Arthritis of the Knee

1. Biomechanics.- Movements of the Normal Knee.- Movements Under Load and Under No Load.- Three-dimensional Nature of Movement.- Movements at the Knee and at Adjacent Joints.- Two-dimensional Simplifications.- How the Motion is Controlled.- Movements Used in Daily Activities.- Forces Transmitted Through the Normal Knee.- The Origin of Forces at the Knee.- Methods of Measuring or Calculating Forces.- Accuracy of Calculations of Forces.- The Principal Forces at the Knee.- Published Values for Forces.- Mode of Transmission of Force Through the Normal Knee.- Tibio-femoral Joint.- Patello-femoral Joint.- The Strength of the Normal Knee.- Strength of the Intact Joint.- Strength of the Bone Tissue.- Strength of the Ligaments.- Forces in Misaligned Natural Knees.- Effects of Misalignment.- Biomechanics of Knee Replacement.- Range of Possibilities.- Basic Requirements.- Tibio-femoral Joint.- Patello-femoral Joint.- Fixation.- Materials.- References.- 2. The Surgical Anatomy and Pathology of the Arthritic Knee.- Normal Alignment and Movement.- Alignment.- Movements.- Incidence of Deformity.- Material.- Definitions.- Results.- Discussion.- Relevant Observations at the Hip.- Summary.- The Nature of the Morbid Anatomical Changes Responsible for Deformity of the Knee in OA and RA.- Varus Instability.- Valgus Instability.- Fixed Varus Deformity.- Fixed Valgus Deformity.- Fixed Flexion.- Loss of Flexion.- Lateral Subluxation of the Patella.- External Rotation of the Tibia.- Hyperextension.- The Stable Neutral Knee.- The Loose Knee.- Lateral Subluxation of the Tibia.- Conclusions.- References.- 3. Clinical Assessment.- Collection of Data.- General Considerations.- Specific Considerations.- Radiological and Ancillary Methods of Examination.- Recording of Data.- Storage, Retrieval, and Analysis of Data.- Presentation of Data.- Tables.- Graphs.- Overall Functional Assessment.- Discussion.- References.- 4. Radiological Examination of the Knee Joint and Other Special Investigations.- Special Radiographs.- Leg Alignment.- Line of Body Weight.- Patello-femoral Joint.- Arthroscopy in Degenerative Arthritis.- Scintigraphy.- Conclusion.- References.- 5. Conservative Management.- Rheumatoid Arthritis.- Systemic Drug Therapy.- Drug Therapy and Operative Surgery Ill.- Local Measures.- Aids and Appliances: Modification of the Environment.- Osteoarthrosis.- Systemic Drug Therapy.- Local Measures.- Aids and Appliances.- References.- 6. Soft-Tissue Operations.- Synovectomy.- Rheumatoid Arthritis.- Osteoarthrosis.- Removal of Baker’s Cyst.- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Soft-Tissue Release Procedures.- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Resection of the Anterior Cruciate Ligament.- Nerve Resection.- Comment.- Meniscectomy.- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Débridement (the Spring-clean Procedure).- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Patellectomy.- Rheumatoid Arthritis.- Osteoarthrosis.- Comment.- Summary.- References.- 7. Arthrodesis.- Historical Background.- Disadvantage of Stiffness at the Knee.- Indications for Primary Arthrodesis of the Knee in 1977.- Arthrodesis as a Revision Procedure.- Requirements for Successful Arthrodesis.- Techniques of Fusion Useful in the Revision of Failed Arthroplasty.- Excision Arthroplasty as a Salvage Procedure.- References.- 8. Osteotomy.- Pathogenesis of Osteoarthritis of the Knee.- Rationale for Surgical Treatment of OA of the Knee.- Choice of a Surgical Procedure.- Femoral or Tibial Osteotomy.- Barrel-Vault Osteotomy of the Tibia.- Supracondylar Osteotomy of the Femur.- Patello-femoral OA Treated by Advancement of the Tibial Tuberosity.- Post-operative Tissue Changes.- Clinical and Radiological Results.- Conclusions.- References.- 9. Tibio-femoral Replacement Using Four Components with Retention of the Cruciate Ligaments. (The Polycentric Prosthesis).- Historical Development.- Discussion.- References.- 10. Tibio-femoral Replacement Using Two Components, with Retention of the Cruciate Ligaments. (The Geometric and Anametric Prostheses).- History.- The Evolution of the Geometric Prosthesis.- Biomechanics as They Relate to the Geometric Prosthesis.- Studies in Mayo Clinic Biomechanical Laboratory.- The Cruciate Ligaments.- Tibial Unit Anchorage.- Indications.- Results.- Complications.- Infection.- Dislocation and Subluxation.- Loosening.- Patellar Dislocation.- Failure of Angular Correction.- Wear.- Re-operation.- The Future.- Operative Technique.- Patello-femoral Replacement.- References.- 11. Tibio-femoral Replacement Using a Totally Constrained Prosthesis and Cruciate Resection. (The Guépar Prosthesis).- Historical Account and Introduction.- Mechanical Findings on Total Hinged Prostheses.- Types of Hinged Prosthesis.- Operative Technique.- Complications.- General.- Intra-operative and Early Local.- Deep Infection.- Affecting the Extensor Apparatus.- Mechanical.- Functional Results.- Pain Alleviation.- Restoration of Movement.- Global Function.- Related to Aetiology.- Conclusions and Indications.- References.- 12. Tibio-femoral Replacement Using a Semi-stabilised Prosthesis and Cruciate Resection (The Sheehan, GSB, Attenborough and Spherocentric Prostheses).- Design Features.- Individual Prostheses.- Intramedullary Fixation.- Patello-femoral Joint.- Clinical Results.- Patello-femoral Symptoms.- Further Remarks on Individual Series.- Sheehan.- Gschwend.- Attenborough.- Spherocentric.- Summary.- References.- 13. Tibio-femoral Replacement Using Two Un-linked Components and Cruciate Resection. (The ICLH and Total Condylar Prostheses).- ICLH (Freeman-Swanson) Arthroplasty.- Initial Design Considerations.- Early Clinical Experience.- Clinical Results Obtained with ICLH Arthroplasty in a Multicentre Clinical Trial up to 1974.- Summary of the Results Obtained up to 1974.- Modifications Introduced in 1975 and 1976.- Prosthetic Complications Encountered in the Period 1970–1974: Nature and Remedies.- Operative Procedure.- Clinical Results.- Indications.- Total Condylar Arthroplasty.- Indications.- Results Obtained with Other Procedures.- Pathology of Arthritis.- Relevance of the Pathology to Replacement of the Knee.- Design Rationale of the Total Condylar Prosthesis (TCP).- References.