The concept of resurfacing or replacing the knee joint was first entertained in the late 1860s.1-4 By 1940 to 1950 the designs were improving significantly but the problem of fixation became a serious barrier to further progress. Before Charnley and his associates developed polymethylmethacrylate (PMMA), knee arthro-plasty was limited to partial replacements of the joint surfaces and hinge designs that relied upon ligament stability and simple bone-metal contact to keep the prosthetic device in the planned posi-tion.5,6 The early replacements did not include the patella. The membrane arthroplasties, 1,2,4 GUEPAR hinge,6 and the Macintosh interpositional arthroplasty5 represented attempts to replace the surface and to relieve discomfort. The early results were encouraging; however, subsequent loosening and progression of the arthritis in other areas of the knee led to prosthetic failure.

In 1969, Charnley's laboratory developed PMMA for use in total hip arthroplasty.7 Gunston applied the same technology to the poly-centric knee and was able to resurface the tibiofemoral articulation and space the cruciate ligaments.8 The prosthetic device was implanted with some simple guides and permitted better range of motion while preserving stability of the joint. Knee designs improved rapidly during the 1970s and 1980s in good part due to the more reliable fixation that the cement provided.

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