Abstract
High tibial osteotomy is an efficient treatment for medial compartment osteoarthritis of the knee; its used for middle aged patients with high activity levels and can delay the need for total arthroplasty.
The results of total knee arthroplasty after failed high tibial osteotomy are controversies; several authors reported inferior outcomes, but others have concluded that tibial osteotomy doesn't bias following total arthroplasty. The aim of this study was to evaluate the results of failed high tibial osteotomy subsequently converted to total knee arthroplasty and compare the results to group of patients underwere primary arthroplasty; the authors evaluate some of technical problems that a previous high tibial osteotomy can generate, like scar tissue, patellar tendon shortening and changes of proximal tibial anatomy.
Methods
50 total knee arthroplasty performed after a previous closed wedge osteotomy were matched with 50 patients operated with a primary knee prosthesis for osteoarthritis. The time from a proximal tibial osteotomy to a prosthesis operation was in mean eight years.
Results
the Knee Society clinical and radiographic score system and W.O.M.A.C. evaluation were used to evaluate knees before surgery and at each follow up (average 5 years).
At an average of five years follow up, the clinical results of total knee arthroplasty after high tibial osteotomy were similar to those of primary knee prosthesis.
Discussion
in our study revision of failed proximal tibial osteotomy appears to have more technical difficulties but with overall outcomes that remain comparable at results after primary total knee arthroplasty, so tibial osteotomy is considered a valid option in younger and very active patients with unicompartmental arthritis.
