolis 12 730 0.3 (0.1, 1.1) 1.1 (0.5, 2.3) 1.6 (0.8, 3.1) 2.9 (1.5, 5.3)

Yrs
1.0%

procedures reported per combination.

Evolution Evolution 8 1636 0.5 (0.2, 1.3) 1.5 (0.7, 3.3)

Genesis II CR Profix Mobile 32 490 1.7 (0.8, 3.3) 3.4 (2.1, 5.5)
There are 5.6 (3.8,
40 8.2) 6.7 (4.6,
combinations 9.6) 9.2 (6.3,
of primary13.3) totalhave
knee
GMK Primary GMK Primary 10 549 0.8 (0.3, 2.1) 2.4 (1.2, 4.7) 4.2 (1.7, 10.2)

0.1 rate of revision compared to all other classes of revision in

0.0%
both
0 1 males
2 3 and4 females.
5 6 7 8Males
9 10 11 12 13 14 15
GMK Sphere
Primary
GMK Primary 23 1602 1.6 (1.0, 2.6)

Genesis II knee replacement. At 15 years, the replacement with hybrid fixation with more
Years Since Primary Procedure Genesis II CR Genesis II 421 13019 0.9 (0.8, 1.1) 2.4 (2.2, 2.7) 3.1 (2.8, 3.5) 4.0 (3.6, 4.4) 4.3 (3.9, 4.7) 5.6 (4.7, 6.7)

primary a higher
3.2) 3.7incidence
(3.2, 4.2) 4.7 of revision
5.3) 6.2for(5.5,surgeon
0.0 60Genesis II 309 6923 tibial
1.0 (0.8, 1.3) 2.8 (2.4, (4.1, 7.0)
Genesis II CR Profix Mobile 32 490 1.7 (0.8, 3.3) 3.4 (2.1, 5.5) 5.6 (3.8, 8.2) 6.7 (4.6, 9.6) 9.2 (6.3, 13.3)

There
Oxinium are
CR cemented femoral and than 400 procedures. The Nexgen CR/Nexgen
Genesis II

(3.7, 8.2)
Genesis II 309 6923 1.0 (0.8, 1.3) 2.8 (2.4, 3.2) 3.7 (3.2, 4.2) 4.7 (4.1, 5.3) 6.2 (5.5, 7.0)

cumulative
Australian Orthopaedic percent
Association revision
National of Replacement
Joint primary total Registry 2016 reported infection than females, with a 15 year
Oxinium CR
Genesis II

00.0 prosthesis combinations with more than 400

Genesis II 686 14338 1.5 (1.3, 1.7) 3.8 (3.5, 4.2) 5.2 (4.8, 5.7) 6.2 (5.8, 6.8) 7.7 (7.0, 8.4)

Genesisreplacement
II
Oxinium PS

knee undertaken for osteoarthritis has the lowest

cumulative 15 year cumulative
incidence percent
Genesis II 686 14338 1.5 (1.3, 1.7) 3.8 (3.5, 4.2) 5.2 (4.8, 5.7) 6.2 (5.8,of 1.6% 7.7and 0.8% Genesis II PS Genesis II 518 14812 1.2 (1.1, 1.4)

6.8)
2.8 (2.6, 3.1) 3.7 (3.4, 4.1) 4.3 (3.9, 4.7)

(7.0, 8.4)
5.0 (4.5, 5.5)

LEGION PS CoCr has the lowest

procedures.
Oxinium PS Ofcumulative
those withpercenta 15 year revision of all PS
cumulative revision (4.2%) (Table KT11).
Journey
Oxinium
Journey 220 3032 1.4 (1.0, 1.9) 4.5 (3.8, 5.3) 6.4 (5.5, 7.4) 8.8 (7.6, 10.0)

is 7.3% (Table KT12 and Figure KT9). respectively (Figure KT12). Kinemax Plus Kinemax Plus
AOANJRR | 2016 ANNUAL REPORT
101 1826 0.9 (0.6, 1.5) 2.4 (1.8, 3.3) 3.1 (2.4, 4.0) 3.9 (3.1, 4.9) 4.5 (3.6, 5.6) 7.8 (6.3, 9.7)

categorized kneespercent revision, the

II Nexgen 518 CR/Nexgen istheir
the
LCS CR LCS 294 3936 1.0 (0.7, 1.4) 3.8 (3.2, 4.4) 5.0 (4.4, 5.8) 6.1 (5.4, 6.9) 7.2 (6.4, 8.1) 9.4 (8.1, 10.8)

