Abstract
Implant selection in TKA remains highly variable. Surgeons consider preoperative deformity, surgical experience, retention or substitution for the PCL, type of articulation and polyethylene, and fixation with or without cement. We have most frequently implanted the same implant for the majority of patients. This is based on the fact that multiple large series of TKA's have demonstrated that the most durable TKA's have been non-modular metal backed tibial components, retention of the PCL, with a cemented all poly patellar component.
The debate of how to handle the PCL continues. In most studies at 10 years there is little reported difference. Second decade concerns usually result from polyethylene issues related to polymer wear. Sagittal “dishing” or ultracongruent implants may be a middle road that allow PCL release or resection and controlled kinematics offering improved short term results. Long term function remains the goal and it appears a CR knee offers that capacity.
Newer implants such as “high flex” and “gender” specific designs have not demonstrated significant functional improvements in controlled series. Uncemented knees in many series have performed well for many surgeons from a fixation standpoint. Polymer wear must be addressed for long term durability.
