Arthritis of the Knee
Clinical Features and Surgical Management
Published on 1. July 1980
Book
Hardback
XIII, 282 pages
978-3-540-09699-3 (ISBN)
Description
Early in its development, the subject matter of any field of surgery is too ill-defined and opinions are too fluid for the production of a book on the subject to be possible. Late in its development, controversy is at an end, and although it is still possible to produce a textbook, it is too late to produce a book that might stimulate discussion and crystallise ideas. This book has that objective, it being the Editor's view that the field of the surgical treatment of arthritis of the knee had reached an appropriate intermediate stage in 1978 when this text was written. Three broad issues stand out as being in need of resolution before the optimum form of surgical treatment for a given knee can be defined more convincingly than is possible at present: Firstly: What symptomatic and physical features of the knee are to be recorded pre- and post-operatively, upon the basis of which comparisons can be made between the results obtained by two different surgeons or with two different tech niques. The resolution of this issue requires general agreement not only upon what features of the knee should be recorded but, crucially, upon how these features should subsequently be presented so as to characterise a particular group of knees.
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Content
1. Biomechanics.- Movements of the Normal Knee.- Movements Under Load and Under No Load.- Three-dimensional Nature of Movement.- Movements at the Knee and at Adjacent Joints.- Two-dimensional Simplifications.- How the Motion is Controlled.- Movements Used in Daily Activities.- Forces Transmitted Through the Normal Knee.- The Origin of Forces at the Knee.- Methods of Measuring or Calculating Forces.- Accuracy of Calculations of Forces.- The Principal Forces at the Knee.- Published Values for Forces.- Mode of Transmission of Force Through the Normal Knee.- Tibio-femoral Joint.- Patello-femoral Joint.- The Strength of the Normal Knee.- Strength of the Intact Joint.- Strength of the Bone Tissue.- Strength of the Ligaments.- Forces in Misaligned Natural Knees.- Effects of Misalignment.- Biomechanics of Knee Replacement.- Range of Possibilities.- Basic Requirements.- Tibio-femoral Joint.- Patello-femoral Joint.- Fixation.- Materials.- References.- 2. The Surgical Anatomy and Pathology of the Arthritic Knee.- Normal Alignment and Movement.- Alignment.- Movements.- Incidence of Deformity.- Material.- Definitions.- Results.- Discussion.- Relevant Observations at the Hip.- Summary.- The Nature of the Morbid Anatomical Changes Responsible for Deformity of the Knee in OA and RA.- Varus Instability.- Valgus Instability.- Fixed Varus Deformity.- Fixed Valgus Deformity.- Fixed Flexion.- Loss of Flexion.- Lateral Subluxation of the Patella.- External Rotation of the Tibia.- Hyperextension.- The Stable Neutral Knee.- The Loose Knee.- Lateral Subluxation of the Tibia.- Conclusions.- References.- 3. Clinical Assessment.- Collection of Data.- General Considerations.- Specific Considerations.- Radiological and Ancillary Methods of Examination.- Recording of Data.- Storage, Retrieval, and Analysis of Data.- Presentation of Data.- Tables.- Graphs.- Overall Functional Assessment.- Discussion.- References.- 4. Radiological Examination of the Knee Joint and Other Special Investigations.- Special Radiographs.- Leg Alignment.- Line of Body Weight.- Patello-femoral Joint.- Arthroscopy in Degenerative Arthritis.- Scintigraphy.- Conclusion.- References.- 5. Conservative Management.- Rheumatoid Arthritis.- Systemic Drug Therapy.- Drug Therapy and Operative Surgery Ill.- Local Measures.- Aids and Appliances: Modification of the Environment.- Osteoarthrosis.- Systemic Drug Therapy.- Local Measures.