REVIEW - Advances in knee arthroplasty for younger patients: traditional knee arthroplasty is prologue, the future for knee arthroplasty is prescient

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Advances in Knee Arthroplasty for Younger Patients: Traditional Knee

Arthroplasty is Prologue, the Future for Knee Arthroplasty Is

Prescient

By Gerard A. Engh, MD

August 2007

Abstract

Total knee arthroplasty (TKA) was a remarkable development in

orthopedic surgery. Joint arthroplasty and arthroscopy were perhaps

the greatest innovations in orthopedics in the 20th century and

occurred without the advantages of today's technology. Initially, TKA

was performed only on elderly patients and those with advanced

rheumatoid arthritis because of concerns with long-term wear of

polyethylene. Surgeons strongly discouraged this surgery for patients

younger than age 60 years because both patients and many orthopedic

surgeons believed that knee implants would last only for approximately

10 years, particularly in younger and more active patients. Reports in

the late 1980s and early 1990s about accelerated polyethylene wear and

osteolysis substantiated the conviction that TKA was contraindicated

in younger patients. This led to complacency toward TKA, thus

inhibiting technological advances in the procedure to develop implants

for younger and more active patients.

Despite discouraging results from some studies, others reported

implant survivorship without significant wear well into the second and

third decade after implantation.1,2 In the early to mid-1990s,

manufacturers began to change methods of sterilization when a strong

correlation was discovered between implant wear and oxidation of

polyethylene sterilized by gamma irradiation in air.3,4 With the

change in sterilization methods and use of newer materials such as

highly cross-linked polyethylene and oxinium, clinical and laboratory

studies revealed a dramatic reduction in wear.5 Additionally, the

continued success in pain relief with this procedure created a growing

interest in total knee arthroplasty (TKA). Orthopedic surgeons began

to expand the indications for this surgery in their clinical practices

to younger and more active patients.

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