Outcome of Total Knee Arthroplasty After High Tibial Osteotomy: Does Malalignment Jeopardize the Results when Using a Posterior-Stabilized Arthroplasty?

Abstract

Background: The controversy regarding the outcome of total knee arthroplasties after high tibial osteotomy may relate to malalignment secondary to overcorrection after high tibial osteotomy (HTO) [1,2] and to the type of arthroplasty itself (posterior-stabilized arthroplasty or posterior cruciate ligamentretaining prosthesis). Questions/Purpose: We asked two questions: (1) Would a posterior-stabilized arthroplasty provide sufficient constrain and improve pain and function in patients with severe malalignment due to a previous HTO? (2) Will malalignment of the previous HTO jeopardize the long-term results of a total knee reconstruction with a posterior-stabilized implant? Patients and Methods: We retrospectively reviewed 25 posterior-stabilized TKAs in 25 patients with severe valgus deformity after HTO (ranging from 10°to 20°of valgus) and compared the results with a series of matched 25 posteriorstabilized TKAs in 25 patients with normocorrection after HTO ranging from 5°of valgus to 5°of varus. Clinical, operative, and radiographic data were reviewed. Minimum follow-up was 10 years after the arthroplasty (average, 15 years; range, 10-20 years). Results: All the knees had standard posterior-stabilized total knee arthroplasty implants. Patients with an overcorrected HTO were more likely to require a soft tissue release to balance the knee. However, Average Knee Society and Function Score improved, respectively, from 48 to 85 and from 50 to 90 points in the severely overcorrected group, versus, respectively, 50 to 89 and 52 to 97 in the normocorrected group, but the range of mobility was superior for patients with normal alignment. Fifteen-year survivorship after the arthroplasty comparison showed no significant difference between the two groups (one revision in each group). Conclusions: Patients with an overcorrected HTO are more likely to require a soft tissue release to balance the knee. However, both groups show improvements in function and pain. With a posterior-stabilized arthroplasty, the degree of deformity has no impact on the longevity of the TKA.

The Mid-Term Outcome of Total Knee Arthroplasty in Patients With Prior High Tibial Osteotomy: A Prospective Study

“…They revealed that patients with an overcorrected HTO were more likely to require a soft tissue release to balance the knee. However, with a posterior stabilized arthroplasty, the degree of deformity had no impact on the longevity of the TKA (14).…”

“…On the other hand, some recent studies revealed opposite results (1,10,(12)(13)(14). In a study by Meding et al the long-term functional scores and survival of bilateral TKAs were compared in patients with a previous HTO in one of the knees.…”

“…Most of the studies demonstrating inferior results in the arthroplasties after HTO were published before 2007 (5,11,15,16). But almost all the recent researches show that previous HTO does not have significant effects on the mid-term clinical and radiologic outcomes (12,14,20,22). It is possible due to improvement in surgical techniques and the design of new prosthesis.…”

“…It is generally accepted that TKA after HTO is technically more difficult (10,11); however, there is still disagreement whether the subsequent TKA is compromised. Although several comparative studies showed contradictory results; some (1,2,10,(12)(13)(14) suggesting that prior HTO does not change later TKA outcome and others (5,11,15,16) concluding that the converse is true.…”

Conversion Total Knee Arthroplasty after Failed High Tibial Osteotomy

“…Many authors recommend the use of the PCL substituting prosthesis for conversion TKA after HTO because of PCL contracture, insufficiency, and postoperative stiffness 52 53) . They claimed that it was difficult to maintain the appropriate tension of the PCL and balance the flexion and extension gap because of the tibial bone defect and the relaxation of the PCL.…”