A 50-year-old female obese patient (BMI41) known for early varus gonarthritis (Figure 1) was operated on by medial opening-wedge HTO with a TomoFix[R] plate (DePuySynthes, USA) and osteoconductive tricalcium phosphate resorbable bone substitute (chronOS[R], DePuySynthes, USA) in March 2009 (Figure 2).
Standard X-rays showed an early bicompartmental gonarthritis (Figure 8).
For our patient, another attempt of osteosynthesis was not an option, as septic arthritis had destroyed the remaining cartilage and had severely worsened the preexisting gonarthritis. In this situation, a total knee replacement needs to be considered as a valid option.
In infected nonunion HTO where gonarthritis could still be treated conservatively, different types of reosteosynthesis have been recommended.
When gonarthritis associated with nonunion HTO was too severe for osteosynthesis, some authors recommended total knee replacement [27, 28].
Caption: Figure 7: June 2012, 2 years after revision, postoperative X-rays showing medial gonarthritis.
However, extract IDS23 (solvent 50% ethanol, 25, 100 and 300 mg/kg) produced a dose-dependent anti-inflammatory effect in rats with experimental gonarthritis
induced by bovine gammaglobulin and silicon particles (diclofenac served as control).