Patients who injure their knees often need surgery to repair the damage or reconstruct the knee. There could be a fracture or torn ligament(s) that requires immediate surgical attention. In many cases, arthritis develops in that knee and creates another problem later. In this article, two orthopedic surgeons provide a thorough review of what to do when posttraumatic knee arthritis gets worse and requires surgical treatment.
The surgeon has some basic decisions to make about what surgery to do beginning with type of patient. For example, younger patients who are still active can be treated with an osteotomy or arthrodesis (fusion). Older, less active adults with posttraumatic knee arthritis may fare better with an arthroplasty (joint replacement).
Osteotomy refers to the removal of a wedge-shaped piece of bone from one side of the knee. The remaining bone is moved to fill in the area where the wedge was removed. This procedure helps realign the bones and joint and redistribute weight and load.
Each of these procedures for the surgical management of posttraumatic knee arthritis is discussed in detail. The authors present common challenges surgeons face leftover from the surgery for the original injury. X-rays, intraoperative photographs, and drawings are included to show types of cases encountered and surgical management for difficult problems.
Some of the issues surgeons must deal with include broken hardware, scar tissue, stiffness, bony defects, malalignment of the joint, and other bone or joint deformities. Each of these problems must be taken into consideration when planning the treatment approach. The surgeon continues the decision-making process with a careful evaluation of the patient.
Location and quality of pain are noted. Range of motion is measured. The patient's gait (walking pattern) is examined and analyzed. Tests for knee instability are performed. X-rays are taken to look for limb malalignment, fractures, and status of the hardware. And finally, lab tests are ordered if there is any suspicion of joint infection.
The surgeon takes into consideration the patient's age, expectations, and goals, along with current activity level and desired activity level. The condition of the knee joint is also a deciding factor in what surgical option is best.
Osteotomy is a corrective procedure. It is used most often in younger adults to unload one side of the joint that is bearing the brunt of the burden. Arthritis affecting just one side of the knee joint is called unilateral or single-compartment degenerative disease. By unloading the side affected by arthritis the most, the knee can be spared much longer. Osteotomy buys the patient time before a total joint is needed.
Patients who benefit from osteotomies usually had a fracture around the knee that resulted in a leg length difference. Malunion or deformity after fracture or ligamentous healing can be treated with an osteotomy. The technique allows the surgeon to restore a more normal mechanical axis (center) of movement while spreading out the forces across the entire joint surface.