Clinico-radiological study of total knee arthroplasty after high tibial osteotomy

Does High Tibial Osteotomy Affect the Success or Survival of a Total Knee Replacement?

“…Since our previous study [8] in 2000, numerous studies have reported on TKAs after HTOs with and without patient-matched comparisons [2-4, 6, 7, 9, 10, 12, 13]. Three studies without patient-matched comparisons concluded the outcome of TKAs after HTOs is inferior to that of TKAs without previous HTOs [7,9,10]. They all note the technically demanding nature of the procedure as the cause for the inferior results.…”

“…Controversy exists regarding the success of a TKA after a prior HTO [2][3][4][6][7][8][9][10][11][12][13]. One might question whether failures would be greater in the long term as the HTO shortens the proximal tibia, the ligaments become lax and the proximal bone is more sclerotic.…”

Complications of closing wedge high tibial osteotomy

“…Whilst some authors have reported no adverse outcome with prior HTO [54][55][56][57][58], others have noted inferior results [59][60][61][62][63][64][65]. None of these studies have particularly long mean follow-up times however.…”

“…The recent trend towards rigid internal fixation and early mobilisation has greatly decreased this occurrence [68][69][70]. Problems associated with patella baja secondary to HTO and subsequent TKA relate to difficulties with patella eversion and thus exposure, an increased number of lateral releases and also a higher risk of patella tendon avulsion [61,62]. Scarring around the proximal tibia also adds to the difficulties associated with exposure [62].…”

High Tibial Osteotomy for Medial Compartment Osteoarthritis: A Comparison of Clinical and Radiological Results from Closed Wedge and Focal Dome Osteotomies

“…As the BlackburnePell index measures the tibia proximal articular surface, it is not reliable in these cases and it is, therefore, recommended that the Insall-Salvati index be used to evaluate patellar height after HTO. In a study of HTO cases using the Maquet technique, Noda et al 6 reported a statistically significant reduction in the Insall-Salvati index. In another study evaluating clinical results using the InsallSalvati index, postoperative patella infera was seen in 12 out of 26 cases of closed wedge osteotomy but in none of the 27 cases of focal dome osteotomy.…”