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The Ascent Total Knee System is taking total knee replacement to new heights by building on over twenty years of clinical experience. One thing has become clear in total knee replacement: surgeons need and want several choices for their patients. Surgeon choice is critical and may be the most important factor in long-term patient satisfaction. Biomet responded to this need by combining its clinical experience, extensive engineering resources, and the clinical experience of Rick Bassett, M.D. and Michael Jacobs, M.D. The combination of these resources provides Biomets surgeon customers with a clinically proven, user friendly system: the culmination of experience from the most responsive company in orthopaedics. The goals of the Ascent Knee System are to: Incorporate design features of proven Biomet knee designs Consistently restore function, stability and durability to the knee, thereby meeting the needs of total knee patients today and tomorrow Provide instrumentation that allows reproducible results and offers the ability to choose the level of constraint intraoperatively Develop new technology to further enhance total knee replacement into the twenty-rst century

The porous coated devices depicted in this brochure are marketed for use with bone cement in the United States. The Ascent system was designed in conjunction with Rick Bassett, M.D., Valley Baptist Hospital, Harlingen, Texas; and Michael Jacobs, M.D., Good Samaritan Hospital, Baltimore, Maryland.

Primary Cruciate Retaining Femorals

Retinacular Relief
On both the medial and lateral sides of the anterior flange, the Ascent femoral component has the added benefit of retinacular relief. Retinacular relief is achieved by streamlining the anterior sides of the component. The retinaculum must travel over the sides of the femoral component for the patella to sit within the femoral groove. By reducing the distance the retinaculum has to travel, the Ascent minimizes the need for lateral releases.

Swept-Back Femoral Design

The swept-back design of the component offers tremendous advantages to both the quadriceps mechanism and the patella. Several authors maintain that less boxy designs provide a smoother transition for the patellar component as the knee goes into flexion.1 The ease of transition may result in fewer patellar clunks, less patellar wear, and a reduction in soft tissue impingement.

Optimal Range of Motion

By design, the Ascent knee specifically addresses range of motion. The Ascent knee offers a tighter posterior proximal radius, this allows easier rollback and provides up to an additional 10 degrees of flexion.2

Deep Patellar Groove

Much has been said about the design of a femoral component and its effects on patellar performance. The Ascent femoral component maintains a deep patellar groove. A deep patellar groove coupled with a true dome patellar articulation helps decrease stresses on the patella by improving patellar tracking, and dispersing stress over a large contact area.

Cruciate Substituting Femorals

Posterior Stabilized Constrainable Femurs
The Ascent Posterior Stabilized System offers a tremendous amount of intraoperative flexibility. This system allows the surgeon to progress from a posterior stabilized to a constrained device simply by changing the tibial bearing. The surgeon is not required to make any additional bone resection when converting to the constrained bearing.
(Amount of Bone Removed)

Box Volume
The Ascent open and closed box P/S femoral components have a significantly smaller box volume in comparison to other competitive designs, minimizing bone removal (Figure 1). The polyethylene P/S tibial spine does not protrude above the top of the open P/S box. Many competitive designs use what appears to be a very small P/S femoral box. However, significant amounts of bone must be removed to accommodate the tibial spine.

Figure 1

Stability
In cruciate sacrificing knees, the height required for the P/S Femoral Cam to jump over the P/S Post is referred to as the hop height. The Ascent knee has a hop height of 18.5mm at 90 degrees of flexion. A notable feature for the Ascent knee is that it maintains its hop height at deep flexion angles where dislocations occur (Figure 2).5

Figure 2

Interchangeability
The condylar radius makes the Ascent posterior stabilized design fully interchangeable. All posterior stabilized femoral components articulate with all posterior stabilized tibial components, providing full flexibility and optimal bone coverage.

All posterior stabilized femoral components interchange with all posterior stabilized tibial components.

Tibial Trays
Biomets tibial plate coverage is designed to accommodate a wide range of bone sizes based on the work of Mensch and Amstutz. The geometry of the nine sizes utilizes the best available bone on the tibial plateau, while offering uniform distribution of tibio-femoral forces.

Based on the work of Mensch and Amstutz, a broad range of tibial sizes covers virtually any requirement.

Plate Options
Primary tibial trays are made from both titanium and cobalt chrome alloys. Titanium
Various primary stem options meet specific patient needs.

baseplates come either with an Interlok finish or a titanium porous plasma sprayed. Porous plasma sprayed baseplates accept up to four 6.5mm cancellous bone screws. Both the porous and stemmed tibial plates can be used with block or wedge augments. All augments are fixed to the baseplates via screws. Cobalt chrome baseplate options come in either fixed I-beam or fixed cruciate fin with an Interlok finish.

Stem Options
The modular primary tray provides for the intraoperative selection of the stem to match the specific needs of the patient. The combination of a Morse-type taper and screw fixation helps maintain a solid connection between the stem and plate.

