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Advanced Surface Technology

Your chance for better results in knee arthroplasty

Advanced Surface Technology is an innovative multilayer coating for knee implants that is unique in the market. With improved mechanical properties and fantastic results in biocompatibility – it is an effective solution to prevent complications in primary and revision surgery. 

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7 layers for protection

Multilayer vs monolayer coatings

Unlike monolayer coatings, the AS 7-layer coating with Zirconium Nitride surface (ZrN) has a buffer zone which compensates the changes in surface hardness and results in more resilient elastic properties. In addition, the transition layers act as an improved metal ion barrier and offer a more efficient metal ion reduction than monolayer coatings with Titanium Niobium Nitride surface (TiNbN).1, 2

Chart: Multilayer vs monolayer coatings

 Ceramic surface

The top layer is made from zirconium nitride, a hard ceramic material. It offers exceptionally high wear resistance. A hard surface increases scratch resistance 2 and ensures lower polyethylene abrasion.

5 transition layers

The five transition layers provide stability and create a barrier effect. These layers prevent the release of metal ions and bridge the difference in hardness.

Bond coating

This adhesive layer provides a firm connection between the implant and the subsequent coated layers.

Multilayer coating

Improving the molecular structure of the layered system. The Advanced Surface multilayer structure provides the coating with high elasticity and prevents an eggshell effect – even under extreme conditions.

Portrait of Ronald Gardner

“I do everything for satisfied patients with good long-term results – so it is a logical consequence for me to use the Advanced Surface Technology implants. The multilayer technology compensates for the changes in the hardness of the surface and provides a safe barrier against the release of metal ions”

Ronald Gardner, MD, Gardner Orthopaedics, Fort Myers, USA

Enhanced biocompatibility

Take care in advance

Complications as a consequence of metal hypersensitivity

It has been discovered that a possible contact allergy to implant materials or the components contained in bone cement may lead to implant intolerance. Endoprostheses are known to release metal ions into the human body. This can lead to immune reactions in patients who are at risk of hypersensitivity. The metal hypersensitivity prevalence among the general population is relatively high at 13%.3 60% of patients with complications after metal implants are sensitive to metals.4

With AS Technology, metal ion concentration is near the level of detection and below biological threshold.2 The material with excellent biocompatibility seals the metallic components, providing an effective metal ion barrier.

Chart: Less metal ion release

One of the most commonly identified pathogens responsible for orthopaedic implant infection is Staphylococcus epidermidis, which can form biofilms on surfaces and lead to medical problems. The AS surface with zirconium nitride top coat showed 45% lower biofilm formation compared with standard uncoated CoCrMo implants.5

Chart: Less biofilm formation

Interleukins (IL-x) are endogenous messenger substances of the cells of the immune system. Elevated levels of interleukin in the blood indicate the presence of an inflammatory reaction. Using implants with Advanced Surface Technology means no additional pro-inflammatory triggering.6

AS wear solution

Essential for longevity: reduction of wear

The wear of the gliding surface is directly linked to aseptic loosening due to osteolysis triggered by polyethylene wear particles. Aseptic loosening is the most common reason for revisions in TKA.7, 8 The interaction of components is therefore very important for the results of a knee surgery and the patient's well being.

Excellent wear rates

The zirconium nitride top coat yields superior surface hardness that is unmatched in the market place. The wear rate is reduced by up to 88% compared to standard implants. This ceramic surface layer stands for improved scratch resistance, good wettability and for better articulation between bearing surfaces.

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    AS knee implants demonstrate up to 88% reduction in wear when compared to CoCrMo prosthesis.9

Improved resistance through Beta sterilization

The combination of AS Technology for the femur and tibia component and the beta sterilization procedure for our gliding surface yields to superior performance. Beta radiation uses higher concentrated, lower penetrating radiation levels for reduced oxidation im aged material. It combines the advantage of low wear with good mechanical properties of conventional polyethylenes.

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    Beta PE provides 70% reduction in oxidation levels.10

AS clinical evidence

Proving clinical results

The clinical performance is very important – not only for the surgeon that aims for a good result after surgery, but also for the patient that needs the confidence to make the right choice for his/her health.​ There are many different studies and papers to prove the effectiveness and advantages of Advanced Surface Technology.

AS implant portfolio

Complete protection – from primary to revision

The AS coating technology can be applied to all implant components. It is important for us to let you decide for your preferred AESCULAP® knee implant system – with the option in AS.

