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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5241_Библиотеки_им_академика_М_И_Перельмана.pdf
xiv
Contributors
GabriellaDituri Hospital for Special Surgery Florida, West Palm Beach, FL, USA
Seper Ekhtiari, MD, MSc, FRCSC Granovsky Gluskin Division of Orthopae-
dics, Sinai Health, Department of Surgery, University of Toronto, Toronto,
ON, Canada
Division of Orthopaedic Surgery, Department of Surgery, McMaster University,
Hamilton, ON, Canada
JonathanR. Franco Department of Orthopedic Surgery, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, USA
TonyK.George University Orthopaedic Associates, Somerset, NJ, USA
StevenB.Haas Hospital for Special Surgery, New York, NY, USA
EmilioD.Hernandez, MD Granovsky Gluskin Division of Orthopaedics, Sinai
Health, Department of Surgery, University of Toronto, Toronto, ON, Canada
StephenM.Howell Department of Biomedical Engineering, University of Cali-
fornia at Davis, Davis, CA, USA
PeterP.Hsiue Hospital for Special Surgery, New York, NY, USA
MauryL. Hull Department of Biomedical Engineering, University of California
at Davis, Davis, CA, USA
Department of Mechanical Engineering, University of California at Davis,
Davis, CA, USA
Department of Orthopaedic Surgery, University of California at Davis,
Davis, CA, USA
FarazJamal JFK Johnson Rehabilitation Institute, Edison, NJ, USA
EbonyJames Hospital for Special Surgery Florida, West Palm Beach, FL, USA
RezaKatanbaf LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute
for Advanced Orthopedics, Baltimore, MD, USA
RichardD.Komistek Department of Biomedical Engineering, University of Ten-
nessee, Knoxville, TN, USA
TsunLaw Hospital for Special Surgery Florida, West Palm Beach, FL, USA
AdolphV.Lombardi Jr JIS Orthopedics, LLC, New Albany, OH, USA
DavidJ.Mayman Adult Reconstruction and Joint Replacement Service, Hospital
for Special Surgery, New York, NY, USA
PatriciaR.Melvin JIS Orthopedics, LLC, New Albany, OH, USA
MichaelA.Mont LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute
for Advanced Orthopedics, Baltimore, MD, USA
Contributors
xv
AlexanderJ.Nedopil Department of Orthopaedic Surgery, König-Ludwig-Haus,
University of Würzburg, Würzburg, Germany
JeffreyA.O’Donnell Hospital for Special Surgery, New York, NY, USA
MartinRoche Hospital for Special Surgery Florida, West Palm Beach, FL, USA
LaurenSacco JFK Johnson Rehabilitation Institute, Edison, NJ, USA
SahilA.Sanghavi Department of Arthroplasty, Sancheti Institute for Orthopae-
dics and Rehabilitation, Pune, India
GilesR.Scuderi Department of Orthopaedic Surgery, Zucker School of Medicine
at Hofstra/Northwell, Hempstead, NY, USA
TonyS.Shen Adult Reconstruction and Joint Replacement Service, Hospital for
Special Surgery, New York, NY, USA
GabrielleN.Swartz LifeBridge Health, Sinai Hospital of Baltimore, Rubin Insti-
tute for Advanced Orthopedics, Baltimore, MD, USA
AlfredJ.Tria Jr Department of Orthopedic Surgery (Emeritus), Rutgers-Robert
Wood Johnson Medical School, New Brunswick, NJ, USA
PeterS.Walker NYU Langone Orthopedic Hospital, New York, NY, USA
NYU Tandon School of Engineering, Brooklyn, NY, USA
JesseI.Wolfstadt, MD, MSc, FRCSC Granovsky Gluskin Division of Orthopaedics, Sinai Health, Department of Surgery, University of Toronto, Toronto,
ON, Canada
Part I
Background
Chapter 1
The Evolution ofTotal Knee Replacements
MohamedF.Albana andGilesR.Scuderi
Introduction
Historically, total knee arthroplasty (TKA) has been the most reliable surgical procedure for end-stage knee arthritis. Currently, the most used implants in primary
TKAs are posterior stabilized (PS) and cruciate retaining (CR) prostheses. In the
late 1960s and early 1970s, these two implants were being designed in parallel.
Michael Freeman and John N.Insall had a close personal relationship that began in
medical school at the Corpus Christie College in Cambridge, UK [1]. Freeman continued on to the London Hospital and Insall began his journey at the Hospital for
Special Surgery (HSS) in 1965. Over the next three decades, the two constantly
communicated their ideas and experiences in both the management of knee arthritis
and the design of total knee arthroplasty.
