Sharing a case of Knee preservation Surgery
M/51,Farmer, 6 years back had Bi-condyler Tibia fr, treated elsewhere, -@18m - implant removal done.
-C/o pain while walking since 3 years, on analgesics since long, painless walking distance around 400 meter.
-Varus due to medial Tibial condyle mal-union.
-Treatment Options:
1)Supervised Neglect: Wait and watch till symptoms worsens, followed by Arthroplasty
2)Re-alignment : Osteotomy
3)Uni-condyler Knee Replacement
4)Total Knee Replacement
As pain was significant enough to address- Supervised neglect was not an option.
He was suggested TKR by few under Govt Schemes but was not keen for that.
Realignment- choice was between High Tibial Osteotomy vs TCVO.
As there was intra-articular mal-alignment post medial Tibial condyle depression TCVO was better choice.
HTO- would have aligned HKA axis but with incongruous joint longevity of it would be less.