Tibial augmentation blocks and wedges are available for the porous and stemmed trays. Canal filling and long stem extensions are available for the stemmed tray.

Compressive Locking Mechanism

Since 1989, Biomets locking bar has been clinically utilized and confirmed as a truly reliable locking mechanism. Unlike snap-in designs, Biomets system features a unique slide-in bar that compresses the polyethylene within the locking mechanism, and reduces micromotion between the plate and polyethylene. Maximum polyethylene thickness is maintained at the periphery due to intercondylar placement of the locking mechanism.
Locking bar generates a compressive polyethylene fit onto the tibial plate while obtaining consistent bearing edge thickness.

ArCom Polyethylene
Argon Packaged: Compression Molded

Wear
Knee wear is predominantly a fatigue mechanism, which may lead to delamination and pitting of the bearing surface. Direct compression molded devices using 1900H raw polyethylene have demonstrated clinically superior resistance to this type of breakdown.1 With traditional machining, stresses are created near the surface of the component. The cutting tool shears the polyethylene and pulls the material apart, creating a region of residual stress. The residual stress may sensitize the material to localized breakdown and oxidation. Oxidation may negatively impact the fatigue characteristics of the polyethylene, causing delamination. Since delamination is a major concern in total knees, Biomet has made the commitment to direct compression mold the Ascent tibial bearings to minimize the potential for wear and oxidative breakdown. ArCom polyethylene is tailored to address the specific wear mechanisms found in total knee replacement.

+
Extruded Bar Stock Machining

=
Oxidized Cross-Section

+
1900H Resin Direct Molding

=
Non-Oxidized Cross-Section

Controlling oxidation is an important aspect in the performance of tibial bearings. Machining operations are a major source of stress and need to be considered to control oxidation before sterilization. Ascent tibial bearings are direct molded out of 1900H Resin to minimize the potential for wear and oxidation breakdown.4

Revision
The Ascent Knee System addresses the complex bone defects that revision cases often present. With various modular options, the surgeon has the ability to customize the implant to fit patient needs. Multiple stem lengths and diameters, along with femoral condylar augmentation and tibial wedges, are availablemaximizing the ability to address bone defects. The intraoperative flexibility is enhanced with the option of a posterior stabilized or constrained bearing depending on collateral deficiency. Additionally, the surgeon is able to choose either a five or seven degree femoral valgus angle for correct placement within the femoral canal.

T-1 Instrumentation
T-1 instruments help solve many of the problems associated with the actual revision procedure and may contribute to the success of the final implant. The T-1 Revision Instruments offer the following features: Proper Establishment of the Joint Line The T-1 Revision Instruments identify for the surgeon the appropriate placement of the joint line relative to the patients patella or other natural anatomy prior to making any bone resections or soft tissue adjustments. Trial First The T-1 Revision Instruments allow the surgeon to trial for joint line and ligament stability prior to making any bone resections. Consistency The T-1 Revision Instruments identify for the surgeon each step of the revision surgery and remove the guesswork involved in extensive revision surgery. The sledding system for both the tibia and femur identifies the appropriate placement of the components and then allows the surgeon to make any adjustments simply and accurately.

Instrumentation
Precise, simple instrumentation enables the surgeon to achieve optimal component position. Optimal component position establishes balance and appropriate tension which subsequently improves function and increases longevity. The Ascent instrumentation enhances function and longevity through design, accuracy and simplicity. This user-friendly instrumentation also provides the flexibility to change from a cruciate retaining to a posterior stabilized or constrained knee within a single integrated system. The instrumentation is easily understood by the scrub team and central supply. Efficient and user friendly, Ascent instrumentation prevents confusion and serves to decrease operative time.

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The Family AGC Maxim FINN Ascent

THE COMPLETE KNEE SYSTEM

Finn Knee

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References
1 Beadling, Lee; Direct-Molded Components Shown to Resist Oxidation, Orthopaedics Today, Vol. 17, No. 4, April 1997 [Citing Furman B., Li S., and Ritter M.]. 2

Basset, Rick W.; Results of 1,000 Performance KneesCementless Versus Cemented Fixation, Journal of Arthroplasty, pp. 409413 Vol. 13, No. 4, 1998.
3

Data on file at Biomet. Data on file at Biomet.

Robinson, R.P., M.D.; Striplin, D.B., M.D.; Posterior Dislocation of the Insall/Burstein II Posterior Stabilized Total Knee Prosthesis, The American Journal of Knee Surgery, pp. 7983 Vol. 5, No. 2, Spring 1992.

ArCom, Ascent, Finn, Interlok and T-1 are trademarks of Biomet, Inc.

P.O. Box 587, Warsaw, IN 46581-0587 219.267.6639 1999 Biomet, Inc. All Rights Reserved Web site: http://www.biomet.com eMail: biomet@biomet.com Form No. Y-BMT-631/103199/M