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


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

veeyemeye at bsnl
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Feb 6, 2008, 11:11 PM

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

Dear Mangal,
I am not an arthroplasty surgeon, but do attend meetings often to keep updated. Dr george's reply seems logical how even without patellar resurfacing TKR patients do well.

I have done HTO in cases similar to the one shown by you. I would do an arthroscopy first to ensure that the lateral compartment is good and then do the HTO.

V M Iyer
--
Prof V M Iyer, Consultant Iyer Orthopaedic Centre
Retd HOD orthopaedic surgery. Govt medical college. Solapur.
India.413001. 91 9822394597

---- 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
>
> >

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