Genesis II PS
with cement Genesis
fixation at 5 years: 14812
2.2%.19 1.2At (1.1, 1.4)longest
2.8 (2.6, 3.1) 3.7 (3.4, 4.1) 4.3 (3.9, 4.7) 5.0 (4.5, 5.5) LCS CR
LCSFemoral
PS
MBT
MBT Tibial
303
N33
9848
N492
0.7 (0.6, 0.9)
1.4 (0.7, 3.0)
2.4 (2.0, 2.7) 3.3 (2.9, 3.7) 4.1 (3.6, 4.6)
5.8 (4.0, 8.3) 7.5 (5.3, 10.5)
5.0 (4.4, 5.6)
Table KT10 Cumulative Percent Revisio

Age
lowest andat Gender
5.3% (Table KT9).
1 Yr 3 Yrs 5 Yrs 7 Yrs 10 Yrs 15 Yrs
Component
Legion CR Component
Genesis II Revised
22 Total
975 1.4 (0.8, 2.5) 2.6 (1.6, 4.0) 3.6 (2.3, 5.7)

Journey
Femoral Tibial N

(5.9, 7.5)
follow-up, the cumulative percent revision of 220
Journey
all other LEGION
3032
combinations
1.4 (1.0, 1.9) 4.5 (3.8, 5.3) 6.4 (5.5, 7.4) 8.8 (7.6, 10.0)
Legion
Oxinium CR
Genesis II 43 2180 0.8 (0.5, 1.3) 2.3 (1.7, 3.1) 2.7 (2.0, 3.8) 3.3 (2.1, 5.1) Component
ACS
Component
ACS Fixed
Revised T
21

Oxinium
Legion
Genesis II 183 7996 1.1 (0.9, 1.4) 3.2 (2.8, 3.8) 3.9 (3.3, 4.7) 4.2 (3.5, 5.0) Active Knee Active Knee 362

Age is a major factor affecting the outcome

is at or below the class average for primary total knee replacement of (Primary“At 15 years, the cumulative percent revision D a t a Oxinium
P e r i o d 1 PS
September 1999 – 31 December 2015
aoa.org .au 207

(4.9, 6.6)
Advance Advance 24
Legion PS Genesis II 51 3208 0.9 (0.6, 1.3) 1.9 (1.4, 2.6) 2.2 (1.6, 3.0)
Advantim Advantim 51

Kinemax Plus Kinemax Plusreplacement.

101 1826The0.9rate
(0.6, 1.5)
of 2.4 (1.8, 3.3) of
3.1primary
(2.4, 4.0) 3.9 (3.1,knee
4.9) 4.5 (3.6, 5.6) 7.8 (6.3, 9.7)
MRK MRK 6 402 0.8 (0.3, 2.4) 1.7 (0.8, 3.8) 1.7 (0.8, 3.8)

20 primary total knee total replacement

Columbus Columbus 53
Maxim Maxim 36 498 1.2 (0.5, 2.7) 2.6 (1.5, 4.5) 4.8 (3.2, 7.1) 5.2 (3.6, 7.6) 6.6 (4.7, 9.4)

Diagnosis OA.) Table KT9AOANJRR | 2016 ANNUAL REPORT Natural Knee

Natural Knee II 23 1129 0.8 (0.4, 1.5) 2.5 (1.6, 3.8) 3.0 (2.0, 4.7) 3.0 (2.0, 4.7)
Duracon Duracon 182

LCS CR LCS with increasing 294 3936

age, 1.0 (0.7, this
1.4) 3.8 (3.2, 4.4) 5.0 (4.4, 5.8) 6.1
for(5.4, 6.9) 7.2 (6.4, 8.1) 9.4 (8.1, 10.8)
GMK Primary GMK Primary 19
Cumulative Percent Revision of Primary Total Knee Replacement with Cemented Fixation
Flex

revision lessens and undertaken osteoarthritis

Natural Knee II Natural Knee II
is 7.3%.”
48 1754 0.5 (0.2, 0.9) 1.3 (0.9, 2.0) 1.9 (1.4, 2.7) 2.7 (2.0, 3.7) 3.6 (2.6, 4.9) Genesis II CR Genesis II 22

