Today's News

Friday, February 23, 1996

Total knee arthroplasty effective against arthritis

Total knee arthroplasty improves function and reduces pain in patients with post-traumatic arthritis, according to a study presented Friday in scientific paper 107 and Poster Exhibit B 53.

Between 1986 and 1995, 15 patients with an average age of 56 years, were studied. All had previous open reduction internal fixation with medial or lateral plates and/or screws to treat tibial plateau fractures. Each had developed arthrosis - the development of post- traumatic arthritis following a tibial plateau fracture.

The patients underwent total knee arthroscopy for treatment of the arthritis. The time from open reduction internal fixation to the arthroplasty averaged three years; six of the 15 patients had nine other procedures between these two surgeries.

Each patient was evaluated one to six years following the arthroplasty. Results of the surgeries were as follows: 27 percent, excellent; 53 percent, good; seven percent, fair; and 13 percent, poor. There was an average increase in arc of motion by 18 degrees, an average postoperative range of motion of 105 degrees, and an improvement of flexion contractures by an average of 11 degrees.

"Results were 80 percent successful, but not as high as prior studies (92.5 percent) where total knee arthroplasty was used for uncomplicated primary osteoarthritis," according to Pamela J. Sherman, MD, resident in the department of orthopaedics at The Hospital for Special Surgery, New York City.

"The procedure does improve knee function and range of motion in those patients debilitated with pain and progressive deformities, but our patient population is small and tends to be younger than that with primary osteoarthritis, which should be taken into consideration when less optimal outcomes are considered."

Intraoperatively, metal wedges were required for 13 percent of the knees, and one knee required additional bone grafting. Restoration of defects in the tibial plateau was accomplished with autogenous bone grafting in one-third of the patients. Two patients required open reduction internal fixation of nonunited fracture fragments with vitallium screws. Constrained condylar knee prostheses were used in 53 percent of the patientS for ligamentous instability or bony deficiency.

Co-authors of the study with Dr. Sherman from The Hospital for Special Surgery are Russell E. Windsor, MD, chief of knee surgery, associate attending orthopaedic surgeon, and associate professor at Cornell Medical Center, New York City; Richard S. Laskin, MD, attending orthopaedic surgeon and professor of clinical orthopaedic surgery, Cornell Medical Center; and Steven B. Haas, MD, MPH, assistant attending orthopaedic surgeon. James V. Bono, MD, attending orthopaedic surgeon, New England Baptist Hospital, and assistant professor of orthopaedic surgery, Tufts University, both in Boston, also participated in the study.

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