Skip to main content
NCBI home page
Canadian Family Physician logoLink to Canadian Family Physician
. 1990 Mar;36:557-558, 561-564.

Reconstructive Surgery of the Lower Extremity

RJ Claridge
PMCID: PMC2280680  PMID: 21234075

Abstract

Non-operative treatments for degenerative arthritis, such as physiotherapy, anti-inflammatory medication, and occupational therapy, can help reduce the impact of the disease on the joint and hence on the mobility of the patient. Once the joint has become so diseased that non-operative modalities are inadequate, it is the task of the orthopedic surgeon to evaluate these individuals and determine which ones would benefit from a reconstructive procedure. The author explores the indications for arthrotomies, resection arthroplasties, arthrodeses, osteotomies, and total joint replacements. Total joint arthroplasty has revolutionized the treatment of degenerative arthritis of the lower extremity, although it is not a panacea for arthritis in the lower extremity.

Keywords: family medicine, orthopedic surgery, reconstructive surgery, rheumatology

Full text

PDF
557

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beauchamp C. G., Kirby T., Rudge S. R., Worthington B. S., Nelson J. Fusion of the first metatarsophalangeal joint in forefoot arthroplasty. Clin Orthop Relat Res. 1984 Nov;(190):249–253. [PubMed] [Google Scholar]
  2. Bittar E. S., Petty W. Girdlestone arthroplasty for infected total hip arthroplasty. Clin Orthop Relat Res. 1982 Oct;(170):83–87. [PubMed] [Google Scholar]
  3. Bolton-Maggs B. G., Sudlow R. A., Freeman M. A. Total ankle arthroplasty. A long-term review of the London Hospital experience. J Bone Joint Surg Br. 1985 Nov;67(5):785–790. doi: 10.1302/0301-620X.67B5.4055882. [DOI] [PubMed] [Google Scholar]
  4. Buchholz H. W., Elson R. A., Engelbrecht E., Lodenkämper H., Röttger J., Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br. 1981;63-B(3):342–353. doi: 10.1302/0301-620X.63B3.7021561. [DOI] [PubMed] [Google Scholar]
  5. Conaty J. P., Mongan E. S. Cervical fusion in rheumatoid arthritis. J Bone Joint Surg Am. 1981 Oct;63(8):1218–1227. [PubMed] [Google Scholar]
  6. Coventry M. B. Upper tibial osteotomy. Clin Orthop Relat Res. 1984 Jan-Feb;(182):46–52. [PubMed] [Google Scholar]
  7. Ewald F. C., Jacobs M. A., Miegel R. E., Walker P. S., Poss R., Sledge C. B. Kinematic total knee replacement. J Bone Joint Surg Am. 1984 Sep;66(7):1032–1040. [PubMed] [Google Scholar]
  8. Fahmy N. R., Barnes K. L., Noble J. A technique for difficult arthrodesis of the knee. J Bone Joint Surg Br. 1984 May;66(3):367–370. doi: 10.1302/0301-620X.66B3.6725347. [DOI] [PubMed] [Google Scholar]
  9. Goldie I. A synopsis of surgery for rheumatoid arthritis (excluding the hand). Clin Orthop Relat Res. 1984 Dec;(191):185–192. [PubMed] [Google Scholar]
  10. Grauer J. D., Amstutz H. C., O'Carroll P. F., Dorey F. J. Resection arthroplasty of the hip. J Bone Joint Surg Am. 1989 Jun;71(5):669–678. [PubMed] [Google Scholar]
  11. Harris W. H., White R. E., Jr Resection arthroplasty for nonseptic failure of total hip arthroplasty. Clin Orthop Relat Res. 1982 Nov-Dec;(171):62–67. [PubMed] [Google Scholar]
  12. Hasselo L. G., Willkens R. F., Toomey H. E., Karges D. E., Hansen S. T. Forefoot surgery in rheumatoid arthritis: subjective assessment of outcome. Foot Ankle. 1987 Dec;8(3):148–151. doi: 10.1177/107110078700800308. [DOI] [PubMed] [Google Scholar]
