text:
|Publication number
|Publication type
|Application number
|Publication date
|Mar 1, 2011
|Filing date
|Apr 20, 2009
|Priority date
|Jun 14, 2001
|Fee status
|Also published as
|Publication number
|Gerard A. Engh, Wesley D. Johnson
|Original Assignee
|Alexandria Research Technologies, Llc
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (269), Non-Patent Citations (13), Referenced by (12), Classifications (67), Legal Events (8)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of U.S. patent application Ser. No. 11/468,922, filed Aug. 31, 2006, which is a continuation of U.S. patent application Ser. No. 10/159,147, filed May 29, 2002, now issued as U.S. Pat. No. 7,115,131, which is a divisional application of U.S. patent application Ser. No. 09/882,591, filed Jun. 14, 2001, now issued as U.S. Pat. No. 6,482,209, the entireties of which are hereby incorporated by reference.
A joint generally consists of two relatively rigid bony structures that maintain a relationship with each other. Soft tissue structures spanning the bony structures hold the bony structures together and aid in defining the motion of one bony structure to the other. In the knee, for example, the bony structures are the tibia and the femur. Soft tissue such as ligaments, tendons, menisci, and capsule provide support to the tibia and femur. A smooth and resilient surface consisting of articular cartilage covers the bony structures. The articular surfaces of the bony structures work in concert with the soft tissue structures to form a mechanism that defines the envelop of motion between the structures. Within a typical envelop of motion, the bony structures move in a predetermined pattern with respect to one another. When fully articulated, the motion defines a total envelop of motion between the bony structures. The soft tissue structures spanning the knee joint tend to stabilize the knee in a transverse plane. This transverse stability enables the bony structures to slide and rotate on one another in an orderly fashion.
The articular surfaces are subject to a variety of diseases, accidents and the like that cause the surfaces to be damaged. A common disorder of joints is degenerative arthritis. Degenerative arthritis causes progressive pain, swelling, and stiffness of the joints. As the arthritic process develops, the joint surfaces wear away, resulting in contractures of the surrounding soft tissues that provide stability to the joint. Changes in the articular surfaces resulting from arthritis decrease stability and increase the translation of the joint.
Treatment of the afflicted articular bone surfaces depends, among other things, upon the severity of the damage to the articular surface and the age and general physical robustness of the patient. The end result commonly necessitates joint replacement surgery wherein the articulating elements of the joint are replaced with artificial elements commonly consisting of a part made of metal articulating with a part made of ultra high molecular weight polyethylene (UHMWPE).
A relatively young patient with moderate to severe degeneration of the knee joint is often treated with drug therapies. While drug therapies may temporarily provide relief of pain, progression of the disease, with resulting deformity and reduced function, ultimately necessitates surgery. Alternative treatments such as nonsteroidal anti-inflammatory drugs, cortisone injections, and arthroscopic debridement similarly provide only temporary relief of symptoms.
In severe situations, the entire articular surface of a bone may be replaced with an artificial surface, as, for example, when condyles at the distal end of the femur are largely replaced with a prosthetic device having polished metal condyles and the tibial plateau is replaced with a plastic bearing that may be supported by a metal component. Joint replacement surgery has become a proven and efficacious method of alleviating pain and restoring function of the joint.
Current methods of preparing the intraarticular rigid elements of a joint to receive components as in joint replacement surgery involve an extensive surgical exposure. The exposure must be sufficient to permit the introduction of guides that are placed on, in, or attach to the joint, along with cutting blocks to guide the use of saws, burrs and other milling devices, and other instruments for cutting or removing cartilage and bone that subsequently is replaced with artificial surfaces. The distal end of the femur may be sculpted to have flat anterior and posterior surfaces generally parallel to the length of the femur, a flat end surface normal to the anterior and posterior surfaces, and angled flat surfaces joining the above mentioned surfaces, all for the purpose of receiving a prosthetic device.
A full joint replacement, using the example of the knee joint, also requires the proximal end of the tibia to be sculpted to receive a prosthesis having a generally upwardly facing bearing surface mimicking the normal tibial bearing surface and designed to articulate with the condylar surfaces of the femoral prosthesis. Typically, this surgery is performed with instruments or guides to orient cutting blocks, such that the preparation of the bone is in concordance with the correct alignment of the limb and the parts are correctly oriented in both coronal and sagittal positions. The guides are placed on exposed bones and generally reference anatomical points on that bone to establish a resection plane. For instance, with total knee replacement, arthroplasty guides are used by referencing, for example, the intramedullary cavity and the epicondylar and posterior condylar axes.
Knee joint prosthesis of the type referred to above are well known, and are described, for example, in Caspari et. al., U.S. Pat. Nos. 5,171,244, 5,171,276 and 5,336,266, Brown, U.S. Pat. No. 4,892,547, Burstein et al. U.S. Pat. No. 4,298,992, and Insall et. al., U.S. Pat. No. 6,068,658.
Substantial effort has been made to provide appropriate degrees of curvature to the condyles. For example, the earlier mentioned U.S. Pat. Nos. 5,171,276, 4,298,992 and 6,068,658 show that the radius of curvature in the anterior-posterior direction of the condyle of a femoral prosthesis may be somewhat greater near the anterior portion of the condyle than near the posterior portion. Kester et al., U.S. Pat. No. 5,824,100 teaches that a portion of this curvature of the condyle may be formed about a constant radius having its origin along a line between the lateral and medial collateral ligament attachment points on the femur.
Historically, a variety of modular prosthetic joint implants have been developed. The following descriptions of modular implants relate specifically to the knee. Early designs for knee implants, called polycentric knee implants, were developed with separate components for the medial and lateral compartments. Additionally, modular fixed-bearing knee implants having a polyethylene insert that is held relatively rigidly in place have been developed. Alternately, there are mobile bearing knee implants wherein the polyethylene bearing is designed to slide or move with minimal or no constraint on a tibial baseplate. Furthermore, both meniscal bearing and fixed bearing knee implants have been developed including either separate polyethylene bearings or a single polyethylene bearing that resides on a metallic tibial baseplate. While implant systems have been developed with fixed bearing elements or mobile bearing elements on the medial and lateral sides of the tibiofemoral joint, systems have not been developed having a combination of a fixed bearing on one side and a mobile bearing on the other side of the tibiofemoral joint.
Mobile bearing tibial implants may be configured to be more congruent with the femoral side of a knee arthroplasty, yielding lower contact stress. The resultant lower contact stress reduces the possibility of damage sometimes encountered with some fixed bearing designs wherein the yield strength of the bearing material is exceeded. In general, fixed bearing implant designs are less difficult to properly align and balance than mobile bearing designs. Mobile bearing designs are frequently desirable to reduce contact stress and the resulting wear of the bearing surface. However, with mobile bearing designs, there is the possibility of the bearing becoming dislodged from the implant. Additionally, mobile bearing knee designs are more surgically demanding to implant then fixed bearing designs.
The combination of a fixed bearing insert for the medial compartment and a mobile bearing insert for the lateral compartment is particularly attractive because the lateral femoral condyle rolls backward on the lateral tibial plateau as much as 10 to 20 mm whereas the medial condyle moves only a few millimeters. A mobile bearing insert is able to accommodate the rollback of the lateral condyle but would not be necessary for the medial condyle.
