Total knee replacement after high tibial osteotomy. Retrospective comparative study between subtractive and additive osteotomies
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Published:
Dec 16, 2021
Keywords:
Total knee replacement, high tibial osteotomy, closure osteotomy, opening osteotomy.
Main Article Content
Abstract
Introduction: Total knee replacement (TKR) after a high tibial osteotomy presents additional technical difficulties. The objective of this study was to analyze the clinical and radiological outcomes of conversion to TKR after a high tibial osteotomy and to compare the evolution of patients with a history of a closing (subtractive) versus opening (additive) osteotomy.
Materials and Methods: A series of 46 knee arthroplasties performed between 1997 and 2019 in 39 patients with a history of a high tibial osteotomy was retrospectively analyzed. The clinical and radiographic parameters were evaluated before and after the arthroplasty by measuring the femorotibial axis, the posterior tibial slope, the Insall Salvati value, and the Knee Society Score. At the same time, the results were compared in patients with a history of subtractive versus additive tibial osteotomy.
Results: In the series of 46 patients, an average follow-up of 5.72 years was achieved (minimum 1, maximum 19). The Knee Society Score for the entire series had an average improvement from 42.3 to 79.8 points. The posterior tibial slope and the IS value did not show great modifications after surgery. In this series, the average survival of additive osteotomy until conversion to TKR was 5.5 years, while for the subtractive one it was 13.5 years.
Conclusions: Despite the technical difficulty that it may present, TKR after a valgus high tibial osteotomy presented a good clinical-radiological evolution in the short and medium term and the type of osteotomy did not affect the results obtained after arthroplasty.
Materials and Methods: A series of 46 knee arthroplasties performed between 1997 and 2019 in 39 patients with a history of a high tibial osteotomy was retrospectively analyzed. The clinical and radiographic parameters were evaluated before and after the arthroplasty by measuring the femorotibial axis, the posterior tibial slope, the Insall Salvati value, and the Knee Society Score. At the same time, the results were compared in patients with a history of subtractive versus additive tibial osteotomy.
Results: In the series of 46 patients, an average follow-up of 5.72 years was achieved (minimum 1, maximum 19). The Knee Society Score for the entire series had an average improvement from 42.3 to 79.8 points. The posterior tibial slope and the IS value did not show great modifications after surgery. In this series, the average survival of additive osteotomy until conversion to TKR was 5.5 years, while for the subtractive one it was 13.5 years.
Conclusions: Despite the technical difficulty that it may present, TKR after a valgus high tibial osteotomy presented a good clinical-radiological evolution in the short and medium term and the type of osteotomy did not affect the results obtained after arthroplasty.
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Tillet, F., Rodríguez, J. A., del Sel, H., & Lopreite, F. A. (2021). Total knee replacement after high tibial osteotomy. Retrospective comparative study between subtractive and additive osteotomies. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(6), 755-762. https://doi.org/10.15417/issn.1852-7434.2021.86.6.1282
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Clinical Research
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References
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good outcome in men with low-grade osteoarthritis after 10-16 years. Acta Orthop 2008;79(2):230-4.
https://doi.org/10.1080/17453670710015021
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14. Bastos Filho R, Magnussen RA, Duthon V, Demey G, Servien E, Granjeiro JM, et al. Total knee arthroplasty after
high tibial osteotomy: a comparison of opening and closing wedge osteotomy. Int Orthop 2013;37(3):427-31.
https://doi.org/10.1007/s00264-012-1765-5
15. Mont MA, Antonaides S, Krackow KA, Hungerford DS. Total knee arthroplasty after failed high tibial osteotomy. A comparison with a matched group. Clin Orthop Relat Res 1994;299:125-30.
