By S. A. V. Swanson (auth.), M. A. R. Freeman M.D. F.R.C.S. (eds.)
Early in its improvement, the subject material of any box of surgical procedure is simply too ill-defined and reviews are too fluid for the construction of a publication at the topic to be attainable. past due in its improvement, controversy is at an finish, and even though it remains to be attainable to supply a textbook, it's too overdue to provide a e-book that would stimulate dialogue and crystallise principles. This booklet has that aim, it being the Editor's view that the sphere of the surgical operation of arthritis of the knee had reached a suitable intermediate degree in 1978 while this article was once written. 3 large matters stand out as being wanting solution sooner than the optimal kind of surgical procedure for a given knee might be outlined extra convincingly than is feasible at the present: first of all: What symptomatic and actual beneficial properties of the knee are to be recorded pre- and post-operatively, upon the root of which comparisons could be made among the consequences acquired by way of various surgeons or with diverse tech niques. The answer of this factor calls for common contract not just upon what positive factors of the knee can be recorded yet, crucially, upon how those beneficial properties may still hence be provided in an effort to characterise a specific team of knees.
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Extra info for Arthritis of the Knee: Clinical Features and Surgical Management
J. Biomech. : Gait as a movement pattern. Am. J. Phys. Med. : Load testing of geometric and polycentric total knee replacements. Clin. Orthop. : Forces transmitted by joints in the human body. Proc. Inst. Mech. Eng. : Analysis of kneejoint forces during flexed-knee stance. 1. Bone Joint Surg. : Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop. Scand. : Forces acting on the femoral head prosthesis. Acta Orthop. Scand.
1978), and by COLLEY et al. (1978). The conclusions to be drawn from these tests are that femoral components are unlikely to loosen in the face of ordinary loads, that tibial components that engage less than the whole area of the tibia are at some risk in compression, particularly if the compressive force is applied eccentrically and the bone is weaker than average, and that in torsion and hyperextension it is perfectly practicable to design prostheses whose bearing surfaces will not transmit moments or forces sufficient Biomechanics of Knee Replacement - to loosen the fixation.
Whilst there is certainly nothing absolutely significant about any particular value, it seems probable that a value close to that of a natural knee will be about right; a large reduction in torsional stability might be dangerous, whilst to increase the torsional stiffness significantly would serve no useful purpose and must, in principle, increase the forces required to be transmitted through the fixation. Any desired torsional stiffness can be achieved by using either conforming or nonconforming articular surfaces.