The conception and design of the condylar total knee, consisting of a single
femoral component covering both medial and lateral femoral condyles and a single
tibial component covering both medial and lateral tibial plateaus, began between
1966 and 1968 and are largely attributed to Freeman and SAV Swanson, PhD [1].
Freeman’s main concern was replacing arthritic knees with severe exion deformities, while Swanson’s main concern was wear of the polyethylene liner [2, 3].
Together, Freeman and Swanson established three parameters to simplify the knee
mechanics and subsequent prosthesis design: (1) both cruciate ligaments are
resected during reconstruction to facilitate deformity correction and maximize the
implant bone contact area; (2) resection of both cruciate ligaments limited posterior
femoral rollback allowing for a single sagittal radius of curvature for the femoral
component; (3) the implant should sit at on cancellous bone allowing for preservation of bone, increased contact area between at the bone–implant interface, and
M. F. Albana · G. R. Scuderi (*)
Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
e-mail: malbana@northwell.edu
Switzerland AG 2024
A. J. Tria Jr., G. R. Scuderi (eds.), The Cruciate Ligaments in Total Knee
Arthroplasty, https://doi.org/10.1007/978-3-031-75992-5_1
3© The Author(s), under exclusive license to Springer Nature
4
M. F. Albana and G. R. Scuderi
simplifying the surgical procedure [2, 3]. This lead to the production of the Freeman-
Swanson total knee, which did not contain a tibial post for fear of increased stress
on the bone–implant interface. Freeman quickly identied this as a aw due to
mediolateral instability with subsequent implant failure [2, 3]. This design did not
incorporate an anterior femoral ange for patellar articulation as the patella was not
routinely resurfaced. Despite a design adjustment in 1974 to include a femoral
ange, manufacturing delays limited availability of the newly designed femoral
component until December 1976 [4]. This new design was renamed the Imperial
College London Hospital (ICLH) knee.
The ICLH knee progressively evolved to include a tibial post and a groove in the
femoral component that articulated with both the tibia and a patellar polyethylene
button. KM Samuelson worked with Freeman to develop this new implant, the
Freeman-Samuelson knee, whose inuence has remained in present day designs [1].
In 1970, Insall along with Chitranjan Ranawat, Alan Inglis, and Peter Walker
established a working group that would bring forward signicant innovation and
inuence the present day TKA. This working group developed an anatomic
cemented TKA that preserved both cruciate ligaments and the duocondylar knee
(Fig.1.1) [1]. Although this was occurring at the same time as Freeman’s innovation
in London, the philosophy was quite different with an emphasis on maintaining both
cruciate ligaments. The duocondylar was rst implanted by Ranawat with Insall as
rst assistant in 1971 and led to several realizations postoperatively: (1) replacing
the patellofemoral compartment should be incorporated in future designs; (2) preservation of both cruciate ligaments limited correction of deformities; (3) xation of
separate tibial components, which the duocondylar knee had, was not as secure as a
single tibial component [5].
The limitations of the duocondylar knee led to the development of the Total
Condylar (TC) prosthesis (Fig.1.2), which was the rst functionally designed prosthesis that sacriced both cruciate ligaments, and the duopatellar prosthesis, which
preserved the PCL (Fig.1.3). The TC prosthesis boasted a trough in the anterior
femoral ange and a resurfaced polyethylene patellar button, resection of both
Fig. 1.1 Duocondylar
prosthesis
1 The Evolution ofTotal Knee Replacements
Fig. 1.2 Total condylar
prosthesis
5
cruciate ligaments allowing for deformity correction, and a symmetric anatomic
bicondylar design addressing the major limitations of the duocondylar knee [1]. The
rst TC knee was implanted by Insall in 1974. Concerns about tibial loosening due
to the highly conforming femoral and tibial components were addressed by designing a single tibial polyethylene component with an added tibial peg that allowed for
torsional stability [6]. Subsequent improvements on the total condylar prostheses
incorporated a cam on the femoral component and a post on the tibial component.
This provided mediolateral stability and allowed for femoral rollback in place of the
sacriced posterior cruciate ligament [1].
Posterior Stabilized
Insall and Walker would make further modications to the TC knee to address two
predictable consequences of cruciate resection [7–10]. The rst was exion instability leading to an anterior shifting of the femur on the tibial polyethylene. The second
was the limited knee exion obtained with the TC knee, which allowed an average
of 90 degrees of exion [10]. Both consequences were corrected with the advent of
6
Fig. 1.3 Duopatellar
prosthesis
M. F. Albana and G. R. Scuderi
the central tibial post. The tibial post acted to block hyperextension and prevented
anterior displacement of the femur in exion by incorporating posterior femoral roll
back [11, 12]. This new design, called the Total Condylar Prosthesis II (TCP II), was
short-lived due to early loosening. Following the failure of the TCP II, Insall began
collaborating with a bioengineer, Albert Burstein, to produce the Insall-Burstein I
(IB I) (Fig.1.4). The IB I was introduced in 1978 and would act as the benchmark
for all future posterior cruciate-substituting designs [13].
