Listen, my friends, and you shall hear
A tale as impressive as Paul Revere.
A story of stiff and painful knees,
Deformed and disabled by arthritic disease.
A tale of treatment of gonarthrosis,
With realignment and joint prosthesis.
Reported by Gluck in eighteen nine-oh,
Hardly a surgeon is now alive
Who remembers that famous man and year.
Stability, mobility, freedom from pain
Describe a knee which needs no cane.
Painful walking and limited range
Describe a knee which needs a change.
Nonoperative care can work quite well,
Until the joint begins to swell.
And scopes can offer a brief delay,
Until it's time for a TKA.
Early remedy was joint resection
And multi-material interposition.
Fat, fascia, and dermis were placed
Into the worn arthritic space.
Metallic spacers and molds were used;
Results were mixed, some joints were abused.
Hinges of ivory, acrylic, and steel
Failed too often for general appeal.
Infection, wear, and instability
Limited outcome predictability.
The search was on for a knee anatomic,
Based on nature's joint kinematics.
An early design, a nonconstrained knee,
Resurfaced the joint and remained hinge-free.
Femoral runners in tibial slides
Had early success ’til implants subside.
Then surgeons designed the condylar knee,
On both sides of the Atlantic Sea.
Metal on poly, fixed with cement,
Gave good results, earning patients’ assent.
Femur and tibia were done by most fellas,
But surgeons debated the role of patellas.
The cruciate question challenged all,
And data did not support one call.
Retain or resect, it matters little,
If gaps are balanced and axis middle.
Bearing surface: mobile or fixed?
Each design has its risk.
Reducing wear is a critical goal,
So osteolysis will take no toll.
Methacrylate fixes most implants to bone,
But some designs use ingrowth alone.
Predictable fixation with only biology
Will follow with new porous technology.
Innovation changed implants with regularity,
Adding flanges, stems, and modularity.
Conformity, constraint, and metal backing,
Knee design issues are never lacking.
Surgical technique improved with time,
And may deserve its own full rhyme.
Incisional length is much discussed,
But quad protection is more august.
Mechanical axis, a key assignment,
Always avoiding malalignment.
Balancing gaps and ligaments is key,
To build a stable and functional knee.
Instruments now build knees to last,
Handheld jigs are in the past.
Predictable alignment and implant rotation
May best be ensured with navigation.
Demand for new knees is constantly rising;
Quality and safety, no compromising.
Education and technology will raise the bar,
So TKA is a surgical star.
Revere rode to "Middlesex village and farm,"
Warning colonials "to be up and to arm."
His midnight message was well received;
He helped young America start to believe.
Knee surgeons treat patients with disabling pain,
Who ask for relief and functional gain.
Designing new implants in evolution
Is the knee surgeon's ongoing revolution.
At the end of this rhyme, after all of the talk,
Our patients are happy to get up and walk.
Improving life, freedom from pain,
Is, for all, the ultimate gain.