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Implant Design & Materials

TKA implant selection: bearing congruency, fixation methods, and material properties (HXLPE vs PEEK) to optimize survivorship and biomechanics.

Overview

Modern total knee arthroplasty (TKA) implants demonstrate functional and patellofemoral joint-related outcomes equivalent to traditional designs [1]. Superiority of one TKA implant design above others could not be demonstrated across groups of implants [61]. Any price premium for one TKA implant system above other systems may not be justified [61]. Longer follow-up is necessary to evaluate the possible advantages of new TKA implant designs [1].

The use of hypoallergenic coated implant systems does not appear to be associated with inferior outcomes in comparable patient cohorts [2]. Cementless total knee replacement fixation shows tolerance to departures from optimal implant positioning with no apparent compromise in durability [10]. Implant stiffness is affected by both material properties and geometry [15]. Implant stiffness considerations should be taken into account in implant selection [15].

For focal chondral lesions, a novel customized femoral resurfacing metal implant showed no implant migration and good subjective outcomes in the short term [3]. Short-term implant safety and patient-related outcome measures for this implant showed good-to-excellent results [3]. Both fixed and mobile bearing medial compartment arthroplasties provided excellent pain relief and function [8]. Both fixed and mobile bearing medial compartment arthroplasties demonstrated durable implant survival [8].

Implant selection of adequate design and strength is critical for successful long-term results, as evidenced by femoral component fracture [5]. The Free-Floating Disc-Shaped Polycarbonate-Urethane Meniscal Implant has high reoperation rates at 24 months of follow-up [4]. Approximately 95% of patients retained this implant at 12 months [4]. Only 64% of patients retained the implant at 24 months [4]. The retention rate casts doubt on the effectiveness of the current design and technique [4].

Decisions on anchor use should be based on factors including cost, impact on revision, and surgeon familiarity [7]. Clinical differences based on patient-reported outcomes are not frequently appreciated between anchor types or designs [7]. Biomechanical characteristics of a new rigid biodegradable anchor for meniscus refixation justify clinical use [9]. A prospective, randomized, single-center trial was designed to compare functional outcomes and cost-effectiveness of a novel personalized TKR implant against two conventional designs [24].

Anatomy & Pathophysiology

Kinematics

Contemporary knee implant designs do not replicate the kinematics of a healthy knee [30]. Minor kinematic differences exist between a natural knee and a total knee replacement, but there are no patellofemoral kinematic differences between fixed-bearing and mobile-bearing TKRs [46]. There are no clear recognizable differences in in vivo kinematics between different design parameters or prostheses, despite kinematics being generally consistent with intended design [47].

Alignment Strategies: Kinematically aligned knees show greater multi-planar mobility, higher sagittal moments, and a more physiological gait pattern compared to mechanically aligned knees [33]. Restoring the premorbid flexion–extension axis of the knee joint leads to better overall functional results compared to mechanical alignment [44]. Focusing on dynamic soft-tissue boundaries rather than static alignment targets may preserve knee kinematics after total knee arthroplasty [49].

Implant Design Profiles: Medial pivot (MP) designs provide a more native-like knee kinematic profile than cruciate-retaining (CR) designs, characterized by a more pronounced MP motion pattern and reduced quadriceps loading [34]. Mobile bearing knees that are not fully conforming in flexion provide little constraint to antero-posterior motion, resulting in a kinematic pattern similar to an ACL-deficient knee [50]. Tibiofemoral conformity is important for preserving native knee kinematics in anatomy-mimetic patient-specific mobile-bearing unicompartmental knee arthroplasty [37].

Ligamentous Status: Retention of the posterior cruciate ligament alone may not achieve physiological knee joint kinematics after total knee arthroplasty [35]. The bicruciate-sacrificing (BCS) cohort showed expected knee joint kinematics [35]. Restoring native knee geometry together with anterior cruciate ligament (ACL) preservation provides kinematic improvements over contemporary ACL-preserving and ACL-sacrificing implants [42].

Component Positioning and Geometry: The femoral component sagittal position is an important factor in knee joint mechanics in posterior stabilized total knee arthroplasty [40]. Postoperative lateral laxity greater than 0.9 mm at 90-degree flexion is associated with physiological kinematic motion and fewer knee symptoms in patient-reported outcomes in posterior cruciate retaining total knee arthroplasty [38]. Tibiofemoral kinematics are unchanged by patellofemoral geometry in TKA, but patellar positions at 90° of flexion offer greater mechanical advantage to the quadriceps with the KneeTec design compared to the Noetos design [51].