  13. Head W. C., Berklacich F. M., Malinin T. I., Emerson R. H., Jr Proximal femoral allografts in revision total hip arthroplasty. Clin Orthop Relat Res. 1987 Dec;(225):22–36. [PubMed] [Google Scholar]
  14. Heywood A. W., Learmonth I. D., Thomas M. Cervical spine instability in rheumatoid arthritis. J Bone Joint Surg Br. 1988 Nov;70(5):702–707. doi: 10.1302/0301-620X.70B5.3192564. [DOI] [PubMed] [Google Scholar]
  15. Hungerford D. S., Krackow K. A. Total joint arthroplasty of the knee. Clin Orthop Relat Res. 1985 Jan-Feb;(192):23–33. [PubMed] [Google Scholar]
  16. Hunter G. A. The results of reinsertion of a total hip prosthesis after sepsis. J Bone Joint Surg Br. 1979 Nov;61-B(4):422–423. doi: 10.1302/0301-620X.61B4.500751. [DOI] [PubMed] [Google Scholar]
  17. Insall J. N., Joseph D. M., Msika C. High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am. 1984 Sep;66(7):1040–1048. [PubMed] [Google Scholar]
  18. Insall J. N. Presidential address to The Knee Society. Choices and compromises in total knee arthroplasty. Clin Orthop Relat Res. 1988 Jan;(226):43–48. [PubMed] [Google Scholar]
  19. Jacobs M. A., Hungerford D. S., Krackow K. A., Lennox D. W. Revision total knee arthroplasty for aseptic failure. Clin Orthop Relat Res. 1988 Jan;(226):78–85. [PubMed] [Google Scholar]
  20. Jones L. C., Hungerford D. S. Cement disease. Clin Orthop Relat Res. 1987 Dec;(225):192–206. [PubMed] [Google Scholar]
  21. Kampner S. L. Total joint prosthetic arthroplasty of the great toe--a 12-year experience. Foot Ankle. 1984 Mar-Apr;4(5):249–261. doi: 10.1177/107110078400400506. [DOI] [PubMed] [Google Scholar]
  22. Kavanagh B. F., Ilstrup D. M., Fitzgerald R. H., Jr Revision total hip arthroplasty. J Bone Joint Surg Am. 1985 Apr;67(4):517–526. [PubMed] [Google Scholar]
  23. Knutson K., Tjörnstrand B., Lidgren L. Survival of knee arthroplasties for rheumatoid arthritis. Acta Orthop Scand. 1985 Oct;56(5):422–425. doi: 10.3109/17453678508994363. [DOI] [PubMed] [Google Scholar]
  24. Langlais F., Roure J. L., Maquet P. Valgus osteotomy in severe osteoarthritis of the hip. J Bone Joint Surg Br. 1979 Nov;61-B(4):424–431. doi: 10.1302/0301-620X.61B4.500752. [DOI] [PubMed] [Google Scholar]
  25. Levy R. N., Volz R. G., Kaufer H., Matthews L. S., Capozzi J., Sturm P., Sherry H. Progress in arthritis surgery. With special reference to the current status of total joint arthroplasty. Clin Orthop Relat Res. 1985 Nov;(200):299–321. [PubMed] [Google Scholar]
  26. Lipson S. J. Rheumatoid arthritis of the cervical spine. Clin Orthop Relat Res. 1984 Jan-Feb;(182):143–149. [PubMed] [Google Scholar]
  27. Lord G., Bancel P. The madreporic cementless total hip arthroplasty. New experimental data and a seven-year clinical follow-up study. Clin Orthop Relat Res. 1983 Jun;(176):67–76. [PubMed] [Google Scholar]
  28. McElwaine J. P., Colville J. Excision arthroplasty for infected total hip replacements. J Bone Joint Surg Br. 1984 Mar;66(2):168–171. doi: 10.1302/0301-620X.66B2.6707049. [DOI] [PubMed] [Google Scholar]
  29. McGarvey S. R., Johnson K. A. Keller arthroplasty in combination with resection arthroplasty of the lesser metatarsophalangeal joints in rheumatoid arthritis. Foot Ankle. 1988 Oct;9(2):75–80. doi: 10.1177/107110078800900203. [DOI] [PubMed] [Google Scholar]
