gms | German Medical Science

Knowing the historical background of the evolution of knee replacement, value and justification of the main principles of the various constructions and designs become understandable. This may contribute to an objective assessment of past and actual endoprostheses and maybe to the avoidance of mistakes in creating innovations.

In the second half of the last century knee replacement started with all-metal hemiarthoplasties for the joint surfaces of tibia, patella and femoral condyles and with hinges for total replacement of the femoro-tibial joint: nearly simultaneously, initially uncemented.

In the beginnig of the seventies, the successful concept of J. Charnleys hip replacement has been transferred to the knee. A similar breakthrough happened for resurfacing and total hinged endprotheses as well. Most successfully it started here in Hamburg, initiated by H. W. Buchholz, E. Engelbrecht, their team and coworkers.

The main efforts of the following period were dedicated for approaching an almost physiological motion and a reliable osteointegration of the implants, partly for the reduction of wear, partly in order to become less dependent of the problems of cementation.

These advances, the improvement of the intrumentation and the development of some modular systems happened mainly in the last two decades of the past century.

The intercalation of a mobile polyethylene bearing between two metallic resurfacing components has been introduced by J. Goodfellow in the late seventies and was adopted for some other designs in order to minimize polyethylene wear and to improve the fixation.

The most important steps and problems on this way will be explained and illustrated.