Double Osteotomy for the Painful Knee in Rheumatoid Arthritis and Osteoarthritis

Abstract

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?

Results of forty two computer-assisted double level osteotomies for severe genu varum deformity

“…Little has been said about this technique in the literature and we could find only one paper reporting on it [1]. It seems that this technique was first described by Benjamin [2] in 1969 for the treatment of rheumatoid arthritis of the knee, but at the time, he did not mention any HKA angle or joint line obliquity. In their paper, Babis et al [1] reported on 24 patients (29 knees) operated on with a conventional technique (two closing wedge osteotomies).…”

High Tibial Osteotomy in the Treatment of Patients With Stage Ii–iii of Knee Osteoarthritis. Immediate Results and Factors Influencing the Outcome

“…[17] оценивали ре-Р е в м о о р т о п е д и я и р е а б и л и т а ц и я На сегодняшний день РА и другие воспалительные артропатии причислены к абсолютным противопоказа-ниям к ВТО [18,19]. Нам не удалось найти статьи о лече-нии методом ВТО вторичного гонартроза при РА, опуб-ликованных после 1990 г. Исторически так сложилось, что ВТО в 60-80-х годах XX в. применяли для лечения как пациентов с ОА КС, так и больных РА и с вторичным гонартрозом [20][21][22][23][24][25]. L.S.…”

“…Chan и J.P. Pollard [21] из 36 КС, прооперированных у больных РА, в 15 случаях (42%) получили хорошие, в 7 (19%) -удовлетворительные и в 14 (39%) -плохие результаты. A. Benjamin [22] привел данные о 36 КС, прооперирован-ных у больных с ОА, и 21 КС у больных с РА и пришел к выводу, что для обеих категорий больных операция одинаково эффективна. A. Ahlberg и соавт.…”

Poor results of double osteotomy for the rheumatoid knee

“…Double osteotomy was performed as described by Benjamin (1969). Flexion, varus or valgus deformity was corrected by osteoclasis of the soft rheumatoid bone or by removing a wedge.…”

“…Double osteotomy of the knee for disabling pain in rheumatoid arthritis or arthrosis was introduced by Benjamin (1969); the majority of patients with rheumatoid arthritis were reported to have pain relief for over 5 years (Benjamin & Helal 1980).…”