- Aids and Appliances.- References.- 6. Soft-Tissue Operations.- Synovectomy.- Rheumatoid Arthritis.- Osteoarthrosis.- Removal of Baker's Cyst.- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Soft-Tissue Release Procedures.- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Resection of the Anterior Cruciate Ligament.- Nerve Resection.- Comment.- Meniscectomy.- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Débridement (the Spring-clean Procedure).- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Patellectomy.- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Summary.- References.- 7. Arthrodesis.- Historical Background.- Disadvantage of Stiffness at the Knee.- Indications for Primary Arthrodesis of the Knee in 1977.- Arthrodesis as a Revision Procedure.- Requirements for Successful Arthrodesis.- Techniques of Fusion Useful in the Revision of Failed Arthroplasty.- Excision Arthroplasty as a Salvage Procedure.- References.- 8. Osteotomy.- Pathogenesis of Osteoarthritis of the Knee.- Rationale for Surgical Treatment of OA of the Knee.- Choice of a Surgical Procedure.- Femoral or Tibial Osteotomy.- Barrel-Vault Osteotomy of the Tibia.- Supracondylar Osteotomy of the Femur.- Patello-femoral OA Treated by Advancement of the Tibial Tuberosity.- Post-operative Tissue Changes.- Clinical and Radiological Results.- Conclusions.- References.- 9. Tibio-femoral Replacement Using Four Components with Retention of the Cruciate Ligaments. (The Polycentric Prosthesis).- Historical Development.- Discussion.- References.- 10. Tibio-femoral Replacement Using Two Components, with Retention of the Cruciate Ligaments. (The Geometric and Anametric Prostheses).- History.- The Evolution of the Geometric Prosthesis.- Biomechanics as They Relate to the Geometric Prosthesis.- Studies in Mayo Clinic Biomechanical Laboratory.- The Cruciate Ligaments.- Tibial Unit Anchorage.- Indications.- Results.- Complications.- Infection.- Dislocation and Subluxation.- Loosening.- Patellar Dislocation.- Failure of Angular Correction.- Wear.- Re-operation.- The Future.- Operative Technique.- Patello-femoral Replacement.- References.- 11. Tibio-femoral Replacement Using a Totally Constrained Prosthesis and Cruciate Resection. (The Guépar Prosthesis).- Historical Account and Introduction.- Mechanical Findings on Total Hinged Prostheses.- Types of Hinged Prosthesis.- Operative Technique.- Complications.- General.- Intra-operative and Early Local.- Deep Infection.- Affecting the Extensor Apparatus.- Mechanical.- Functional Results.- Pain Alleviation.- Restoration of Movement.- Global Function.- Related to Aetiology.- Conclusions and Indications.- References.- 12. Tibio-femoral Replacement Using a Semi-stabilised Prosthesis and Cruciate Resection (The Sheehan, GSB, Attenborough and Spherocentric Prostheses).- Design Features.- Individual Prostheses.- Intramedullary Fixation.- Patello-femoral Joint.- Clinical Results.- Patello-femoral Symptoms.- Further Remarks on Individual Series.- Sheehan.- Gschwend.- Attenborough.- Spherocentric.- Summary.- References.- 13. Tibio-femoral Replacement Using Two Un-linked Components and Cruciate Resection. (The ICLH and Total Condylar Prostheses).- ICLH (Freeman-Swanson) Arthroplasty.- Initial Design Considerations.- Early Clinical Experience.- Clinical Results Obtained with ICLH Arthroplasty in a Multicentre Clinical Trial up to 1974.- Summary of the Results Obtained up to 1974.- Modifications Introduced in 1975 and 1976.- Prosthetic Complications Encountered in the Period 1970-1974: Nature and Remedies.- Operative Procedure.- Clinical Results.- Indications.- Total Condylar Arthroplasty.- Indications.- Results Obtained with Other Procedures.- Pathology of Arthritis.- Relevance of the Pathology to Replacement of the Knee.- Design Rationale of the Total Condylar Prosthesis (TCP).- References.