A 1985 synthesis by Insall reviewing the principles and outcomes of total knee arthroplasty at the Hospital for Special Surgery. Drawing on 403 cases (100 total condylar, 303 posterior stabilized) followed 2–9 years, the paper addresses prosthesis selection, bone-cut sequencing, soft-tissue balancing, fixation, and rehabilitation. The central question: what technical principles govern a durable, functional TKA result?
When you stand at the operating table correcting a varus knee, the temptation is to cut more bone to split the difference. Insall's data — and his explicit instructions. Say the opposite: release the soft tissue, balance the ligaments, and keep the tibial cut at a constant 5 mm regardless of the defect beneath it.
This paper is why the soft-tissue release sequence is taught before bone cuts in every TKA curriculum. Varus correction goes medial-to-deep, then periosteal, stepwise. Stopping as soon as balance is achieved. Valgus correction releases lateral capsule, lateral ligament, popliteus, posterior capsule, and iliotibial band in sequence.
The under-1% loosening rate with cemented all-polyethylene tibial components set the standard that cementless proponents had to match. When residents ask why we still cement most primary TKAs, this is the paper behind the answer.
The 7% patellar complication rate established early that the patellofemoral joint is the weak link in TKA. A finding that continues to drive debates about selective versus routine resurfacing.
A 1985 synthesis by Insall reviewing the principles and outcomes of total knee arthroplasty at the Hospital for Special Surgery. Drawing on 403 cases (100 total condylar, 303 posterior stabilized) followed 2–9 years, the paper addresses prosthesis selection, bone-cut sequencing, soft-tissue balancing, fixation, and rehabilitation. The central question: what technical principles govern a durable, functional TKA result?
When you stand at the operating table correcting a varus knee, the temptation is to cut more bone to split the difference. Insall's data — and his explicit instructions. Say the opposite: release the soft tissue, balance the ligaments, and keep the tibial cut at a constant 5 mm regardless of the defect beneath it.
This paper is why the soft-tissue release sequence is taught before bone cuts in every TKA curriculum. Varus correction goes medial-to-deep, then periosteal, stepwise. Stopping as soon as balance is achieved. Valgus correction releases lateral capsule, lateral ligament, popliteus, posterior capsule, and iliotibial band in sequence.
The under-1% loosening rate with cemented all-polyethylene tibial components set the standard that cementless proponents had to match. When residents ask why we still cement most primary TKAs, this is the paper behind the answer.
The 7% patellar complication rate established early that the patellofemoral joint is the weak link in TKA. A finding that continues to drive debates about selective versus routine resurfacing.