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The challenges of total knee arthroplasty in posttraumatic osteoarthritis: A cook book approach

Published in N° 003 - September / October 2019
Article viewed 65 times

The challenges of total knee arthroplasty in posttraumatic osteoarthritis: A cook book approach

By Friedrich Boettner in category
Hospital for Special Surgery - 535 East 70th Street - New York, NY 10021 / Email: [email protected]

Trauma can initiate the deterioration of cartilage inside the knee and result in end-stage osteoarthritis requiring a total knee arthroplasty. However, intra- and extraarticular deformities as result of trauma trigger osteoarthritis through different mechanisms and pose different challenges at the time of knee replacement surgery.

Introduction

Trauma can initiate the deterioration of cartilage inside the knee and result in end-stage osteoarthritis requiring a total knee arthroplasty. However, intra- and extraarticular deformities as result of trauma trigger osteoarthritis through different mechanisms and pose different challenges at the time of knee replacement surgery.

Extraarticular deformities as a result of a femur or tibia fracture usually initiate the development of osteoarthritis through malalignment of the knee. Since they usually are not associated with direct knee injuries the range of motion and overall stability of the knee resembles the clinical picture of primary osteoarthritis of the knee. However, its surgical correction is much more complex since normal alignment of the knee can usually only be achieved in a one stage total knee replacement if either the extraarticular deformity is corrected via a corrective osteotomy at the time of surgery or the extraarticular deformity is corrected through intraarticular soft tissue balancing [1]. In this group of patients, the most challenging clinical question is whether an extraarticular corrective osteotomy is needed prior to joint replacement. Careful planning considering the extend of the coronal deformity on hip to ankle standing views and...

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