LCS® Mobile Bearing Knee Arthroplasty: A 25 Years Worldwide Review PDF
Preview LCS® Mobile Bearing Knee Arthroplasty: A 25 Years Worldwide Review
Springer-Verlag Berlin Heidelberg GmbH KAREL J. HAMELYNCK • }AMES B. STIEHL (EDS.) LCS® Mobile Bearing Knee Arthroplasty A 25 Years Worldwide Review With 497 Figures and 6 Tables Springer KAREL J. HAMELYNCK, MD, PhD Hospital Slotervaart Ziekenhuis Lauwesweg 6 1066 EC Amsterdam The Netherlands TAMES B. STIEHL, MD Orthopaedic Hospital ofWisconsin 575 West Riverwoods Parkway, #204 Milwaukee, Wisconsin, 53212 USA ISBN 978-3-642-63944-9 ISBN 978-3-642-59347-5 (eBook) DOI 10.1007/978-3-642-59347-5 Die Deutsche Bibliothek-CIP-Einheitsaufnahme Lcs• mobile bearing knee arthroplasty: a 25 years worldwide review I Kare! J. Hamelynck; James B. Stiehl (ed.).-Berlin; Heidelberg; New York; Hong Kong; London; Milan; Paris; Tokyo ; Springer, 2002 ISBN 978-3-642-63944-9 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer· Verlag. Violations are liable for prosecution under the German Copyright Law. Springer. Verlag Berlin Heidelberg New York a member of BertelsmannSpringer Science+ Business Media GmbH http:/ /www.springer.de © Springer-Verlag Berlin Heidelberg 2002 Originally published by Springer-Verlag Berlin Heidelberg New York in 2002 Softcover reprint of the hardcover Ist edition 2002 DePuy• The Components comprising the complete APC are protected by European Patent 0519 873 BI; USA Patent 5395 40 I, japanese Patent 27 41 644 and Swiss Patent 689 539 which are licensed to DePuy International Limited by Mr. AndreR. Baechler, Kapsteig 44, CH 8032 Zurich, Switzerland. LCS" and Porocoat' are registered Irademarks and Milestone", Completion'" and DuoFix'" are Irademarks of DePuy Orthopaedics, Inc. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant proteelive laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about the application of operative techniques and medications contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: design & production, Heidelberg Typesetting: medio Technologies AG, Berlin SPIN: 10859079 18/3130/ag 54 3 2 1 0-Printedan acid-free paper Foreward Twenty-five years have come and gone like the "blink of an eye"! In our world of LCS knee replacement, this quarter century marks a unique time for us to reftect upon the events and especially the people who have contributed toward the worldwide success of this controver sial yet extremely versatile, mobile-bearing knee replacement system. The events, of course, are now history but are worth sharing briefty. The initial prime moving event was the meeting and collaboration of two motorcycle riders, one an orthopae dic surgeon and the other a mechanical engineer in 1974 at Martland Hospital in Newark, New Jersey. This chance meeting of two dissimilar personalities linked by a common hobby and a common orthopaedic development goal, led to personal friendship, personal sacrifice and thousands ofhours of research and development in the field ofhuman joint replacement technology. The friendship stilllasts, the personal sacrifice has been rewarded and research and development still continues to this day, a testimony to the concept of perseverance! Other extremely notable events include: the exposure to the Oxford meniscal bearing con cept, exposure to the Insall tibial-cut-first surgical technique, completion of FDA cemented and cementless clinical trials in the United States, mechanical failure of the Porous Coated Anatomie (PCA) knee replacement and development of an international LCS market. The people involved most notably include the faithful United States and International orthopaedic surgeons, who despite extreme peer pressure, decided to use a knee replace ment device based on sound mechanical engineering and biological principles rather than commercial hype. Their acceptance of advanced mobile-bearing concepts will forever give us a feeling of great affection and pride; for in a sense, they accepted our baby child, the LCS knee, before it had matured into a worthy adult! Other extremely notable people include: the United States sales, marketing and engi neering departments of DePuy in Warsaw, Indiana; the sales, marketing and engineering staffs of DePuy International in Leeds, England as weil as the LCS Knee Product Managers worldwide. Without their timely resources and educational seminars, dissemination of our mobile-bearing concepts around the world would not have happened. We sincerely appreci ate all of their