Their implant was designed to recreate how real knees work and became a game-changer in the field. It was the first implant to address all anatomically shaped parts in the knee. With this implant as the foundation, surgeons and developers have advanced the field immensely.
Now knee replacements are standard-of-care procedures and new patient-specific technology is built on the anatomical principles the HSS surgeons studied. Mickey Mantle's first knee surgery in We consider Mickey Mantle a baseball legend today, but in he was a New York Yankees rookie that spent part of the season in the team's farm system and was trying to prove himself in his first World Series when an injury during game two forced him to watch the rest of the series from the sideline.
He was attempting to catch a ball when his cleat spike hit a rubber drain or sprinkler and caused the first knee injury of his career. Mantle subsequently underwent knee surgery — and several surgeries throughout his career — yet still managed to become one of the most well-regarded baseball players in history.
However, according to a New York Times article , the injury and surgeries prevented him from become one of the greatest statistical performers in history. First knee arthroscopy.
Severin Nordentof, a physician in Denmark, is credited with using the first endoscope to look inside of a knee joint in However, without evidence of surgical intervention, he is not considered to have performed the first knee arthroscopy. Forty-three years later, renowned Japanese surgeon Masaki Watanabe, MD — known for his development of arthroscopy instrumentation — performed the first recorded operative procedure under arthroscopic control.
He removed a solitary giant cell tumor from a knee joint during the procedure, and then in performed the first partial meniscectomy under endoscopic control. Watanabe was also considered a great teacher and shared his knowledge freely. He authored the Atlas of Arthroscopy, published in English in , and his research became the basis of modern minimally invasive knee surgery today. Adrian Peterson's knee surgery and amazing recovery. Adrian Peterson was in the running for the National Football League's most valuable player and noted Hall of Fame prospect for the Minnesota Vikings when he tore his anterior cruciate ligament in December The injury was gruesome and would have left many athletes on the sideline for months — if not the rest of their career.
However, Mr. Peterson called on renowned knee surgeon James Andrews, MD, noted for his work with elite athletes and returning them to play. Peterson not only underwent the surgery six days after injury, but also completed a rigorous rehabilitation schedule and then returned to start for the Vikings week one of the season — just nine months after surgery, according to Bleacher Report.
He continued to put up outstanding numbers post-injury and threatened to break league records. Peterson's recovery has now become a benchmark for other athletes suffering ACL tears — fairly or not — as he raised the bar for future knee surgery recovery.
Dwayne Wade's knee replacement surgery. Nearly a decade before he became part of the Miami Heat's "Big Three," Dwayne Wade underwent his first knee surgery to remove the meniscus from his left knee. He was a Marquette college basketball player and decided to undergo the procedure to return to play. While Mr. Wade still became a superstar in the National Basketball League, he battled chronic knee pain and issues throughout his career, leading toward a second knee surgery in Wade said he regretted that first knee surgery — technology was less advanced than it is today, and he wasn't thinking about having a long-term career.
He was more focused on returning to play in the short term. Wade helped lead the Miami Heat to several championship games, even winning two championship rings, but his injuries may have prevented him from achieving even more. Wade continues to play for the Heat, but without that first knee surgery he may have made more significant contributions to the game and changed basketball history forever. However, knee joints with degenerative arthritis usually show soft tissue contracture, and when preserving the posterior cruciate ligament, the soft tissue balance is not easy to achieve, which possibly increases the risk of early failure due to polyethylene insert overloading caused by posterior cruciate ligament unbalanced tension [ 16 ].
Posterior-substitution prosthesis showing that the post-and-cam mechanism offers no restraint to varus or valgus stability Courtesy of Biomet.
When the posterior cruciate ligament substitution type is used, even degenerative knee joints with relatively severe deformities can achieve ligament balance, and when flexed at degrees, the post of the tibial polyethylene contacts the cam of the femoral component and induces posterior placement of femoral bone, which allows relatively satisfactory roll-back and can achieve sufficient knee joint flexion Figure 3 [ 17 ].
However, bone loss at the intercondylar notch makes revision surgery difficult, and fracture may occur intra-operatively or post-operatively in patients with small femurs.
From the biomechanical perspective, neither posterior cruciate ligament preservation nor substitution types can totally replace the biomechanics of the normal knee joint. Furthermore, many clinical studies have concluded that there is no significant difference between these two types of prosthesis.
Traditional fixed bearing knee arthroplasties have produced good clinical results at years postoperatively. Unfortunately, problems associated with polyethylene wear can occur in the long-term, especially in young patients.
This wear can be reduced by reducing contact stress at the joint surface and by improving the wear characteristics of the material used. Contact stress may be reduced by increasing conformity between the femoral component and the polyethylene insert. The development of mobile-bearing articulating polyethylene surfaces in implants for patients undergoing total knee arthroplasty reflects the efforts made by designers to optimize wear while addressing the complexities of function.
However, the trade-off for conformity and free mobile range in fixed bearing knee arthroplasty makes marked improvements in contact stress near impossible. To solve this problem, mobile bearing interposition knee arthroplasty was invented to reduce contact stress but to preserve freedom of movement. However, in the case of the mobile bearing insert, the bearing can be dislocated when flexion extension gaps are inadequate.
In Europe, this mobile bearing prosthesis has been used for decades with good clinical results, but recent reports have found no significant differences between this mobile bearing prosthesis and fixed bearing polyethylene. Mobile bearing knee prosthesis, which reduces contact stress but preserves freedom of movement Courtesy of Biomet. Concern over the long-term tolerance of bone cement fixation led to the development of a non-cemented fixation design in Hungerford et al.
