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Orthopaedic

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Arthritis

Question
69 out of 101
 

A 65 year old male presented to the clinic with complains of having pain and swelling of the left knee since 2 years. Weight bearing X-rays showed grade III changes of osteoarthritis at the left knee joint. Which of the following would be most appropriate Rx of this patient? (AIPG 2010)



A Conservative treatment

B Arthroscopic washing

C Partial knee replacement

D Total knee replacement

Ans. D

Total knee replacement.

Radiographic grades of severity for osteoarthritis of the knee (atlas of standard radiographs, 1963)

Grade

Definition

Grade 1

Doubtful narrowing of joint space and possible osteophytic lipping.

Grade 2

Definite osteophytes and possible narrowing of joint space.

Grade 3

Moderate multiple osteophytes, definit narrowing of joint space, and some sclerosis and possible deformity of bone ends.

Grade 4

Large osteophytes, marked narrowing of joint space, severe sclerosis, and definite deformity of bone ends.

The Ahlbäck classification of radiographic knee OA of the tibiofemoral joint and the Kellgren and Lawrence grading system

Ahlbäck grade

Ahlbäck definition

Grade I

Joint space narrowing (joint space < 3 mm)

Grade II

Joint space obliteration

Grade III

Minor bone attrition (0–5 mm)

Grade IV

Moderate bone attrition (5–10 mm)

Grade V

Severe bone attrition (>10 mm)

Kellgren & Lawrence grade

Kellgren & Lawrence definition

Grade 1 ‘Doubtful’

Minute osteophyte, doubtful significance

Grade 2 ‘Minimal’

Definite osteophyte, unimpaired joint space

Grade 3 ‘Moderate’

Moderate dimunition of joint space

Grade 4 ‘Severe’

Joint space greatly impaired with sclerosis of subchondral bone Joint space greatly impaired with sclerosis of subchondral bone

Grade 4 ‘Severe’

Joint space greatly impaired with sclerosis of subchondral bone Joint space greatly impaired with sclerosis of subchondral bone

HT osteotomy

General selection criteria for osteotomy for genu valgum include

a. age younger than 65 years,

b. isolated Ahlback grade I or II lateral compartmental arthrosis,

c. minimum ligamentous laxity,

d. >90° arc of motion of the knee, and

e. a flexion contracture of <15-20°.

Unicompartmental knee arthroplasty

a. Unicompartmental knee arthroplasty in which just one femoral condyle is replaced has gained popularity over the last decade because it is less invasive than TKA and has a shorter recovery period. However, very few patients meet the strict selection criteria for this proce- dure.

b. These criteria are as follows:

i. Degenerative changes must be unicompartmental, and lack of involvement of the opposite femoral condyle must be confirmed radiographically.

ii. The patellofemoral articulation must have only minimal changes, and both the anterior and posterior cruciate ligament must be intact.

iii. Knee flexion must be greater than 90°, with a flexion contracture of less than 15°.

iv. The patient must have a sedentary lifestyle and weigh less than 275 lbs.

v. Patients with inflammatory arthritis and hemophilia are not candidates for this procedure.

TKA

a. TKA continues to be the best option for improving knee pain and function, with the ability to correct varus or valgus articular deformity in end-stage OA.

b. It is the treatment of choice in patients over age 55 with progressive and painful OA in whom nonsurgical and less-invasive treatments have failed.

The Role Of Arthroscopy & Lavage Is Still Controversial

a. Knee arthroscopy does not alter the progression of knee OA, and its use is controversial, since trials comparing arthroscopic debride- ment, lavage, and a placebo procedure reveal no difference among the groups.

b. Yet despite this, it is often used early in the treatment of OA, specifically for mechanical symptoms, and primarily for symptom relief.

c. Carefully selected patients with symptoms that are primarily mechanical in nature—eg, presence of loose bodies, locking, or a specific mechanism of injury2—may have some functional improvement after arthroscopy.

Arthritis Flashcard List

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