Columbus®

The interchangeable and anatomically-designed Columbus® Knee prosthesis offers proper physician choice and patient specificity. Columbus® has comprehensive options to cover all bicondylar indications and intraoperative situations. Discover universality – Discover individualityImplant to conserve or sacrifice the posterior cruciate ligamentFixed or rotating platformCemented or cementless with Plasmapore® (for AS version, the Plasmapore® coating is only available as custom made implant)Tibial Augmentation options and tibial stemsPE heights up to 20 mmExtensive size options with 14 femur sizes and 11 tibia sizesAS coated version for optimized wear and patients with metal allergy Discover mobility – Discover stabilityROM up to 140°Improved stability even in difficult ligament situationsTrochlea design supports natural patella tracking Discover quality – Discover innovationsGood clinical performanceNavigated or manual operating techniqueMinimally invasive or conventional operating techniqueWear results down to below 1 mg per million cycles acc. to ISO 14243Two decades of successWith over 650,000 implantations in 43 countries all over the world, Columbus® is our most established knee system. Well proven in 54 publications with 98% survival rate after 10 years in studies.[1] Fantastic results in the English, Australian and German national joint registry.[2-4]20 years Columbus®. 20 years of excellent outcomes. We are proud of it.

Columbus® Revision

Today revision surgery represents already around 15 percent of knee replacement surgeries. Due to more and more earlier implantations and more severe bone defects, the numbers continuously rise. Based on the very successful design of the Columbus® knee endoprostheses, the development of the Columbus® Revision System was just a logic consequence.The new developed revision system is characterized by:Small production tolerancesPrecision of the cutsDemand-oriented implant portfolioLow PE wearManual or OrthoPilot navigated CT-free surgical techniqueImplants in CoCr or also as Advanced Surface (AS) version available

VEGA System®

The posterior stabilized VEGA Knee System was developed to fulfill the modern-day requirements of patient and surgeons for a modern knee implant system. The following objectives were considered in its design: Natural kinematics through a rollback and a pivotal motion around the medial condyleDuring flexion, the natural knee shows increased rollback of the femur on the lateral side while the femur rotates around the medial center.[1] The asymmetric cam design of VEGA facilitates this lateral rollback and medial rotation, and therefore enables a natural pivotal motion.[2] Stability even in high flexion Based on the design and the position of the PS box and post, the contact point of the box and post move distally with an increase of flexion. Therefore the increased jumping distance in flexion can reduce the subluxation risk. The synchronized contact surfaces between the articulating components maximize the bearing surface stress distribution in extension, reducing the risk of delamination. The high congruency between femur and tibia in extension as well as the line contact up to 160° of flexion stabilizes the patient’s movements and reduces wear. To reach higher varus-valgus stability a PS+ gliding surface with a mediolaterally wider PS post is available. Posterior inclination of the post design prevents anterior impingement with the extensor mechanism and increases resistance to dislocation. Soft tissue friendly and bone sparing implant design [2] Besides the reconstruction of natural kinematics, two attributes were in the foreground during the development of the VEGA Knee System. A soft tissue friendly design as well as the reduction of bone loss. 13 femur sizes, including standard and narrow sizes, and 11 tibial sizes, including standard and AP+ sizes, offer a wide range for a better bone fit regardless of gender, size, morphotype or race. Additionally, the VEGA System®’s narrow low-profile box helps to preserve bone and results in stable patellar tracking. A short tibial stem design as well as slim tibial wings support the bone sparing philosophy of VEGA. Furthermore the curved wing design facilitates a high rotational stability. Long-term performance through innovative materials  Advanced Surface: Wear is the number one reason for long-term knee replacement revisions.[3] To combat this issue, the AS coating can deliver up to a 65 % reduction in wear when compared to a CoCr prosthesis, as demonstrated in testing with other Aesculap knee designs. Furthermore, with the AS coating metal ion concentrations remain low and are below any biological threshold. This makes the AS coated implants an ideal solution for patients who are allergic to metal. The AS multilayer coating reduces the hardness from top to bottom in a gradient-like fashion, resulting in an improved elastic modulus. This makes it stable against mechanical stresses and strains.[4-7]Beta Polyethylene: All of Aesculap’s polyethylenes are sterilized under Beta radiation, which reduces oxidation, decelerates the aging process, and yields better wear rates.[8-10] Easy handling and precise results with the new generation of IQ instruments as well as the OrthoPilot® Navigation SystemPatient specific with OrthoPilot® NavigationUser-friendly with IQ Instruments

e.motion®

The e.motion® product family: flexible, compatible, homogenous: Flexible The e.motion® knee endoprosthesis system offers the surgeon a number of implant options depending on the soft-tissue conditions and the extent of the bone defect – a system for many indications. This modularity is achieved through compatibility among the e.motion® products. The mobile platform offers high congruency with all its advantages for wear and kinematics.[1] Compatible The navigated e.motion® offers improved implant alignment in combination with the 20 years experienced OrthoPilot® computer aided operating techniques.[2] Homogenous The IQ instrument platform has been designed to facilitate the workflow not only for the surgeon, but the operation room team as a whole, by enhancing ergonomics and operative efficiency.[3]

