Revision total knee arthroplasty after failed high tibial osteotomy

Eleven patients (12 knees) who underwent revision total knee arthroplasty after failed high tibial osteotomy are reviewed. All patients were evaluated clinically and radiographically before osteotomy and arthroplasty, and in the follow-up period. The time from osteotomy until arthroplasty ranged from 9 months to 9 years, 6 months (average: 4 years, 5 months). The average follow-up period after arthroplasty was 6 years, 11 months (range: 1 year, 6 months to 13 years). On the basis of the Japan Orthopaedic Association osteoarthritic knee scoring system, the results of total knee arthroplasty after osteotomy were found to be comparable with the results after primary arthroplasty. Patients were divided into two groups according to the time from osteotomy to arthroplasty, alignment of the leg before arthroplasty, and the reason for requiring revision arthroplasty. Group 1 included 6 patients with 6 knees who underwent arthroplasty within 3 years after osteotomy. The main reason for revision arthroplasty in Group 1 was pain due to the recurrence of a varus deformity. Group 2 included 5 patients (6 knees) who underwent revision arthroplasty more than 5 years after osteotomy. The main reason for revision arthroplasty in Group 2 was pain or hydrarthrosis due to the progression to bi-compartmental or tri-compartmental osteoarthritis. There was no significant difference in the clinical results between the two groups. Concerning patellar height, LT/LP of Group 1 was significantly lower than that of Group 2. There were no significant differences in the radiographic findings among the two study groups and the control group of 71 patients (110 knees) who underwent primary total knee arthroplasty, except for alignment before arthroplasty. Using the Japan Orthopaedic Association osteoarthritic knee scoring system, previous osteotomy does not seem to affect the outcome of total knee arthroplasty. With refinement of the technique of high tibial osteotomy, revision total knee arthroplasty after 3 years or less would be avoidable, however, revision total knee arthroplasty due to osteoarthritic deterioration over time would be inevitable.