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https://doi.org/10.1054/arth.2000.6621
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19. Van Raaij TM, Bakker W, Reijman M, Verhaar JAN. The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord 2007;8:74. https://doi.org/10.1186/1471-2474-8-74
20. Badawy M, Fenstad AM, Indrekvam K, Havelin LI, Furnes O. The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy. Acta Orthop 2015;18(1):734-9. https://doi.org/10.3109/17453674.2015.1060402
21. Kazakos KJ, Chatzipapas C, Verettas D, Galanis V, Xarchas KC, Psillakis I. Mid-term results of total knee
arthroplasty after high tibial osteotomy. Arch Orthop Trauma Surg 2008;128(2):167-73.
https://doi.org/10.1007/s00402-007-0488-3
22. Efe T, Heyse TJ, Boese C, Timmesfeld N, Fuchs-Winkelmann S, Schmitt J, et al. TKA following high tibial
osteotomy versus primary TKA--a matched pair analysis. BMC Musculoskelet Disord 2010;11:207.
https://doi.org/10.1186/1471-2474-11-207
23. Amendola A, Rorabeck CH, Bourne RB, Apyan PM. Total knee arthroplasty following high tibial osteotomy for
osteoarthritis. J Arthroplasty 1989(4 Suppl):S11-S17. https://doi.org/10.1016/s0883-5403(89)80002-6
24. Villalba C, Fachinetti E, Garzón A. Artroplastia total de rodilla pososteotomía de tibia. Rev Asoc Argent Ortop
Traumatol 2002;67(2):83-87. Disponible en: https://www.aaot.org.ar/revista/1993_2002/2002/2002_2/670203.pdf
25. Bello D. Reemplazo total de rodilla pososteotomías altas fallidas. Dificultades técnicas y resultados. Rev Asoc
Argent Ortop Traumatol 2004;69(3):214-23. Disponible en: https://www.aaot.org.ar/revista/2004/n3_vol69/art5.pdf
2. Cerciello S, Vasso M, Maffulli N, Neyret P, Corona K, Panni AS. Total knee arthroplasty after high tibial osteotomy. Orthopedics 2014;37(3):191-8. https://doi.org/10.3928/01477447-20140225-08
3. Song SJ, Bae DK, Kim KI, Lee CH. Conversion total knee arthroplasty after failed high tibial osteotomy. Knee Surg Relat Res 2016;28(2):89-98. https://doi.org/10.5792/ksrr.2016.28.2.89
4. Ehlinger M, D’Ambrosio A, Vie P, Leclerc S, Bonnomet F, Bonnevialle P, et al. Total knee arthroplasty after
opening-versus closing-wedge high tibial osteotomy. A 135-case series with minimum 5-year follow-up. Orthop
Traumat Surg Res 2017;103(7):1035-9. https://doi.org/10.1016/j.otsr.2017.07.011
5. Insall JN, Dorr LD, Scott RD, Norman W. Rationale of the Knee Society Clinical Rating System. Clin Orthop Relat
Res 1989;248:13-4. https://doi.org/10.1097/00003086-198911000-00004
6. Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971;101(1):101-4. https://doi.org/10.1148/101.1.101
7. Ewald FC. The Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Clin
Orthop Relat Res 1989;248:9-12. PMID: 2805502
8. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy. J
Bone Joint Surg Br 2008;90(5):592-6. https://doi.org/10.1302/0301-620x.90b5.20386
9. Efe T, Ahmed G, Heyse TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, et al. Closing-wedge high tibial
osteotomy: survival and risk factor analysis at long-term follow up. BMC Musculoskelet Disord 2011;12:46.
https//doi.org/10.1186/1471-2474-12-46
10. Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, et al. Long-term survival of high tibial
osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 2011;39(1):64-70.
https://doi/org/10.1177/0363546510377445
11. Van Raaij T, Reijman M, Brouwer RW, Jakma TS, Verhaar JN. Survival of closing-wedge high tibial osteotomy:
good outcome in men with low-grade osteoarthritis after 10-16 years. Acta Orthop 2008;79(2):230-4.
