The document discusses the history and future of total knee replacement (TKR). It describes the two main approaches in TKR design - the anatomical approach which preserves soft tissues and the functional approach which simplifies knee mechanics. While the anatomical approach aims to maintain knee function, issues with component alignment and fixation led to the functional approach. However, this resulted in high contact stresses due to incongruent surfaces. More recent mobile-bearing designs aim to allow motion while reducing stresses, but surgery is more complex. The document questions whether newer techniques like computer navigation can improve outcomes long-term.

1. THE FUTURE OF TOTAL KNEE REPLACEMENT

17. Total knee arthroplasty today “ Current etiologies and modes of failure in total knee arthroplasty revision” Kevin J. Mulhall, Hassan M. Ghomrawi, Sean Scully, John J. Callighan, Khaled J. Saleh Clinical Orthopaedics and Related Research 446, pg 45-50, 2006

22. Total knee arthroplasty today Do we want a rotating platform + posterior stabilisation ?

23. Total knee arthroplasty today Do we want to retain the cruciate ligaments, replace just what is needed ?

25. 1: Mechanical axis  The AP Femoral cuts are also made at right angles to the mechanical axis