The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study

Abstract

Background: We performed a matched case control study to assess the effect of prior high tibia valgus producing osteotomy on results and complications of total knee arthroplasty (TKA).

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

“…The 17 knees followed at an average of 59.4 months had outcomes of 94% with excellent or good results and no differences in knee score, function score, or ROM [4]. van Raaij et al [12] reported no differences between the knees in their patient-matched comparison with an average followup of 3.7 years. The final patient-matched studies also found HTOs do not have a negative effect on later TKAs [6].…”

“…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.…”

The Mid-Term Outcome of Total Knee Arthroplasty in Patients With Prior High Tibial Osteotomy: A Prospective Study

“…The results seem to deteriorate in time and overall failure rates of 20% at five years and 40% at eight years are reported (8,9). Controversy exists regarding the success of a TKA after a previous HTO (7,8,10). Previous incisions, difficult exposure due to soft tissue scaring, patella baja, malunion or nonunion, offset of tibial shaft, change in the anatomy of tibial plateau, distortion of the joint line tilt and slope, retained osteosynthesis and subacute infections are technical challenges when performing a TKA after proximal tibia osteotomy (7)(8)(9).…”

“…However, the natural history of following HTO is more or less expected and with longer follow-up, the results worsen. Therefore, a high tibial osteotomy can be considered as a way to postpone total knee arthroplasty (TKA) in young patients (5)(6)(7). The results seem to deteriorate in time and overall failure rates of 20% at five years and 40% at eight years are reported (8,9).…”

“…Controversy exists regarding the success of a TKA after a previous HTO (7,8,10). Previous incisions, difficult exposure due to soft tissue scaring, patella baja, malunion or nonunion, offset of tibial shaft, change in the anatomy of tibial plateau, distortion of the joint line tilt and slope, retained osteosynthesis and subacute infections are technical challenges when performing a TKA after proximal tibia osteotomy (7)(8)(9). It is generally accepted that TKA after HTO is technically more difficult (10,11); however, there is still disagreement whether the subsequent TKA is compromised.…”