Scott R D
Orthop Clin North Am. 1982 Jan;13(1):89-102.
Over the past 25 years at the Brigham Hospital we have seen prosthetic knee arthroplasty evolve from metal interpositional hemi-arthroplasty to the current generation of metal-to-plastic total knee replacements. Surely this evolutionary process will continue for may more years. Time will help us answer many of the questions and controversies that exist regarding posterior cruciate retention, patellar resurfacing, and unicompartmental replacement. We have yet to establish the optimal tibial stem length and shape and whether metal backing is truely beneficial. It is still to be determined whether the standard condylar femoral component should have condylar lugs to enhance fixation or an intramedullary stem with no condylar lugs. In the meantime, we have the use of a graduated system of prostheses that can be tailored to the individual needs of each patient and can predictably relieve pain and improve function in well over 90 per cent of cases. Late complications requiring revision surgery (most often patellar problems or tibial loosening) are occurring at a rate of 1 per cent per year of follow-up, and we hope these will be minimized by the recent advances we have discussed.
在过去25年里，在布里格姆医院，我们见证了人工膝关节置换术从金属间置半关节置换术发展到如今的金属对塑料全膝关节置换术。当然，这一演进过程肯定还会持续许多年。时间将帮助我们解答许多关于后交叉韧带保留、髌骨表面置换和单髁置换的问题及争议。我们尚未确定最佳的胫骨柄长度和形状，以及金属衬垫是否真的有益。标准的股骨髁部件是否应带有髁突凸耳以增强固定，还是应采用无髁突凸耳的髓内柄，这仍有待确定。与此同时，我们使用了分级假体系统，该系统可根据每位患者的个体需求进行定制，并且在超过90%的病例中能够可靠地缓解疼痛并改善功能。需要翻修手术的晚期并发症（最常见的是髌骨问题或胫骨松动）在每年的随访中发生率为1%，我们希望通过我们所讨论的最新进展将这些并发症降至最低。