The IB I design contained a dished all-polyethylene tibial component with a
tibial post-femoral cam mechanism that allowed for femoral rollback and increased
ROM [11]. Shortly thereafter, laboratory studies demonstrated that metal-backed
components transmitted loads from the prosthesis to the bone better than polyethylene alone [14]. By 1980, Insall was exclusively implanting IB I with a metal-backed
tibial component, which demonstrated tremendous clinical performance and survivorship data for nearly a decade to follow [15–19]. In 1988, the IB II prosthesis was
introduced to the market. This new iteration featured a modular tibial tray with the
ability to add both augments and stem extensions to the core prosthesis (Fig.1.5)
[11]. While the IB II featured improvements in the tibial components, the NexGen
Legacy Posterior Stabilized Knee Prosthesis (LPS) (Zimmer, Warsaw, IN), introduced in the mid-1990s, focused on the femoral component. The LPS prosthesis
offered side-specic femoral components with a raised lateral femoral ange and a
1 The Evolution ofTotal Knee Replacements
Fig. 1.4 Insall-Burstein I
7
deeper trochlear recess for optimal patellar tracking [11]. More recently, these
devices evolved into the widely used Persona PS prosthesis (Zimmer Biomet,
Warsaw, IN) with moderate sagittal and coronal plane conformity (Fig.1.6). Further
modications including increased size options for better soft tissue balancing and,
eventually, press-t designs maintained the groundbreaking advances originally
introduced with the IB I and IB II prostheses.
Cruciate Retaining
In the early 1970s, Phil Wilson, Jr., who was serving as the surgeon and chief of
HSS at the time, encouraged Ranawat to concentrate on the duopatellar design
while Insall was focuses on the total condylar prosthesis [1]. Ranawat drew from his
experience in total hip arthroplasty xation and convinced Walker to design similar
stem xation for the TC and duopatellar prostheses to improve torsional xation [1].
The nal peg geometry was incorporated into both prostheses in 1974 drawing from
the Charnley hip stem xation and biomechanical knee simulator tests carried out
by Walker [1].
8
Fig. 1.5 Insall-Burstein II
prosthesis
M. F. Albana and G. R. Scuderi
As discussed above, the duopatellar prosthesis preserved the posterior cruciate
ligament in hopes of maintaining posterior femoral rollback allowing for increased
passive knee range of motion. Insall reported his experience using the total condylar
knee prosthesis in 125 consecutive knees with an average age of 68.2 years and
noted patients had an average range of motion of 94° [75°–125°] [8]. A year later,
Ewald etal. published their ndings on kinematic total knee arthroplasties, which
consisted of preserving the posterior cruciate ligament. In their review of 124 consecutive knees with an average age of 76years old, the average range of motion
106° [93°–119°] [20]. The proponents of cruciate retaining designs touted this preservation of range of motion, particularly as it translated to improved maintenance of
activities of daily living [21, 22]. Furthermore, a 10-year survival analysis comparing the cruciate retaining design to the total condylar knee demonstrated similar
clinical and radiographic success rates [23]. In light of similar survival rates, greater
range of motion, and reduced shear forces at the bone–prosthesis–cement interface
[24] with a retained posterior cruciate ligament, the philosophy of posterior cruciate
retention established itself as a reasonable alternative to the traditional cruciate
resection approach.
The duopatellar prosthesis, the rst cruciate preserving design, was implanted at
HSS in 1974 and continued until 1976. In 1974, Ranawat and Walker introduced
1 The Evolution ofTotal Knee Replacements
Fig. 1.6 Persona PS
prosthesis
9
both the duopatellar and TC prostheses to the surgeons in Boston, where the posterior cruciate sparing approach would thrive. In 1975, Peter Walker left HSS to work
with Clement Sledge and Fred Ewald on further developing the duopatellar design.
Although the results of the duopatellar prosthesis demonstrated excellent outcomes,
Ranawat and Inglis, who remained at HSS, determined that the results were no better than the TC prosthesis [1] and the power of deformity correction with excision
of the posterior cruciate ligament was too valuable leading to the abandonment of
duopatellar prosthesis and the preservation of the posterior cruciate ligament at
HSS [1].
Bi-cruciate Retaining Designs
The bi-cruciate retaining (BCR) designs experienced a span of popularity early in
the 1970s. The theory of preserving both cruciate ligaments for a more anatomic
knee replacement was appealing to many, but the initial designs did not demonstrate
longevity. The rst BCR prosthesis was the polycentric TKA, which had failure rate
as high as 34% at 10-year follow-up [25]. These early failures were attributed to