Knee Arthroplasty(Archived)

Excerpt

Knee arthroplasty is a reconstruction of the knee joint. It is more commonly referred to as a total knee replacement and is a very reliable procedure with predictable results. Total knee arthroplasty (TKA) is an excellent treatment option for individuals with symptomatic osteoarthritis in at least 2 of the 3 compartments of the knee and who have failed conservative treatment. Additionally, partial knee arthroplasty (PKA) is an excellent treatment option for individuals with symptomatic osteoarthritis localized to 1 compartment of the knee and who have failed conservative treatment. The primary goal of either surgery is durable pain relief with the improvement of functional status.

The history of TKA dates back to the mid to late 1800s when the first implants were made from ivory and fixed to the bone using a combination of colophony and plaster of Paris. This design did not produce favorable results and was eventually replaced with metal implants in the 1930s. In the 1950s, a hinged prosthesis was designed to replace the femur and tibia, as well as the stabilizing ligaments surrounding the knee. While this produced satisfactory results, there was a high rate of failure and poor long-term outcome due to the failure of reproducing the natural kinematics of the knee joint. This was subsequently replaced with a prosthesis that replicated the shape of the distal femur, preserved the collateral and cruciate ligaments, and consisted of a plastic bearing on the tibia. Since this breakthrough in prosthesis in the 1970s, the design has evolved to focus on replicating the anatomy and normal function of the knee joint. Furthermore, advances have been made in fixation techniques and wear properties of the bearing surface which positively affects the longevity of the knee replacement.