Two primary difficulties exist with current joint replacement surgeries. These relate to the invasiveness of the procedure and achieving proper alignment of the bony structures and the prostheses thereupon.
Alignment. A difficulty with implanting both modular and non-modular knee implants having either separate femoral and/or tibial components has been achieving a correct relationship between the components. Surgical instruments available to date have not provided trouble free use in implanting multi-part implants wherein the femur and tibia are prepared for precise component-to-component orientation. While alignment guides aid in accurate orientation of the components relative to the axis of the long bones to achieve a restoration of a correct tibiofemoral alignment (usually 4-7 degrees valgus), they provide limited positioning or guidance relevant to correct component-to-component alignment and/or ligament tension to restore alignment.
It is preferable to orient implants normal to the resultant forces through the joint to subject bearing surfaces to compressive rather than shear forces. Moreover, the components of the implant are preferably oriented one to the other to minimize wear. Complications may result if the implant is not correctly oriented with respect to the supporting bone. If the implant is not placed normal to the mechanical axis, a shearing force results between the implant and bone that may lead to implant loosening.
In a properly aligned knee, the mechanical axis of the leg (a straight line drawn from the center of the hip joint to the center of the ankle) passes slightly medial to the center of the knee. This alignment is generally called the gross alignment of the leg. The alignment of the implants impacts the gross alignment of the leg. If the implants are malaligned, the resulting mechanical axis may be shifted medially or laterally, resulting in an imbalance in the loads carried by the medial or lateral condyles. This imbalance, if severe, may lead to early failure of the implant.
In addition, the orientation of the components to each other, for example the orientation of the femoral to the tibial component, with unicondylar and bicondylar implants has largely not been addressed. This may account for the high failure rates of early bicondylar designs and as well as for the higher failure rate of unicondylar implants relative to total knee implants as demonstrated in some clinical studies. When considering bicondylar and unicondylar designs, alignment of each part relative to the other parts is critical to avoid accelerated wear with a mal-articulation of the components.
Although various prosthetic devices have been successfully used with patients, the configuration and position of the articulating surfaces of the prosthesis, that is, for example, the condyles in a knee joint are predetermined based upon the prosthesis that is selected. While efforts are made to tailor the prosthesis to the needs of each patient by suitable prosthesis choice and size, this in fact is problematical inasmuch as the joint physiology of patients can vary substantially from one patient to another.
Invasiveness. In order to appropriately sculpt the articulating surface of a bone, it is often necessary to surgically expose the joint. In the case of the femur, the patellar tendon of the knee joint is surgically exposed and is moved to one side of the joint to enable a substantially full anterior access to the joint. Surgical exposure is necessary to accommodate the bulk and geometry of the components as well as the instruments for bone preparation. Such surgical exposure increases bleeding, pain, and muscle inhibition; all of which contribute to a longer hospitalization before the patient can be safely discharged to home or an intermediate care facility.
Desirably, in the case of knee replacement surgery, neither the collateral ligaments nor the cruciate ligaments are disturbed, although it is often necessary to remove or release cruciate ligaments in the event a substantial joint replacement is to be performed. Collateral ligaments can be partially taken down or released to provide appropriate tension adjustment to the patient's knee in concert with joint replacement surgery. In most instances, such releases can be accomplished through smaller incisions than the standard midline or medial parapatellar incisions historically used for knee arthroplasty.
Arthroscopic surgery is available, and beneficial, for removing and repairing damaged intraarticular tissues. Although arthroscopic procedures are far less invasive and are often successful for minor surgical repairs, (as when an articular surface is to be smoothed, for example, or cartilage is to be repaired), such procedures generally are not appropriate for substantial joint replacement. They are generally inadequate for replacing joint surfaces with artificial implants.
Conventional surgical procedures including unicompartmental and total joint replacement historically require extensive surgical exposure and prolonged hospital stays and rehabilitation. More recently unicondylar procedures have been performed through smaller incisions that do not necessitate dislocation of the patella. The reduction in pain and more rapid recovery of knee function has reduced the length of hospital stay and the need for strong narcotic medications. It is desirable to realize such benefits for patients with bicompartmental and tricompartmental knee arthroplasty.
For patients who require articular surface replacement, including patients whose joints are not so damaged or diseased as to require whole joint replacement, it would be desirable to provide surgical methods and apparatuses that could be employed to gain surgical access to articulating joint surfaces, to appropriately sculpt the surfaces, to provide artificial, e.g., metal or plastic, articular bearing surfaces, and then to close the surgical site, all without substantial damage or trauma to associated ligaments and tendons. To reach this goal, of course, a procedure must be provided to enable articulating surfaces of the joints to be appropriately sculpted using minimally invasive apparatuses and procedures.
The present invention provides an implant system that restores individual patient joint kinematics and involves minimally invasive surgical procedures. The instruments and implants disclosed accomplish accurate bone and soft tissue preparation, implant orientation and implant fixation through limited surgical exposure. The implant system is comprised of implants and instrumentation that provide intraoperative surgical options for articular constraint and facilitate proper alignment and orientation of the knee to restore kinematics as defined by the individual patient anatomy. To do so, the implants provide a surgeon intraoperative options to reconstruct various degrees of joint stability via selection of fixed or mobile bearing components for each compartment of the knee (medial tibiofemoral joint, lateral tibiofemoral joint and patellofemoral joint). The range of implants may cover each compartment of the knee and may include combinations of fixed and mobile bearing configurations.
In traditional total knee replacements, the femoral component is generally a unitary piece and the tibial component is a unitary piece. In the current invention, the femoral side may be resurfaced by two or three components and the tibial side may be resurfaced by two components or a unitary piece. Optionally, the components of the femoral side may be comprised of a plurality of flexible segments.
Proper alignment and positioning of the implant components is facilitated by instrumentation that utilizes the soft tissue structures of the knee to guide bony resections for patient-specific alignment and orientation of the implants. The surgical instrumentation prepares the articular surfaces of a synovial joint from a single point of reference to allow the introduction of separate components for the medial and lateral tibiofemoral compartments, and the patellofemoral compartments with precise orientation. Thus, the instrumentation provides bony resections in accordance with such alignment and orientation requirements. The alignment positioning is important for proper restoration of anatomic alignment of the knee joint and for proper orientation of the components to one another.
With respect to forming or sculpting articular surfaces of a joint, the method of the current invention enables the articular bone surfaces to be sculpted according to the individual physiology of each patient to restore as much as possible the natural function of the joint. In this method, a bone sculpting tool is attached to one of the bones of a joint, and the tool sculpts the articular surface of the other bone as the joint is articulated.
Thus, in one embodiment, the present invention provides a method of appropriately sculpting the articular surface of a first bone that normally articulates with a second bone. The method involves providing an apparatus comprising a bone sculpting tool attached to a bone mount, attaching the mount rigidly to the second bone with the tool in bone sculpting engagement with the articular surface of the first bone, and then sculpting the articular surface by articulating one of the bones with respect to the other.
