Geometric total knee replacement in osteoarthritis

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The current methods of treating osteoarthritis of the knee are osteotomy, debridement, tibial plateau replacement arthroplasty, femoral mold arthroplasty, hinged metal on metal total knee replacement arthroplasty, and arthrodesis of the knee. Osteotomy of the proximal tibia has been performed frequently in cases of osteoarthritis of the knee. It is most useful in cases in which the osteoarthritic changes are only on the medial or lateral side of the knee joint with a genu valgum or varum deformity. Patients with flexion contractures of 20° or more, instability, or valgus deformity greater than 20° are not suitable for tibial osteotomy. Realignment of the weightbearing line by tibial osteotomy is not likely to relieve the symptoms when the disease is severe.1,2

Another operation available for treating the osteoarthritic knee is the debridement procedure described by Magnuson.3 This operation consists of removing osteophytes from the margins of the knee joint and ridges from the central portions of the joint; it may include patellectomy. Pain may be relieved in some instances, but patellectomy often further weakens an already atrophied quadriceps muscle. Consequently, patients may experience buckling of the knee, a feeling of unsteadiness, and weakness. Magnuson’s procedure is of limited value and cannot be relied upon to correct the more severe forms of osteoarthritis of the knee joint.4

The metal on metal hinged type of total knee replacement devised by Walldius,5 Young,6 and Shiers7 can correct the severe deformities of osteoarthritis, but complications have been frequent. Loosening or fracture of the stems of the . . .



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