By Michel Bonnin
This paintings goals to summarize essentially the present recommendations within the surgery of Osteoarthritis of the knee, together with excessive Tibial or Femoral Osteotomy, Unicompartmental Knee Arthroplasty and overall Knee Arthroplasty.This e-book might be learn at diverse degrees: uncomplicated chapters are fairly devoted to non-specialized or junior surgeons, rheumatologists, radio logists and physiotherapists. extra really expert points facing tricky situations and arguable issues are devoted to hugely really good surgeons. quite a few chapters specialize in tricky circumstances in fundamental TKA, akin to TKA on stiff knees, TKA in case of serious deformity or TKA following HTO or failed UKA. technique and recommendations in revision TKA also are mentioned within the moment a part of the book.Thanks to its didactic process, the reader will locate quickly solutions to technical or conceptual problems. using quite a few figures, X-rays and algorithms clarifies the statements and courses the reader all through this publication.
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Extra info for Osteoarthritis of the knee
Thickness of the patella The patella is often thin, especially on the lateral side. The residual thickness of the patella after resection must be such that there is no risk of fracture. The fracture’s risk increased in patella wiberg III. In practical terms, this means a thickness of at least 13mm. If the patella is too thin, there are two options: – the surgeon may perform peripheral patellar remodelling, and refrain from inserting a patellar prosthesis; – the more ambitious alternative (to be considered where the inadequate thickness is confined to the lateral one-third of the patella) consists in placing a cancellous graft between the polyethylene prosthesis and the patella, at the cementing stage.
ACL reconstruction The role of an ACL reconstruction in the osteoarthritic knee is controversial. Some authors have suggested that osteoarthritis is a contraindication to ACL reconstruction (4, 32, 47). Concerns include increased pain, joint contact forces and constraint leading to an increase in the progression of osteoarthritis. Others contend that reconstruction is worthwhile to improve stability, function and proprioception and helps reduce pain with the hope of halting arthritic advancement.
In a later study Pinczewski et al. (20) evaluated a group of 90 patients who had normal menisci at the time of surgery five years post surgery. Patient rating was 90% normal or nearly normal, 98% had a Grade 0 pivot shift and 97% had no degenerative changes seen radiographically. Their study support the view that reconstruction of the ACL is a reliable technique allowing full rehabilitation of the previously injured knee. In the presence of normal menisci there is a low incidence of osteoarthritic change despite continued participation in sporting activity.