Material and Long-Term Outcomes: There are no statistical differences in knee kinematics and retropatellar pressure distribution between rapid prototype and standard materials (cobalt-chromium alloy) [41]. Knee kinematics and muscle activation do not appear to change in the first 2 post-operative years following implantation of a highly congruent mobile-bearing total knee prosthesis [31]. One year after second-stage knee revision surgery, kinematic and kinetic values remain lower than those observed in a normal reference population [48]. The kinematics of the FPV patellofemoral replacement are closer to normal than those of total knee implants, but still differ from normal knees [43].

Classification

Modern TKA Implants: Modern total knee arthroplasty (TKA) implants are equivalent to traditional TKA implants in functional and patellofemoral joint-related outcomes [1]. Longer follow-up is necessary to evaluate the possible advantages of new TKA implant designs [1]. Differences observed between ultra-congruent and standard cruciate-retaining inserts in total knee arthroplasty were not clinically significant [55].

Hypoallergenic Coatings: The use of hypoallergenic coated implant systems does not appear to be associated with inferior outcomes in comparable patient cohorts [2].

Tibial Components: Surgeons should consider the risk of medial cortex perforation due to peg position of morphometric tibial components in unicompartmental knee arthroplasty [6].

Anchors: Decisions on anchor use should be based on factors including cost, impact on revision, and surgeon familiarity because clinical differences based on patient-reported outcomes are frequently not appreciated between anchor types or designs [7]. The biomechanical characteristics of a new rigid biodegradable anchor for meniscus refixation justify its clinical use [9].

Fixation and Stiffness: For the implant studied, the long-term outcome is not expected to be influenced by the type of fixation to the bone [13]. Implant stiffness is affected by both material properties and geometry, which should be considered in implant selection [15].

Infection Prevention: New developments in implant design and material aim to reduce implant-related infections [16].

Classification Systems: A generic implant classification enables comparison across implant designs, as demonstrated by a complete implant library containing characteristics of 32,500 orthopaedic implants covering about 85 different hip and 85 different knee implants [54]. A new classification system for periprosthetic femur fractures following TKA considers fracture location and implant type, is easy to use, shows good interobserver reliability, and allows conclusions to be drawn on treatment recommendations [58].

Other Considerations: Bisphosphonates and other pharmaceutical agents may, along with improvements in implant design and material properties, provide more durable joint arthroplasties [11]. A stochastic lattice-based porous implant design provides a well-defined design process and dependable selection criteria for design parameters of unicompartmental knee arthroplasty implants with Voronoi structures [57]. Differences in implant design can influence bone resection and component alignment for a given patient-specific instrumentation (PSI) system [60].

Clinical Presentation

Modern Implant Equivalence and Long-Term Outcomes: Modern total knee arthroplasty (TKA) implants demonstrate functional and patellofemoral joint-related outcomes equivalent to traditional TKA implants [1]. Longer follow-up is necessary to evaluate the possible advantages of new TKA implant designs [1]. In comparable patient cohorts, the use of hypoallergenic coated implant systems does not appear to be associated with inferior outcomes at ten-year follow-up [2].

Customized and Resurfacing Implants: A novel customized femoral resurfacing metal implant for focal chondral lesions showed no implant migration and good subjective outcomes in short-term follow-up [3]. The short-term implant safety and patient-related outcome measures for this implant showed good-to-excellent results [3]. Early studies suggest that custom-made implants may improve survival rates and patient-reported outcomes [12]. Computer-assisted systems improve precision in the context of custom-made implants and patient-specific alignment [12]. However, conclusive evidence regarding long-term efficacy and cost-effectiveness of custom-made implants is lacking [12].

Meniscal and Patellar Implants: The free-floating disc-shaped polycarbonate-urethane meniscal implant has high reoperation rates at 24 months of follow-up [4]. Approximately 95% of patients retained the free-floating disc-shaped polycarbonate-urethane meniscal implant at 12 months, but only 64% retained it at 24 months [4]. The retention rate of the free-floating disc-shaped polycarbonate-urethane meniscal implant casts doubt on the effectiveness of the current design and technique [4]. A new rigid biodegradable anchor for meniscus refixation demonstrated biomechanical characteristics that justify clinical use [9]. The potential complications caused by the first-generation Meniscus Arrow are possible also using the second-generation Meniscus Arrow in the fixation of bucket-handle tears in the vascular area of the meniscus [19]. Orthogrid (OR) patellar implants showed improvements in some secondary patient-reported outcome measures compared to other designs [20]. Optimal orientation (OO) patellar implants exhibited superior bone coverage and improvements in several intraoperative, radiographic, and scintigraphic outcomes [20].