In some situations, it may be desirable to distract the first bone from the second bone either preoperatively or during surgery. Thus, a distractor may be provided with the apparatus. A distraction force provided between the femur and the tibia during the sculpting procedure accounts for material that has worn away from the articular surfaces. Use of a distraction force generally re-establishes normal alignment of the joint. Additionally, a distractor may be used preoperatively to assess the range of motion of the joint and patient kinematics.
In another embodiment, the invention provides an apparatus for sculpting the articular surface of a first bone that normally articulates in a predetermined manner with the second bone. The apparatus comprises a bone sculpting tool, a mount attachable rigidly to the second bone, and an adjustable attachment attaching the sculpting tool to the mount and enabling the position and orientation of the tool to be adjusted into bone-sculpting proximity to the articular surface so that the articular surface is sculpted as the second bone is articulated with respect to the first bone. Alternately, a plurality of bone sculpting tools may be used where the tools are positioned either on individual mounts or on a single mount to support the plurality of tools.
The invention also provides implants for replacing the surfaces of the joint between the first bone and the second bone. The implants are specifically designed to fit through minimally invasive incisions and incorporate any and all combinations of fixed and mobile bearing inserts or parts. Since the surgical procedure preferably is performed through minimally invasive incisions the implants are designed to fit through such incisions and be either oriented or joined within the joint.
The implants include a second bone baseplate and a first bone implant. The second bone baseplate may be either one piece to cover most of the prepared surface of the second bone as relates to the joint, or separate baseplates as have been used with mobile and fixed bearing prosthetic components. In addition, the second bone baseplate may accommodate separate fixed and mobile bearing inserts. The first bone implant is comprised of a plurality of components to replace the bearing surface of the first bone. Optionally, a portion of the first bone implant may be configured of a plurality of flexible segments bonded in place. Such a configuration permits the articulation of the second bone to the first bone to mould the flexible segments in appropriate position.
Thus, in a further embodiment, the invention provides a method of appropriately replacing the articular surface of a first bone that normally articulates with a second bone. The method involves providing an apparatus comprising a bone sculpting tool attached to a bone mount, attaching the mount rigidly to the second bone with the tool in bone sculpting engagement with the articular surface of the first bone, and then sculpting the articular surface by articulating one of the bones with respect to the other. Further, resurfacing the articular surfaces with appropriate minimally invasive implants wherein the implants are joined within the confines of the joint cavity. In one embodiment, a plurality of flexible segments are provided to resurface a portion of the first bone. The flexible segments are set in an adhesive along the resected surface of the first bone.
Specifically, for example, the invention may be used for replacing the surfaces of a femur and a tibia. Thus, a femoral implant having a plurality of components and a tibial baseplate are provided. The tibial baseplate may have a fixed bearing attachment as well as a mobile bearing attachment.
Typically, a total knee joint replacement involves replacing the articular surfaces of the lateral femoral condyle 12, the medial femoral condyle 14, the medial tibial condyle 30 and the lateral tibial condyle 32. The lateral meniscus 22, and the medical meniscus 20 are removed. Desirably, neither the collateral ligaments 26 and 27 nor the cruciate ligaments 24 and 28 are disturbed. However, the collateral ligaments 26 and 27 may be partially taken down to provide appropriate tension adjustments to the patient's knee after joint replacement has been completed.
As seen in
The instrumentation of the current invention generally calls for resecting the tibia at the lateral tibial plateau and the medial tibial plateau. This resection may be done by methods known by those skilled in the art, using a resection guide, saw, etc. Alternately, as shown in
As seen in
Alternately, as seen in
As seen in
Thus, for example, in knee surgery, the tool may be mounted to the tibia with the sculpting surface of the tool in engagement with a condylar surface of the femur that is, one or both of the condyles. As the knee joint is articulated (flexed), the sculpting tool appropriately sculpts the articular surface of the femur in a manner that is dependent upon the individual physiology of that patient's knee, that is, upon the collateral ligaments, the patellar tendon, etc. Although the invention is described in the context of a total knee replacement, it is understood that the invention has application throughout orthopaedics where the surfaces of an articulating joint are to be modified or resurfaced to restore function and relieve pain.
In a preferred embodiment, the knee joint capsule is surgically accessed without lateral dislocation of the patella, thereby permitting normal flexion of the knee during the sculpting process. The patient's individual physiology and the interplay between the patient's soft tissues and bone work to guide the device used for sculpting cartilage and bone from the end of the femur and/or tibia as relates to the knee. In the example of the knee, the tibia travels around the end of the femur along a guided path that is controlled by the ligaments and soft tissues that surround and provide support to the knee.
An alternate mount configuration involves an external fixture having burrs attached thereto. The external fixture may be of any configuration that supports the burrs in a position relative to the tibia for sculpting the femur. One example includes an external support member having an arm extending therefrom, the burr attached at the distal end of the arm.
The motor may be an electric motor, a pneumatic motor, or a hydraulic motor integral with the cutting element. Note that in the case of a hydraulic motor, the flexible shaft is not necessary. The cutting element may be driven by available surgical power instruments, such as surgical drills, Midas Rex and Anspaq hi speed drill/cutters, etc. Such equipment is available in pneumatic and battery operated forms. The cutting element may alternately be driven by a power source developed uniquely for this invention. For example, the power source may be an electric or pneumatic motor. It may also be a hydraulic motor driven by sterile saline solution.
In the case of a hydraulic motor driven with saline solution, the motor may be incorporated into the milling cutter, as illustrated in
In another embodiment as shown in
In similar fashion,
Cartilage and bone of the femoral condyles may be removed in one or more passes of a shaving element 80 as shown in
Using the instrumentation shown, articular surface of the femur may be sculpted according to the patient's individual physiology by articulating the tibia with reference to the femur. The method involves providing the apparatus having a bone sculpting tool attached to a bone mount, attaching the mount rigidly to the second bone with the tool in bone sculpting engagement with the articular surface of the first bone, and then sculpting the articular surface by articulating one of the bones with respect to the other.
Preoperative evaluation of patient x-rays may be used to assess deformity of the joint and appropriate spacing required to realign the joint. Additionally, spacers, for example balloons, may be used preoperatively to assess the range of motion of the joint and patient kinematics.
During the surgery appropriate spacers are placed between the bone structures to provide appropriate distraction and alignment of the joint. A distraction force provided between the femur and the tibia during the sculpting procedure may be used to account for material that has worn away from the articular surfaces. Use of a distraction force generally re-establishes normal alignment of the joint. Such spacers also tension the soft tissue structures to reduce the envelop of motion between the bone structures and increase transverse and rotational stability of the joint. The spacer may further be used to support the bone-cutting element during resection of the bone structures. Ligament releases necessary to restore appropriate limb alignment and ligament tension/balance may be performed prior to inserting the spacers.
Anyone of a variety of devices may be used to maintain appropriate tension of the ligaments capsule and tendons. Such tensioning devices may include, but are not be limited to, gravity with the weight of the lower limb, intraarticular spacers, bladders, balloons, bellows, gear mechanisms, scissor mechanisms, or other expandable devices, or other elements that might engage or attach to the opposing sides of the joint. Moreover, the distraction force may be provided by an expanding base in the cutting element. A distraction device may also be useful in conjunction with a mount having skid surfaces on the shoulders. The shoulder allows the depth and shape of the femoral resection to be controlled both by the articulation of the tibia to the femur and the shape of the femur.
