Osteoarthritis of the Knee

Ilizarov High Tibial Osteotomy (HTO)
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Osteo-arthritis of the knee Ilizarov apparatus is applied only to the tibia
Osteo-arthritis of the knee is common in India and typically afflicts ladies. The inner compartment of the knee gets worn out due to a varus deformity and causes severe pain. Total knee Replacement is too expensive for most patients. In this 76 year old lady, the right  knee was operated upon and a Unicondylar knee replacement was done 3 years ago. She opted for a Ilizarov HTO for her left knee.

 

 The Ilizarov apparatus is applied only to the Tibia and the varus deformity is corrected using a small 5 mm skin incision and straightening of the bone. The apparatus is well tolerated and permits the patient to walk about quite well. The great advantage of  the Ilizarov is that correction can be fine tuned after surgery by observing the patient walk.

After treatment
The treatment was over in about 3 months. There was good correction of the deformity and pain relief and ability to walk better with less stiffness . Interestingly, the Unicondylar Knee Replacement done on the other side started loosening out and gave pain to the patient within 4 years. After a Ilizarov HTO, pain relief may last from about 5 years to almost 15 years, depending on the initial stage of the Osteoarthritis and accuracy of correction.

 

X-ray after treatment

X-ray after treatment
X-rays show the deformity in the upper tibia with the narrowing of joint space on the inner aspect of the knee. There is increased sclerosis in the subchondral bone. Post Operative Xray shows that there is a correction into valgus of about 7degrees. This has been achieved with an angulation-translation manoeuvre with the distal fragment translated laterally. This will help in weight transmission through the centre of joint and healing of the Osteoarthritis--this should give pain relief for about 8 to 10 years at least.

 
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