Discussion and Future Possibilities

How Has the Present Status Been Reached, and What Further Advances Can Be Made?
  • Peter S. Walker


It is now just over 50 years since the first artificial knees were invented. Based on data from the recently formed American Joint Replacement Registry, two design types dominate the market, the cruciate retaining (CR) type and the posterior stabilized (PS) type. Both were designed by 1980. It can be asked why these designs became successful. Among the reasons are the influence of the designers and their institutions, the inertia built up by manufacturers, familiarity in the operating room, and satisfactory survivorship and function. Even though several new design types have been introduced before and since 1980, they have not been shown to be superior using PROM evaluations. This however may be partly a limitation of PROMs in distinguishing differences. Nevertheless there are several factors where a new design or technique could be accepted and gain market share. The criteria include greater durability, improved function, quicker recovery time, increased flexion, reduced time and cost of surgery, and strong research and educational support. It is concluded that artificial knees will be used for a long time in the future, on the grounds that they are likely to remain as an effective treatment for arthritis, and there will be further improvements to artificial knees in the coming years.


CR knee PS knee Artificial knee success PROMs Criteria for success Criteria for improvement Future of artificial knees Knee osteoarthritis treatment 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Peter S. Walker
    • 1
  1. 1.Department of Orthopedic SurgeryNew York UniversityNew YorkUSA

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