(5.6, 8.4)
Nexgen CR Nexgen 109 3735 0.5 (0.3, 0.8) 1.4 (1.0, 1.8) 1.8 (1.4, 2.3) 2.1 (1.7, 2.6) 2.8 (2.3, 3.4) 5.3 (3.8, 7.4) Genesis II CR Profix Mobile 30

LCSFemoral
CR
difference MBT Tibial
becomes more303 9848
N evident 0.7 (0.6,
with 0.9)
time. 2.4 (2.0, 2.7) 3.3 (2.9, 3.7) 4.1 (3.6, 4.6) 5.0 (4.4, 5.6)
Nexgen CR Genesis II PS Genesis II 16

N
Natural Knee II 6 786 0.3 (0.1, 1.0) 0.6 (0.2, 1.6) 0.6 (0.2, 1.6)
Flex LCS CR LCS 143

551(0.7,
Yr 3 Yrs 5 Yrs 7 Yrs 10 Yrs 15 Yrs
Nexgen CR LCS CR MBT 265
Nexgen 254 16286 0.7 (0.6, 0.8) 1.5 (1.3, 1.7) 2.0 (1.8, 2.3) 2.3 (2.0, 2.6) 2.7 (2.2, 3.2)

After
LCS PS four years,
Component
Femoral MBT those aged
Component
Tibial 33 less
Revised
N N
than 1.4
Total
492 years3.0) 5.8 (4.0, 8.3) 7.5 (5.3, 10.5)
Flex
Nexgen LCCK Nexgen 24 604 1.8 (0.9, 3.2) 3.5 (2.2, 5.5) 5.0 (3.2, 7.6) 5.0 (3.2, 7.6)
LCS CR
LCS Duofix
MBT Duofix
MBT Duofix
547
437
1

1 Yr 3 Yrs 5 Yrs 7 Yrs 10 Yrs 15 Yrs

Nexgen LPS Nexgen 221 5618 1.0 (0.7, 1.3) 2.3 (1.9, 2.7) 2.9 (2.5, 3.4) 3.7 (3.2, 4.3) 4.8 (4.2, 5.5) 5.7 (4.9, 6.6)

have over AGC

four IItimes Revised
the rate
975 of 0.5
1.4revision
Maxim Maxim 37

Component
Legion
AGC CR Component
Genesis 22
176 Total
3493 (0.8, 0.9)
(0.4, 2.5) 2.6 (2.0,
2.4 (1.6, 4.0)related
3.0) 3.6 (2.9,
3.5 (2.3,differences
5.7) 4.1 (3.5, 4.9)
4.2) 5.4 (4.6, 6.3)are
8.9 (7.1, 11.1)
Nexgen LPS

Age in outcome
Nexgen 838 27014 0.9 (0.8, 1.0) 2.3 (2.1, 2.5) 3.2 (3.0, 3.4) 3.9 (3.6, 4.2) 5.0 (4.7, 5.5) Natural Knee
Flex Natural Knee II 28
Flex
Optetrak-PS Optetrak 159 2398 1.5 (1.1, 2.1) 4.7 (3.9, 5.7) 6.6 (5.6, 7.8) 7.9 (6.7, 9.2) 9.6 (8.1, 11.4)

compared
LegionKnee to those aged 75 years or older Natural Knee II Natural Knee II 210

Active Active Knee 40 1430 1.0 (0.6, 1.6) 2.4 (1.6, 3.4) 3.6
evident (2.6, 5.0)
within 4.4 males
both (3.0, 6.3) and
4.9 (3.3, 7.2)
females (Table
Optetrak-PS Optetrak-RBK 37 720 1.6 (0.9, 2.8) 3.9 (2.7, 5.9) 5.3 (3.7, 7.5) 6.9 (4.9, 9.7) Nexgen CR Nexgen 102

KT13 Genesis
and IIFigure KT10). 43 2180
Males 0.8 (0.5, 1.3) 2.3 (1.7, 3.1) 2.7 (2.0, 3.8) 3.3 (2.1, 5.1)
PFC Sigma CR MBT 24 1125 0.7 (0.4, 1.4) 1.5 (0.9, 2.4) 1.8 (1.2, 2.8) 2.1 (1.4, 3.3) 2.8 (1.8, 4.3) Nexgen CR Nexgen TM CR 39

