LCS® Mobile Bearing Knee Arthroplasty : A 25 Years Worldwide Review

This book reviews the LCS Mobile Bearing Arthroplasty which has been enthusiastically embraced by surgeons worldwide since introduction in 1977. Dr. Frederick Buechel and Dr. Mike Pappas developed a total knee prosthesis based on the concepts of low contact stress with unconstrained articulation using a mobile polyethylene bearing and highly conforming geometry. The long-term clinical results and evolutionary changes in surgical technique and understanding of total knee arthroplasty will be discussed. Recent scientific methodologies including wear simulation and fluoroscopic kinematic analysis have provided enlightening insight to clinical performance. Future modifications to the implant system will be described. Surgeons interested in proposing future designs using the mobile bearing concept will benefit from the knowledge of this experience. Front Matter....Pages I-XIX Front Matter....Pages 1-1 Introduction: Evolution of Meniscal Bearings....Pages 2-2 The Mechanics of the Knee and Prosthesis Design....Pages 3-15 The Historical Perspective of Mobile-Bearing Knee Implants....Pages 17-18 The LCS Story....Pages 19-25 Front Matter....Pages 27-27 Biomechanics of Total Knee Arthroplasty (TKA)....Pages 29-38 Engineering Design of the LCS Knee Replacement....Pages 39-52 Stability Characteristics of the Tibial-Femoral and Patellar-Femoral Articulations....Pages 53-56 Kinematics of the LCS Mobile Bearing Total Knee Arthroplasty....Pages 57-66 Wear Studies of the LCS....Pages 67-80 Front Matter....Pages 81-81 Indications....Pages 83-119 Surgery....Pages 121-207 LCS® Multicenter Worldwide Outcome Study....Pages 209-233 Complications and Management....Pages 235-270 Revision....Pages 271-291 Front Matter....Pages 293-293 Design Considerations of Existing Mobile Bearing TKA....Pages 295-300 Mobile Bearing Knee Prosthesis — Description and Classification....Pages 301-307 Front Matter....Pages 309-309 Introduction....Pages 311-311 The A/P-Glide Knee Prosthesis — Rationales, Kinematics and Results....Pages 313-320 LCS Complete....Pages 321-331 Navigation and Soft-Tissue Balancing of LCS TKA....Pages 333-342 Front Matter....Pages 309-309 Cementless Fixation Options in Total Knee Arthroplasty....Pages 343-348 New Materials for Mobile Bearing Knee Prosthesis — Titanium Nitride Counterface Coatings for Reduction of Polyethylene Wear....Pages 349-351 Minimally Invasive Unicompartmental Knee....Pages 353-358 The Modular LCS Patella Femoral Joint Replacement....Pages 359-364 Back Matter....Pages 365-371 Worldwide experience with the Lcs• mobile bearing total knee prosthesis has been unpar­ alleled both in terms of enduring popularity and outstanding long-term clinical results. Buechel and Pappas's design was based on the principles of; restoring anatomical joint function to as near normal as possible, minimising contact stresses to avoid wear and darn­ age to the bearing surfaces. and finally the idea that constraint should refiect the need for mobility, to avoid shear stresses and loosening of the implant. In 1977, the LCS® knee was implanted by Dr. Frederick Buechel. This was the first mobile bearing, tri-compartmental knee implant. This was also the first to successfully address the key issues ofloosening, wear and patello-femoral problems associated with earlier designs. The unique design solution was the creation of a common articulating geometry for the tibia and patella on the distal femoral surface. This resulted in a tibial and patellar articulation that was mobile in nature, but with an identical radius of curvature and conformity. The mobile bearing concept was considered sufficiently novel and unproven that the US FDA (Food & Drug Administration) required that it be validated in an Investigational Device Evaluation (IDE). An FDA IDE study involving 25 US surgeons was initiated in 1981. Validation of the clinical success of the device in this study resulted in FDA approval of the LCS, Knee (for cemented, tri-compartmental use) in 1985. This review looks at the LCS Mobile Bearing Arthroplasty, which was introduced in 1977. The prosthesis is based on the concepts of low contact stress with unconstrained articulation using a mobile polyethylene bearing and highly conforming geometry.