A 70-year-old woman with end-stage knee OA (Kellgren-Lawrence Grade 4) has a fixed varus deformity of 18° on clinical examination with medial joint line obliteration. On weight-bearing knee X-ray, the mechanical axis passes through the medial compartment. The most appropriate surgical option is:
- A High tibial osteotomy (HTO) to correct varus alignment
- B Unicompartmental knee arthroplasty (UKA) medial compartment
- C Arthroscopic debridement and lavage
- D Total knee arthroplasty (TKA) with posterior-stabilized design ✓
Explanation
End-stage (K-L Grade 4) tricompartmental OA with fixed varus deformity of 18° in a 70-year-old woman is a classic indication for total knee arthroplasty (TKA). HTO is indicated in younger patients (<55–60 years) with isolated medial compartment OA, minimal fixed deformity, and preserved joint space. UKA requires intact ACL, normal BMI, flexion contracture <10°, varus <10°, and isolated medial compartment disease — not applicable with severe deformity. Arthroscopic debridement has no proven benefit in severe OA. TKA achieves correction of deformity, pain relief, and functional restoration simultaneously with excellent 15-year survivorship (>95%).
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.