Background
Epidemiology
Much less common than hip and knee OA
Patients tend to be younger
Much less common than hip and knee OA
Patients tend to be younger
Trauma
RA
Rickets / osteomalacia
Horizontal joint line important
- < 10° tilt acceptable
> 10o joint line tilt / due to femoral valgus
- continues to overload lateral compartment
Stage 0
Natural history mixed
- depends on size of lesion and diagnosis
- treat if becomes asymptomatic
- may benefit from bisphosphonates
Stage 1 / Normal X-ray, abnormal MRI
Forage: 80% G/E
Bisphosphonates
Stage 2 / Abnormal X-ray with cysts and sclerosis
A: As for Stage I
Metabolic Bone Disease
Paget's
Fracture Malunion
Previous Osteotomy
1. Intra-articular correction
2. Simultaneous osteotomy and TKR
3. Staged correction and TKR
Femur
- draw line of mechanical axis of femur
Inflammation of achilles tendon; insertional or noninsertional
Tendonitis / Tendonosis / Rupture
Triceps surae
- medial and lateral gastrocnemius
- soleus
- surrounded by paratenon which allows gliding and supplies nutrition
Inserts middle 1/3 calcaneal tuberosity
- 2 x 2 cm area
- 90o rotation distally
Retrocalcaneal bursa (x2)