Choices, Compromises, and Controversies in Total Knee Arthroplasty

Area of Science:

• Orthopaedic Surgery
• Biomedical Engineering

Background:

• Total knee arthroplasty (TKA) is a common procedure for knee arthritis, yet significant controversies persist regarding its optimal application.
• An increasing patient population with debilitating knee arthritis faces diminishing healthcare resources, necessitating evidence-based best practices.

Purpose of the Study:

• To examine the current evidence and debates surrounding total knee arthroplasty (TKA).
• To inform orthopaedic surgeons on best practices for patient selection, implant choice, and surgical technique in TKA.

Main Methods:

• Review of existing literature and clinical evidence on TKA.
• Analysis of current controversies in TKA candidate selection, surgical approach, and implant design.

Main Results:

• Debate exists on TKA candidacy, including whether to establish exclusion criteria based on complication risk and manage modifiable risk factors.
• Ongoing discussion surrounds the choice between TKA and partial knee arthroplasty for unicompartmental arthritis.
• Controversy persists regarding the ideal implant design and surgical approach (anatomic vs. functional) for preserving or substituting cruciate ligaments in condylar TKA.

Conclusions:

• Careful examination of evidence is crucial for determining best practices in TKA.
• Optimizing TKA involves addressing patient selection, managing risk factors, and considering implant and surgical technique variations.
• Further research and consensus are needed to resolve ongoing debates in condylar TKA for improved patient care.