The clinical history and development of the low contact stress total knee arthroplasty

Contemporary total knee arthroplasty (TKA) has evolved over the past 30 years as a result of early prosthetic design failure. Hinge-type implants demonstrated a high loosening rate because of overconstraint. Curved-on-flat prostheses, which were popular in the late 1970s, became associated with a high incidence of polyethylene failure. The Low Contact Stress (LCS) Total Knee System (DePuy Orthopaedics Inc, Warsaw, Ind), a mobile-bearing knee arthroplasty design, was introduced in 1977. The LCS Total Knee System, now in its 25th year without alterations in articular geometry, has demonstrated clinical success and has had an impact on evolving prosthetic designs. Introduced in 2001, the LCS Complete Total Knee System provides further refinements in patient fit without changing the fundamental design principles. Surgeons are cautioned to use a well-proven clinical design, as biomechanical variations critically impact clinical outcomes.