[Choice of treatment in gonarthrosis (author's transl)]

The natural history of arthrosis is worse for the knee than for the hip. The majority of knee patients become socially isolated because of deficient walking ability associated with increasing instability and pain, usually not remedied by non-operative treatment. In most early cases of varus arthrosis, slight over-correction by osteotomy will provide permanent freedom from pain and retained motion. In advanced stages and in most cases of valgus arthrosis, osteotomy is unreliable. Provided the contralateral compartment is preserved, a unicompartmental arthroplasty is then indicated. However, in the worst cases with severe bone loss and ligamentous instability, a bicondylar or total endoprosthesis should be used. The diagnostic and therapeutic recommendations proposed here are based on experience over a 20-year period including long-term prospective studies, notably a Swedish multi-center study involving 5000 knee arthroplasties. In a general sense, the treatment of gonarthrosis now has a rational basis which in each individual case requires exact roentgenographic analysis, careful choice of operative method and, not least, surgical precision. In the majority of cases an early precise osteotomy should prevent the need for major arthroplasty later in life.