Recent advances in total knee replacement surgery.

The evolution of total knee replacement designs and techniques has made possible predictable and long-lasting pain relief in the treatment of knee arthritis. Excellent long-term results have been obtained with cemented knee replacement, with or without preservation of the posterior cruciate ligament. Attempts to achieve similar results with cementless implants have been hampered by designs with thin polyethylene and high-contact stresses, leading to early failure. Unicompartmental replacement can be used in the treatment of focal arthritis in one compartment, but designs with thin polyethylene must be avoided. Low molecular weight heparin can be a useful adjunct to warfarin in the prevention of deep-vein thrombosis. Further studies must be made to lower the incidence of infection, mechanical failure, and wear-debris generation.