https://doi.org/10.1080/17453670710015021
12. Mont MA, Antonaldes S, Maar DC, Krakow KA, Hungerford DS. Total knee arthroplasty after failed high
tibial osteotomy: Long-term follow-up and results. A comparison to a matched control group. J Arthroplasty
1993;8(1):109. https://doi.org/10.1016/s0883-5403(06)80141-5
13. Gill T, Schemitsch EH, Brick GW, Thornhill TS. Revision total knee arthroplasty after failed unicompartmental
knee arthroplasty or high tibial osteotomy. Clin Orthop Relat Res 1995;321:10-8. PMID: 7497653
14. Bastos Filho R, Magnussen RA, Duthon V, Demey G, Servien E, Granjeiro JM, et al. Total knee arthroplasty after
high tibial osteotomy: a comparison of opening and closing wedge osteotomy. Int Orthop 2013;37(3):427-31.
https://doi.org/10.1007/s00264-012-1765-5
15. Mont MA, Antonaides S, Krackow KA, Hungerford DS. Total knee arthroplasty after failed high tibial osteotomy. A comparison with a matched group. Clin Orthop Relat Res 1994;299:125-30.
https://doi.org/10.1097/00003086-199402000-00016
16. Han JH, Yang J-H, Bhandare NN, Suh DW, Lee JS, Chang YS, et al. Total knee arthroplasty after failed high tibial
osteotomy: a systematic review of open versus closed wedge osteotomy. Knee Surg Sports Traumatol Arthrosc
2016;24(8):2567-77. https://doi.org/10.1007/s00167-015-3807-1
17. Haddad FS, Bentley G. Total knee arthroplasty after high tibial osteotomy. J Arthroplasty 2000;15(5):597-603.
https://doi.org/10.1054/arth.2000.6621
18. El-Azab H, Glabgly P, Paul J, Imhoff AB, Hinterwimmer S. Patellar height and posterior tibial slope after open- and closed-wedge high tibial osteotomy. Am J Sports Med 2010;38(2):323-9. https://doi.org/10.1177/0363546509348050
19. Van Raaij TM, Bakker W, Reijman M, Verhaar JAN. The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord 2007;8:74. https://doi.org/10.1186/1471-2474-8-74
20. Badawy M, Fenstad AM, Indrekvam K, Havelin LI, Furnes O. The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy. Acta Orthop 2015;18(1):734-9. https://doi.org/10.3109/17453674.2015.1060402
21. Kazakos KJ, Chatzipapas C, Verettas D, Galanis V, Xarchas KC, Psillakis I. Mid-term results of total knee
arthroplasty after high tibial osteotomy. Arch Orthop Trauma Surg 2008;128(2):167-73.
https://doi.org/10.1007/s00402-007-0488-3
22. Efe T, Heyse TJ, Boese C, Timmesfeld N, Fuchs-Winkelmann S, Schmitt J, et al. TKA following high tibial
osteotomy versus primary TKA--a matched pair analysis. BMC Musculoskelet Disord 2010;11:207.
https://doi.org/10.1186/1471-2474-11-207
23. Amendola A, Rorabeck CH, Bourne RB, Apyan PM. Total knee arthroplasty following high tibial osteotomy for
osteoarthritis. J Arthroplasty 1989(4 Suppl):S11-S17. https://doi.org/10.1016/s0883-5403(89)80002-6
24. Villalba C, Fachinetti E, Garzón A. Artroplastia total de rodilla pososteotomía de tibia. Rev Asoc Argent Ortop
Traumatol 2002;67(2):83-87. Disponible en: https://www.aaot.org.ar/revista/1993_2002/2002/2002_2/670203.pdf
25. Bello D. Reemplazo total de rodilla pososteotomías altas fallidas. Dificultades técnicas y resultados. Rev Asoc
Argent Ortop Traumatol 2004;69(3):214-23. Disponible en: https://www.aaot.org.ar/revista/2004/n3_vol69/art5.pdf