The ADVANCE® Double-High Knee received its name because it provides high flexion and high stability in PCL-retaining knees. To manage more dynamic function, the articular surface features a raised anterior lip like the ADVANCE® Medial-Pivot Knee and a PCL-guided flexion path to provide anterior stability and deep natural flexion.

The ADVANCE® Double-High Knee utilizes the same femoral, tibial and patellar components as the ADVANCE® Medial-Pivot Knee. An insert exchange (with no additional bone cuts) is required to convert from PCL-retaining to sacrificing intraoperatively.

Raised Anterior Lip
Reduces anterior sliding (paradoxical motion) by maintaining the femoral
placement through flexion 5,10
May share anterior stresses with the posterior cruciate ligament (PCL), allowing
longer, more effective PCL function
Designed to minimize PCL loosening 11,12,13

PCL-guided Flexion Path
Designed to allow the PCL-dictated translation and rotation demonstrated in deep flexion 4,14
Medial side – Features low-profile articular surfaces to allow PCL-guided flexion 4
Lateral Side – Allows the anterior/posterior translation found in the normal knee

References

1. Komistek, R.; Walker, SA: An in vivo kinematic determination of the F/S 1000 medial pivot knee. Wright Medical Technology, Inc., Test Request TR97-0046, 1997.
2. S.G. Elias, MD, MAR; Freeman, MD, FRCS; and E.I. Gokcay, MD: A Correlative Study of the Geometry and Anatomy of the Distal Femur. Clinical Orthopedics Related Research: 260, 1990.
3. Blaha JD, et al. In vivo determination of kinematics for subjects having either an anterior cruciate ligament retaining or medial pivot total knee arthroplasty. Scientific Exhibit AAOS, 2002.
4. Stuchin S, Intermediate term follow-up of a new medial-pivot total knee. Poster presentation. AAOS 2005.
5. Komistek RD, et al. In vivo fluoroscopic analyses of the normal human knee. Clin Orthop 410:69-81. 2003.
6. Minoda M, et al. Polyethylene Wear Particles in Synovial Fluid After Total Knee Arthroplasty. Clin Orthop. 410:165-172,2003.
7. Kurosaka M, et al. Maximizing flexion after total knee arthroplasty. The needs and the pitfalls. J Arthroplasty 17(4) suppl 1. 2002.
8. Lotke PA. The posterior cruciate ligament in total knee arthroplasty: a commentary. University of Pennsylvania Orthopaedic Journal. Vol 12: 109. 1999.
9. Wright Medical Technology Report. Clinical survey of patient satisfaction – A study of bilateral knee recipients. MK475-701.
10. Schmidt R, Blaha JD, Penenberg BL, Maloney WJ, Komistek RD, Fluoroscopic analyses of cruciate retaining and medial pivot knee implants. Clin Orthop 410:139-147. 2003.
11. Mahoney OM, Noble PC, Rhoads DD, Alexander JW and Tullos HS. Posterior cruciate function following total knee arthroplasty: A biomechanical study. J Arthroplasty, 9:569-78. 1994.
12. Laskin R, O’Flynn H. Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis. Clin Orthop 345:24-28. 1997.
13. Nelson CL. Total knee arthroplasty with preservation of the posterior cruciate ligament. University of Pennsylvania Orthopaedic Journal. Vol 12:96- 99. 1999
14. Pritchett JW, Patient preferences in knee prostheses. JBJS (BR): 979-982, 2004.
15. Schmidt R, Komistek R, et al., Fluoroscopic Analyses of Cruciate-Retaining and Medial-Pivot Knee Implants. Clin Orthop Relat Res. 410:139-147. 2003.
16. Font-Rodriguez DE, G. Scuderi, J. Insall, R. Windsor and M. Moran: Survivorship of Cemented total knee arthroplasty., Clin Orthop Relat Res. Dec;(345):79-86. 1997.
17. Wright Engineering Report, ER010034.