Definition: degenerative disease of synovial joints that causes progressive loss of articular cartilage
Risk factors : obesity, gender ( female) repetetive trauma, articular fracture, malalignment, metabolic syndrome
Symptoms
function-limiting knee pain : effect on walking distances
pain at night or rest
activity induced swelling
knee stiffness
mechanical : instability, locking, catching sensation
Regular imaging : Scanogram, Knee AP +L + Sunrise view + Schuss
Conservative Treatment
Pain killers + NSAIDs + Physical therapy + weight loss : first line treatment
corrective splints or wedge insoles : ??
Steroids Injection : for very painful knee
Hyaluronic acid injection: for stage 1-2-3 generally
Surgical Treatment
High tibial Osteotomy
indications
good vascular status
non-obese patients
pain and disability interfering with daily life
only one knee compartment is affected
compliant patient that will be able to follow postop protocol
Contre-indicated if
flexion contracture >15 degrees
knee flexion <90 degrees
procedure will need >20 degrees of correction
patellofemoral arthritis
inflammatory arthritis
ligament instability
Uni compartmental knee prosthesis
An age younger than 60 years, a body weight of 82 kg or more, performing heavy work, having chondrocalcinosis and having exposed bone in the patellofemoral (PF) joint are not contraindications for unicompartmental knee arthroplasty (UKA).
Severe wear of the lateral facet of the PF joint with bone loss and grooving is a contraindication for UKA.
The best indication is bone to bone (or ratio <20%), with preoperative arc of motion of 90 degress with less than a 5 degrees flexion contracture, and fixed varus deformity < 10 degrees or fixed valgus deformity <5 degrees.ACL should be intact
Total knee Arthroplasty : for tricompartimental osteoarthritis that has not respond to medical treatment .
Revision cases, mechanically deformed limbs, ligament laxity and bone loss often require more constrained knee prosthesis