(Table
Oxinium CR have a KT14,
PFC Sigma CR PFC Sigma 277 11461 0.8 (0.7, 1.0) 1.9 (1.6, 2.2) 2.4 (2.1, 2.7) 2.9 (2.5, 3.3) 3.4 (3.0, 3.9) Nexgen CR Flex Nexgen 143

Advance Advance II 54 918 1.5 (0.9, 2.6) 4.1 (3.0, 5.6) Figures
4.8 (3.6, KT13 and
6.4) 6.0 (4.5,KT14).
8.0) 7.2 (5.4, 9.6)
PFC Sigma PS MBT 204 5828 0.9 (0.7, 1.1) 2.6 (2.2, 3.1) 3.5 (3.0, 4.1) 4.1 (3.6, 4.7) 4.6 (3.9, 5.3)
Nexgen CR Flex Nexgen TM CR 164
PFC Sigma PS PFC Sigma 241 7167 1.2 (1.0, 1.5) 2.6 (2.2, 3.0) 3.2 (2.7, 3.6) 3.5 (3.1, 4.0) 4.5 (3.9, 5.3)

higher rate of revision compared to females

Nexgen LPS Nexgen TM LPS 22

Legion
Profix Profix 139 3285 1.1 (0.8, 1.5) 2.6 (2.1, 3.2) 3.2 (2.6, 3.9) 3.9 (3.3, 4.7) 4.6 (3.9, 5.4) Nexgen LPS

Apex Knee CR Apex Knee 2 586 0.2

1.1 (0.0,
(0.9, 1.2) 0.6
3.2 (0.1,
(2.8, 2.5)
Nexgen 13

Genesis II 183 7996 1.4) 3.8) 3.9 (3.3, 4.7) 4.2 (3.5, 5.0)
Profix Oxinium Profix 78 999 1.9 (1.2, 3.0) 5.0 (3.8, 6.5) 6.6 (5.2, 8.3) 7.4 (5.9, 9.3) 8.0 (6.4, 10.0) Flex

D ata(Table
Period 1 KT14
Oxinium and
PS ember Figure KT11).
RBK RBK 76 2157 0.9 (0.6, 1.5) 2.6 (1.9, 3.4) 3.4 (2.6, 4.3) 4.1 (3.2, 5.3) 5.7 (4.4, 7.5) Nexgen LPS
Nexgen TM LPS 22

207
SAIPH SAIPH 6 719 0.3 (0.1, 1.3) 1.7 (0.7, 4.1) Flex
Sept 1999
Apex Knee PS Apex Knee
– 31 December
4
2015
1116 0.4 (0.1, 1.2)
Score Score 10 515 1.1 (0.5, 2.7) 1.7 (0.8, 3.5) a o a . o rg . au
2.1 (1.0, 4.3) PFC Sigma CR AMK Duofix 52

Legion PS Genesis II 51 3208 0.9 (0.6, 1.3) 1.9 (1.4, 2.6) 2.2 (1.6, 3.0)
Scorpio CR Series 7000 85 1780 0.9 (0.5, 1.4) 2.2 (1.6, 3.1) 2.9 (2.2, 3.8) 4.1 (3.2, 5.2) 5.0 (4.0, 6.2) PFC Sigma CR MBT 59
Scorpio NRG PFC Sigma CR MBT Duofix 105

Attune CR Attune 17 3199 0.5 (0.3, 0.9)

Series 7000 27 1387 0.7 (0.4, 1.3) 1.4 (0.9, 2.3) 2.2 (1.4, 3.4) 3.0 (2.0, 4.5)
CR Profix Profix 85

MRK MRK 6 402 0.8 (0.3, 2.4) 1.7 (0.8, 3.8) 1.7 (0.8, 3.8)
Scorpio NRG RBK RBK 250
Series 7000 54 2555 0.6 (0.4, 1.0) 1.7 (1.2, 2.3) 2.3 (1.8, 3.1) 2.6 (1.9, 3.5)
PS Score Score 74

Attune PS Attune 7 1632 0.4 (0.2, 0.9)

