Long-term results of total knee arthroplasty following high tibial osteotomy according to Wagner

Abstract

Purpose There is relatively little information available about the long-term results of total knee arthroplasty (TKA) following high tibial osteotomy. The aim of our study was to share our experiences and long-term results of TKA after a previous closing wedge high tibial osteotomy according to Wagner. Methods In a retrospective study we identified 48 consecutive patients who had undergone TKA after a previous closing wedge high tibial osteotomy according to Wagner with a follow-up of over ten years. The average duration of follow-up after the TKA was 13.3 years (min 10.0, max 15.5). X-rays were taken in two planes before TKA, one week after TKA and at the latest follow-up. Tibiofemoral alignment was measured on weightbearing long-leg anteroposterior radiographs. Radiolucent lines at the latest follow-up were documented. Functional evaluations were performed preoperatively and postoperatively (at the time of latest follow-up).Results The mean Knee Society function score increased from 63.1 points preoperatively to 90.0 points postoperatively. The mean overall Knee Society score increased from 93.2 points preoperatively to 160.8 points postoperatively. The mean average femoro-tibial angle was corrected from varus 0.8°(varus 14°-valgus 8.0°) preoperatively to valgus 7.6°(valgus 2-9°) at the last follow-up. Conclusions The closing wedge high tibial osteotomy according to Wagner does not compromise subsequent total knee replacement and leads to good clinical and radiological results.

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

“…They also found use of stemmed implants similar to that in our study. Some independent studies with small numbers of patients have found equal outcome in TKA patients operated after HTO and in patients with a primary TKA regarding functional outcome and survival (Meding et al 2000), or functional measures only (Treuter et al 2012), whereas other studies have indicated more failures with higher reoperation rates (Parvizi et al 2004, Haslam et al 2007). …”

Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy

“…The two most commonly performed HTO techniques for varus osteoarthritis are medial opening wedge HTO and lateral closing wedge HTO. Closing wedge HTO has a long history of use in cases of varus osteoarthritis and the majority of studies of results of TKA after HTO focus on lateral closing wedge osteotomies [2,20]. Frequently reported problems are related to previous surgery and consist of hardware removal, joint exposure, dealing with tibial deformities due to the previous osteotomy and managing soft tissue mismatches.…”

How safe are orthoroentgenograms in determining the amount of correction for varus deformities?

“…Ameliyat esnasında, ameliyat öncesinde hesaplanmış olan varus deformitesinin düzeltilmesine çalışılır. [5][6][7] Varus deformitesinin miktarını saptamak amacıyla en sık başvurulan yöntem, ameliyat önce-si dönemde çekilen ortoröntgenogramlardır. [8] Ortoröntgenogramların, deformite miktarını tespit etmede çok başarılı bir yöntem olduğunu belirten pek çok çalışma vardır.…”