These implant designs have a surface topography that is conducive to bone ingrowth. Most are coated or textured so that the new bone actually grows into the surface of the implant. They may also use screws or pegs to stabilize the implant until bone ingrowth occurs. However, because they depend on new bone growth for stability, non-cemented implants require a longer healing time than cemented replacements.
Non-cemented implants, unfortunately, showed higher failure rates than cemented knee arthroplasties due to aseptic loosening and bone loss.
In all knee replacement implants, metal rubs against the polyethylene insert, and although the metal is polished and the polyethylene is treated to resist wear, the loads and stresses of daily movements generate microscopic particle debris, which in turn, can trigger inflammatory responses that result in osteolysis or loosening. Because non-cemented implants have not been used as long as cemented implants, comparisons after long-term use are not possible.
However, some studies have shown that non-cemented fixation has success rates comparable to those of cemented fixation [ 21 ]. Nevertheless, non-cemented knee arthroplasty has not widely adopted, but recent material developments have resulted in materials that enhance bone ingrowth which has led to the use of non-cemented knee arthroplasty in young patients. Revision total knee arthroplasty is often associated with poorer outcomes due to bone loss and ligament damage, which can result in ligamentous laxity and imbalance.
A constrained condylar knee design was developed to resist coronal moments in the plane caused by soft-tissue deficiency. Constrained condylar knee designs have the advantage of allowing changes in the center of rotation during flexion, and thereby, theoretically impart less tangential anterior-posterior stress across the prosthetic interface [ 22 ].
An early model of constrained condylar knee design was proposed by Insall et al, although similar to posterior cruciate ligament substitution knee arthroplasty, the polyethylene post is thicker and longer, which provides stability for valgus and varus movements as well as not posterior movements [ 23 ]. Excessive constraint is a problem when the LCCK is used and this causes failure by loosening the prosthesis. Thus, in difficult knee arthroplasty cases, usage may be determined during surgery by taking into consideration the need for constraint.
For example, in severe valgus knee joints, the LCCK polyethylene insert may be a good candidate, but posterior cruciate substitution tibial bearing is recommended over the constrained type. The development of arthroplasty design and materials has led to long-term endurance, but the not infrequent need for revision due to polyethylene wear has been a cause of patient dissatisfaction. To reduce polyethylene wear, a cross-linked polyethylene bearing was developed and used in hip replacements in s, and thus, its effectiveness has been proven.
However, in knee arthroplasty, it has neither been widely used nor widely studied. Recently improved resistance in posterior cruciate substitution knees have been reported to lead to cam and post delamination, pitting, cracking or fractures [ 25 ]. Generally, postoperative knee motion range for total knee arthroplasty is less than degrees. Recently, to obtain motion ranges similar to those of the normal knee joint, high flexion femoral prostheses with a thickened posterior portion of femoral prostheis and a wider contact surface with the bearing are being used to reduce contact pressure and wear Figure 6.
To prevent collision between the patellar ligament and bearing at high degrees of flexion, a high flexion bearing with an oblique cutting of the anterior bearing has been developed.
Furthermore, many authors have reported that high flexion knee arthroplasty can result in smaller contact loadings and wider ranges of motion than previous knee arthroplasties. For example, Huang et al. Laskin [ 27 ] has also published similar findings. In addition to pain reduction and restoration of function, survivorship is also a decisive contributor to the success of TKA. Thanks to its extended posterior condyle radius, which has been broadened all round, the NexGen CR-Flex system offer a larger contact surface during deep bending, and therefore, spreads contact stress over a large area.
However, some authors [ 28 , 29 ] have reported no increase of flexion when using high-flexion prostheses. In particular, in a clinical study that used both knee implants, high flexion knee arthroplasty did not show a significant increase in knee joint flexion range. This issue needs to be proven by long-term follow up over 10 to 15 years [ 30 ]. High flexion type prosthesis Courtesy of Zimmer. The most important thing to remember when performing posterior cruciate ligament preserving knee arthroplasty is to balance the posterior cruciate ligament and prevent instability by ligament disruption when flexed.
For these reasons, deep-dished polyethylene insert also called ultracongruent insert was developed. This bearing insert has moderate conformity in coronal and sagittal planes, which can prevent edge loading caused from paradoxical anterior translation due to elevation of the anterior lip of the prosthesis, prevent elevation in flexion, and prevent posterior subluxation Figure 7. In , when John N.
When patients had debilitating knee arthritis, their best option was often the temporary relief of pain medication.
Seeking new hope for their patients, Dr. Inglis, MD, and biomechanical engineer Peter Walker, PhD, to design and develop the modern total knee implant, called the total condylar knee. Insall and Dr. Ranawat first used the total condylar knee with patients in For the first time, a knee implant recreated the way a real knee works, allowing patients to move naturally and without pain. Goldring, MD , Richard L. Menschel Research Chair. Previous implants were cumbersome for surgeons to implant. Since , HSS physicians, scientists, and engineers have continued to advance knee prostheses, dramatically increasing implant longevity and developing better implant materials.
They now track long-term patient outcomes through a joint replacement registry that enrolls more than 30, participants and analyze retrieved implants at the Mary and Fred Trump Institute for Implant Analysis, in order to understand how the implants have performed and improve that performance.
Sculco, MD. Our team is devoted to identifying areas where we can achieve even higher standards across the pathway of care. Patients often require the replacement of both knees.
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