Unicompartmental and Bearing Design Considerations: Implant selection of adequate design and strength is critical for successful long-term results, as demonstrated by a case report of femoral component fracture in a Brigham unicompartmental knee [5]. There is a potential risk of medial cortex perforation due to peg position of morphometric tibial components in unicompartmental knee arthroplasty [6]. Surgeons should consider the risk involved in the type of implant used for unicompartmental knee arthroplasty due to potential medial cortex perforation risks [6]. Fixed and mobile bearing medial compartment arthroplasties both provided excellent pain relief and function and durable implant survival [8]. No difference was seen in the prevalence of radiolucent lines between mobile-bearing and fixed-bearing PFC Sigma cruciate-retaining total knee arthroplasties [21]. There was a greater than 94% implant survival rate for both mobile-bearing and fixed-bearing PFC Sigma cohorts at 14 years [21]. Mobile-bearing total knee arthroplasty implants combined with surface cementation produced satisfactory clinical and radiographic outcomes at 5-year follow-up [22]. Equivalent mid-term clinical outcomes of mobile-bearing total knee arthroplasty with surface cementation can be obtained with other implant designs and cementation techniques [22].

Anchor Selection and Revision Factors: Decisions on anchor use should be based on factors including cost, impact on revision, and surgeon familiarity because clinical differences based on patient-reported outcomes are frequently not appreciated between anchor types or designs [7]. Patient factors, rather than implant selection and surgical technique, likely play a large role in the presence of postoperative pain associated with cemented and uncemented long-stemmed tibial components in revision total knee arthroplasty [32]. Currently, no significant differences in clinical outcomes have been noted with regard to sex-specific implants in total knee arthroplasty [39].

Future Directions and Acetabular Systems: The trabecular metal monoblock acetabular cup system showed excellent early clinical and radiographic behavior [18]. New developments in implant design and material aim to reduce implant-related infections in orthopedic surgery [16]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [17]. Bisphosphonates and other pharmaceutical agents may, along with improvements in implant design and material properties, provide more durable joint arthroplasties in the near future [11].

Investigations

Plain radiography: Radiolucent lines were prevalent in mobile-bearing knee systems, with prosthesis survival slightly lower than fixed-bearing designs [14]. Close monitoring of radiolucencies is important with continued follow-up in cemented total knee arthroplasty [75]. The prosthesis-bone interface remained stable and unchanged radiographically at nine to twelve years for cementless tibial components [28]. Radiographic results for cementless Oxford unicompartmental knee replacement were better with secure bony attachment to the implants [64]. Reliable fixation was achieved in cementless Oxford unicompartmental knee replacements with only one (0.1%) revision for loosening, no radiographic evidence of loosening in the remaining cases, and no fractures related to implantation at ten-year follow-up [78].

MRI: The mean reduction in volume of poly-L-lactic acid bioabsorbable interference screws was approximately two thirds after 2 years as measured by magnetic resonance imaging [66]. Implanted bioabsorbable scaffolds did not present normal meniscal tissue with MRI, and the implant volume was considerably less than expected at minimum 5-year follow-up [67]. MRI supports both preoperative planning and postoperative assessment of fragment healing for osteochondral lesions repaired with a bioabsorbable device [68]. Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [76]. All-polymer PEEK knee prostheses demonstrate favourable imaging characteristics without clinically relevant metal-related artefacts and with good visibility of simulated implant complications across radiography, CT, and MRI [63].

CT: Radiographic screw incorporation into adjacent bone was apparent at 3 years for Bilok interference screws in anterior cruciate ligament reconstruction [62]. Osteoconductivity of β–Tricalcium Phosphate Poly-L-Lactic Acid interference screws was confirmed by CT scans at 75% of screw sites, which completely filled the site in 10% [70]. Dual-energy CT and ceramic or titanium prostheses reduce CT artifacts and provide superior image quality of total knee arthroplasty [74]. Full-titanium or ceramic prostheses allow for better CT visualization of the bone–prosthesis interface [74]. A better performance in some measurements was observed in an MRI/X-ray-based patient-specific instrumentation system than in a CT-based system for total knee replacement [72].

Other Considerations: Bisphosphonates and other pharmaceutical agents may provide more durable joint arthroplasties alongside improvements in implant design and material properties [11]. Technologic advances in implant materials, design, amputee care, and imaging continue to drive improvements in patient care and outcomes [17]. The Trabecular Metal Monoblock Acetabular Cup System showed excellent early clinical and radiographic behavior [18]. Orthopaedic Innovations (OR) implants showed improvements in some secondary patient-reported outcome measures in total knee arthroplasty [20]. Orthopaedic Innovations (OO) implants exhibited superior bone coverage and improvements in several intraoperative, radiographic, and scintigraphic outcomes in total knee arthroplasty [20]. Three-dimensional image-based robotic-arm assisted unicompartmental knee arthroplasty demonstrated high implant survivorship and good-to-excellent clinical outcomes at minimum 10 years follow-up [73]. Novel porous metal pillars yielded satisfactory clinical outcomes and reliable radiological evidence of fixation in primary total knee arthroplasty with a minimum 2-year follow-up [77].

