Theory and Practice of Meniscal Knee Replacement: Designing against Wear

This paper attributes the high rate of high-density polyethylene (HDP) wear in many knee prostheses to incongruity of their articular surfaces. The authors discuss the anatomical and kinematic features of the knee which have led most designers to choose incongruous surfaces and review the reasons for employing free bearings, analogues of the natural menisci, to provide congruity without restriction of movement. There are theoretical reasons against employing freely mobile bearing in the absence of a functioning anterior cruciate ligament (ACL) and the authors' experience has confirmed this limitation in practice. It is concluded that, in bicompartmental replacement, the movements of the meniscal bearing should be limited in the anteroposterior direction. For unicompartmental arthritis, an unconstrained bearing can be employed if, as is usually the case, all ligaments are intact.