Recent advances in designs, approaches and materials in total knee replacement: literature review and evidence today.

Ever since Themistocles Gluck described the use of an ivory cup as a tibial hemiarthroplasty in 1894, knee arthoplasty has continued to evolve. Both human ingenuity and intensive clinical research has led to an improved understanding of biomaterials and knee kinematics, resulting in the modern total knee replacement which has enjoyed such a clinical and commercial success. As it increases in popularity, attempts to improve knee arthroplasty have been driven by demands for improved function and implant survival, particularly in younger, more demanding patients. Research continues to see if advances in implant instrumentation, materials and design will translate into improved clinical outcomes and longevity.

Standardized mortality ratios and fatal pulmonary embolism rates following total knee replacement: a cohort of 936 consecutive cases.

Mortality and fatal pulmonary embolism rates in 936 consecutive primary total knee replacements (TKR) were determined during a 3-month postoperative period. Postmortem examinations verified the cause of death in all but 3 patients, and follow-up was performed on all but 1 patient. All patients had elastic stockings as mechanical prophylaxis. No deaths occurred from pulmonary embolism confirmed by postmortem examinations. At worst, the fatal pulmonary embolism rate was 0.43% (4/936; confidence interval [CI]=0.14%-1.17%). The all-cause mortality rate was 0.64% (6/936; CI=0.26%-1.46%). The patient mortality was compared with the population mortality of England and Wales using standardized mortality ratios. The standardized mortality ratios for both sexes combined was 0.74 (CI=0.29-1.52). A lower mortality was observed in women (0.67) than in men (0.84) during the first 3 postoperative months compared to the general population. Fatal pulmonary embolism after TKR with the routine use of graded elastic stockings and early mobilization is rare. In this series, the death rate in patients undergoing TKR appears to be lower than that in the general population.