Smith+Nephew’s LEGION Hinged Knee (HK) System with proprietary OXINIUM (oxidized Zirconium) implant technology has debuted in the United States. OXINIUM delivers the durability of metals, the wear resistance of ceramics, and corrosion resistance better than both.^1-11 

“Our proprietary OXINIUM Technology is ideal for revisions. Building on the performance of our LEGION HK System, our latest innovation allows Smith+Nephew to raise the bar in knee surgery, delivering the most advanced material technology for patients requiring a complex knee revision,” said Craig Gaffin, president of Global Orthopaedics at Smith+Nephew. “It demonstrates our commitment of Life Unlimited for patients requiring complex knee procedures by providing solutions that address the risk factors commonly associated with this type of surgery.”

Part of the LEGION Total Knee (TK) System, the LEGION HK System aims to provide a natural range of motion with medial pivot, lateral roll back, and screw home. Since 2011, the LEGION HK System has enabled surgeons to transition intraoperatively from a constrained revision knee implant to a cobalt chrome-hinged assembly.
 
The award-winning OXINIUM Technology¹² has demonstrated lower inflammatory response,^*6,7 superior wear resistance, reduced surface damage,^+3,4 and fewer signs of corrosion damage^+9,13 compared to cobalt chrome, ultimately helping to mitigate common risk factors associated with revision procedures.^14,15 LEGION revision with proprietary OXINIUM Technology has established itself as the best performing bearing with the lowest risk of re-revision compared to the class average.^13,16
 
“The LEGION HK System with OXINIUM Technology allows me to achieve a stable reconstruction in the coronal and sagittal planes despite my patient’s multiple previous surgeries and ligamentous, capsular deficiency,” stated Kevin Hardt, M.D., of Northwestern Memorial Hospital System. “The innovative, posteriorly located, rotational axis with the LEGION HK System provides an extension moment to augment quad function. In addition, the instrumentation is straightforward and compliments my normal revision workflow.” 
 
Smith+Nephew develops solutions to repair, regenerate and replace soft and hard tissue. The firm’s 18,000 employees invent and apply new technologies across three global business units—Orthopaedics, Sports Medicine & ENT, and Advanced Wound Management. Founded in Hull, United Kingdom, in 1856, Smith+Nephew now operates in more than 100 countries, and generated $5.5 billion in 2023 sales. Smith+Nephew is a constituent of the FTSE100. 
 
References
¹ Hunter G, Dickinson J, Herb B, et al. Creation of oxidized zirconium orthopaedic implants. Journal of ASTM International. 2005;2:1-14.
² Long M, Riester L, Hunter G. Nano-hardness Measurements of Oxidized Zr-2.5Nb and Various Orthopaedic Materials. Abstract presented at: 24th Annual Meeting of the Society for Biomaterials. April 22-26, 1998, San Diego, California.
³ Parikh A, Hill P, Pawar V, Sprague J. Long-term Simulator Wear Performance of an Advanced Bearing Technology for THA. Poster presented at: 2013 Annual Meeting of the Orthopaedic Research Society. Poster no. 1028.
⁴ Papannagari R, Hines G, Sprague J, Morrison M. Long-term wear performance of an advanced bearing technology for TKA. Poster presented at: 2011 Annual Meeting of the Orthopaedic Research Society. Poster no. 1141.
⁵ Smith+Nephew 2010. OR-10-155.
⁶ Dalal A, Pawar V, McAllister K, Weaver C, Hallab NJ. Orthopedic implant cobalt-alloy particles produce greater toxicity and inflammatory cytokines than titanium alloy and zirconium alloy-based particles in vitro, in human osteoblasts, fibroblasts, and macrophages. J Biomed Mater Res Part A. 2012;100A:2147-2158.
⁷ Hallab NJ, McAllister H, Jacobs JJ, Pawar V. Zirconium-alloy and zirconium-oxide particles produce less toxicity and inflammatory cytokines than cobalt-alloy and titanium-alloy particles in vitro, in human osteoblasts, fibroblasts and macrophages. Annual Meeting of the Orthopaedic Research Society (ORS), 2012. San Francisco, CA.
⁸ Aldinger P, Williams T, Woodard E. Accelerated Fretting Corrosion Testing of Zirconia Toughened Alumina Composite Ceramic and a New Composition of Ceramicised Metal Femoral Heads. Poster presented at: 2017 Annual Meeting of the Orthopaedic Research Society. Poster no. 1037. 
⁹ Smith+Nephew 2016. OR-16-127.
¹⁰ ASTM International Standard Specification for Wrought Zirconium-2.5 Niobium Alloy for Surgical Implant Applications (UNS R60901) Designation: F 2384 – 10.
¹¹ Patrick C, Delhougne G, Patel A. Retrospective Analysis of Oxidized Zirconium Bearing Surface in Hip Replacement 90-Day Episode Claims. ISPOR EU Poster, 2019.
¹² 2005 ASM International Engineering Materials Achievement Award.
¹³ Cartner J, Aldinger P, Newman M. Characterization of tapers in TKA revisions from a 16-year retrieval database. Poster presented at: Orthopaedic Research Society Annual Meeting; 2016; Orlando, FL.
¹⁴ Agarwal S, Kabariti R, Kakar R, Lopez D, Morgan-Jones R. Why are revision knee replacements failing? The Knee. 2019;26:774-778. 
¹⁵ Yu S, Bolz N, Buza J, et al. Rerevision Total Knee Arthroplasty: Epidemiology and Factors Associated with Outcomes. Orthopaedic Proceedings. 2018;99-B:Supplement 6. Available at: https://online.boneandjoint.org.uk/doi/abs/10.1302/1358992X.99BSUPP_6.ISTA2016-117.
¹⁶ National Joint Registry for England, Wales and Northern Ireland: LEGION revision OXINIUM (with revision tibial) implant summary report 15 August 2024. Report available upon request.
 
* The results of in vitro cytokine expression analyses have not been proven to quantitatively predict clinical cytokine expression.
+ The results of in vitro wear simulation testing have not been proven to quantitatively predict clinical wear performance.