Scorpio PS Scorpio 30 510 1.2 (0.5, 2.6) 3.8 (2.4, 5.9) 4.4 (2.9, 6.6) 5.3 (3.6, 7.7) 6.4 (4.5, 9.1)
Scorpio CR Series 7000 183

MaximKT12 Cumulative
Maxim 36 498 1.2 (0.5,
Total2.7)
Knee2.6 (1.5, 4.5) 4.8 (3.2, 7.1) 5.2 (3.6, OA)
7.6) 6.6 (4.7, 9.4)
Scorpio PS Scorpio+ 57 900 1.2 (0.7, 2.2) 4.0 (2.9, 5.5) 5.6 (4.3, 7.4) 6.0 (4.6, 7.8) 6.9 (5.3, 9.0)
Table Percent Revision of Primary Replacement (Primary Diagnosis Scorpio PS Series 7000 170 3205 1.1 (0.8, 1.5) 2.9 (2.3, 3.5) 4.0 (3.3, 4.8) 5.0 (4.3, 5.9) 6.8 (5.8, 8.1)
Scorpio
NRG CR
Series 7000 42

(3.3, 5.2) BalanSys BalanSys 20 1417 0.2 (0.0, 0.6) 1.5 (0.8, 2.5) 1.9 (1.1, 3.2) 2.6 (1.5, 4.5) 3.9 (2.2, 7.1)
Triathlon CR Triathlon 497 25632 0.8 (0.7, 0.9) 2.1 (1.9, 2.3) 2.6 (2.4, 2.8) 3.0 (2.7, 3.4) 3.8 (3.2, 4.5) Scorpio
Series 7000 60

Natural Knee
Triathlon PS Triathlon 185 5886 1.5 (1.2, 1.8) 3.2 (2.7, 3.7) 4.0 (3.4, 4.6) 4.6 (3.9, 5.3) NRG PS

Natural N N
Class Knee II 23 1129 0.8 (0.8,
(0.4, 1.5) 2.4
2.5 3(2.1,
(1.6, 3.8) 3.3
3.05(2.9,
(2.0, 4.7) 3.9
3.0 (3.5,
(2.0, 4.7)
Vanguard CR Maxim 133 6778 0.6 (0.4, 0.8) 2.2 (1.8, 2.7) 2.8 (2.4, 3.4) 3.3 (2.7, 4.0) Scorpio PS Series 7000 44

Duracon Knee Duracon 424 8968 1.0 1 Yr 1.2) Yrs 2.8) Yrs 3.7) 7 Yrs4.3) 4.8 10
(4.3,
Yrs5.3) 7.0
15(5.9,
Yrs 8.2)
Triathlon CR Triathlon 265 1

Flex
Vanguard CR Vanguard 14 967 0.5 (0.2, 1.3) 1.4 (0.8, 2.5) 1.7 (0.9, 3.2)

Revised Total
Vanguard PS Maxim 166 3500 1.9 (1.5, 2.4) 4.6 (3.9, 5.4) 5.7 (4.9, 6.7) 6.8 (5.7, 8.0) Triathlon PS Triathlon 46
Vanguard CR Maxim 32

E.MotionKnee II E.Motion 18 446 1.9 (0.9, 3.7) 4.8 (3.0, 7.6) 1.9 (1.4, 2.7) 2.7 (2.0, 3.7)
Other (177) 497 8717 1.6 (1.3, 1.8) 4.1 (3.6, 4.6) 5.9 (5.3, 6.5) 7.1 (6.5, 7.8) 8.6 (7.9, 9.5) 12.0 (10.0, 14.4)

Natural Natural Knee II 17213

48 1754 0.5
1.0(0.2,
(1.0,0.9)
1.1) 1.3
2.7(0.9,
(2.7,2.0) 3.6
5.3(2.6,
(5.2,4.9)
TOTAL 8762 266814 Vanguard CR Regenerex 43

Total Knee 482373 2.8) 3.6 (3.6, 3.7) 4.4 (4.3, 4.4) 5.4) 7.3 (7.1, 7.6)
Vanguard CR Vanguard 29
Note: Some cementless components have been cemented

Evolis Evolis 12 730 0.3 (0.1, 1.1) 1.1 (0.5, 2.3) 1.6 (0.8, 3.1) 2.9 (1.5, 5.3)
Other (68) 509
Only combinations with over 400 procedures have been listed

