History of Knee Replacement

Knee replacement surgery is a medical procedure where a patient's full or partial knee structure is replaced by synthetic components. It is designed to allow the patient to retain as much function as possible while relieving pain in the knee and surrounding areas. The majority of knee replacements are performed due to osteoarthritis but may also be used to treat other conditions and diseases.

Early History

• The first knee surgeries were performed in 1891 by German surgeon Theophilus Gluck, who experimented with a number of different materials, including harvested muscle and fat, nylon and pig bladders to cushion the knee joint and relieve pain. He is also believed to have performed the first true knee replacement surgery, using ivory to simulate the knee joint structure. The ivory joint was hinged and stabilized using plaster or metal.

The 1960s and '70s

• There was little improvement in knee replacement surgery from the late 19th century through the 1950s. Gluck's ivory and plaster technique was updated several times using metal and plastic components, but they were still formed into a hinge-type device that was both inflexible and prone to complication and failure. In 1974, a group of researchers at Massachusetts General Hospital developed a rounded plastic component that closely resembled the traditional knee structure and allowed for total joint replacement. Their design is often referred to as the "total condylar knee."

Mobile-Bearing Replacements

• The mobile-bearing knee replacement was designed during the late 1970s and early 1980s, though it is still being perfected and updated. This technique is designed to improve rotational and maximize function and flexibility after surgery. A mobile-bearing replacement allows the synthetic joint platform to rotate, as opposed to a fixed-bearing joint, which is more stationary. This technology was developed at Martland Hospital in New Jersey by Fred Buechel, a surgeon, and Michael Pappas, an engineer. The Buechel-Pappas joint replacement system is still widely used today.

Minimally Invasive Surgery

• Until the 1990s, knee replacement surgery was performed through a highly invasive procedure that required up to a foot-long incision down the front of the knee. This surgery was considered highly traumatic and came with an extensive recovery period. Since the late 1990s, however, many surgeons have begun to use a minimally invasive technique that requires only a 3-to-5-inch incision. Rather than cutting down the front of the leg, damaging the slow-to-heal thigh muscle, the cuts can be made in the side of the knee, and the kneecap is pushed to the side for access. This technique allows for faster recovery and fewer complications.

Computer-Assisted Knee Replacement

• During the 21st century, advancements in medical technology have allowed surgeons to utilize a process known as robotic knee replacement. This type of surgery uses a series of CT scans to create a customized knee replacement plan based on an individual's unique needs. It consists of a computer-assisted planning program and robotic instruments used to make incisions and position implants. The robotic instruments are able to manipulate tools and implants much more accurately than the human eye. Because of the precise nature of this technology, many common knee replacement problems are avoided.