History Of Knee Arthroplasty
The Total Knee Replacement is one of the most important orthopaedic surgical advances of the twentieth century. The first knee replacement was performed in 1968. Since then improvements in surgical materials and techniques have greatly increased its effectiveness. Approximately 25,000 knee replacements are performed each year in Australia alone.
- The development of total knee arthroplasty began back in 1860, when the German surgeon, Themistocles Gluck, surgically implanted the first primitive hinge joints made of ivory.
- 1951 saw the introduction of the Walldius hinge joint. Initially this was manufactured from acrylic, then in 1958 it was manufactured from cobalt and chrome. Unfortunately, this hinge joint suffered from early failure.
- During the early 1960s, John Charnley’s cemented metal-on-polyethylene total hip arthroplasty inspired the development of the modern total knee replacement. Frank Gunston, from the same hospital as Charnley, went on to design an unhinged knee that replaced both the medial and lateral sides of the joint with separate condylar components. Improved biomechanics resulted from the preserved intact cruciate and collateral ligaments, which maintained the stability of the femoral and tibial components and the design allowed the centre of rotation to change with flexion of the knee.
- The metal-on-polyethylene condylar design which completely replaced the femoral and tibial articulating surfaces, was pursued throughout the early 1970s. The result was an implant that relied on component geometry and soft tissue balance to provide stability and a large articulating surface area to spread load and minimise polyethylene wear. Improvements in component materials, geometry and fixation continued throughout the 1970s and 1980s.
- Advancements in more accurate sizing, the option of patella femoral replacement, better instrumentation as well as components that allow an increased range of motion and a lower wear rate have since been developed and implemented.