Nexgen CR Nexgen 109 3735 0.5 (0.3, 0.8) 1.4 (1.0, 1.8) 1.8 (1.4, 2.3) 2.1 (1.7, 2.6) 2.8 (2.3, 3.4) 5.3 (3.8, 7.4)
TOTAL 4830 10

TOTAL 17213 482373 Note: Only combinations with over 400 proc

Evolution Evolution 8 1636 0.5 (0.2, 1.3) 1.5 (0.7, 3.3)

Nexgen CR
Natural Knee II 6 786 0.3 (0.1, 1.0) 0.6 (0.2, 1.6) 0.6 (0.2, 1.6)
GMK
Flex Primary GMK Primary 10 549 0.8 (0.3, 2.1) 2.4 (1.2, 4.7) 4.2 (1.7, 10.2)
GMK Sphere
Nexgen CR
208 aoa.org.au D at a P er i o d 1 S e pte m be r 1999 – 31 De ce m be r 2015

GMK Primary
Nexgen 23
254 1602
16286 1.6
0.7 (1.0,
(0.6, 2.6)
0.8) 1.5 (1.3, 1.7) 2.0 (1.8, 2.3) 2.3 (2.0, 2.6) 2.7 (2.2, 3.2)
Primary
Flex
Figure KT9
Genesis Cumulative Percent Revision of Primary Total Knee Replacement (Primary Diagnosis OA) 4.3 (3.9, 4.7)
Nexgen IILCCK
CR Genesis
Nexgen II 421
24 13019
604 0.9
1.8 (0.8,
(0.9, 1.1)
3.2) 2.4
3.5 (2.2, 2.7)
5.5) 3.1
5.0 (2.8,
(3.2, 3.5)
7.6) 4.0
5.0 (3.6,
(3.2, 4.4)
7.6) 5.6 (4.7, 6.7)
Genesis
Nexgen IILPS
CR Profix
Nexgen Mobile 32
221 490
5618 1.7
1.0 (0.8,
(0.7, 3.3)
1.3) 3.4
2.3 (2.1,
(1.9, 5.5)
2.7) 5.6
2.9 (3.8,
(2.5, 8.2)
3.4) 6.7
3.7 (4.6,
(3.2, 9.6)
4.3) 9.2
4.8(6.3,
(4.2,13.3)
5.5) 5.7 (4.9, 6.6)
20%
(3.7, 5.3) Genesis
Nexgen IILPS Total Knee
Genesis
Nexgen II 309
838 6923
27014 1.0
0.9 (0.8, 1.3)
1.0) 2.8
2.3 (2.4,
(2.1, 3.2)
2.5) 3.7
3.2 (3.2,
(3.0, 4.2)
3.4) 4.7
3.9 (4.1,
(3.6, 5.3)
4.2) 6.2
5.0 (5.5,
(4.7, 7.0)
5.5)
Oxinium
Flex CR 18%

Genesis II
Optetrak-PS OptetrakII 159 2398 1.5 (1.3,
(1.1, 1.7)
2.1) 4.7 (3.5,
(3.9, 4.2)
5.7) 6.6 (4.8,
(5.6, 5.7)
7.8) 7.9 (5.8,
(6.7, 6.8)
9.2) 9.6
Genesis 16% 686 14338 1.5 3.8 5.2 6.2 7.7(8.1,
(7.0,11.4)
8.4)
Oxinium PS
Optetrak-PS Optetrak-RBK 37 720 1.6 (0.9, 2.8) 3.9 (2.7, 5.9) 5.3 (3.7, 7.5) 6.9 (4.9, 9.7)
Genesis II PS Genesis II 14% 518 14812 1.2 (1.1, 1.4) 2.8 (2.6, 3.1) 3.7 (3.4, 4.1) 4.3 (3.9, 4.7) 5.0 (4.5, 5.5)
Cumulative Percent Revision

