Advances in knee arthroplasty for younger patients: traditional knee arthroplasty is prologue, the future for knee arthroplasty is prescient.

Total knee arthroplasty (TKA) was a remarkable development in orthopedic surgery. Joint arthroplasty and arthroscopy were perhaps the greatest innovations in orthopedics in the 20th century and occurred without the advantages of today's technology. Initially, TKA was performed only on elderly patients and those with advanced rheumatoid arthritis because of concerns with long-term wear of polyethylene. Surgeons strongly discouraged this surgery for patients younger than age 60 years because both patients and many orthopedic surgeons believed that knee implants would last only for approximately 10 years, particularly in younger and more active patients. Reports in the late 1980s and early 1990s about accelerated polyethylene wear and osteolysis substantiated the conviction that TKA was contraindicated in younger patients. This led to complacency toward TKA, thus inhibiting technological advances in the procedure to develop implants for younger and more active patients.