efforts. Thus, it is with a sense of nostalgia and pride that we remember the development of the New Jersey Low-Contact-Stress Knee Replacement System together with the association of the many fine surgeons, engineers and salesmen around the world that contributed to its success. We hope that the mobile-bearing principles that we have established will continue tobe embraced encouraged and improved upon for the future good of our patients. We would like to thank all of you for the opportunity to be of service to mankind! Sincerely, FREDERICK F. BUECHEL, SR., MD FACS MICHAEL J. PAPPAS, PHD, PE Preface Worldwide experience with the Lcs• mobile bearing total knee prosthesis has been unpar alleled both in terms of enduring popularity and outstanding long-term clinical results. Buechel and Pappas's design was based on the principles of; restoring anatomical joint function to as near normal as possible, minimising contact stresses to avoid wear and darn age to the bearing surfaces. and finally the idea that constraint should refiect the need for mobility, to avoid shear stresses and loosening of the implant. In 1977, the LCS®k nee was implanted by Dr. Frederick Buechel. This was the first mobile bearing, tri-compartmental knee implant. This was also the first to successfully address the key issues ofloosening, wear and patello-femoral problems associated with earlier designs. The unique design solution was the creation of a common articulating geometry for the tibia and patella on the distal femoral surface. This resulted in a tibial and patellar articulation that was mobile in nature, but with an identical radius of curvature and conformity. The mobile bearing concept was considered sufficiently novel and unproven that the US FDA (Food & Drug Administration) required that it be validated in an Investigational Device Evaluation (IDE). An FDA IDE study involving 25 US surgeons was initiated in 1981. Validation of the clinical success of the device in this study resulted in FDA approval of the LCS, Knee (for cemented, tri-compartmental use) in 1985. The IDE study was extended to validate the cementless and fixed stem revision designs which were approved for sale in the US in 1990. European use of LCS, began in 1984. During this period, surgeons around the world be came intrigued with the prosthesis and its potential for long term clinical performance due to the problems experienced with existing knee designs. The fact that the LCS design has remained almost entirely unchanged is a tribute to the design excellence of the LCS®K nee system. Any future refinements will not violate the LCS proven design principles. Du ring the past 25 years, a large body of Iiterature has accumulated regarding total knee arthroplasty. Some of the theories of total knee performance have been proved as scientific fact whilst others have fallen out of favour. The LCS implant remains "futuristic" to the ex tent that recent kinematic inquiries have confirmed the ingenious elements of the design. Such research has spurred interest in the mobile bearing concept from other total knee designers. This book will carefully document the history, development, and clinical outcome to date of this unique device. The vista for the future is evolutionary advances in knowledge of knee function, which will guide surgeons to better surgical technique and instrumentation. Finally we wish to thank our publishing editor Thomas Guenther of Springer Verlag for his competent support and organization without which this project would not have been completed. K. }. HAMELYNCK AND J.B. STIEHL (Eos.) Table of Contents I History 1 The Mechanics ofthe Knee and Prothesis Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 J.W. GooDFELLow, J. O'CoNNOR 2 The Historical Perspective of Mobile-Bearing Knee lmplants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 R.D. }ONES 3 The LCS Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 F.F. ßUECHEL II Design of the LCS 4 Biomechanics ofTotal Knee Arthroplasty (TKA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 K.J. HAMELYNCK, J.-1. BRIARD, M.J. PAPPAS 5 Engineering Design of the LCS Knee Replacement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 M.J. PAPPAS 6 Stability Cha racteristics of the Tibiai-Femoral and Patellar-Femoral Articulations . . . . . . . . . . . . . . . . . . . 53 A.S. GREENWALD 7 Kinematics ofthe LCS Mobile Bearing Total Knee Arthroplasty.................................... 57 J.B. STIEHL, R.D. KOMISTEK 8 Wear Studies of the LCS... