Background
Closing wedge high tibial osteotomy (HTO) as a treatment for medial compartment osteoarthritis has a long history. As a result of improvements in operative methods and in the quality of the implants used for total knee arthroplasty (TKA), the use of HTO has decreased considerably in recent years. The clinical results of HTO deteriorate with time despite the initial satisfactory results. The aim of this study was to assess the clinical and radiological results as well as patient satisfaction following knee arthroplasties for failed HTO and to identify the various variables affecting the results.
Patients and methods
Twenty-eight bilateral TKAs were performed in patients who had previously undergone a closed wedge HTO. Different radiological assessments were performed and the American Knee Society Scores were recorded preoperatively and at the latest follow-up. Moreover, patients were asked whether they were satisfied with their operation. The average follow-up was 2.5 years and the average age of the patients was 60.5 years.
Results
The average femoral–tibial angle was corrected from varus 6.5° to valgus 5.75°. The mean improvement in the postoperative arc of flexion was 25°. Preoperatively, the average American Knee Society Score was 45 points and at the final follow-up, it was 82; the improvement was significant.
Conclusion
In conclusion, TKA after HTO improves knee function, but it is a technically demanding operation with altered anatomy and significant balancing problems, and a meticulous surgical technique may lead to satisfactory results in such cases.