The effect of high tibial osteotomy on the upper tibial venous pattern in primary painful osteoarthritis of the knee joint was studied by preoperative and three to six months postoperative intraosseous phlebograms. The normal phlebographic pattern was established by phlebograms in five patients with normal knees. The preoperative engorgement, tortuosity of the medullary sinusoids, and slow dye clearance showed a remarkable conversion to a near normal appearance after the operation. Rest pain disappeared in all patients after the osteotomy, suggesting that venous congestion is the cause of 'rest pain'.
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