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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


There are a multitude of choices and implant varieties for primary total knee arthroplasty (TKA). TKA implant systems differ in a number of design characteristics intended to either improve performance through optimizing kinematic function (such as the medial pivot, mobile bearing, gender-specific or high-flexion designs) or by increasing the durability of the TKA by minimizing long-term failure modes, such as wear and osteolysis with highly cross-linked polyethylene.

Further adding to the complexity of choice, is the re-emergence of cementless fixation in response to improve longevity in the progressively younger TKA patient population. The patella creates additional decision-making in TKA, as while most surgeons in the US resurface the patella, there are some who routinely do not which is a much more commonly accepted practice outside of the US. Finally, metal hypersensitivity is a controversial, yet unavoidable issue, which forces the consideration of “nickel-free” or ceramic-coated implants. Unfortunately, there is paucity of outcome data to support one implant choice over another, which is problematic in the modern arena of value-based cost reductions in healthcare.

Further confounding the issue is the inability of current outcome measures to accurately assess the differences in performance of the various TKA designs. This talk will provide the latest evidence particular to the major TKA component choices as they relate to patient pathology.