title: Duopatellar total knee replacement: the Brigham experience.
abstract: 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.
mesh_terms: D001172:Arthritis, Rheumatoid / Q000601:surgery; D004868:Equipment Failure; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D007720:Knee Prosthesis / Q000295:instrumentation*; D008670:Metals; D010003:Osteoarthritis / Q000601:surgery; D010969:Plastics; D011474:Prosthesis Design; D011859:Radiography
chemical_list: D008670:Metals; D010969:Plastics