, Volume 472, Issue 1, pp 105-110
Date: 09 May 2013

Total Knee Arthroplasty After High Tibial Osteotomy: No Differences Between Medial and Lateral Osteotomy Approaches

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Abstract

Background

High tibial osteotomy (HTO) has long been accepted as an effective treatment for unicompartmental osteoarthritis of the knee in young, active adults. For varus knees, the two most commonly performed valgus-producing HTOs are the lateral closing wedge and the medial opening wedge. Regardless of technique, some HTOs fail and are converted to TKA. To our knowledge, no studies have directly compared TKAs done after lateral closing-wedge osteotomies to those done after medial opening-wedge osteotomies.

Questions/purposes

We compared pain- and function-related outcomes and survivorship of TKAs in patients who previously underwent medial opening-wedge and lateral closing-wedge HTOs.

Methods

We reviewed our institutional database to identify all patients having undergone a HTO with subsequent conversion to TKA and identified 188 lateral closing-wedge HTOs and 77 medial opening-wedge HTOs. Mean followup was 88 months (range, 3–264 months) for the lateral closing-wedge HTO cohort and 59 months (range, 3–180 months) for the medial opening-wedge cohort. SF-12, WOMAC, and Knee Society Scores, as well as survivorship at 5 years, were compared between the two groups. Statistical analysis was completed using the independent-samples t-test.

Results

No differences were found between groups in postoperative SF-12 scores (p = 0.77 for the mental component summary score and p = 0.21 for the physical component summary score), WOMAC scores (p = 0.67), or Knee Society Scores (p = 0.80). No difference was found in survivorship between groups at 5 years.

Conclusions

Our results suggest there is no difference in functional outcomes or survivorship of TKA in patients having previously undergone medial opening-wedge and lateral closing-wedge HTOs.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

The institution of the authors has received, during the study period, funding from Stryker Orthopaedics (Mahwah, NJ, USA), Smith & Nephew Inc (Memphis, TN, USA), and DePuy Orthopaedics, Inc (Warsaw, IN, USA).
One of the authors certifies that he (JM) has received payments or benefits, during the study period, of less than USD 10,000 from DePuy. One of the authors certifies that he (DN) has received payments or benefits, during the study period, of less than USD 10,000 from Smith & Nephew and Stryker. One of the authors certifies that he (JH) has received payments or benefits, during the study period, of less than USD 10,000 USD from Smith & Nephew, Stryker, and DePuy.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.