PFC Sigma CR MBT 24 1125 0.7 (0.4, 1.4) 1.5 (0.9, 2.4) 1.8 (1.2, 2.8) 2.1 (1.4, 3.3) 2.8 (1.8, 4.3)
Journey
PFC Sigma CR PFC Sigma
Journey 277
12% 220 11461
3032 0.8 (1.0,
1.4 (0.7, 1.9)
1.0) 1.9 (3.8,
4.5 (1.6, 5.3)
2.2) 2.4 (5.5,
6.4 (2.1, 7.4)
2.7) 8.8
2.9(7.6,
(2.5,10.0)
3.3) 3.4 (3.0, 3.9)
Oxinium
PFC Sigma PS MBT 204 5828 0.9 (0.7, 1.1) 2.6 (2.2, 3.1) 3.5 (3.0, 4.1) 4.1 (3.6, 4.7) 4.6 (3.9, 5.3)
Kinemax Plus Kinemax Plus10% 101 1826 0.9 (0.6, 1.5) 2.4 (1.8, 3.3) 3.1 (2.4, 4.0) 3.9 (3.1, 4.9) 4.5 (3.6, 5.6) 7.8 (6.3, 9.7)
(4.6, 6.6) PFC Sigma PS PFC Sigma 241 7167 1.2 (1.0, 1.5) 2.6 (2.2, 3.0) 3.2 (2.7, 3.6) 3.5 (3.1, 4.0) 4.5 (3.9, 5.3)
LCS CR LCS 294 3936 1.0 (0.7, 1.4) 3.8 (3.2, 4.4) 5.0 (4.4, 5.8) 6.1 (5.4, 6.9) 7.2 (6.4, 8.1) 9.4 (8.1, 10.8)
Profix Profix 8% 139 3285 1.1 (0.8, 1.5) 2.6 (2.1, 3.2) 3.2 (2.6, 3.9) 3.9 (3.3, 4.7) 4.6 (3.9, 5.4)
LCS CR MBT 303 9848 0.7 (0.6, 0.9) 2.4 (2.0, 2.7) 3.3 (2.9, 3.7) 4.1 (3.6, 4.6) 5.0 (4.4, 5.6)
Profix Oxinium Profix 6% 78 999 1.9 (1.2, 3.0) 5.0 (3.8, 6.5) 6.6 (5.2, 8.3) 7.4 (5.9, 9.3) 8.0 (6.4, 10.0)
LCS PS MBT 33 492 1.4 (0.7, 3.0) 5.8 (4.0, 8.3) 7.5 (5.3, 10.5)
RBK RBK 76 2157 0.9 (0.6, 1.5) 2.6 (1.9, 3.4) 3.4 (2.6, 4.3) 4.1 (3.2, 5.3) 5.7 (4.4, 7.5)
Legion CR Genesis II 4% 22 975 1.4 (0.8, 2.5) 2.6 (1.6, 4.0) 3.6 (2.3, 5.7)
SAIPH SAIPH 6 719 0.3 (0.1, 1.3) 1.7 (0.7, 4.1)
Score Score 2% 10 515 1.1 (0.5, 2.7) 1.7 (0.8, 3.5) 2.1 (1.0, 4.3)
Scorpio CR Series 7000 0%
85 1780 0.9 (0.5, 1.4) 2.2 (1.6, 3.1) 2.9 (2.2, 3.8) 4.1 (3.2, 5.2) 5.0 (4.0, 6.2)
D ata Scorpio
Period 1NRG 0 1 2015
2 3 4 5 6 7 8 9 10 11 12 13 14 15
Series 7000
Sept ember 1999 – 31 December
27 1387 0.7 (0.4, 1.3) 1.4 (0.9, 2.3) 2.2 (1.4, 3.4) 3.0 (2.0, 4.5) a o a . o rg . au 207
CR Years Since Primary Procedure

