1. The Evolution of Total Knee Arthroplasty Wayne R Conrad, MD

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

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

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

5. 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

6. Bone Cuts - Preparing The Femur

7. Bone Cut “Jigs”

8. Distal Femur Cuts

9. Sizing The Femur

10. Preparing The Tibia

11. Preparing the Patella

12. Cementing The Components

14. Plastic Articular Spacer

15. PRE OP

16. Radiographs
Post Op
PRE OP

17. 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

18. Total Knee Replacement
2010 – 693,400!

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

20. SHOULDER ANATOMY

21. BONEY ANATOMY

22. Indications for Total Shoulder Arthroplasty
Osteoarthritis
Rheumatoid Arthritis
Avascular Necrosis
Fractures

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

25. 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

26. Charles Neer MD

28. 1973 plastic Glenoid component added

29. NEER Total Shoulder Radiographs

31. Radiographs

32. Cemented Prosthesis

33. Uncemented Prosthesis

34. Modularity

36. Reverse Shoulder Arthroplasty
Developed to treat rotator cuff Arthopathy

37. 1985 Developed the Reverse total shoulder in France
Paul Grammont MD
1985 Developed the Reverse total shoulder in France

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

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