A comparison of osteotomy and joint replacement in the surgical treatment of the arthritic knee

The relatively small numbers of knees compared in this study make it impossible to draw conclusions with great confidence. On the other hand we believe that the quality of our comparison has been improved by our effort to match the groups of knees under study. Our results lead to the controversial conclusion that, at least in RA and in elderly patients with OA, ICLH arthroplasty is preferable to osteotomy regardless of the pathology and preoperative deformity and that osteotomy should not be used as a temporizing procedure before ICLH arthroplasty. We are unable to say whether or not similar conclusions would apply to other forms of arthroplasty but we suspect that they would. Certainly joint replacement is now widely preferred to osteotomy at the hip and it is difficult to see why the knee should be different. It should not be concluded from these results that replacemnt is to be preferred to osteotomy for the mildly damaged knee. It does however appear that if osteotomy fails (for technical or other reasons), it may then be difficult to obtain a satisfactory result even by replacement. Thus if a patient with a mildly damaged knee is not to be disabled irreparably, it may be better to avoid osteotomy until the day comes when the causes of failure after this operation can be predicted preoperatively and prevented. The data presented here suggest (as do those in many other studies) that one step in this direction is to confine osteotomy to the varus OA knee. Even in this group the surgeon should, we believe, do his utmost to avoid surgery altogether until the parents' disability is unacceptable. In summary therefore, we now advance the view that if the arthritic knee is sufficiently disabling to require major surgery, it should be replaced. If the disability is less severe, the joint should be treated conservatively.