By Richard S. Laskin MD, FACS, Robin A. Denham FRCS, FRCS(E), A. Graham Apley FRCS (auth.)
"Knee substitute is sure to fail-providing the sufferer lives lengthy enough". there's a few fact during this hoary cliche, so why write books at the topic? i feel the answer's that knee alternative has finally turn into demonstrated or even good. The extra absurd surgical extravaganzas were known and discarded; this day a sufferer can count on to depend upon his new knee to serve him with convenience for a good variety of years. after all even the early knee replacements usually made the sufferer cozy; the difficulty was once they only didn't final. All too usually the innovator's enthusiasm was once overtaken by means of the patient's disillusionment. certainly, the operation may good were deserted had it no longer been for the desire that in the future the magnificent effects on the hip can be matched on the knee. those pioneer prostheses have been designed as if the knee have been biomechanically as ordinary because the hip. sadly, a number of complexities quickly turned obvious; in reaction the types multiplied-and multiplied-until the standard orthopaedic practitioner turned hopelessly bewildered. He came upon himself subjected to excessive strain propaganda; from the health professional delivering a miracle therapy, from the engineer looking status and from the producer awaiting fortune. traveling his unit as a staff, this trio was once practically irresistible.
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Additional info for Replacement of the Knee
1982). Cloutier has designed special instruments for the operation, including a tibio-femoral distractor and aligner. Fig. 19a,b. The Cloutier total knee. a The implant is non-constrained. The plastic plateau surfaces are supported by a metal tray. b The Cloutier tibio-femoral distractor is used to align the knee. The Kinematic Condylar Anterior Joined Total Knee (Fig. 20) This is one of a five-membered knee system designed to cover most of the anatomical and functional problems encountered in the performance of total knee replacement.
Ingliss et al. (1978) reported a 1-3-year followup using this prosthesis in 42 patients. Post-operative relief of pain and correction of deformity were excellent in most patients. Although there were no cases of gross loosening, 45% of all the knees had bone-cement radiolucencies (81 % using two-piece tibial components, and 33% using a one-piece stemmed tibial component). The average post-operative range of flexion was 98°; 41 of the 45 patients a Fig. 27a,b. The Kodama-Yamamoto knee. a The femoral component is inserted without acrylic cement: the waffled interior surface is used to obtain an interference fit.
The designers implanted both the PCA and several other conforming knee implants into cadaveric knees and then compared the torque curves The Spectrum of Total Knee Replacement 34 than did an implant with a smooth polyethylene surface; furthermore. the porous metal surface resisted tensile stresses two times greater than those resisted by the polyethylene surface. The components may be inserted either with or without cement. For cemented fixation. the tibial components with a central stem are used; for uncemented applications.
Replacement of the Knee by Richard S. Laskin MD, FACS, Robin A. Denham FRCS, FRCS(E), A. Graham Apley FRCS (auth.)