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J Knee Surg 2022; 35(07): 767-775
DOI: 10.1055/s-0040-1718599
Original Article

The Journey Bicruciate Knee Replacement: Design Modifications Yield Better Early Functional Results and Reduce Complications

Lazaros Oikonomidis
1   Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
,
Alasdair J. A. Santini
1   Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
,
John S. Davidson
1   Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
,
Joanne V. Banks
1   Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
,
Andrew Phillipson
1   Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
,
Jill Pope
1   Lower Limb Arthroplasty Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Abstract

The Journey-I total knee replacement was designed to improve knee kinematics but had several complications including early dislocation. The Journey-II modification was introduced to reduce these while maintaining high function. To assess whether the modified Journey-II prosthesis has succeeded in its designers aims, we undertook an observational study of prospectively recorded data to analyze and compare the two knees. A total of 217 Journey-I and 129 Journey-II knees were identified from the department's prospectively collated registry and were assessed at 1 year by a comparative statistical analysis using numerous factors including pain, functional activity, physical assessment, Short Form-12 (SF-12), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Oxford scores. The statistical tests included Chi-square, Wilcoxon's rank and Mann–Whitney U-tests with the level of significance set at p < 0.05. There was a variation in primary patella resurfacing between the two groups with 14.3% in the Journey-I cohort and 66.7% in the Journey-II cohort. Both replacements demonstrated excellent postoperative function, but the Journey II performed significantly better than Journey I with fewer complications (37 vs. 10) and better improvement in almost all clinical scores including pain (p < 0.01), mobility outcomes (p = 0.018), Oxford (p = 0.004), and WOMAC (p = 0.039) scores but not with flexion improvement and SF-12 score. There was significant improvement in patellofemoral pain postoperatively in both the Journey I (p = 0.011) and Journey II (p = 0.042) arthroplasty; however the primarily resurfaced patella in a Journey-II implant had better postoperative scores. The main complication of dislocation in the Journey I was not seen in the modified Journey-II implant with stiffness requiring intervention reduced in Journey II. These results suggest that the Journey II has improved short-term clinical outcomes compared with Journey I with reduction of dislocation and other complications.

Keywords

knee arthroplasty - journey I - journey II - dislocated total knee replacement


Publication History

Received: 15 December 2019

Accepted: 25 August 2020

Article published online:
27 October 2020

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