Total knee arthroplasty following high tibial osteotomy for osteoarthritis

The authors assessed the effect of proximal tibial osteotomy on the results of a subsequent total knee arthroplasty. A retrospective, clinical and radiographic analysis was carried out between a study group of 39 patients with 42 total knee arthroplasties following osteotomy and a control group of 39 patients with 41 primary arthroplasties. Outcome was assessed using the Hospital for Special Surgery (HSS) knee score, pain, function, range of motion, and radiographic evaluation. The follow-up period averaged 37 months (range, 24-50 months). The study group had 88% good or excellent results using the HSS score, compared to 90% in the control group. Function and pain improved equally in both groups. The control group had, on average, 14 degrees greater range of motion (115 degrees v. 101 degrees) after arthroplasty. The control group had, on average, posterior inclination of the tibial plateau of 7 degrees before operation and 3 degrees after operation; the corresponding values in the study group were 2 degrees and 1 degree. Using the HSS score and pain and function as parameters, previous osteotomy does not seem to affect the outcome of total knee arthroplasty. Conversely, range of motion following arthroplasty appears to be less in those with prior osteotomy. In addition, a high tibial osteotomy may alter the inclination of the tibial plateau.