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Total knee replacement following high tibial osteotomy.
Sanjeev Madan1, R K Ranjith, Nicholas J Fiddian
1Department of Orthopaedic Surgery, The Royal Bournemouth Hospital, Castle Lane East, Bournemouth, England.
Bulletin (Hospital for Joint Diseases (New York, N.Y.))
|June 28, 2003
Summary
Knee arthroplasty after high tibial osteotomy (HTO) can yield inferior results compared to primary knee arthroplasty. Pre-operative lateral subluxation significantly impacts outcomes, making HTO knee arthroplasty technically demanding.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Reconstructive Surgery
Background:
- High tibial osteotomy (HTO) is a common procedure for knee osteoarthritis.
- Conflicting reports exist regarding the efficacy of knee arthroplasty following HTO.
- Assessing outcomes and identifying predictive factors for post-HTO knee arthroplasty is crucial.
Purpose of the Study:
- To evaluate clinical and radiological outcomes of knee arthroplasty after HTO.
- To assess patient satisfaction following post-HTO knee arthroplasty.
- To identify variables influencing the success of post-HTO knee arthroplasty.
Main Methods:
- Retrospective analysis of 29 post-HTO knee arthroplasty cases.
- Evaluation of preoperative and postoperative range of motion and deformity.
- Analysis of weight-bearing radiographs and patient satisfaction scores.
- Comparison of outcomes based on osteotomy type and surgical parameters.
Main Results:
- Average follow-up was 7.5 years; average interval between procedures was 4.7 years.
- 17.2% of patients had poor results.
- Significant pre-operative subluxation (9 mm vs. 3.64 mm) was noted in failed arthroplasties (p=0.033).
- Failed cases showed a trend towards valgus tibial cut and greater lateral tibial tray translation.
Conclusions:
- Knee arthroplasty after HTO is technically challenging due to altered anatomy and balancing issues.
- Outcomes of post-HTO knee arthroplasty are generally inferior to primary knee arthroplasty.
- Pre-operative lateral subluxation appears to be a significant negative predictor of surgical success.