Prior high tibial osteotomy is not a contraindication for medial unicompartmental knee arthroplasty

Abstract

PurposeTo report on the outcome and complications of minimal invasive medial unicondylar knee arthroplasty (UKA) after failed prior high tibial osteotomy (HTO) as treatment for medial osteoarthritis in the knee. The hypothesis was that good results can be achieved, if no excessive postoperative valgus alignment and abnormal proximal tibial geometry is present. MethodsAll medial UKAs after failed prior HTO (n = 30), performed between 2010 and 2018 were retrospectively reviewed. The patients were followed for revision surgery and survival of the UKA (defined as revision to TKA). Clinical examination using the Knee Society Score (KSS), Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as radiological examination was performed. Radiographs were studied and the influence of the demographic factors and the radiographic measurements on the survival and the clinical outcome was analysed. ResultsAfter a follow‐up of 4.3 ± 2.6 years (2.1–9.9) 27 UKAs were available. The survival rate was 93.0%. Two UKAs were revised to TKA (excessive valgus alignment and tibial loosening with femoropatellar degeneration). Two further patients had revision surgery (hematoma and lateral meniscus tear). Follow‐up clinical and radiological examination was performed in 21 cases: KSS 82.9 ± 10.1 (54.0–100.0), KSS (function) 93.3 ± 9.7 (70.0–100.0); OKS 42.7 ± 6.0 (25.0–48.0); WOMAC 7.9 ± 15.6 (0.0–67.1). No significant influence of demographic factors or radiological measurements on the clinical outcome was present. ConclusionPrior HTO is not a contraindication for medial UKA, because good‐to‐excellent results can be achieved in selected patients with medial osteoarthritis and previous HTO, treated with medial UKA, in a midterm follow‐up. Excessive mechanical valgus axis should be avoided; therefore, patient selection and accurate evaluation of medial laxity, preoperative mechanical axis, joint line convergence and proximal tibial geometry are important. Level of evidenceIII.

10-Year Survival Rates After High Tibial Osteotomy Using Angular Stable Internal Plate Fixation: Case Series With Subgroup Analysis of Outcomes After Combined Autologous Chondrocyte Implantation and High Tibial Osteotomy

“…These findings are in accordance with present studies and disprove earlier descriptions of higher complication rates for TKA after HTO. 36 Patients remained physically active on a recreational level. In HTO for progressing medial OA, a higher BMI at the time of surgery resulted in a lower functional outcome.…”

“…These findings are in accordance with present studies and disprove earlier descriptions of higher complication rates for TKA after HTO. 36 Patients remained physically active on a recreational level. In HTO for progressing medial OA, a higher Patients in the combined HTO and ACI subgroup presented good-to-excellent functional outcome in line with their very high TKA-free survival rates even after 10 years.…”

Treatment of medial-sided injuries in patients with early bicruciate ligament reconstruction for knee dislocation

“…In chronic medial side injury, reconstruction is recommended [ 23 , 39 ] because late repair of the medial side might lead to an inferior outcome [ 19 ]. Combined MCL and PCL injury is rare [ 3 , 18 , 31 ], with no clear consensus on treatment strategies [ 4 , 38 ].…”

Mid- to Long-Term Outcomes After Medial Open-Wedge High Tibial Osteotomy in Patients With Radiological Kissing Lesion

“… 18 , 32 AKS knee and function scores were graded as excellent (80-100), good (70-79), fair (60-69), or poor (<60). 4 , 18 , 42 ROM was evaluated using a 30-cm plastic movable arm preoperatively and at every follow-up. 37 Preoperative and postoperative AKS scores and ROM were compared between the RKL and no-RKL groups.…”