1.5, 14.6) Scorpio NRG

Series 7000 54 2555 0.6 (0.4, 1.0) 1.7 (1.2, 2.3) 2.3 (1.8, 3.1) 2.6 (1.9, 3.5)
PS Today’s orthopaedic environment demands simple solutions with proven clinical
Scorpio PS Scorpio
history. With30the durability
510 1.2 (0.5, 2.6) 3.8 (2.4,Technology,
of VERILAST™ 5.9) 4.4 (2.9, 6.6) 5.3 (3.6, 7.7) flexibility
interoperative 6.4 (4.5, 9.1)
Scorpio Number
PS at Risk
Scorpio+ 570 Yr 900 1 Yr
1.2 (0.7, 2.2) 3 Yrs
4.0 (2.9, 5.5) 5 Yrs
5.6 (4.3,
of both implants and instrumentation, and a rich clinical heritage, the7.4) 7
6.0 Yrs
(4.6, 7.8) 6.910(5.3,
Yrs 9.0)
LEGION 15 Yrs
Scorpio
Total PS
Knee Series 7000 170 1.1 (0.8, 1.5) 322059
482373 3205 425331 2.9 (2.3, 3.5) 232848
4.0 (3.3, 4.8) 158068
5.0 (4.3, 5.9) 6.8 (5.8, 8.1)
73984 2040
Total Knee System gives surgeons peace of mind not only in the OR but with
Triathlon CR Triathlon 497 25632 0.8 (0.7, 0.9) 2.1 (1.9, 2.3) 2.6 (2.4, 2.8) 3.0 (2.7, 3.4) 3.8 (3.2, 4.5)
the knowledge that their patients can return to their active lifestyles.
Triathlon PS Triathlon 185 5886 1.5 (1.2, 1.8) 3.2 (2.7, 3.7) 4.0 (3.4, 4.6) 4.6 (3.9, 5.3)
Vanguard CR Maxim 133 6778 0.6 (0.4, 0.8) 2.2 (1.8, 2.7) 2.8 (2.4, 3.4) 3.3 (2.7, 4.0)
Vanguard CR Vanguard 14 967 0.5 (0.2, 1.3) 1.4 (0.8, 2.5) 1.7 (0.9, 3.2)
 References

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. Biomet publication, Claims for E1 Antioxidant Infused Technology
8. Ref: DePuy Attune 510 K Document K101433 Dec 10, 2010
9. Hallab NJ, Anderson S, Stafford T, Glant T, Jacobs JJ. “Lymphocyte responses in patients with total hip arthroplasty.” J Orthop Res 2005; 232:384e91.
10 Niki, Yasuo et al. “Screening for symptomatic metal sensitivity: a prospective study of 92 patients undergoing total knee arthroplasty.” Biomaterials 26 (2005) 1019–1026
11. Nasser, S. “Biology of foreign bodies: tolerance, osteolysis, and allergy”, Total Knee Arthroplasty, J. Bellemans, M.D. Ries, and J. Victor (eds.), Springer Verlag, Heidelberg, Germany,
2005, pp. 343-352.
12. Granchi, Donatella et al. “Sensitivity to implant materials in patients with total knee arthroplasties.” Biomaterials 29 (2008) 1494-1500
13 ASTM International Standard Specification for Wrought Zirconium-2.5Niobium Alloy for Surgical Implant Applications (UNS R60901) Designation: F 2384 – 05 and Standard Specification for
Cobalt-28 Chromium-6 Molybdenum Alloy Castings and Casting Alloy for Surgical Implants (UNS R30075): Designation: F 75 – 07
14. Hallab, Nadim et al. Metal Sensitivity in Patients with Orthopaedic Implants, The Journal of Bone & Joint Surgery, Vol 83-A No. 3. March 2001 p428-43616.
15. Total knee arthroplasty at 15-17 years: does implant design affect outcome? Victor J, Ghijselings S, Tajdar F, Van Damme G, Deprez P, Arnout N, Van Der Straeten C.,
Int Orthop. 2014 Feb;38(2):235-41. doi: 10.1007/s00264-013-2231-8. Epub 2013 Dec 18.
16. Bhandari, Saccone, Sprague, “The GENESIS II Total Knee System in Primary Total Knee Arthroplasty: A Systematic Literature Review of Clinical Outcomes”, Bone&Joint Outcome, Vol 01, No
01-August 2011.
17. Smith & Nephew Technical Memo TM-11-013A Comparison of LEGION and GENESIS II OXINIUM Femoral Designs.
18. LEGION Primary Knee System: A Prospective, Multi-Center, Non-Randomized, Safety and Efficacy Clinical Study of the LEGION Primary Knee System for Primary Total Knee Replacement in
Subjects with Degenerative Knee Disease. 10-K300-95301, 29 April 2014. Version 1.0.
19. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide:AOA; 2016 Table KT9: Cumulative Percent Revision of Primary Total Knee Replacement
with Cement Fixation.
20. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide:AOA; 2016 Table KT12: Cumulative Percent Revision of Primary Total Knee Replacement
(Primary Diagnosis OA)

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