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Management of the Posttraumatic Arthritic Knee

Dr. Bedi is Fellow, Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY. Dr. Haidukewych is Orthopaedic Surgeon, Florida Orthopaedic Institute, Temple Terrace, FL.

Dr. Haidukewych or a member of his immediate family has received research or institutional support from DePuy, has received royalties from DePuy, is a consultant to or an employee of DePuy, and has stock or stock options held in Surmodics. Neither Dr. Bedi nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Asheesh Bedi, MD, and George J. Haidukewych, MD

Reprint requests: Dr. Bedi, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.

Excellent long-term outcomes can be achieved with contemporary methods of ligament reconstruction and open reduction and internal fixation for injuries around the knee; nevertheless, posttraumatic arthritis frequently develops. Reconstruction options for symptomatic posttraumatic knee arthritis include osteotomy, arthrodesis, and arthroplasty. Surgical challenges include the presence of extensive (often broken) hardware, scarring, stiffness, bony defects, compromised soft tissues, and malalignment. Patient age and activity and the anatomic location and extent of damage to the articular surface must be taken into account when determining the surgical treatment plan. For younger patients, osteotomy, allograft transplantation, or arthrodesis of the knee is considered, whereas older, low-demand patients are usually treated with arthroplasty. Attention to specific technical details and careful surgical technique are necessary to achieve a successful result. Functional improvement is usually seen following arthroplasty and, sometimes, arthrodesis. However, complications are common, and outcomes following arthroplasty are generally inferior to those reported for other diagnoses.