Specifically, for pre-operative assessment, spacers such as balloons may be provided in both the medial and the lateral resections. During surgery, a balloon may be provided in the medial resection and a spacer, for example a bellows, having a cutter attached may be provided in the lateral resection. Alternately a bellows having a cutter attached may be provided in both the lateral and the medial resections.
As the tibia is articulated through flexion and extension, the femoral cutter prepares resections in the femoral condyles for receiving femoral components of a knee implant.
The surgical procedure is preferably performed through minimally invasive incisions that do not necessitate subluxation or dislocation of the patella. Therefore, implants such as the femoral, tibial or patellar implants are designed that may be fit through minimally invasive incisions and either oriented or joined within the joint. The femoral and tibial implants may be attached to bone with conventional bonding methods such as with, but not limited to, polymethylmethacrylate or by direct attachment to bone as with, but not limited to, a porous ingrowth surface.
The tibial baseplate is optionally configured as one piece to cover most of the prepared surface of the tibial plateau as relates to the knee. If configured as a single platform, the tibial baseplate provides a capture mechanism for a fixed bearing or a mobile bearing insert for either the medial or lateral tibiofemoral compartment. As an option a single platform is designed that provides a fixed bearing capture mechanism for the medial tibiofemoral compartment and a mobile bearing capture mechanism or a simple platform to receive a mobile bearing insert. Since right and left tibial baseplates are required, the same baseplate may be used for a mobile bearing medial insert and a fixed bearing lateral insert.
Alternatively, as depicted in
It is preferable to place all of the implants through small incisions. As seen in
As shown in
The bearing elements may be manufactured of ultra high molecular weight polyethylene but may also be manufactured of any suitable biocompatible material as known in the art. The bearing elements generally include three compartments: medial tibial condyle, lateral tibial condyle and patella. Preferably, a choice of bearing elements is provided for either fixed or mobile bearing of each compartment. Thus, for example, the surgeon would have at his discretion inserting either a mobile bearing or a fixed bearing insert into each of the tibial components, one medial and one lateral.
The convex surface of the femoral condyle is the bearing surface and interacts with the tibial bearing implants. Optionally, the femoral component(s) may include a fin along its convex internal surface for upward driven implantation. The fin may be shaped as a web extending from one portion of the internal surface to another.
The femoral components may include an alignment device to orient separate femoral components in relationship to one another and/or to the tibial components.
The femoral components are provided in a variety of sizes and optionally include components that are flexible to provide optimum fit for minor variations in the shape of the prepared femoral condyles.
In use, the resected femoral condyle is covered with doughy bone cement. The femoral implant is placed and loaded against the resected femoral condyle until the bone cement cures.
The preferred method for preparing the femoral condyle uses the tibia as a support for the milling cutter. The soft tissue structures of the knee provide the path of motion to move the cutter through the femoral condyle. The kinematics of the knee are well understood and defined. This approach necessarily results in a unique shape machined into each femoral condyle due to variations in soft tissue structures and bony structures from patient to patient.
In an alternate embodiment, the femoral condyles may be ridged and of given size. Each implant is composed of a plurality of components 170. Components 170 are cemented in place with bone cement, which acts as a grouting material to fill the space between the implant and the supporting bone. Bone cement has been shown to provide long term implant stability when applied in thickness up to two mm. Hence, a range of implant sizes covers the range of femoral condyle sizes anticipated and the variation in shape anticipated.
While a preferred embodiment of the present invention has been described, it should be understood that various changes, adaptations and modifications may be made therein without departing from the spirit of the invention and the scope of the appended claims.
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|Andre Bahler
|Prosthetic arrangement for a complex joint, especially knee joint
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|Femoral component, tool and method
|Nov 24, 1992
|Jul 5, 1994
|Etablissements Tornier
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|Title not available
|Title not available
|Title not available
|Title not available
|Title not available
|Title not available
|Title not available
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|Oct 14, 1999
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|Walker Peter S
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|Title not available
|Jul 25, 2000
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|Michel Bercovy
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|Waldemar Link (Gmbh & Co.)
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|"Bicondylar St. Georg Sledge Knee Arthroplasty" Stockley et al., Clinical Orthopaedics and Related Research, No. 255, pp. 228-233, Jun. 1990.
|"Failed Polycentric Total Knee Prostheses" Shoji et al., The Journal of Bone and Joint Surgery, vol. 58-4, No. 6, pp. 773-777, Sep. 1976.
|"Minimal Incision Total Knee Arthroplasty" Alfred J. Tria, Jr., MD and Thomas M. Coon, MD. Clinical Orthopaedics and Related Research. No. 416 pp. 185-190. Lippincott Williams & Wikins, Inc. 2003.
|"New Jersey Low Contact Stress Knee Replacement System" Buechel and Pappas, Surgical Reconstruction and the Arthritic Knee II, p. 153, 1989.
|"Patellofemoral Arthroplasty: A three-to Nine-Year Follow-up Study" Arciero et al., Clinical Orthopeadics and Related Research, No. 236, pp. 60-71, Nov. 1988.
|"Richards Mod II Knee" Marketing Materials, Link et al., 1976.
|"Richards Modular Knee System" Orthopedic Catalog, Richards, pp. 34-39 and 49, 1979.
|"Subvastus Approach for Total Knee Arthroplasty" A Prospective, Randomized, and Observer-Blinded Trial G.S. Roysam, FRCS (orth) and M.J. Oakley, FRCS, The Journal of Arthroplasty. vol. 16, No. 4, 2001. Churchill Livingstone 2001.
|"The Femorapatellar Endoprosthesis-still of value today?" Fink et al., Z Orthop Ihre Grenzgeb., pp. 137(3);247-52, May-Jun. 1999.
|"The Femorapatellar Endoprosthesis—still of value today?" Fink et al., Z Orthop Ihre Grenzgeb., pp. 137(3);247-52, May-Jun. 1999.
|"The Subvastus Approach for Total Knee Arthroplasty Resulted in Better Short-Term Outcomes Than Did the Parapatellar Approach" G.S. Roysam and M.J. Oakley. The Journal of Bone & Joint Surgery. vol. 84A. No. 2. Feb. 2002.
|Kinematic I and Oxford Knee Arthroplasty-A 5-8 year Follow-up Study Bourne et al., 2 The Journal of Arthroplasty, No. 4, pp. 285-291, Dec. 1987.
|Kinematic I and Oxford Knee Arthroplasty—A 5-8 year Follow-up Study Bourne et al., 2 The Journal of Arthroplasty, No. 4, pp. 285-291, Dec. 1987.
|Citing Patent
|Filing date
|Publication date
|Apr 7, 2011
|Aug 6, 2013
|Smith & Nephew, Inc.
|Instrumentation for implants with transition surfaces and related processes
|Nov 20, 2007
|Sep 3, 2013
|Smith & Nephew, Inc.