EnduRo

Due to today's growing demographic situation, revision operations will continue to play a significant role in the future. The particular challenges of hinged implant revisions require an implant that performs the functions of the collateral ligamentous apparatus without restricting essential joint functions such as flexion and rotation.The EnduRo system offers this flexibility with 24° rotation and a flexion angle of up to 140°. The sophisticated lift technology of the axis mechanism supports the axis while preventing dislocation and allowing for insertion of the tibial stem offset near the jointline. The axis is coupled with the femoral component through a tapered cone and is equipped with a locking nut to prevent dislocation.An extensive product portfolio including various implant sizes, augments, stem extensions and gliding surfaces gives the surgeon the flexibility to adapt the implant to the patient. The EnduRo system is based on the use of proven cobalt-chromium-molybdenum components in combination with carbon fiber reinforced PEEK for the materials of the axis-bearing components. Promising in-vitro results have indicated that and increased longevity of these implant components can be expected [1]. In addition, the optional AS Advanced Surface version can reduce the release of metal ions and improve wear behavior, which was demonstrated during in-vitro experiments [2-5]. Precise implementation of the preoperative planning in the operating room is essential for the success of the procedure. The EnduRo instruments are designed to support just that and enable reproducible surgical procedures for the physician and the team.

Portrait of Ronald Gene Hood

“As it happens, I was a candidate for a knee replacement, and I chose Advanced Surface Technology, which I use on every single patient. Why should I use a lesser item for my patients?”

Ronald Gene Hood, MD, St. Francis Health System, Muskogee, USA

Related Documents

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References

  1. Ragone V, Canciani E, Biffi CA, D'Ambrosi R, Sanvito R, Dellavia C, Galliera E. CoCrMo alloys ions release behavior by TiNbN coating: an in vitro study. Biomed Microdevices. 2019 Jul 4;21(3):61.
  2. Reich J, Hovy L, Lindenmaier HL, Zeller R, Schwiesau J, Thomas P, Grupp TM. Präklinische Ergebnisse beschichteter Knieimplantate für Allergiker [Preclinical evaluation of coated knee implants for allergic patients]. Orthopade. 2010 May;39(5):495-502.
  3. Schäfer T, Böhler E, Ruhdorfer S, Weigl L, Wessner D, Filipiak B, Wichmann HE, Ring J. Epidemiology of contact allergy in adults. Allergy. 2001 Dec;56(12):1192-6.
  4. Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am. 2001 Mar;83-A(3):428-36.
  5. Pilz M, Staats K, Tobudic S, Assadian O, Presterl E, Windhager R, Holinka J. Zirconium Nitride Coating Reduced Staphylococcus epidermidis Biofilm Formation on Orthopaedic Implant Surfaces: An In Vitro Study. Clin Orthop Relat Res. 2019 Feb;477(2):461-466.
  6. Thomas P, Hisgen P, Kiefer H, Schmerwitz U, Ottersbach A, Albrecht D, Summer B, Schinkel C. Blood cytokine pattern and clinical outcome in knee arthroplasty patients: comparative analysis 5 years after standard versus "hypoallergenic" surface coated prosthesis implantation. Acta Orthop. 2018 Dec;89(6):646-651.
  7. Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, Böhler N, Labek G. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty. 2013 Sep;28(8):1329-32
  8. Australian National Joint Replacement Registry 2022.
  9. Grupp TM, Giurea A, Miehlke RK, Hintner M, Gaisser M, Schilling C, Schwiesau J, Kaddick C. Biotribology of a new bearing material combination in a rotating hinge knee articulation. Acta Biomater. 2013 Jun;9(6):7054-63.
  10. Blömer W, Lohrmann E. Verschleißbeständigkeit von UHMWPE-Artikulationen in der Hüftgelenksendoprothetik. In: Weller S, Braun A, Eingartner C, Maurer F, Weise K, Winter E, Volkmann R. Das BICONTACT Hüftendoprothesensystem 1987-2007. Stuttgart: Georg Thieme Verlag; 2007. p. 94-100.
  11. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2021 Annual Report, Adelaide; AOA, 2021: 258.
  12. Lützner J, Beyer F, Lützner C, Tille E, Postler AE. A Novel Multilayer-Coating for Total Knee Arthroplasty Implants is Safe – 10-Year Results From a Randomized-Controlled Trial. J Arthroplasty. 2023 Jan;38(1):90-95.e1.
  13. Whiteside LA. Clinical Results of Revision TKA in Patients With Presumed Metal and Cement Allergy. J Arthroplasty. 2022 Jun;37(6S):S250-S257.
  14. Puente Reyna, A. L., Fritz, B., Schwiesau, J., Schilling, C., Summer, B., Thomas, P., & Grupp, T. M. (2018). Metal ion release barrier function and biotribological evaluation of a zirconium nitride multilayer coated knee implant under highly demanding activities wear simulation. Journal of biomechanics, 79, 88–96. https://doi.org/10.1016/j.jbiomech.2018.07.043
  15. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty: 2020 Annual Report, Adelaide; AOA, 2020: 1-474. [Accessed from: https://aoanjrr.sahmri.com/annual-reports-2020]
  16. Bormann, T., Kraenzler, S., Jaeger, S., Kluess, D., Mittelmeier, W., Renkawitz, T., & Kretzer, J. P. (2023). Stability of ceramic coatings on retrieved knee prostheses. Journal of the mechanical behavior of biomedical materials, 144, 105997. https://doi.org/10.1016/j.jmbbm.2023.105997

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