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The Journal of Bone and Joint Surgery 82:1767 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Surgical Options for the Middle-Aged Patient with Osteoarthritis of the Knee Joint*{dagger}

Arlen D. Hanssen, M.D.{ddagger}, Michael J. Stuart, M.D.{ddagger}, Richard D. Scott, M.D.§ and Giles R. Scuderi, M.D.#

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
*Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2001 in Instructional Course Lectures, Volume 50. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
{dagger}One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was Zimmer, Warsaw, Indiana.
{ddagger}Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905. E-mail address for A. D. Hanssen: hanssen.arlen@mayo.edu.
§Department of Orthopedic Surgery, Harvard Medical School, 125 Parker Hill Avenue, Boston, Massachusetts 02120.
#Insall-Scott-Kelly Institute for Orthopaedics and Sports Medicine, 170 East End Avenue, New York, N.Y. 10128.


   Introduction
 
Arthritic disease of the knee joint hindering lifestyle choices in an active aging population has become increasingly frequent. The pathology within the knee joint can vary from localized unicompartmental arthritis to end-stage tricompartmental arthritis. Associated conditions include extensive meniscal degeneration, ligamentous instability, localized articular cartilage defects, limb malalignment, and joint-line obliquity. Nonoperative treatments to reduce the pain associated with joint inflammation include activity modification, weight loss, anti-inflammatory or analgesic medications, intra-articular injections, periarticular muscle-strengthening, and stress-offloading with braces or heel-wedges. However, when the pain and associated impairment do not resolve satisfactorily with nonoperative modalities, surgical intervention may be considered.

Surgical options include arthroscopic débridement, ligamentous reconstruction, realignment osteotomy, unicompartmental arthroplasty, and total knee arthroplasty. In the absence of infection or extensor mechanism disruption, arthrodesis of the knee is an extremely rare option for the active middle-aged patient. For the purposes of this discussion, the middle-aged patient will be defined in . . . [Full Text of this Article]


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