Treatment

Implant Selection

Modern total knee arthroplasty (TKA) implants demonstrate functional and patellofemoral outcomes equivalent to traditional designs, though longer follow-up is required to evaluate potential advantages of new designs [1]. In medial unicompartmental knee arthroplasty (UKA), both fixed and mobile bearing systems provide excellent pain relief, function, and durable survival [8]. There is no difference in primary TKA outcomes between mobile-bearing and fixed-bearing implants; selection should be based on surgeon preference and clinical judgment [59]. For mobile-bearing TKA, surface cementation produces satisfactory 5-year clinical and radiographic outcomes equivalent to other techniques [22]. Cementless TKA fixation tolerates departures from optimal positioning without compromising durability [10]. Regarding the patella, modern prosthesis designs show no difference in mid-term clinical or radiological outcomes between resurfaced and non-resurfaced patellae [86].

For focal chondral lesions, a novel customized femoral resurfacing metal implant showed no migration and good-to-excellent short-term subjective outcomes [3]. A hydrogel implant is as effective as osteochondral autologous transplantation for focal cartilage injury at 24 months, with both showing satisfactory results compared to preoperative status [45]. The Free-Floating Disc-Shaped Polycarbonate-Urethane Meniscal Implant was retained by approximately 95% of patients at 12 months but only 64% at 24 months, associated with high reoperation rates [4].

Implant stiffness, determined by material properties and geometry, must be considered for proximal tibial strain in medial UKA [15]. Adequate design and strength are critical for long-term success, as evidenced by femoral component fractures in unicompartmental knees [5]. Surgeons must consider the risk of medial cortex perforation due to peg position in morphometric tibial components for UKA [6]. Uncemented resurfacing-type medial UKA exhibits a high rate of loosening, whereas standard cemented implants remain the optimal solution [84]. In revision TKA, modular cemented stems show survivorship comparable to early nonmodular cemented stems and recent shorter-term uncemented series [81]. Hinged implants are indicated in revision cases with major bone loss or compromised soft tissue/ligament integrity where semiconstrained devices fail [82].

Hypoallergenic coated implant systems do not appear associated with inferior outcomes in comparable cohorts [2]. Early studies suggest custom-made implants may improve survival and patient-reported outcomes, while computer-assisted systems improve placement precision; however, conclusive evidence on long-term efficacy and cost-effectiveness is lacking [12]. A prospective trial compares a novel personalized TKA implant against conventional designs [24]. A rotating-platform, mobile-bearing, posterior-stabilised TKA design may reduce peri-prosthetic bone resorption, supported by the absence of osteolysis at minimum 10 years [29]. Cemented single-radius, condylar-stabilized TKA without posterior cruciate ligament sacrifice demonstrates excellent survival and safety [52]. The addition of osteoconductive materials to bioabsorbable screws does not associate with bone formation at 2 years despite satisfactory clinical outcomes [83]. A multifactorial approach to preventing aseptic loosening in primary TKA is essential, considering patient-specific and prosthetic factors [85].

Surgical Approach / Technique

Navigated implantation of unicompartmental knee prostheses using non-image-based systems improves radiological accuracy with minimal deviation from conventional technique [80].

Complications

Polyethylene wear: Long-term evaluation is required to comment on differences in polyethylene wear and implant longevity between Hi-flex and standard posterior cruciate substituting polyethylene tibial inserts [26]. The benefit of potential long-term wear reduction with LCS mobile-bearing implants may not be realized in community-based settings due to varying surgical skills and patient demographics [27]. Radiolucent lines were prevalent in LCS mobile-bearing knee systems, and prosthesis survival was slightly lower than fixed-bearing designs, requiring long-term follow-up [14].

Implant Failure & Loosening: Implant selection of adequate design and strength is critical for successful long-term results, as evidenced by femoral component fracture in a Brigham unicompartmental knee [5]. Survivorship of the Oxford Knee in the first 600 patients was less successful than reported by prosthesis designers, approximating revision rates reported in national joint registries [65]. The Free-Floating Disc-Shaped Polycarbonate-Urethane Meniscal Implant has high reoperation rates, with only 64% of patients retaining the implant at 24 months compared to 95% at 12 months [4]. Potential complications caused by the first-generation Meniscus Arrow implant are also possible with the second-generation implant used for bucket-handle tears in the vascular area [19].

