Knee arthroplasty owes its origin to resection and resectioninterposition techniques. Fergusson is credited with performing the first resection knee arthroplasty of the knee for arthritis, in 1861, and Verneuil performed the first interposition arthroplasty in 1863 (using a flap of joint capsule between the resected bone ends). Other interposition materials used over time included skin, fat, muscle and chromatized pig bladder. These grafts had limited success in ankylosed knees, but not in arthritis. Campbell popularized the use of free fascial grafts in the late 1920's.
The first mould hemiarthroplasty (replacement of surfaces with a metallic mould) of the knee was attempted by Campbell and Boyd in 1940, and Smith-Petersen in 1942, but with limited success in pain relief. Tibial hemiarthroplasty was also attempted by McKeever and MacIntosh unsuccessfully. All of these had early loosening and severe pain.
The first true femoral and tibial articular replacement (incidentally metal-on-metal) appeared in the 1950's as hinged implants developed by Walldius, Shiers and others. The GUEPAR hinge was later developed, followed by the Spherocentric knee and the Kinematic Rotating Hinge in 1981. These early designs failed due to improper understanding of knee kinematics, infection and loosening.
In 1971, Gunston reported his results with the Polycentric knee (which incorporated the concepts of Charnleys low-friction hip arthroplasty), introducing the concept of “femoral rollback”. These knees had improved kinematics, but failed due to inadequate fixation. This was followed by a variety of knees viz. the Geomedic knee (1973), the ICLH design by Freeman and Swanson, and the Duocondylar knee (anatomical replacement similar to the Polycentric knee).
The Total Condylar Prosthesis (by Insall and others at the Hospital for Special Surgery in 1973) was subsequently developed, for which Ranawat et al reported survivorships of 94 percent at 15 years followup. This has set the standard for survivorship of all present day knee replacement prostheses. Concurrently, the Duopatellar knee (the first tricompartment knee, with anterior flanging for patellar articulation and cruciate-retaining) was developed, which evolved into the Kinematic prosthesis, widely used in the 1980's.
However, these designs had problems of limited flexion, which were corrected by Insall-Burnstein designs in 1978, (which incorporated a central cam mechanism to induce femoral rollback), thereby improving range of flexion.
The Constrained Condylar Knee (CCK) was thereafter developed by Insall by enlarging the central post of the tibial polyethylene insert constraining it against the medial and lateral walls of a deepened central box of the femoral component. This design has been used for revision arthroplasty when bone loss and instability are present, as well as for difficult primary arthroplasties in patients with extreme valgus deformity and MCL insufficiency.
The first mobile-bearing knee seems to derive its origin from the Oxford Knee designed by Goodfellow and O’Conner in 1976 as a bicondylar knee, with totally congruent tibial polyethylene inserts (menisci) that were free to move on a polished metal tibial base-plate. The Low Contact Stress (LCS) design was thereafter developed by Beuchel and others, and is being increasingly used today, especially in younger patients.
Resurfacing of only one knee compartment was introduced by McKeever in the 1950's (metal tibial hemi-arthroplasty), with early failure due to pain and loosening. Marmor developed his version in the 1970's, anatomically shaped flat, all-polyethylene component, with reasonable success. Subsequently, metal-backed components were developed and successfully implanted.
The present-day concept is to use prosthesis according to the type and severity of arthritis, and the associated deformity and laxity. The golden rule for the beginner is to acquaint oneself with one particular implant system, and to attempt knee replacement in knees with relatively mild deformity, and then to gradually extend the scope of the system to severe deformities and complexities.
Many new prosthetic materials (ceramics), designs (mobilebearing, hi-flex), bearing surfaces (metal-metal or ceramic-poly), and binding options (hydroxyapatite-coating) have been researched, but the tried and tested should be the method of choice for the early lerners.