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 8.1 Wear-analysis of Mobile Bearing Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 H.M.J. McEwEN, D.E. McNuLTY, D.D. AUGER, R. FARRAR, Y.S. LIAO, M.H. STONE, J. FISHER 8.2 Retrieval Analysis of Mobile Bearing Prosthetic Knees Devices................. 74 J.P. COLLIER, l.R. WILLIAMS, M.B. MAYOR 111 Clinical 9 lndications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 9.1 Mobile Bearing Unicompartmental Knee Replacement . . . . . . . . . . . . . . . . . . . . . . . . 83 P.A. KEBLISH, J.L. BRIARD 9.2 Bicruciate Ligament Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 K.J. HAMELYNCK 9.3 Posterior Cruciate Ligament Retention...................................... 101 W. MUELLER, N.F. fRIEDERICH X Table of Contents 9.4 Cruciate Ligament Substitution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 J.B. SORRELLS, D.E. BEVERLAND 9.5 Patella Options in TKA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 P.A. KEBLISH 10 Surgery .................................................................................... 121 10.1 Surgical Technique of the LCS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 F.F. BUECHEL 10.2 Why the Tibial Cut First? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 J.B. STIEHL, R.B. SORRELS 10.3 Approaches to the Varus Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 R. WINDHAG ER, CH. AIGNER 10.4 Surgical Approaches: Lateral Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 P.A. KEBLISH 10.5 Tibial Crest Osteotomy...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 T.K. DROBNY, U.K. MUNZINGER 10.6 Technique for Non-Resurfacing of the Patella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 D.E. BEVERLAND 10.7 Femoral RotationBasedon Tibial Axis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 J.G. BoLDT, J.B. STIEHL, P. THUEMLER 10.8 Alternative Technique of Conservative Distal Femoral Cut First................ 183 D. BEVERLAND 10.9 Approaching the Asian Knee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 P.K.CHIU 10.10 The Rheumatoid Knee....... ........................................... 201 K.J. HAMELYNCK 11 Lcs• Multicenter Worldwide Outcome Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 11.1 The LCS Clinical Experience - An Overview of the Literature. . . . . . . . . . . . . . . . . . 209 J.B. STIEHL 11.2 LCS~Worldwide Multicenter Outcome Study................................ 212 K.J. HAMELYNCK, J.B. STIEHL, P.E VOORHORST 11.3 Biologkai Fixation in Uncemented Mobile Bearing TKA. . . . . . . . . . . . . . . . . . . . . . 225 T.Y. KASHIWAGI, J.G. BOLDT, P.A. KEBLISH Table of Contents XI 12 Complications and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 12.1 LCS Rotating Platform Dislocation and Spinout- Etiology, Diagnosis and Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 D.E. BEVERLAND, L.R. JoRDAN 12.2 Complications and Management: Bearing Exchange . . . . . . . . . . . . . . . . . . . . . . . . . 241 F.F. BUECHEL 12.3 The Unstable Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 J.B. STIEHL, K.J. HAMELYNCK, J.L. BRIARD 12.4 Aseptic Loosening in the LCS Total Knee Arthroplasty. . . . . . . . . . . . . . . . . . . . . . . . 253 L.R. JoRDAN, J.L. ÜLIVIO 12.5 Patella Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 G.HOOPER 12.6 The Evaluation and Treatment of the Painful Replaced Knee . . . . . . . . . . . . . . . . . . 264 B. THOMAS, J.B. STIEHL 13 Revision ................................................................................... 271 13.1 Mobile Bearings in Revision TKA ......................................... 271 F.F. BUECHEL 13.2 Revision of Hinge to Rotating Platform-Techniques and Results. ............. 281 J.G. FITZEK 13.3 Hinge Total Knee Arthroplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 R.D.JONES IV Design Worldwide Trends in Mobile Bearing TKA 14 Design Considerations of Existing Mobile Bearing TKA .......................................... 295 J.B. STIEHL 15 Mobile Bearing Knee Prosthesis-Description and Classitication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 J.-L. BRIARD V Future Trends with the LCS 16 lntroduction ............................................................................... 311 J.B. STIEHL 17 The A/P-Giide Knee Prosthesis-Rationales, Kinematics and Results.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313 R.D. ÜAKESHOTT, R.D. KoMISTEK, J.B. STIEHL
The list of books you might like