Fixation & Positioning: Cementless total knee replacement fixation demonstrates tolerance to departures from optimal implant positioning with no apparent compromise in durability [10]. For the specific implant studied, long-term outcomes are not expected to be influenced by the type of fixation (cemented vs. cementless) to the bone at two years [13]. Whether biological fixation of cementless implants results in increased long-term survivorship compared to cemented implants requires longer follow-up, based on two-year migration results [23]. Both uncemented tantalum metal components and cemented tibial components have excellent survivorship up to 15 years after implantation in total knee arthroplasty [25]. Cementless components in unicompartmental knee arthroplasty showed fixation that is at least as good as, if not better than, cemented devices, based on second-year migration and radiolucency data [69]. There is a potential risk of medial cortex perforation due to peg position of morphometric tibial components in unicompartmental knee arthroplasty [6].

Other Considerations: Modern TKA implants are equivalent to traditional TKA implants in functional and patellofemoral joint-related outcomes, but longer follow-up is necessary to evaluate possible advantages of the new design [1]. Hypoallergenic coated implant systems do not appear to be associated with inferior outcomes compared to standard implants in comparable patient cohorts at ten-year follow-up [2]. A novel customized femoral resurfacing metal implant for focal chondral lesions showed no implant migration and good-to-excellent short-term patient-related outcome measures [3]. Conclusive evidence regarding the long-term efficacy and cost-effectiveness of custom-made implants is lacking, although early studies suggest they may improve survival rates and patient-reported outcomes [12]. Clinical differences based on patient-reported outcomes are frequently not appreciated between anchor types or designs, suggesting decisions should be based on cost, impact on revision, and surgeon familiarity [7]. Implant wastage occurred in 3.8% of cases using navigation in total knee arthroplasty, contributing 0.73% to the total implant cost [71].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity, desk work, or driving.

Full activity (months): Evidence does not provide specific month ranges for manual work, sport, or full range of motion/strength return.

Complete recovery / outcome plateau (months): Evidence does not provide specific month ranges for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: Evidence does not specify physical therapy phasing, immobilisation duration, weight-bearing or range of motion progression, or sling/brace removal timing.

Functional milestones: Modern total knee arthroplasty (TKA) implants are equivalent to traditional TKA implants in functional and patellofemoral joint-related outcomes [1]. The Free-Floating Disc-Shaped Polycarbonate-Urethane Meniscal Implant showed high reoperation rates at 24 months of follow-up [4]. Approximately 95% of patients retained this implant at 12 months, while only 64% retained it at 24 months [4]. A novel customized femoral resurfacing metal implant for focal chondral lesions showed good subjective outcomes [3]. Short-term patient-related outcome measures for this novel implant showed good-to-excellent results [3].

Other Considerations: Implant selection of adequate design and strength is critical for successful long-term results [5]. For the implant studied, the long-term outcome is not expected to be influenced by the type of fixation to the bone [13]. Radiolucent lines were prevalent in the LCS mobile-bearing knee system, requiring long-term follow-up [14]. Prosthesis survival for the LCS mobile-bearing knee system was slightly lower than fixed-bearing designs [14]. No difference was seen in the prevalence of radiolucent lines between mobile-bearing and fixed-bearing PFC Sigma cruciate-retaining total knee arthroplasties [21]. There was a greater than 94% implant survival rate for both mobile-bearing and fixed-bearing PFC Sigma cohorts at 14 years [21]. Matched cemented and cementless TKRs both have 10-year implant survival rates of greater than 95% [79]. Both uncemented tantalum metal components and cemented tibial components have excellent survivorship up to 15 years after implantation [25]. In retained knees, the implant was stable and the prosthesis-bone interface was unchanged radiographically at nine to twelve years for components inserted without cement [28]. The absence of osteolysis at minimum 10 years supports the hypothesis that a rotating-platform, mobile-bearing, posterior-stabilised total knee arthroplasty design may reduce peri-prosthetic bone resorption in the long term [29]. The uncemented HAP component has satisfactory early clinical outcomes [56]. The use of hypoallergenic coated implant systems does not appear to be associated with inferior outcomes in comparable patient cohorts [28].

Longer follow-up is necessary to evaluate the possible advantages of new implant designs [1]. Whether the biological fixation of cementless implants will result in increased long-term survivorship requires longer follow-up [23]. Long-term evaluation is required to comment on differences in polyethylene wear and implant longevity between Hi-flex and standard posterior cruciate substituting polyethylene tibial inserts [26]. The benefit of potential long-term wear reduction with the LCS implant may not be realized in a community-based setting [27]. Surgical skills, surgical experience, and diverse patient demographic factors may affect early outcomes in community-based settings [27]. Further studies with long-term follow-up are needed to determine whether the grafted area maintains structural and functional integrity over time in Autologous Matrix-Induced Chondrogenesis for focal cartilage defects [53]. Long-term follow-up is necessary to determine the durability of the uncemented HAP component [56].

