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Smith and Nephew Journey patello-femoral replacement surgical technique

Overview

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Learn the Smith and Nephew Journey patello-femoral replacement surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Smith and Nephew Journey patello-femoral replacement surgical procedure.

The indication for patello-femoral partial knee replacement is isolated arthritis of the patellofemoral joint (PFJ). This is often seen in conjunction with biomechanical abnormalities such as trochlea dysplasia, patella maltracking and patella alta in a relatively young age group, of people in their fifth decade, who require intervention with arthroplasty. An older subset of patients is also recognised less frequently have these associated biomechanics issues with their PFJ arthritis. The degenerative disease in older patients may start in the PFJ, and would eventually progress to a more generalised tricompartmental arthritis should their lifespan allow; until such time they remain suitable candidates for isolated patello-femoral replacement as the risk of progression is low given their age relative to likely life-expectancy . 

The Journey patellofemoral replacement is a sided trochlea on-lay component which is produced in Oxinium to reduce wear and increase wetability. Oxinium is a trade name of a Smith and Nephew product used for joint reconstruction implants; it is oxidised zirconium as the ceramic surface of a transformed alloy through a patented process. This bearing surface is harder, more wettable and lighter than standard metal and has over ten years clinical experience. The use of Oxinium is a unique selling point for this implant with the potential benefits of longevity and better bio-integration on account of its biomechanics properties.

R.H. Zimlich, M. Levesque, W. Jones, H.D. Schutte, Jr., B.J. Livingston, W. Sauer, M. Spector, and K. Weaver, “In-vitro and in-vivo effect of particulate debris on TKA articulating surfaces”, scientific exhibit SE038, 65th Ann. Mtg. Am. Acad. Orthop. Surg., New Orleans, LA, March 19-23, 1998.

J. Fisher and D. Dowson, “Tribology of total artificial joints”, Proc. Instn. Mech. Engrs., 205 (H2), 1991, pp. 73-79.

The Journey Oxinium trochlea is paired with the Genesis II Patella which is produced and distributed in two forms: the three peg onlay and the single peg biconvex inlay design. Whilst both designs have long-term follow-up, my preference is for the inlay biconvex single peg component to allow fine-tuning of the patella (bone and polyethylene) thickness during the preparation steps as described in this technique.

My reason for using the Journey PFJ is a combination of familiarity with the Genesis II patella (being a Genesis user for total knee replacements) and the theoretical and laboratory suggested benefits of Oxinium to reduce wear and improve wetability.

Author: James Murray

Institution: AOC, Southmead Hospital, Bristol. UK

Feedback

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
  • Your dashboard also will contain a record of the time you have spent logged onto and using the site.
  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .

CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity

COURSE

Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

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