Challenging the Experts on Complex Primary Knee Replacement Cases

    At the beginning of a session on complex primary knee replacement at last fall’s Transatlantic Orthopaedic Congress, moderator Craig Della Valle, MD, noted that all the cases he would be presenting featured patients who needed surgery to relieve knee pain and restore functioning.

    What type of knee replacement they needed was the question, he said.

    Dr. Della Valle presented radiographs and history for 6 cases. The expert panel that accepted his challenge to review these cases and offer their insights into the best surgical options for the patients included:

    • Alfred J. Tria Jr., MD
    • Jean-Noël A. Argenson, MD, PhD
    • David J. Backstein, MD, MEd, FRCSC
    • Mark W. Pagnano, MD
    • Matthew S. Austin, MD
    • David J. Mayman, MD

    Here are the basics of the cases they reviewed:

    Case 1

    • 50-year-old female
    • Tibial plateau fracture 2 years prior, repaired with open reduction internal fixation (ORIF)
    • Presents with knee pain
    • Range of motion (ROM) 0° to 125° in flexion

    Case 2

    • Prior patella fracture
    • Presents with post-traumatic arthritis

    Case 3

    • 52-year-old male
    • Prior tibial plateau fracture from a crane accident; retrograde femoral nail and ORIF
    • Presents with 10 flexion contracture, with ROM of 10° to 85°

    Case 4

    • 64-year-old male
    • Combined intramedullary nail and open approach to reducing a femur fracture in 1969
    • Presents with a stiff knee and varus deformity
    • 5 flexion contracture, with ROM of 5° to 65°

    Case 5

    • 84-year-old female
    • Prior tibial plateau fracture treated non-operatively
    • Presents with 90° flexion contracture; minimally ambulatory

    Case 6

    • 68-year-old female
    • Left high tibial osteotomy in 1996
    • Presents with bilateral knee pain
    • Bilateral knee contracture, with ROM of 15° to 115° in the right knee and 15° to 105° in the left knee

    Click the image above to find out what the experts had to say during this case-based panel discussion.