Unicompartmental knee replacement after high tibial osteotomy

Abstract

The outcome of high tibial osteotomy (HTO) deteriorates with time, and additional procedures may be required. The aim of this study was to compare the clinical and radiological outcomes between unicompartmental knee replacement (UKR) and total knee replacement (TKR) after HTO as well as after primary UKR. A total of 63 patients (63 knees) were studied retrospectively and divided into three groups: UKR after HTO (group A; n = 22), TKR after HTO (group B; n = 18) and primary UKR (group C; n = 22). The Oxford knee score (OKS), Knee Society score (KSS), hip-knee-ankle angles, mechanical axis and patellar height were evaluated pre- and post-operatively. At a mean of 64 months (19 to 180) post-operatively the mean OKS was 43.8 (33 to 49), 43.3 (30 to 48) and 42.5 (29 to 48) for groups A, B and C, respectively (p = 0.73). The mean KSS knee score was 88.8 (54 to 100), 88.11 (51 to 100) and 85.3 (45 to 100) for groups A, B and C, respectively (p = 0.65), and the mean KSS function score was 85.0 (50 to 100) in group A, 85.8 (20 to 100) in group B and 79.3 (50 to 100) in group C (p = 0.48). Radiologically the results were comparable for all groups except for patellar height, with a higher incidence of patella infra following a previous HTO (p = 0.02).

Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment

“…Within recent years, there has been good evidence that arthroplasty after osteotomy is associated with excellent results despite being technically demanding. 38,40,52 Thus, by postponing primary arthroplasty even in severe osteoarthritis, osteotomies can improve the unsolved problem of impending multiple revision arthroplasties, especially in younger patients.…”

Combined Biplanar High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Abrasion/Microfracture in Severe Medial Osteoarthritis of Unstable Varus Knees

“…Furthermore, if arthroplasty should be necessary within the further course because of persistent or reoccurring complaints from unicondylar osteoarthritis, a corrected axis and regained ligamentous stability might facilitate or enable the implantation of a UKA instead of a TKA in the first place in these cases, which would not have been possible in an ACL-insufficient knee with significant varus malalignment. 45,46 Functional improvements were reported by several authors after combined procedures of HTO and ACLR: A recently published review of 11 studies with simultaneous HTO and ACLR reported improvements in all subjective evaluations, regardless of the scoring system used. 28 A great heterogeneity regarding surgical technique, indication, and outcome measurement is present in the included studies.…”

Correction of coronal alignment correlates with reconstruction of joint height in unicompartmental knee arthroplasty

“…1-4 Accuracy of implant positioning and restoring the proper limb alignment are required for the long-term survival of the implants. 5 A neutral correction or slight undercorrection in the coronal alignment is advocated in the literature.…”