|Patello-femoral joint implant and instrumentation
|Jun 27, 2011
|May 20, 2014
|Biomet Sports Medicine, Llc
|Apparatus for repairing bone defects
|Jun 27, 2011
|Oct 28, 2014
|Biomet Sports Medicine, Llc
|Method for repairing bone defects
|Jan 28, 2011
|Dec 2, 2014
|Smith & Nephew, Inc.
|Cruciate-retaining knee prosthesis
|Apr 22, 2014
|Nov 24, 2015
|Bonutti Skeletal Innovations Llc
|Method of performing total knee arthroplasty
|May 19, 2014
|Apr 5, 2016
|Biomet Sports Medicine, Llc
|Apparatus for repairing bone defects
|Dec 12, 2013
|May 23, 2017
|Stryker Corporation
|Extended patellofemoral
|Oct 27, 2014
|Jul 4, 2017
|Biomet Sports Medicine, Llc
|Method for repairing bone defects
|Apr 7, 2011
|Jul 28, 2011
|Dees Jr Roger Ryan
|Instrumentation for Implants with Transition Surfaces and Related Processes
|Jan 28, 2011
|Aug 4, 2011
|Lenz Nathaniel M
|Cruciate-retaining knee prosthesis
|Nov 20, 2007
|Oct 11, 2012
|Smith & Nephew, Inc.
|Patello-femoral joint implant and instrumentation
|U.S. Classification
|623/20.18, 623/20.23, 623/20.31, 623/20.21
|International Classification
|Cooperative Classification
|European Classification
|May 7, 2014
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Industrial Lubricant is a recognized leader in the area of equipment lubrication management. We service multiple industries including mining, railroad, agriculture, timber & logging, industrial and energy, and construction. We lead the industry in automatic lubrication system design, installation and service, and provide the latest lubrication and filtration equipment for many industries.
Industrial Lubricant has adopted a Drug and Alcohol Testing Policy that covers all employees and job applicants who are not covered by ILCO's DOT Testing Policy. Copies of this policy are available upon request from the HR Department.
We are currently seeking qualified applicants for the following positions (please click on position title for complete job description and to apply):
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subset: commoncrawl


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The Driving Force in CleanThe Polaris 9300 Sport is one of the most technologically advanced robotic pool cleaners on the market and it sports a sleek design. The Polaris 9300 Sport delivers superior cleaning and functionality.The Polaris 9300 Sport automatic pool cleaner features vortex technology for picking up larger debris quickly. This cleaner has deep-cleaning scrubbing brush action. The brush scrubs the floor and walls of the pool all the while loosening dirt and debris. The dirt and debris is then removed through an oversized suction intake found on the bottom of the cleaner. It's innovative drive system operates the wheels independently of each other, which allows for greater traction and maneuverability. The wheels can turn in opposite directions giving it the ability to get in and out of corners. Removing a filter bag from other pool cleaners can be such a hassle. The 9300 Sport cleaner's large capacity filter bag can easily be removed from the top of the cleaner. No more messy filter bags!
Designed for in-ground pools of all shapes Cleans pool walls, floor and steps Vortex vacuum technology Reduce energy consumption nearly 90% Includes a powder-coated alloy caddy Dimensions – 17" W x 8.5" H x 19" D Caddy Dimensions – 20" x 20" x 34" Weight – 16 lbs. without Caddy Includes 60 ft cord Power Supply Output – 28 Volt DC Power Supply Input – 120 Volt 50-60 Hz Maximum Pool Size – 20 ft x 50 ft 2 Year Limited Warranty


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My friend and I stayed for one night - we flew in to see the Rolling Stones concert - and everyone at the hotel was friendly and helpful. Kudos to Dave, our shuttle driver, who helped us figure out the train and subway connections. I would highly recommend this hotel.
- Official Description (provided by the hotel):
- Stay Smart at the Brand New Holiday Inn Express Philadelphia Airport in Essington, PA. Our courtesy shuttle will take you to the only hotel on the Delaware River waterfront. Located adjacent to Governor Printz Park, our guests enjoy the scenic views of the river and marina. Explore the attractions, restaurants and entertainment of Downtown Philadelphia. Don't miss the historic sites, including the Liberty Bell, Independence Hall, National Constitution Center and Betsy Ross House. Also discover the Old City District, where you will experience the best shopping, dining and culture. If you're a sports fan, the hotel is minutes from the Philadelphia Sports Complex. This site includes Lincoln Financial Field, Wells Fargo Center and Citizens Bank Park. The Philadelphia Union Soccer Stadium, PPL Park, is 3 miles away, near Harrah's Casino and Racetrack. For our business clientele, we are located close to Boeing, UPS, Sunoco, Philadelphia Navy Yard, and the airlines serving the Philadelphia International Airport. After a long day, enjoy the waterfront scenery, or keep up with your workout routine in our fitness room. Jump start your day with our Express Start breakfast, serving your favorite hot breakfast selections and hot cinnamon rolls. ... more less
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- Also Known As:
- Holiday Inn Express Philadelphia Airport Hotel Essington


text: If you guessed entry into the Glass Slipper Challenge you would be right!!! DH said that I may be able to do the Tinkerbell too so I can get a PINK Coast-to-Coast medal!!! I am out of this world excited!!! I do have a question though...how much do you think it will be to do Tinkerbell & Glass Slipper???


text:
The Society of Automotive Engineers (SAE) publishes two books on the growing topic of multiaxial fatigue for automotive, aerospace and material engineering markets. Multiaxial Fatigue by Darrel F. Socie and Gary B. Marquis, provides engineers, researchers and students with a working knowledge of the fatigue damage processes and models under multiaxial states of stress and strain. The concepts presented in the book are "material independent" and will be useful in designing test programs for ...
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Harold I Johnson
Found 10 Records, 10 Photos and 13,825,025 Family Trees
Born in Oregon, USA on 1886 to Willis E Johnson and Carrie Adelle Ingham. Harold I married Agnes Svoboda. Harold I married Madge L Johnson. He passed away on 5 May 1977 in Santa Ana, Orange, California, USA.
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Surname meaning for "Johnson"
English and Scottish: patronymic from the personal name


text:
Starting a handset manufacturing business from scratch must rank as the boldest and most courageous acts over the last 12 months.INQ is Meehan's vision that communicating has been redefined for a generation growing up on Facebook and Instant Messaging. The idea followed after Meehan commissioned a Skype phone when he was Hutchison Whampoa's group handset buyer. It has outstripped expectations, leaving Meehan with bigger ambitions. His standing in the industry and vision has forced other manufacturers to think differently on the future of mobile devices, and made operators consider stocking devices from this new entrant.
Power 50 Profile: Javier Garcia Gomez, lightRadio team leader, Alcatel-Lucent
Power 50 Profile: Jeremy Darroch, CEO, BSKYB
Power 50 Profile: Stephen Elop, CEO, Nokia
Power 50 Profile: Srini Gopolan, consumer director, Vodafone
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Huawei - 'Our 2017 focus is premium products'
Retail Special
S6 to re-ignite the market
Brightstar 20:20 and HTC join forces
Meeting the challenge of in-building coverage


text:
Coma Dream
Credits & Info
- Uploaded
- Feb 8, 2008 | 8:25 AM EST
- File Info
- Song
- 5 min 10 sec
- Score
- 4.26 / 5.00
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Please contact me if you would like to use this in a project. We can discuss the details.
