The Evolution of Total Knee Arthroplasty Wayne R Conrad, MD

History Total Knee Replacement was developed simultaneously in many centers in the USA and Europe in the early 1970s Polycentric TKR

Followed THR Concepts Polished Stainless Steel Alloy Femur Ultra High Molecular Weight Polyethylene Plastic Femur PMMA Cement to Bone

Early Total Knee Replacement Hip Bone Cuts Done by Hand! Saw Burr Chisel Alignment By Eye! By feel of ligament tension! “String” Ankle

Refinements of mid 70s and 80s Better Alignment Guides On the Surface In the Bone Canal Cutting “Jigs” – precise bone cuts Metal backing of Tibia Plastic Patella resurface Modularity Many Sizes for Femur, Tibia and Patella

Bone Cuts - Preparing The Femur

Bone Cut “Jigs”

Distal Femur Cuts

Sizing The Femur

Preparing The Tibia

Preparing the Patella

Cementing The Components

Plastic Articular Spacer

PRE OP

Radiographs Post Op PRE OP

COMPUTER ASSISTED NAVIGATION SURGERY OUTRIGGER LASER REFLECTORS ATTACHED TO THE BONE LASER REFLECTOR SCRIBE SET UP DETERMINES BONE SIZE AND ANGLES REFLECTORS ON INSTRUMENTS GUIDE BONE CUTS

Total Knee Replacement 2010 – 693,400!

HISTORY OF TOTAL SHOULDER REPLACEMENT Tim P. Tymon, M.D.

SHOULDER ANATOMY

BONEY ANATOMY

Indications for Total Shoulder Arthroplasty Osteoarthritis Rheumatoid Arthritis Avascular Necrosis Fractures

Incidents of Arthroplasty 53,000 Shoulder Arthroplasty done in the US per year 900,000 Hips and Knees replaced per year

Early History 1893 – French surgeon Pean inserted platinum and rubber components to replace a shoulder joint destroyed by tuberculosis. 1951 – NEER I Vitallium Hemiarthroplasty prosthesis which resulted in pain relief and good function compared to previous options

Charles Neer MD

1973 plastic Glenoid component added

NEER Total Shoulder Radiographs

Radiographs

Cemented Prosthesis

Uncemented Prosthesis

Modularity

Reverse Shoulder Arthroplasty Developed to treat rotator cuff Arthopathy

1985 Developed the Reverse total shoulder in France Paul Grammont MD 1985 Developed the Reverse total shoulder in France

Used in France since the late 80’s Approved by the FDA in 2004 for use in the USA

Current indications Rotator Cuff Arthropathy Proximal Humeral fractures Fracture problems Fixed Dislocations Post Traumatic Arthritis Tumors TSA Revisions Chronic cuff tears without Arthritis