John Insall's 1988 presidential address to The Knee Society surveys the unresolved trade-offs in TKA design and technique — PCL retention vs. sacrifice, flat vs. conforming tibial surfaces, cemented vs. cementless fixation, and femur-first vs. tibia-first resection — using institutional outcome data and biomechanical reasoning to argue that most design choices are genuine compromises rather than settled questions.
Essential reference for understanding the historical development of TKA design philosophy and the fundamental engineering trade-offs that continue to influence modern implant selection.
John Insall's 1988 presidential address to The Knee Society surveys the unresolved trade-offs in TKA design and technique — PCL retention vs. sacrifice, flat vs. conforming tibial surfaces, cemented vs. cementless fixation, and femur-first vs. tibia-first resection — using institutional outcome data and biomechanical reasoning to argue that most design choices are genuine compromises rather than settled questions.
Essential reference for understanding the historical development of TKA design philosophy and the fundamental engineering trade-offs that continue to influence modern implant selection.