- Score:
- Rated 4.26 / 5 stars
- Plays & Downloads:
- 7,447 Plays | 551 Downloads
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- Electronic - Ambient
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Author Comments
Rated 5 / 5 stars
I feel like I was in a horrible plane crash, I'm in critical condition, nurses are tending to my lifeless body, hooked up to a life support machine. My heart rate unsteady. Dying...
Rated 5 / 5 stars
davvero bella..
Rated 5 / 5 stars
Ambient isn't really my total style, put this was cool.
i really like the concept of it. Good job.
Rated 5 / 5 stars
"IV stat"
This is still one of the better and unique songs on NG. Very distant and sterile, I love the hospital feel to it.
Rated 5 / 5 stars
Love it
This is my personal favorite song on all of NG. I've had it on my MP3 since you first uploaded it and even now I'm still noticing new things in it.
This isn't just epic. This is a perfectly formed masterpiece.


text:
With a strong economy led by government, education, and health care, the Raleigh-Durham/Research Triangle area consistently ranks among the nation's best economies. That's why the area's real estate markets will continue to improve as jobs and the population continue to grow, says L. Andrew Holland, senior vice president of Middle Market Real Estate in the Raleigh, North Carolina, office of Wells Fargo Bank.
"Wells Fargo views the Triangle and eastern North Carolina as good real estate markets, and is actively pursuing commercial real estate loans in the area," he adds. "The Triangle is receiving a significant amount of positive press in the national media and a number of developers from other markets continue to come here to develop or purchase properties."
The multifamily sector has improved significantly and the Class A warehouse segment has also shown some improvement. "The office and flex sectors will continue to struggle in the near term," says Holland. "We are reviewing several proposed multifamily projects and we are seeing some targeted expansion in retail, especially with single-tenant buildings such as drugstores."
The Raleigh market will experience further healing over the next 12 to 18 months, adds Michael E. Harris, executive vice president and chief operating officer of Highwoods Properties. "With seemingly improving economic conditions and activity, the general prediction is that the office market should see positive net office absorption during 2011," he says. "Large office vacancy blocks—50,000 square feet [4,650 sq m] or more—of Class A space have dwindled significantly, but there still are enough large Class A vacancies available, which will continue to deter spec development."
Harris, who is a member of ULI's Industrial & Office Park Development Council, adds that some areas of activity and bright spots in the market include financial services, health care, biopharma, clinical research, and technology. "Since announcing their decision to stay in Wake County, there has been a lot of buzz about Red Hat's 350,000-square-foot [32,550-sq-m] build-to-suit opportunity. Where and when they land is unknown at this time," he says.
The Raleigh area is also experiencing an uptick in the retail sector, says Austin Williams, retail vice president at Crosland, LLC, a diversified real estate firm based in the Southeast. Williams notes that the retail vacancy in the area has just fallen below the 8 percent mark—to 7.8 percent—for the first time since 2009, according to the Karnes Research Report.
"While there remains a pervasive slackness in the market and many tenants continue to struggle, the dearth of new retail development is supporting a slow but sustainable recovery," says Williams. "Retailers who want to be in the Triangle are finding attractive first positions in the marketplace, and those that are already here and doing well are able to shore up additional positions at a great value."
Overall, there was more than 800,000 square feet (74,400 sq m) of active retail development underway in the first quarter of 2011. "This is a positive sign that fundamentals have improved," Williams continues. "Nearly all projects underway were conceived well before the market downturn, and have been on hold and retrenching for several years. These are not speculative in nature; rather, they are driven by formal retailer commitments. They will not flood the currently fragile market with fresh vacancy; instead, they will bolster the recovery with new, stable product occupied at market rents."


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Old School Volume 2 coming November 6
Discussion in 'Sesame Merchandise' started by Phillip, Aug 19, 2007.
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Is the National League Just Inferior?
Once Again, the American League Is Winning the Interleague Battle
If new MLB commissioner Rob Manfred decides to rethink the All-Star Game, one option would be to award World Series home-field advantage to the league that wins the interleague season series. On the surface, that method seems fairer than pinning it on the outcome of a glorified exhibition.
But on second thought, there may be one problem with this approach: The National League wouldn't stand a chance. The American League sits on the verge of winning interleague play for the 11th consecutive year.
Plenty of theories have been bandied about for the AL's supremacy, most of them revolving largely around random variance—the AL has simply had better players and teams of late. New York Mets outfielder Curtis Granderson, who has played in both leagues, suggested that the unbalanced nature of the schedule could play a role as well. (Natural geographic rivals, like the Yankees and Mets, meet every year, which could skew the results.)
At this point, though, it seems reasonable to wonder if there exists a larger, more systemic explanation—one that would keep the AL in charge permanently.
The use of the designated hitter in the AL could favor it in interleague. Because of the DH, AL teams can more easily acquire offensive-minded players without worrying about their negative impact on defense. NL teams, for instance, were less likely to pursue Nelson Cruz last winter out of concern that he couldn't play the field daily. Cruz, who signed with the Baltimore Orioles, led the majors with 34 homers entering Friday, while DHing about half the time.
"Most National League clubs don't have that extra guy that they could DH 70% of the time," Mets general manager Sandy Alderson said, "which I think can make a difference."
Write to Jared Diamond at email@example.com


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Class reunion
The Lehighton Area High School Class of 1980 will hold its class reunion on June 26 at the Orioles Community Center. For details visit the class Web site at: http://classreport.org/usa/pa/lehighton/lahs/1980/ or contact Deb Tanczos-Yanders at email@example.com or (610) 377-0151.
Class President Ann Hunsicker-Morrissey has volunteered to serve as class administrator. She would like to invite LAHS Class of 1980 alumni to visit the Web site to fill out a profile so they can be reached regarding the reunion.


text:
Focusing On Patients, Not Paychecks
Not that financial incentives aren't effective or necessary; we're all responsive to financial rewards, and many of these programs have produced measureable results. But the dialogue is so heavily centered on changing physician behavior with monetary incentives that I wonder how many doctors are growing tired of being poked, prodded, and led around by a financial carrot.
Most physicians want to focus on their patients, not their pocketbooks, says Jose Greer, MD, assistant dean of academic affairs at Florida International University College of Medicine. His approach to improving healthcare delivery begins the first day prospective physicians begin medical school--he's developing an innovative pilot program based on what he refers to as outcomes-based education. "We set the competencies we expected our students to have upon graduation and worked our way backwards."
The goal is to produce well-rounded, socially conscious physicians; it's like a liberal arts education for medical students. Some of the more interesting classes cover the ethical and moral foundations of medicine, the role of medicine in society, and training in cultural competency, which includes not just race and ethnicity, but age, gender, lifestyle, socioeconomics, and other social determinants that often correlate to health factors.
From there, students venture out into the local community to work with interdisciplinary teams--nursing, public health, education, and law students--to track and manage the health of an underserved population. With medicine trending toward increased specialization and focusing on specific procedures or organs, a trend driven largely by financial incentives, Greer wants future physicians to take a step back and proactively treat patients in the context of their larger community by incorporating social determinants, epidemiology, and biostatistics as diagnostic tools.