  30. Nevitt M. C., Epstein W. V., Masem M., Murray W. R. Work disability before and after total hip arthroplasty. Assessment of effectiveness in reducing disability. Arthritis Rheum. 1984 Apr;27(4):410–421. doi: 10.1002/art.1780270408. [DOI] [PubMed] [Google Scholar]
  31. Newton S. E., 3rd Total ankle arthroplasty. Clinical study of fifty cases. J Bone Joint Surg Am. 1982 Jan;64(1):104–111. [PubMed] [Google Scholar]
  32. OTTOLENGHI C. E., FRIGERIO E. Intertrochanteric osteotomies in osteo-arthritis of the hip. J Bone Joint Surg Am. 1962 Jul;44-A:855–896. [PubMed] [Google Scholar]
  33. Oakeshott R. D., Morgan D. A., Zukor D. J., Rudan J. F., Brooks P. J., Gross A. E. Revision total hip arthroplasty with osseous allograft reconstruction. A clinical and roentgenographic analysis. Clin Orthop Relat Res. 1987 Dec;(225):37–61. [PubMed] [Google Scholar]
  34. Pellicci P. M., Wilson P. D., Jr, Sledge C. B., Salvati E. A., Ranawat C. S., Poss R., Callaghan J. J. Long-term results of revision total hip replacement. A follow-up report. J Bone Joint Surg Am. 1985 Apr;67(4):513–516. [PubMed] [Google Scholar]
  35. Pellicci P. M., Wilson P. D., Jr, Sledge C. B., Salvati E. A., Ranawat C. S., Poss R. Revision total hip arthroplasty. Clin Orthop Relat Res. 1982 Oct;(170):34–41. [PubMed] [Google Scholar]
  36. Ranawat C. S., Boachie-Adjei O. Survivorship analysis and results of total condylar knee arthroplasty. Eight- to 11-year follow-up period. Clin Orthop Relat Res. 1988 Jan;(226):6–13. [PubMed] [Google Scholar]
  37. Salvati E. A., Chekofsky K. M., Brause B. D., Wilson P. D., Jr Reimplantation in infection: a 12-year experience. Clin Orthop Relat Res. 1982 Oct;(170):62–75. [PubMed] [Google Scholar]
  38. Salvati E. A., Wilson P. D., Jr, Jolley M. N., Vakili F., Aglietti P., Brown G. C. A ten-year follow-up study of our first one hundred consecutive Charnley total hip replacements. J Bone Joint Surg Am. 1981 Jun;63(5):753–767. [PubMed] [Google Scholar]
  39. Scott R. D. Revision total knee arthroplasty. Clin Orthop Relat Res. 1988 Jan;(226):65–77. [PubMed] [Google Scholar]
  40. Scott R. D., Sarokhan A. J., Dalziel R. Total hip and total knee arthroplasty in juvenile rheumatoid arthritis. Clin Orthop Relat Res. 1984 Jan-Feb;(182):90–98. [PubMed] [Google Scholar]
  41. Sim F. H., Chao E. Y. Hip salvage by proximal femoral replacement. J Bone Joint Surg Am. 1981 Oct;63(8):1228–1239. [PubMed] [Google Scholar]
  42. Sledge C. B., Walker P. S. Total knee arthroplasty in rheumatoid arthritis. Clin Orthop Relat Res. 1984 Jan-Feb;(182):127–136. [PubMed] [Google Scholar]
  43. Sponseller P. D., McBeath A. A., Perpich M. Hip arthrodesis in young patients. A long-term follow-up study. J Bone Joint Surg Am. 1984 Jul;66(6):853–859. doi: 10.2106/00004623-198466060-00005. [DOI] [PubMed] [Google Scholar]
  44. Søballe K., Boll K. L., Kofod S., Severinsen B., Kristensen S. S. Total hip replacement after medial-displacement osteotomy of the proximal part of the femur. J Bone Joint Surg Am. 1989 Jun;71(5):692–697. [PubMed] [Google Scholar]
  45. Wade P. J., Denham R. A. Arthrodesis of the knee after failed knee replacement. J Bone Joint Surg Br. 1984 May;66(3):362–366. doi: 10.1302/0301-620X.66B3.6725346. [DOI] [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES