Total Knee Arthroplasty After High Tibial Osteotomy: No Differences Between Medial and Lateral Osteotomy Approaches

Young active patients with medial knee osteoarthritis (OA) combined with varus leg alignment can be treated with high tibial osteotomy (HTO) to stop the progression of OA and avoid or postpone total knee arthroplasty (TKA). Closing-wedge osteotomy (CWO) and opening-wedge osteotomy (OWO) are the most commonly used osteotomy techniques. The purpose of this study was to compare the clinical and radiologic outcomes and complications between OWO and CWO. We retrospectively evaluated 23 studies including 17 clinical trials from published databases from their inception to May 2015. We evaluated the clinical outcomes including operation time, visual analog scale (VAS), maximal flexion, and hospital for special surgery knee (HSS) score. The radiologic outcomes included patellar height measured by posterior tibial slope angle, hip-knee-ankle (HKA) angle, femorotibial (FT) axis, and limb length. Complications recorded included the incidence of deep vein thrombosis (DVT), common peroneal nerve injury, opposite cortical fracture, etc. There were no differences in most of the clinical outcomes except the operation time. OWO increased the posterior slope angle and limb length, decreased the patellar height, and provided higher accuracy of correction. CWO led to a higher incidence of opposite cortical fracture.

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“…However, the posterior tibial slope with long-term follow-up had no statistical difference between the OWO and CWO (95% CI: À1. 25…”

Section: Radiological Outcomesmentioning

confidence: 99%

Comparison between Closing-Wedge and Opening-Wedge High Tibial Osteotomy in Patients with Medial Knee Osteoarthritis: A Systematic Review and Meta-analysis

Sun

Zhou

et al. 2016

J Knee Surg

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“…However, a study from Preston et al (2014) showed no differences between lateral and medial osteotomy approaches regarding functional outcomes or survivorship of TKA.…”

Section: Discussionmentioning

confidence: 97%

The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy

Badawy¹,

Fenstad²,

Indrekvam³

et al. 2015

Acta Orthopaedica

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Background and purpose — Previous studies have found different outcomes after revision of knee arthroplasties performed after high tibial osteotomy (HTO). We evaluated the risk of revision of total knee arthroplasty with or without previous HTO in a large registry material.Patients and methods — 31,077 primary TKAs were compared with 1,399 TKAs after HTO, using Kaplan-Meier 10-year survival percentages and adjusted Cox regression analysis.Results — The adjusted survival analyses showed similar survival in the 2 groups. The Kaplan-Meier 10-year survival was 93.8% in the primary TKA group and 92.6% in the TKA-post-HTO group. Adjusted RR was 0.97 (95% CI: 0.77–1.21; p = 0.8).Interpretation — In this registry-based study, previous high tibial osteotomy did not appear to compromise the results regarding risk of revision after total knee arthroplasty compared to primary knee arthroplasty.

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“…Total knee arthroplasty after a closing-wedge is much more complicated and technically difficult than in an opening-wedge osteotomy. Preston et al 24 found that functional outcomes for arthroplasty after conversion from lateral closing-wedge HTO to be similar to those after conversion from medial opening-wedge HTO. The opening wedge, however, has the advantage of preserving the bone stock for future arthroplasty (Haslam et al 25 ).…”

Section: Table 3 Comparison Of Outcome Based On Implant Usedmentioning

confidence: 98%

Evaluation of Functional Results of Medial Opening Wedge High Tibial Osteotomy for Unicompartmental Osteoarthritis Varus Knee

Bakki¹,

Yennapu²,

Kolluru³

et al. 2017

jebmh

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BACKGROUNDOsteoarthritis commonly affects the medial compartment of knee giving rise to varus deformity in majority of cases. Significant varus deformity further aggravates the pathology due to medialisation of the weight bearing line osteotomy of the proximal tibia realigns this weight bearing axis, thereby relieving pressure on the damaged medial compartment. OWHTO is a promising option in this scenario because it is associated with high accuracy in correcting the deformity and less number of complications when compared to lateral closing wedge HTO or UKA. In this study, we evaluate the functional outcome of HTO in patients with unicompartmental osteoarthritis.

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Total Knee Arthroplasty After High Tibial Osteotomy: No Differences Between Medial and Lateral Osteotomy Approaches

Cited by 52 publications

References 10 publications

Comparison between Closing-Wedge and Opening-Wedge High Tibial Osteotomy in Patients with Medial Knee Osteoarthritis: A Systematic Review and Meta-analysis

Comparison between Closing-Wedge and Opening-Wedge High Tibial Osteotomy in Patients with Medial Knee Osteoarthritis: A Systematic Review and Meta-analysis

The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy

Evaluation of Functional Results of Medial Opening Wedge High Tibial Osteotomy for Unicompartmental Osteoarthritis Varus Knee

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