Cheryl Holder, MD, medical director of North Dade Health Center, who is coordinating the community outreach program through her practice, thinks refocusing medical training can restore the connection with the community and the broad understanding of the patient that characterized old-style family doctors. "Hopefully we can take the students back to where the physician understood the community, understood factors playing in the community that cause what we diagnose. We hope to get a little more understanding, and through understanding more empathy to make us better physicians."
That last line might elicit some eye rolls from hard-nosed pragmatists, but Greer and Holder may be onto something when it comes to rethinking medical education. A study in this month's Academic Medicine found a dramatic "hardening of the heart" during medical school. Researchers saw a measurable drop in vicarious empathy, which not only affected how physicians interact with and treat patients, but can also determine which specialty a student chooses after training (i.e., students with higher empathy levels were more likely to choose primary care).
Greer plans to demonstrate a return on investment for the FIU program by reducing emergency room visits, improving health literacy, and increasing preventative care. If successful, the program will help address the challenges of providing medical care--improving quality, reducing costs, and maybe even alleviating primary care shortages--by allowing doctors to focus on patients, not paychecks.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at email@example.com.


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" Country: Australia / World Region: Australasia / Pacific "
All the wonderful things you've heard about Australia are true! It is an absolutely fantastic country.
I'll tell you about my trip and an overview of the places that I went.
I was only in Oz for three weeks and landed at Sydney airport. I was lucky to be staying with family friends who collected me and took me to their home in the Coogee area of Sydney. My friends threw a BBQ for me down at the beach on the day I arrived and had invited many of their friends. Iit was such a welcoming experience but I would say that this is typical of Australians - very friendly and welcoming and they want to show off their country!
Coogee is a 20 minute bus journey from the centre of Sydney but you feel a million miles away from the hustle and bustle of the city. The beach is great but watch out for the sea currents- they are very strong.
There is a lovely coastal walk that goes from Coogee to Bondi beach - it takes about an hour and a half and you can get the bus back - it has some stunning scenery.
Sydney itself is great and it's fantastic to see the scenes you're seen so many times in pictures. The view of the opera house from the botanic gardens is wonderful as it is from the public ferry.
The next stop on my itinery was the blue mountains which is about an hour from Sydney by train. I stayed in Katoomba which isn't much to write home about in itself but has easy access to all the sights. There's some fantastic walking and again the scenery is amazing but so different to Sydney- the blue mountains are lush and green.
Next I went to Tasmania which is somewhere that most people miss from their itinerary but it should not be overlooked. I was lucky because Tasmania is not famed for it gorgeous sunny weather but it was beautiful when I was there. We hired a car and travelled from Launceston to Hobart. I don't really have fond memories of Launceston but that could be because we had quite poor accommodation and only stayed one night. As we travelled down the island there were some fantastic remote places and beautiful lakes. We had some lovely accommodation and saw an unbelievable amount of wildlife. If you like animals, Tassie is the place for you. There are some fantastic walking opportunities. Hobart is a great city- all the Australian cities seem to have their own unique feel - they don't blur into one in my mind like some other countries do. The waterfront and the botanic gardens are particular highlights in Hobart.
Next I flew to Melbourne but didn't really see it before setting off on a trip on the Great Ocean Road. The views of the apostles and the coastline in general was amazing. A helicopter trip over the apostles was brilliant. For me there was too much driving, I would have like to have got out and walked small sections along the coast but I was on an organised trip.
I then went to Kangaroo island which is beautiful - again this is a great place for seeing wildlife - Penguins and Pelicans in particular! It's also a good place to try sandboarding - but try not to fall off and bump your head like I did!
Adalaide was next - quite a laid back and arty feel to this city.
The final part of my trip involved flying to Alice springs which is an interesting little place - I took a walk to the Telegraph museum which was a great place to start learning about Australia's history. There's also a museum about the real flying doctors. From Alice I did a trip out to Uluru (Ayers rock) and Kings canyon. Again it's great to see the iconic images of Australia for real. I walked round Uluru - the native people don't like you climbing it as it is sacred - but many people still do it.
If you want to see a lot of Australia in a short amount of time then I do recommend that you get a couple of internal flights - don't forget that the country is huge! I covered a lot in my 3 weeks and it was a pretty active trip - be aware of your own limitation and don't try to take on too much. Do what's right for you - I think I paced my trip o.kfor me but you might prefer to see one of two places in more depth.
It is of course a long way there and back from the UK and so I wouldn't recommend going for anything less than 3 weeks ideally.
we recently went on a football tour to australia, and it was great especially when you finally arrive, we went to two places Brisbane, and Sydney.
the weather in sydney was great it got upto 24 degrees C and this was their winter, and as you came in on the plane other the beautiful coast line and see it lit up and yet still be able to see through the clear blue water, it was beautiful it didn't even show chance of being cold or rain it was worth the flight.
the sights were amazing, the amarillo which is called the sydney opera house and we even travelled out to bondi bay which was warm but not anything speical in my mind. Manly which you travel to on a boat was warm and is nice and calm especially for shopping.
the food was perfect you could get anything you want at a really cheap price for some really nice food.
weather, same as sydney
the beach was beautiful, and so was the town
shopping in brisbane was great and so was the mini gold and it was so calm and laid back, it was just beautiful and much better than our weather.
Though Bondi is better known to foreign tourists, Coogee, another eastern suburb is equally beautiful, and well worth a visit. I have been living within sight of this beach for slightly more than 2 months now Im in a neighbouring suburb, but I live in a high-rise block and it hasnt lost its charm during that time. The beach is large and sandy and the water is clear and free from fish (including, most of the time, sharks). Its not the busiest place in the area in terms of the number of people or the quantity of things to see and do, but its a beautiful place to relax, and its not entirely dead. For example you could...
<< Go for a swim >>
As well as the gorgeous beach, Coogee has several sea pools for swimming in. One, to the north of the bay, has cliffs for jumping off, but is essentially just a small inlet blocked in on 3 sides by rocks. To the south is a small kiddies pool next to the Surf Life Saving Club, and further over the headland is the women and childrens pool. Known as topless lesbian central this is in fact a perfectly nice place to go there are changing facilities and showers, and a large pool with great views. There are also huge rocky areas to lie on, making a break from getting sand in your pants, and I often spend weekend afternoons down here reading the paper, soaking up the sun and chilling.
<< Go for a walk >>
The coastal path from Coogee to Bondi in the north and Maroubra in the south offers amazing views. From Coogee to Bondi takes between 90 minutes and 2 hours but is well worth it, and there are lots of places to stop and rest along the way. You pass several small beaches such as Bronte and Clovelly, most of which have cafes or kiosks and sea pools too. At the moment, the international festival Sculpture By The Sea is on between Tamarama and Bondi, making a visit even more essential.
<< Go for brunch >>
Coogee is literally teeming with pavement cafes and restaurants serving all manner of cuisine, from McDonalds to Gourmet Seafood and Thai and Italian. Gourmet doesnt mean all that much over here they stick the word into most restaurant names but it does tend to indicate a sit-and-enjoy kind of place rather than an eat-and-run fast food joint. As in most seaside resorts, having a view of the beach is something youll pay extra for, so the promenade places are slightly more expensive, but even they are no exorbitant. Breakfast menus are available all day and are extensive from raisin toast to American style pancakes to eggs cooked and served in any number of different ways. On a sunny day theres no better way to spend a few hours than by meeting friends for brunch, and its something we do quite frequently. I have yet to try somewhere and not enjoy it, but the Coogee Café, on Coogee Bay Road (just up from, um, Coogee Bay) is especially recommended for their pancakes concoctions. I love the tradition of having a huge stash of magazines for you to flick through while you eat. Well often grab a New Idea or Womens Day (kinda like a hybrid of Heat and Closer) to catch up on the essential gossip in between bites.
<< Go for ice cream >>
Ice cream is good, especially when the suns shining and its 35 C as it is here today. Coogee has a variety of places serving it up: theres a Baskin Robins tucked away in a convenience store at the south end of the beach, and a branch of Gelatissimo on the main street whose concoctions are pur heaven. Be sure to try a chocolate filled and chocolate-coated wafer roll with your ice cream. Like a flake, but posher. Most cafes also have ice cream selections, with most offering much more than the usual vanilla/chocolate/strawberry.
<< Go out at night >>
As a small place, the nightlife is centred around a few bars, some late opening restaurants and the main hotels. The Coogee Bay hotel gets most of our custom, and is an amazing place with numerous bars, outside seating with a view of the beach just across the road, a club, live bands and much more, plus free entry to most bits most of the time. Its a sociable place, frequented by locals as much as backpackers, and drinks prices are reasonable. The Palace hotel, just along the prom at the north end of the beach, is also worth a visit, if only for the Ikea style pod chairs they have suspended from the ceiling on one of the levels, perfect for swinging the night away. Going out runs on the same age rules as the UK, though ID is essential for everyone regardless of age, and I had to smile really nicely the time I left mine at home. ID must have an age / date of birth on a simple student card is not sufficient, though how many under 18s there are doing post-grad degrees I dont know. Dress codes are relaxed, though some places dont let you in in flipflops trainers, randomly, are fine.
<< Go shopping >>
Though no one could mistake it for a shopping Mecca, Coogee has all the essentials. For groceries, a few minutes up Coogee Bay Road there is a small precinct with a Woolworths Metro in it (over here Woolworths is a supermarket). The same road has a couple of bakeries and some convenience stores, and lots and lots of take aways. There are a handful of boutique-style clothes shops, some surf shops, a few travel agents and estate agents (Thank you Mr Hooker ) and some random newsagents / stationary / a bit of everything else places. For better shopping, jump on a bus to the monster shopping centre at Bondi Junction, or check out the markets at the north end of Bondi beach on a Sunday.
<< Go and stay there >>
Living within walking distance I havent tried out the accommodation in Coogee, although there is a reasonable choice considering its small size. In addition to the Bay and Palace Hotels, there are a few smaller B&Bs, and a couple of youth hostels. For longer stays, weekly rents start at about $120 for a room in a shared house or apartment, and are readily available.
<< Go further afield >>
The nearest suburb to Coogee, Randwick, is very different from Coogee. Gone are the beach, the pool and the backpackers, and in there place are a cinema (with an amazing selection of food .gelato, cakes, sandwiches, salads, chocolate lasagne), a bowling alley, a great pre-loved bookstore, two small shopping centres, a whole road of proper shops (i.e. ones not selling souvenirs) and a funky little dining precinct called The Spot where we eat on a regular basis. Highly recommended come Arthurs and Caffe Ciao for proper food, and Sugar Plum for monster ice cream sundaes (for 6 people to share), waffles and more. Randwick is a 20-30 min trek up the steep hill or a 5 min / $1.20 bus journey, but going back down you can do it in 15 mins. Yep, the hill is that steep. Its worth it though, especially on a Tuesday when its $5 night at the cinema.
<< Go get there >>
Coogee it easily accessible from the city, airport and other suburbs by bus, and many routes terminate on the promenade. Unfortunately there is no train station nearby (I prefer trains to busses because theyre confined to tracks so you know where youre going all the time) the nearest are Sydney central or Bondi Junction.
has a route planner option for planning trips in and around Sydney, or look at
Taxis are also plentiful, especially at night, and some of the drivers are fascinating. Just last night we had a former Academic Lawyer from Poland who seemed to like to talk about politics and corrupt business men.
I dont have long left in Sydney before I take all my annual leave for ever more and go wandering off to Cairns to see what adventures Queensland beholds. Coogee is one thing Ill miss, then and when I eventually return home. Its a chilled out place, like Ibiza but with fewer drugs, like Minorca but with better ice cream, with a warm, friendly feel to it. Its as suitable for families as it is for backpackers which is rare in my experience, and is, bearing in mind Sydney centre, Manly and Bondi, comparatively cheap. Its safe, cheerful and clean, and I couldnt have asked for a better suburb to have at the end of my road for my time in Oz.
Australia is definitely the holiday of a lifetime. Unfortunately my friend and I could only go for four weeks but what a brill holiday we had. Starting of in Melbourne we shopped in all the best stores ate till we could eat no more, Melbourne offers a wide selection of restaurants and all at a very low price. We snorkelled on the geat barrier reef, spotted koalas up a tree in North Queensland, walked along The Rocks and saw the Opera house and Bridge in Sydney hiked up the Blue Mountains travelled back by train to melbourne to see the sights then sipped wine in the vineyards of Adelade feed the kangaros also won a few dollars in the casino but alas had to head off back to Ireland. But we will return.


text: Here's a really handy tip. If you go to the Select menu and choose Same, you can instantly select all the shapes with the same colour, stroke colour, blending mode, opacity and stroke weight. This is ideal if you want to rapidly change similar elements in a complex piece of work.


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Tebow Time
I, along with the rest of America, have developed quite an obsession with Tim Tebow. If you weren't watching the Broncos/Patriots game yesterday, there better be a good reason. Even if you don't like watching football, you've got to LOVE watching Tebow and the Broncos somehow pull through in the 4th quarter. So popular is this quarterback sensation that there was even a Tebow skit on SNL this past weekend.
But what a bummer that the Broncos lost. I was really rooting for them.
I was so bummed I decided to make banana muffins.
Which turned out absolutely delicious…
Banana Muffins recipe (makes 6)
- 3/4 cups all-purpose flour
- 1/2 teaspoon baking powder
- 1/2 teaspoon baking soda
- 1/4 teaspoon salt
- 1.5 large bananas, mashed
- 1/3 cup white sugar
- 1/2 egg, beaten
- 1/6 cup butter, melted
- Preheat oven to 350 degrees F. Coat muffin pans with non-stick spray, or use paper liners. Sift together the flour, baking powder, baking soda, and salt; set aside.
- Combine bananas, sugar, egg, and melted butter in a large bowl. Fold in flour mixture, and mix until smooth. Scoop into muffin pans.
- Bake in preheated oven. Bake mini muffins for 10 to 15 minutes, and large muffins for 25 to 30 minutes. Muffins will spring back when lightly tapped.