[Orthopod] Where would you draw the line?


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[Orthopod] Where would you draw the line?

mangalparihar at gmail
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Feb 6, 2008, 10:44 PM

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

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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