Essay on total knee arthroplasty.

Patient selection in total knee arthroplasty can be a difficult problem for the surgeon. It appears that more young patients are appearing with advanced arthritis of the knee than in the past. Many patients have had previous knee injuries resulting in premature development of degenerative arthritis. The authors believe that in selected cases total knee arthroplasty may be offered to younger patients. Young patients incapacitated by rheumatoid or inflammatory arthritis should not be denied reconstruction by total knee arthroplasty. The problem arises in the more active patient in his forties or fifties who has advanced arthritis of the knee not suitable for treatment by other means. The authors believe that these patients should not be treated by conventional total knee arthroplasty. On an experimental basis, the authors have been performing cementless total knee arthroplasty in younger, more active patients with disabling arthritis. Precision of surgical technique is critical with the newer cementless type of knee replacement.