[Orthopod] Re: Where would you draw the line?


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[Orthopod] Re: Where would you draw the line?

george.s.thomas at gmail
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Feb 6, 2008, 10:55 PM

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[Orthopod] Re: Where would you draw the line?	Can't Post

The question is why is anterior knee pain not invariable when the patella is
not resurfaced? (Most studies seem to agree that anterior knee pain is
commoner when the patella is not resurfaced). The real answer to this is at
present unknown, but a guess is that, the patella articulating against metal
causes less synovitis than the patella articulating against the destroyed
cartilage of the femur. If this is true then doing a HTO is not wise.
I think the most important reason why most surgeons who do TKR with
selective resurfacing of the patella, do so, is because of the fear of
complications. Many Indian patients have very small and thin patellae, so
the risk of fracture is ever present in the surgeon's mind.

On 2/6/08, Dr Mangal Parihar <mangalparihar@gmail.com> wrote:
>
>
> Dear all,
>
> I would appreciate your thoughts on this.
>
> The attached pictures are of a 56 year old lady, overweight, with varus
> bilaterally.
>
> She walks with a stiff legged gait, no obvious lateral ligament laxity.
>
> Her only complaint is pain on weightbearing. Pain is on the medial side.
> She
> has no pain on flexion movements in an unloaded position, inspite of the
> radiological PF arthritis.
>
> Despite the severity of the wear on the medial side, her lateral
> compartment
> is quite ok.
>
> Needless to say, all conservative measures have been exhausted.
>
> I believe that she will benefit by an HTO - fixator assisted. I have
> warned
> them that I cannot "guarantee" the longevity of the result, but that I
> believe that 5-7 years would not be an unrealistic minimum.
>
> She is from a higher economic stratum and can well afford a TKR.
>
> My reasoning on HTO and PF arthritis is thus - "there are so many
> arthroplasty surgeons who do not resurface the patella and it continues to
> be a hotly debated topic even today in arthroplasty meetings.
> If resurfacing of the patella is not mandatory in a knee replacement, then
> could it be that the PF arthritis on xray (in the absence of symptoms) is
> just a smokescreen and not a true contraindication to an HTO. Would it
> then
> be reasonable to extend the relative indications of an HTO to include
> patients with PF arthritis as long as their symptoms are consistent with
> medial overloading"
>
> What do you think - would you consider an HTO in this case?
>
> If no - why ? (actually, even if yes, I would be interested in your take
> on
> the issue)
>
> All thoughts (ESPECIALLY CRITICISMS) welcome.
>
> With regards
>
> Mangal Parihar
>
> >
>
>

--
George Thomas,
Orthopaedic Surgeon,
Chennai, India
Editor, Indian Journal of Medical Ethics,
www.issuesinmedicalethics.org
www.ijme.in

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