[Indications of prosthesis in the treatment of knee diseases]

Hinge prostheses of the knee expose to so many local or even systemic complications that they should be used only for reconstruction of the knee after tumoral excision. In all other indications, prosthesis of the knee must be semi-constrained or non-constrained. Moreover, it seems that it would be useful to choose the prosthesis that preserves the ligaments to the best, in order to reduce as much as possible the stress imposed on bone/prosthesis interfaces and to limit the size of the prosthesis that preserves the ligaments to the best, in order to reduce as much as possible the stress imposed on bone/prosthesis interfaces and to limit the size of the prosthesis on which depends the amount of bone removed and the risk of septic complications. In rheumatic diseases prosthesis of the knee is the only sensible surgical treatment. Since the inflammatory process involves all three compartments of the knee, the prosthesis must be of the three-compartment type. In degenerative (gonarthrosis) and post-traumatic diseases of the knee, prosthesis is needed only when conservative surgery (osteotomy for realignment or malunion) is inadequate, with global femorotibial or femoropatellar involvement and major laxity of the ligaments. In global femorotibial diseases the prosthesis utilized can only be three-compartmental; in one-compartment femorotibial diseases, one-compartment prosthesis is rational if there is no lesion of the capsule and ligaments. When anatomical conditions are still compatible with conservative surgery, prosthetic surgery will be preferred only when the patient's general condition requires prompt resumption of walking.(ABSTRACT TRUNCATED AT 250 WORDS)