Contraindications


Instability due to bone destruction is the main contraindication. Double osteotomy reduces the range of movement a shade, consequently a preoperative range of less than 45° is generally a contraindication and over 90° is desirable. Obesity is undesirable but not an absolute contraindication
An expectation of life of less than 5 years is a contraindication owing to the more rapid return of function following a total prosthetic replacement.
Loss of joint space on radiography, however severe, is not a contraindication if there is a reasonable range of movement. Areas denuded of cartilage, seen at operation are consistent with a satisfactory result.



Results

Between 1961 and 1984 550 double osteotomies were carried out [AB]; 200 were for rheumatoid arthritis. Pain was relieved for over 5 years in 80%). The range of movement is never increased although the patient thinks so when pain is relieved. Following a successful double osteotomy, the radiographic appearance gradually improves although with less increase in joint space than that seen in the upper limb. Disuse atrophy reverses and the internal bony structure as seen radiographically improves. A review at 9-16 years after operation of 50 patients who had been pain-free at 5 years revealed that 36 remained free from symptoms and 14 had recurrence of pain at times varying from 6 to 15 years. These patients considered the period free from pain justified the operation.