Total knee arthroplasty after high tibial osteotomy - A comparison study in patients who had bilateral total knee replacement

Background: The outcome of total knee replacement after high tibial osteoto my remains uncertain. We hypothesized that the results of total knee replac ement with or without a previous high tibial osteotomy are similar. Methods: The results of a consecutive series of thirty-nine bilateral total knee arthroplasties performed with cement at an average of 8.7 years after unilateral high tibial osteotomy were reviewed. There were twenty-seven me n and twelve women. Preoperatively, the knee scores according to the system of the Knee Society were similar for all of the knees; however valgus alig nment and patella infera were more common in the knees with a previous high tibial osteotomy. Bilateral total knee replacement was staged in seven pat ients and was simultaneous in thirty-two patients. The results of the total knee arthroplasties were retrospectively reviewed with respect to the knee and function stores according to the system of the Knee Society, the radio graphic findings, and the complications. Results: Intraoperatively, no notable differences were identified in the nu mber of medial, lateral, or lateral patellar releases required. However, le ss lateral tibial hone mas resected in the group with a previous high tibia l osteotomy (average, 5.3 millimeters) than in the group without a high tib ial osteotomy (average, 7.5 millimeters). The average duration of follow-up was 7.5 years (range, three to sixteen years) in the group with a pre,ions high tibial osteotomy and 6.8 years (range, two to ten years) in the group without a high tibial osteotomy. At the time of the final follow-up, the k nee and function scores were similar for the two groups (89.0 and 81.0 poin ts, respectively far the group with a previous high tibial osteotomy, and 8 9.6 and 83.9 points, respectively, for the group without a high tibial oste otomy). Although more knees were free of pain in the group without a previo us high tibial osteotomy (thirty-six) than in the group with a previous ost eotomy (thirty-three), this difference was not found to be significant nifh the numbers available (p = 0.4810). Knee alignment and stability; femoral and tibial component alignment, and range of motion also were similar in bo th groups postoperatively. One all-polyethylene tibial component was revise d in the high tibial osteotomy group. Two knees in each group required mani pulation. There were no deep infections. Conclusions: While patients,vith a previons high tibial osteotomy may have important differences preoperatively, including valgus alignment, patella i nfera, and decreased bone stock in the proximal part of the tibia, the pres ent study suggests that the clinical and radiographic results of primary to tal knee arthroplasty in knees with and without a previous high tibial oste otomy are not substantially different. In our relatively small group of pat ients, the previous high tibial osteotomy had no adverse effect on the outc ome of the subsequent total knee replacement.