What's the "Best" Total Knee Replacement?

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Total Knee Replacement (TKR) is an operation where the worn ends of the bones that make up the knee joint are resurfaced with metal and plastic implants.  Surgeons have many options to choose from.  Not only do several manufactures make different brands of knee replacements, but within each brand are different types.

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For example, in a "PCL sacrificing" knee replacement, the PCL (posterior cruciate ligament) in the knee is removed and its function is replaced by the special geometry of the implant.  There are also a group of implants known as "mobile bearing" or rotating platform" where one of the components (the tibial insert) actually moves or rotates relative to the metal tibial implant affixed to the tibia (shin bone).

Given the myriad of implants available, it is natural to ask, "Which total knee replacement is best?"  Unfortunately, the answer to that question is not straightforward.  While each manufacture will tout the benefits of their particular design, long-term follow-up of most contemporary implants yields similar results.  In reality, it is probably more important for perspective patients to seek out a good, experienced surgeon, rather than a particular product.

This is because factors such as proper alignment of the implant components and restoration of appropriate soft tissue tension (things which the surgeon directly controls) are more likely to influence the outcome of a total knee replacement than the particular brand of implant.

At the end of the day, perspective knee replacement recipients should seek out a doctor they are comfortable with and one that has a lot of experience with a particular implant system.  Experience is important because the technique of total knee replacement is rather involved.   The surgeon must utilize a series of complex instruments to perform the operation.  Often, these instruments are "implant specific" so surgeons will usually become loyal to a single brand allowing them to develop familiarity and expertise with a particular system.

So the answer to the question "what knee replacement is best" may simply be the one which your experienced surgeon has chosen to utilize.

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