To unravel the mystery of how clinical outcomes in total joint orthopedics have become devoid of reliable guidance, let’s embark on a historical forensic journey through the decades of evolving implants, techniques, and conflicting studies.
The Dawn of Total Knee Replacements: The 1970s
The total joint segment of orthopedics began in earnest after bone cement received FDA approval in 1972, sparking early experiments with partial and total knee replacements. Pioneering designs like the Marmor Unicompartmental Knee and the Total Condylar Knee emerged as the first moderately successful implants. Clinical studies from the late 1970s primarily documented what succeeded and failed in implant design, serving as foundational explorations. In 1978, John Insall, MD, introduced the first Posteriorly Stabilized Knee (PS) at Hospital for Special Surgery, which necessitated sacrificing the posterior cruciate ligament (PCL). Around the same time, Boston surgeons developed PCL-retaining knees (CR). The literature of this era focused on performance evaluations by designers and their peers.
Explosion of Innovation and Designs: The 1980s
The 1980s brought a surge in orthopedic implant companies and d...
