Indication For Total Knee Arthroplasty Research Articles

Outcome of osteotomies for the treatment of haemophilic arthropathy of the knee.

The knee is one of the most commonly affected joints in haemophilic arthropathy leading to stiffness and disability. It is the aim of this study to investigate the outcome of corrective osteotomies around the knee. We report on the long-term results of ten osteotomies around the knee for severe haemophilic arthropathy and axial deviation at an average of 7.25+/-1.8 years postoperatively. Seven high tibial (preoperatively 7.2+/-2 degrees varus) and three supracondylar osteotomies (preoperatively 7+/-3 degrees valgus) were performed on seven patients (three of them bilateral). The clinical score of the Advisory Board of the World Federation of Haemophilia (average 7.4 points preoperatively) remained unchanged in two patients, improved in three patients and deteriorated in five patients. The radiological Pettersson score (average 8.2 points preoperatively) showed a worsening of 2.5 points over the time. Patients reported a subjective improvement for seven osteotomies, with sports activity in three patients, although the range of motion did not change significantly. Total knee arthroplasty was considered to be a failure, i.e. endpoint of follow-up. Six knees were replaced in four patients by total arthroplasty after a mean of 6.6 years. Although survival of osteotomies around the knee in haemophilic arthropathy is lower than in non-haemophilic patients, we think that it is a choice of treatment, which, at least, postpones the indication for total knee arthroplasty in this young patient group.

The Evolution of Total Knee Arthroplasty

The current status of knee replacement surgery suggests that high density polyethylene and chrome cobalt alloy or stainless steel are acceptable materials for use in the intra-articular environment of the knee; that prosthetic components of knee units can be firmly fixed in bone with methylmethacrylate; and that a wide range of prosthetic units are available which will provide acceptable clinical results if used within the limits for which they have been designed. The indications for total knee arthroplasty have been designed. The indications for total knee arthroplasty have become reasonably simple and straightforward. Contraindications for the use of the various units available are relatively obscure and very seldom stressed. Each unit available will fail, however, if used under conditions of bone loss, deformity, and ligamentous instability for which it was not designed. The importance of the surgeon understanding and respecting the limitations of the total knee unit he chooses, and skillfully adapting it to the pathologic anatomy and pathophysiology of the patient's knee cannot be overemphasized.