Prosthetic fixation in cementless total knee arthoplasty. Influence of techniques, prosthetic design and bone graft enhacement

The knowledge of the biological and mechanical factors which have an influnce in non cemented knee prosthesis' survival and the complexity of the biomechanical (kinematic) demands to which are summitted the different non cemented prosthesis, show the importance of a "natural" solution specially in the field of the substitition of the interposition fibrocartilague structures, such as the meniscus. In the same way it is important to study the behaviourof the different revetment surfaces (Titanium, chrom-cobalt etc..) Lastly, a solid fixation of the implant demands a quality bone, that, in its case, will have come from an autograft

Alternate surgical approaches in mobile-bearing total knee arthroplasty.

Surgical approaches in nonconstrained mobile-bearing total knee arthroplasty (TKA) should provide the best access for specific deformity correction. Alternatives to the standard medial approach include the medial midvastus and subvastus approaches, and the direct lateral approach, with or without tibial tubercle osteotomy or proximal rectus snip. The direct lateral approach is a recommended alternative for fixed valgus knees, especially if there is lateral patellar subluxation and significant rotational deformity. The subvastus and midvastus medial approaches preserve quadriceps integrity and patella stability, and are recommended for severely unstable knees in nonobese, non-fixed valgus, and medial unicompartmental knee replacements