It’s pretty uncommon in my practice. The data and the AAOS guidelines are pretty clear it’s not going to make a difference for the average patient. I’ve been referred too many knee caps with AVN to be a big fan. Facetectomy seems fine to do. I do now but the level 1 studies didn’t and didn’t matter.

Here’s how they were managed. The lateral OA was found in the setting of advanced PF OA. The patient wanted a total. On the other side the PF joint was good and with no lateral symptoms a medial uni was a reasonable option —and was the patient’s first choice.
#orthopedics

It’s an interesting one because of all the patient teaching involved. Very different conversations with those options on the table.

Explant. One versus two-stage but because it’s a difficult organism with a high failure rateI would counsel for a spacer. Aspiration before replant. At least two weeks abx post-op. And check an A1C and get nutrition labs. There may be a way to medically optimize to improve the odds.

You learn more about the pt from 2 secs in the doorway than from 2 hrs on the phone

If you don’t have a dx from the hx you’ve got your work cut out for you.

If you haven’t reproduced the sx on exam you don’t have a dx yet.

One outlier will negate 100 hrs saved by your new shortcut.