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Are all MB knees the same? Is MB really better than FB? Jean-Louis Briard
classification ,[object Object],[object Object],[object Object]
#1 Maximum Conformity Can be achieved through: Multi-radius   sagittal   femoral  geometry  with a distal sphere Constant radius sagittal FT  geometry  with a posterior sphere A - SPHERICAL DESIGNS B -OVOID DESIGNS Never spherical Coronal & sagittal radius are different
Multi-radius   sagittal   femoral geometry: J curve   with a distal sphere:  S2 Extensive area contact near to extension (R: 50mm ) But circular line contact in Flexion LCS  & Generics, Interax ISA, Genesis II/ Profix, Innex, Link TACK, Cinétique A 1  SPHERICAL DESIGNS S2
Constant radius sagittal FT geometry   with a posterior sphere Contact area more limited in extension (R: 25mm ) Larger contact in flexion Rotaglide, SAL, TRAC,  MBK, Oxford TMK A 2  - SPHERICAL DESIGNS
[object Object],[object Object],[object Object],[object Object],[object Object]
Moving from a fixed bearing to a mobile bearing without changing the femoral implant ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],530 mm 2 407 mm 2 902 mm 2
But in face of V/V tilting and subsequent lift-off which divides the area by 2,  900 mm 2  seems safer Remember with LCS and poor PE, wear is exceptional !
#2 Motion of the Bearing relative to the tibial tray (H.Mc Ewen) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Multi-directional motion SAL, Rotaglide, LCS AP Glide MBK/LPS Flex, Oxford  Genesis II/Profix  (Rot/Translating) NB: There is a potential for increase wear due the   " crossing patterns "  motion  at the  BACK SIDE  of the tibial bearing (file!)
Multidirectional Unidirectional Study conducted at Leeds University by  Hannah McEwen, J.Fisher Has proven the value of the LCS concept designed 30 y ago !
UHMWPE Kinematics UHMWPE orientates in principle direction of sliding  (Pooley & Tabor 1972,  Proc.Roy.Soc.Lon.A, 329, 251) Strength increased  parallel to sliding but reduced strength transverse to sliding  (Wang et al. 1996,  Proc.IMechE,  210H, 141) + Multidirectional works  as a file ! : Consequence : # 1
Abrasive Wear Mono directional Multi directional # 2 Limited furrows Huge amount removed
Fixed vs RP Fixed bearing Multidirectional motion of femoral component relative to bearing RP Mobile bearing Bearing rotation decoupled:  Linear rotation at  tibial counterface  with reduced rotation at  femoral counterface Not to speak of Backside wear !
[object Object],[object Object],[object Object],[object Object]
Stability  is an issue ,[object Object],[object Object],[object Object]
LCS spinout but very exceptional (4/2000) Stability  is an issue
LCS RP prosthetic stability Deep Dish Jump height: 6 mm ,[object Object],jump height  reflects : the " forgiven  " laxity
[object Object],[object Object],[object Object],[object Object],[object Object]
So, the PFC  Σ  RP ,[object Object]
PS RP (0-70°) ,[object Object],[object Object],[object Object]
[object Object],TRAC HLS IB2 Importance of  surgical technique  to keep good stability and so allow soft tissues to function & dissipate the stresses (load sharing) that can lead to wear & loosening LCS
PS and MB ++++ ,[object Object],[object Object]
[object Object],[object Object]
LCS system Unchanged for 30 years and widely copied today ! Rotating Platform
Results Complications LCS RP ,[object Object],[object Object],[object Object],[object Object],[object Object]
LCS results a) complications ,[object Object],[object Object],[object Object],abandoned !
LCS spinout but very exceptional (4/2000) Stability  is an issue

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Briard Jl. Are All Mb Knees The Same. Slide 1 28

  • 1. Are all MB knees the same? Is MB really better than FB? Jean-Louis Briard
  • 2.
  • 3. #1 Maximum Conformity Can be achieved through: Multi-radius sagittal femoral geometry with a distal sphere Constant radius sagittal FT geometry with a posterior sphere A - SPHERICAL DESIGNS B -OVOID DESIGNS Never spherical Coronal & sagittal radius are different
  • 4. Multi-radius sagittal femoral geometry: J curve with a distal sphere: S2 Extensive area contact near to extension (R: 50mm ) But circular line contact in Flexion LCS & Generics, Interax ISA, Genesis II/ Profix, Innex, Link TACK, Cinétique A 1 SPHERICAL DESIGNS S2
  • 5. Constant radius sagittal FT geometry with a posterior sphere Contact area more limited in extension (R: 25mm ) Larger contact in flexion Rotaglide, SAL, TRAC, MBK, Oxford TMK A 2 - SPHERICAL DESIGNS
  • 6.
  • 7.
  • 8.
  • 9. But in face of V/V tilting and subsequent lift-off which divides the area by 2, 900 mm 2 seems safer Remember with LCS and poor PE, wear is exceptional !
  • 10.
  • 11. Multidirectional Unidirectional Study conducted at Leeds University by Hannah McEwen, J.Fisher Has proven the value of the LCS concept designed 30 y ago !
  • 12. UHMWPE Kinematics UHMWPE orientates in principle direction of sliding (Pooley & Tabor 1972, Proc.Roy.Soc.Lon.A, 329, 251) Strength increased parallel to sliding but reduced strength transverse to sliding (Wang et al. 1996, Proc.IMechE, 210H, 141) + Multidirectional works as a file ! : Consequence : # 1
  • 13. Abrasive Wear Mono directional Multi directional # 2 Limited furrows Huge amount removed
  • 14. Fixed vs RP Fixed bearing Multidirectional motion of femoral component relative to bearing RP Mobile bearing Bearing rotation decoupled: Linear rotation at tibial counterface with reduced rotation at femoral counterface Not to speak of Backside wear !
  • 15.
  • 16.
  • 17. LCS spinout but very exceptional (4/2000) Stability is an issue
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25. LCS system Unchanged for 30 years and widely copied today ! Rotating Platform
  • 26.
  • 27.
  • 28. LCS spinout but very exceptional (4/2000) Stability is an issue