Design evolution in total knee replacement: which is the future?

Total knee replacement (TKR) procedures have evolved in the last 40 years to guarantee improvements implants life and an excellent joint function. The goals for the future evolutions are make easier prosthesis implantation and promote precision. The demand for TKR will rise for the life length increase and for the risk factors impact increase. Design evolution in total knee replacement has to satisfy these new necessities: anatomic congruence, range of motion, less material wear and better resistance to the weight bearing and to the stresses. This paper analyzes design evolution, materials development and future purposes in total knee arthroplasty. At the beginning, TKR history is treated; then we compare several prosthetic designs developed during years. At last the paper speak about recent innovations, like CAD (computer aided design) for example, born to reach the most important goal in the future: better TKR design, is the one that better imitate natural knee characteristics, and that is able to integrate it-self with capsule-ligaments and muscle-tendons patient structures.

Arthroscopic treatment of meniscal tears: with all-inside suture technique: 1 years follow up results.

BACKGROUND: In the last years meniscal repair surgeries have evolved to less invasive all-arthroscopic technique. PURPOSE: To determine the short-term success rate and reoperation rate of all-inside meniscal sutures with a concomitant anterior cruciate ligament reconstruction. METHODS: Eighteen meniscal repairs were performed using an all inside suture technique. A concomitant anterior cruciate ligament reconstruction was done in all patients.The mean follow-up was 14 months (range 12-18). The success rate was determined by the presence of normal or nearly normal parameters of the Henning Classification based on magnetic resonance imaging. RESULTS: Sixteen (89%) of the meniscal repairs had normal or nearly normal characteristics according to Henning Classification. Two patients (11%) required partial arthroscopicmeniscectomy. CONCLUSIONS: Current techniques do not require accessory posteromedial or posterolateral incisions and significantly reduce the incidence of complications and pain associated with more invasive surgery. The short-term evaluation of the meniscal repairs with concomitant anterior cruciate ligament-reconstruction shown good results with satisfaction of the patients.