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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 December;59(6):355-63
Update of contemporary lower extremity total joint arthroplasty
Garcia R. M., Goldberg V. M.
Department of Orthopedic Surgery University Hospitals Case Medical Center Case Western Reserve University Cleveland, OH, USA
Total joint arthroplasty has proved to be a reliable and reproducible procedure for the treatment of debilitating joint arthritis. Current studies have demonstrated greater than 90% survival rate at 15-20 years for both total knee and total hip arthroplasty. The contemporary total knee introduces a female gender specific design to accommodate the “gynoidal” distal femur while high-flex designs aim to increase knee flexion. The contemporary total hip has similarly tried to match the physiologic properties of the proximal femur with the use of more flexible prosthetic materials. For both total knee and hip arthroplasty, reducing polyethylene wear and its associated osteolysis has continued to be a major focus of contemporary designs. Advancements in polyethylene manufacturing and sterilization in addition to alternative bearing surfaces have shown significant reductions in wear both in vitro and in vivo. Current surgical techniques have also undergone advancements by reducing patient morbidity with minimally invasive approaches and improving implant positioning with computer assisted surgical navigation. Unfortunately, the results of total ankle arthroplasty have been inferior when compared to total knee and hip arthroplasty. Newer total ankle designs have attempted to restore the normal ankle anatomy with the hope of improving implant survival and patient outcomes.