Key Evidence

  • [L3] Longer follow-up is necessary to evaluate the possible advantages of this new implant design. (10.1007/s00167-018-5161-6)
  • [L1] In comparable patient cohorts, the use of this coated implant system does not appear to be associated with inferior outcomes. (10.1016/j.arth.2025.11.018)
  • [L4] The short-term implant safety and patient-related outcome measures showed good-to-excellent results. (10.1007/s00167-017-4805-2)
  • [L5] Although approximately 95% of patients retained the implant at 12 months, only 64% did so at 24 months, casting doubt on the effectiveness of the current design and technique. (10.1016/j.arthro.2025.01.016)
  • [Case_report] Implant selection of adequate design and strength is critical for successful long-term results. (10.1007/s00167-003-0434-z)
  • [L5] Surgeons should consider the risk involved in the type of implant used. (10.1007/s00167-020-06242-8)
  • [Commentary] Decisions on implant use should be based on factors including cost, impact on revision, and surgeon familiarity because frequently, clinical differences based on patient-reported outcomes are not appreciated between anchor types or designs. (10.1016/j.arthro.2020.01.006)
  • [L3] Both designs provided excellent pain relief and function and durable implant survival. (10.1016/j.arth.2008.11.067)
  • [L5] These biomechanical characteristics of this new implant justify clinical use. (10.1007/s00167-003-0439-7)
  • [L4] The study suggests tolerance of the material and fixation interfaces to departures from optimal implant positioning with no apparent compromise in durability. (10.1302/0301-620x.96b11.34327)
  • [L5] Along with improvements in implant design and material properties, bisphosphonates and other pharmaceutical agents may, in the near future, be part of the growing armamentarium that provides more durable joint arthroplasties. (10.5435/00124635-200604000-00003)
  • [L5] While early studies suggest that custom-made implants may improve survival rates and patient-reported outcomes, and computer-assisted systems improve precision, conclusive evidence regarding long-term efficacy and cost-effectiveness is lacking. (10.1016/j.jisako.2024.100339)
  • [L1] For this implant, the long-term outcome is not expected to be influenced by the type of fixation to the bone. (10.1302/0301-620x.103b1.bjj-2020-0788.r1)
  • [L3] Long-term follow-up is required as radiolucent lines were prevalent and prosthesis survival was slightly lower than fixed-bearing designs. (10.1007/s00167-010-1166-5)
  • [L5] Implant stiffness is affected by both material properties and geometry, and this should be considered in implant selection. (10.1302/0301-620x.95b10.31644)
  • [L4] The summary highlights current standards in prevention and treatment of infections in orthopedic surgery, new developments in implant design and material aiming to reduce implant-related infections, improved diagnostic methods for germ identification, and current treatment algorithms. (10.1016/j.injury.2006.04.018)
  • [L4] The implant showed excellent early clinical and radiographic behavior. (10.1016/j.arth.2008.09.027)
  • [L4] The potential complications caused by the implant reported in the earlier literature using the first-generation arrow are possible also using this implant. (10.1007/s00167-004-0610-9)
  • [L1] However, OR implants showed improvements in some secondary patient-reported outcome measures, and OO implants exhibited superior bone coverage and improvements in several intraoperative, radiographic, and scintigraphic outcomes. (10.2106/jbjs.22.00655)
  • [L1] No difference was seen in prevalence of radiolucent lines, and there was a greater than 94% implant survival rate for both cohorts at 14 years. (10.1302/0301-620x.100b10.bjj-2017-1450.r1)
  • [L2] Thus, equivalent mid-term clinical outcomes of the index combination can be obtained with other implant designs and cementation techniques. (10.1007/s00167-019-05512-4)
  • [L1] Whether the biological fixation of the cementless implants will result in increased long-term survivorship requires a longer follow-up. (10.1302/0301-620x.102b8.bjj-2020-0054.r1)
  • [L2] This paper presents a study protocol for a prospective, randomized, single-center trial designed to compare functional outcomes and cost-effectiveness of a novel personalized TKR implant against two conventional designs. (10.1186/s12891-019-2830-7)
  • [L1] However, both have excellent survivorship up to 15 years after implantation. (10.1302/0301-620x.102b8.bjj-2019-1448.r1)
  • [L1] Long-term evaluation will be required to comment on differences in polyethylene wear and implant longevity. (10.1016/j.arth.2008.11.025)
  • [L2] The study suggests the benefit of potential long-term wear reduction with the LCS implant may not be realized in a community-based setting, where a variety of surgical skills, surgical experience, and diverse patient demographic factors may affect early outcomes. (10.2106/jbjs.k.01363)
  • [L4] In the twenty-six knees in which the prosthesis had been retained, the implant was stable and the prosthesis-bone interface was unchanged as seen radiographically at the time of the most recent follow-up examination. (10.2106/00004623-199603000-00004)
