History of Total Knee Replacement

ABSTRACT

Hinge arthroplasty was first introduced over 100 years ago, and it has been refined over the years through a succession of increasingly complex designs that have led to the present rotating hinge prosthesis. Though no official date marks the origin of the condylar knee, the modern condylar and unicompartmental total knee replacements were developed between 1969 and 1980. Compared with the hinge prosthesis, condylar knee replacement requires less bone resection. Utilizing instrumentation to achieve soft-tissue balance for fixing a varus/valgus deformity, the operation is easily reproducible, which in turn, results in a successful outcome. In the late 1970s and early 1980s, metal backing of the tibial inserts to improve fixation, modularity to improve ease of use and noncemented fixation to increase durability were introduced. In the late 1980s, for revision surgery, stem fixation with and without cement, and metal wedges were created to address bone loss and soft tissue instability. In the current age of technological advances, reproducing the knee kinematics for minimizing wear and increasing the range of motion, together with proper alignment and stability, have become the major goals of total joint replacement, and this is very doable with the use of modern sophisticated instruments and navigation-guided surgery.