Clinical Context
A typical patient is a 62-year-old ambulatory adult with chronic medial compartment osteoarthritis and progressive anteromedial tibial plateau collapse causing pain, reduced knee range of motion, and an antalgic gait. Conservative measures including activity modification, nonsteroidal anti-inflammatory drugs, intraarticular corticosteroid injections, physical therapy, and bracing provided incomplete relief. Imaging (weight-bearing radiographs and MRI) demonstrates focal tibial plateau degeneration with loose articular fragments and synovial hypertrophy. The orthopedic surgeon schedules reconstruction of the tibial part of the knee with debridement and partial synovectomy to remove diseased bone and cartilage, recontour the tibial surface, address unstable fragments, and reduce synovial impingement.
Preoperative workflow includes history and physical, medical clearance, medication reconciliation, informed consent with discussion of risks (infection, bleeding, stiffness), and baseline neurovascular exam. Intraoperative steps typically involve regional or general anesthesia, a sterile knee arthrotomy or arthroscopic-assisted approach, debridement of devitalized bone and cartilage on the tibial plateau, partial synovectomy to remove inflamed synovium, reconstruction or grafting of the tibial articular surface as indicated, hemostasis, and layered closure. Postoperative care includes pain control, early range-of-motion exercises, deep vein thrombosis prophylaxis per protocol, weight-bearing status based on reconstruction stability, and outpatient follow-up with radiographic assessment and rehabilitation to restore gait and function.