  • [L4] The absence of osteolysis at minimum 10 years supports the hypothesis that this design may be able to reduce peri-prosthetic bone resorption in the long term. (10.1007/s00167-014-3118-y)
  • [L5] The knee implant designs investigated did not replicate the kinematics of a healthy knee. (10.2106/jbjs.h.00817)
  • [L4] Knee kinematics and muscle activation do not appear to change in the first 2 post-operative years. (10.1007/s00167-012-1936-3)
  • [L3] Patient factors, rather than implant selection and surgical technique, likely play a large role in the presence of postoperative pain. (10.1302/0301-620x.103b6.bjj-2020-2439.r2)
  • [L4] The kinematically aligned knee showed greater multi-planar mobility, higher sagittal moments, and a more physiological gait pattern compared to the mechanically aligned knee. (10.1186/s12891-025-09445-7)
  • [L5] The MP design provides a more native-like knee kinematic profile than the CR design, with a more pronounced MP motion pattern and reduced quadriceps loading. (10.1002/ksa.12624)
  • [L3] The BCS cohort showed expected knee joint kinematics. (10.2106/jbjs.20.00024)
  • [L5] These results confirm the importance of tibiofemoral conformity in preserving native knee kinematics. (10.1007/s00167-019-05540-0)
  • [L3] Postoperative lateral laxity greater than 0.9 mm at 90-degree flexion was associated with physiological kinematic motion, leading to fewer knee symptoms in the PROMs. (10.1016/j.jisako.2024.100357)
  • [L5] Currently, no significant differences in clinical outcomes have been noted with regard to sex-specific implants, but further study, including direct comparisons between sex-specific implants and sex-neutral implants, might be useful. (10.2106/jbjs.i.00404)
  • [L5] This study found that the femoral component sagittal position is an important factor in knee joint mechanics. (10.1007/s00167-018-5093-1)
  • [L5] No statistical differences were found in knee kinematics and retropatellar pressure distribution between rapid prototype and standard materials. (10.1155/2015/185142)
  • [L3] The kinematics of the FPV implant was closer to normal than those of total knee implants; however, there were still differences from the normal knees. (10.1007/s00167-011-1717-4)
  • [L2] Restoring the premorbid flexion–extension axis of the knee joint leads to better overall functional results compared to mechanical alignment. (10.1007/s00167-016-4136-8)
  • [L1] Both techniques showed satisfactory results compared to preoperative status, with the Hydrogel implant being safe and effective. (10.1007/s00167-018-4834-5)
  • [L5] There are minor kinematic differences between a natural knee and a TKR in this cadaveric model, but there are no patellofemoral kinematic differences between the fixed-bearing and mobile-bearing TKR. (10.1007/s00167-010-1320-0)
  • [L3] Despite kinematics being generally consistent with the kinematics intended by their design, there were no clear recognizable differences in in vivo kinematics between different design parameters or prostheses. (10.1007/s00167-011-1605-y)
  • [L4] This study shows that 1 year after second-stage knee revision surgery, kinematic and kinetic values remain lower than those observed in a normal reference population. (10.1007/s00167-014-3376-8)
  • [L3] Focusing on dynamic soft‐tissue boundaries rather than static alignment targets may preserve knee kinematics after TKA. (10.1002/ksa.70312)
  • [L4] These knees, which are not fully conforming in flexion, provide little constraint to antero-posterior motion, resulting in a kinematic pattern similar to an ACL-deficient knee. (10.1007/s00167-003-0384-5)
  • [L3] The results confirm that tibiofemoral kinematics are unchanged, but that patellar positions at 90° of flexion offer greater mechanical advantage to the quadriceps using the KneeTec than using the Noetos. (10.1007/s00167-015-3565-0)
  • [L3] The findings of excellent implant survival, safety, and functional outcomes indicate that this combination is a safe and effective option in routine TKA. (10.1302/0301-620x.106b8.bjj-2023-1371.r1)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L4] A complete implant library containing characteristics of 32,500 orthopaedic implants was developed, covering about 85 different hip and 85 different knee implants. (10.1302/2058-5241.4.180063)
  • [L2] Differences observed between the two types of inserts were not clinically significant. (10.1007/s00167-021-06833-z)
  • [L5] Additionally, the model and associated analysis provide a well-defined design process and dependable selection criteria for design parameters of UKA implants with Voronoi structures. (10.1186/s13018-024-05006-1)
  • [L4] The new classification system for PPF of the femur following TKA considers fracture location and implant type, is easy to use, shows good interobserver reliability, and allows conclusions to be drawn on treatment recommendations. (10.1186/s12891-017-1855-z)
  • [L2] Surgeons should select implants based on personal preference and clinical judgment. (10.1016/j.arth.2024.10.084)
