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DOUBLE OSTEOTOMY FOR THE PAINFUL KNEE IN RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS

A. Benjamin 1

1 West Hertfordshire Hospital Group Berkhamstead, England

1. Double osteotomy was performed on 1 50 knees between 1961 and 1969. The first fifty-seven cases were assessed independently.

2. The operation of osteotomy of the upper end of the tibia and the lower end of the femur is described. it is emphasised that the osteotomy sites are close to the bone ends and well within the cancellous expansion.

3. The indications for the operation are pain and loss of function in a mobile arthritic knee joint.

4. Flexion of the knee is important during the operation to allow the popliteal artery to be moved away from bone. Arteriograms at necropsy show the danger of damaging the popliteal artery when the knee is extended.

5. The operation appears to be equally effective in osteoarthritis and rheumatoid arthritis. The proliferated synovium of the active rheumatoid knee regresses rapidly following operation.

6. The operation has resulted in relief of pain and increase in function in many knees which had no deformity. When a deformity did exist before operation recurrence of the deformity did not appear to influence the result.

7. The cause of relief of symptoms after osteotomy is not known, and it is suggested that answers to the following questions should be sought: Why are some arthritic knees painful and some not ? Why does physiotherapy relieve pain ? Why does osteotomy relieve pain? Why is double osteotomy followed by regression of synovial proliferation ? Why does osteotomy sometimes fail ? Would osteotomy of one bone (tibia or femur) be sufficient?
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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General