In 2003, a fixed bearing tibial component, known as the Vanguard M, that could be used with the Oxford instrumentation was introduced (Fig. 1.12). The reason this was introduced was to allow surgeons in the United States of America to use the Oxford instrumentation as the mobile bearing version was not yet FDA-approved. Prior to the approval of the mobile bearing Oxford in the United States, large numbers of Vanguard Ms were implanted. The use of the device has since decreased; however, it is still available and can be used by surgeons who have worries about stability of the mobile bearing or if there is a problem with recurrent dislocation. The device, which was initially designed for the medial compartment, can also be used in the lateral compartment. For the surgeon who is not very experienced with the OUKA, it is probably preferable to use a fixed bearing device rather than a mobile on the lateral side. However, the Vanguard M was designed for the medial side and is not the optimal shape for the lateral side. To address this issue, a fixed bearing lateral Oxford (FLO) has been introduced. This is interchangeable with the mobile lateral arthroplasty and the combination should allow surgeons of all levels of experience to use an OUKA on the lateral side.