  • [L3] We could not demonstrate superiority of one design above others across these groups of implants, and any price premium for one above the other systems may not be justified. (10.1302/0301-620x.101b7.bjj-2018-1382.r1)
  • [L4] Radiographic screw incorporation into the adjacent bone was apparent at 3 years. (10.1016/j.arthro.2006.12.026)
  • [L5] All-polymer PEEK knee prostheses demonstrate favourable imaging characteristics in a cadaveric setting, without any clinically relevant metal-related artefacts and with good visibility of simulated implant complications across radiography, CT, and MRI. (10.1186/s13018-026-06736-0)
  • [L4] The radiographic results are better with secure bony attachment to the implants in every case. (10.1007/s00167-015-3879-y)
  • [L3] Our experience was not as successful as reported in the literature from the prosthesis designers but does more closely approximate the revision rates reported in several national joint registries. (10.1016/j.arth.2008.01.286)
  • [L4] The mean reduction in volume of the poly-L-lactic acid screws as measured by magnetic resonance imaging after 2 years was approximately two thirds. (10.1177/0363546505285384)
  • [L4] However, the implanted scaffolds did not present normal meniscal tissue with MRI, and the implant volume was considerably less than expected. (10.1016/j.arthro.2017.12.019)
  • [L4] It supports the use of MRI for both preoperative planning and postoperative assessment of fragment healing. (10.1016/j.arthro.2007.07.025)
  • [L1] As second-year migration is predictive of subsequent loosening, and as radiolucency is suggestive of reduced implant–bone contact, these data suggest that fixation of the cementless components is at least as good as, if not better than, that of cemented devices. (10.1302/0301-620x.97b2.34331)
  • [L4] Osteoconductivity was confirmed by CT scans at 75% of the screw sites and completely filled the site in 10%. (10.1016/j.arthro.2007.10.004)
  • [L4] Implant wastage occurred in 3.8% of cases, contributing 0.73% to the total implant cost. (10.1016/j.arth.2008.01.289)
  • [L1] For a few measurements, a better performance was observed in the MRI/X-ray-based system than in the CT-based system. (10.1007/s00167-013-2667-9)
  • [L3] Three-dimensional image-based RA-UKA demonstrated high implant survivorship and good-to-excellent clinical outcomes at minimum 10 years follow-up. (10.1007/s00167-023-07599-2)
  • [L4] These findings support the use of dual-energy CT as a solid imaging base for clinical decision-making and the use of full-titanium or ceramic prostheses to allow for better CT visualization of the bone–prosthesis interface. (10.1007/s00167-018-5001-8)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [L4] The use of novel porous metal pillars yielded satisfactory clinical outcomes and reliable radiological evidence of fixation in this study with a minimum 2-year follow-up. (10.1186/s12891-023-06962-1)
  • [L3] Our results suggest that reliable fixation was achieved with only one (0.1%) revision for loosening, no radiographic evidence of loosening in the remaining cases and no fractures related to implantation. (10.1007/s00167-019-05544-w)
  • [L3] Matched cemented and cementless TKRs both have 10-year implant survival rates of >95%. (10.2106/jbjs.21.00179)
  • [L3] Navigated implantation of a UKP with the used, non-image-based system improves the accuracy of the radiological implantation without any significant inconvenience and with little change in the conventional operative technique. (10.1007/s00167-002-0333-8)
  • [L3] Survivorship was comparable to early series of nonmodular cemented stems and similar to recent shorter-term follow-up series of modular uncemented stems. (10.1016/j.arth.2006.12.058)
  • [L4] Hinged implants should be considered in cases where major bone loss or compromised soft tissue and ligamentous integrity renders semiconstrained devices prone to failure. (10.1016/j.arth.2024.10.126)
  • [L1] Despite satisfactory clinical outcomes, the addition of osteoconductive materials to bioabsorbable screws is not associated with bone formation at the screw site at 2 years. (10.1016/j.arthro.2012.10.021)
  • [L4] At the present time, the standard cemented implants and the conventional designs for unicompartmental knee replacement still represent the optimal solution. (10.1007/s00167-014-3444-0)
  • [L3] A multifactorial approach to prevention and management is essential, considering patient-specific factors and prosthetic considerations. (10.1186/s12891-024-07913-0)
  • [L1] There is no superiority of patellar resurfacing or non-resurfacing in terms of clinical or radiological outcomes at mid-term. (10.1007/s00167-021-06521-y)

See Also

References

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[85] Does body mass index (BMI) significantly influence aseptic loosening in primary total knee arthroplasty? Insights from a long-term retrospective cohort study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07913-0

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2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.