There is an increasing trend towards performing a high tibial osteotomy (HTO) with a medial opening wedge technique. Amongst the potential advantages is easier conversion to a total knee replacement (TKR), although literature regarding this is scarce. We report our early clinical and radiological results, along with the technical issues encountered.

From our database, we identified thirty-one patients who had undergone thirty-two TKRs after medial opening wedge HTOs. Clinic and operative records were reviewed, and our database used for knee society scores. Those patients not seen in the last twelve months were reviewed in clinic. All pre- and postoperative radiographs were reviewed. The average age of the patients was fifty-seven years, and the average time from HTO to TKR was 4.5 years.

Difficulties with patella eversion were seen in 12.5%, and the knee balanced easily in 85% of cases. The tibia had minimal deformity in most cases, and all osteotomies were healed at the time of conversion. A stem was used in ten cases, and only if metalwork was removed at the time of conversion (which was done in twenty-three of the thirty-two). Minimum one year follow-up was available for twenty-six patients, with a mean follow-up time of twenty-eight months (range twelve to ninety-three months). The average Knee Society knee score was eighty-eight, function score seventy-five, and total score one hundred and sixty-two. Compared to non-matched group of 1149 primary TKRs (of older average age), the knee score was significantly lower, and there was a higher percentage of patients in the poor category. Poor results correlated strongly to the presence of chronic pain or workers compensation issues, and also to whether the knee had undergone revision HTO prior to TKR.

We conclude that the conversion of a medial opening wedge HTO to a TKR is relatively straightforward technically, and some aspects are easier than performing a TKR after a lateral closing wedge osteotomy (using historical controls). The clinical results appear inferior to that of a TKR performed without a prior osteotomy, although the results in our osteotomy group were skewed by a small group of chronic pain and workers compensation cases.

Introduction A procedure of selective musculo-tendinous lengthenings is presented as treatment for chronic lateral elbow pain. The rationale for surgery is to decrease tensile force at the lateral epicondyle and simultaneously reduce posterior interosseous nerve compression in the radial tunnel. This study presents biomechanical and clinical data on this surgical technique.

Methods In a human cadaver study, force transducer measurements were made in the common extensor tendon, and after sequential tensioning of the muscles arising from the lateral epicondyle. In a separate cadaver study, a balloon catheter measured pressure in the radial tunnel after sequential musculo-tendinous lengthening of the forearm extensor muscles. A preliminary clinical study was performed on 12 subjects (13 elbows). All had failed extensive conservative treatment and subsequently underwent combined musculo-tendinous lengthening of ECRB, EDC, and superficial head of supinator (SHS). In the clinical series, 75% of subjects were involved in Work Cover claims. Clinical outcomes in this small series were reviewed.

Results ECRB and EDC tensioning produced the largest force transducer measurements in the common extensor tendon at the lateral epicondyle. SHS increased force transducer measurements moderately, suggesting this muscle may also contribute to the clinical syndrome of lateral epicondylitis. ECRL and ECU tensioning lead to non significant increases in force transducer measurements. Radial tunnel pressure dropped substantially (77%) after musculo-tendinous lengthening of SHS. Lengthening of other forearm extensors had little effect on measured radial tunnel pressure. All subjects recorded improvement in visual analogue pain scores, with post-operative scores between zero and two. Grip strength was preserved or improved. By the criteria of Roles and Maudsley, nine elbows were excellent, two good, one fair and one poor. Overall 11 of the 12 subjects reported they would have the procedure again.

Conclusions This study demonstrates a biomechanical basis for SHS in the aetiology of lateral epicondylitis and radial tunnel syndrome, and supports a combined musculo-tendinous lengthening of ECRB, EDC, and SHS in the treatment of chronic lateral elbow pain. Satisfactory clinical results are reported in this group of patients including those involved in Work Cover claims.