HSS Journal ®

, Volume 9, Issue 2, pp 134–137 | Cite as

Outcome of Total Knee Arthroplasty After High Tibial Osteotomy: Does Malalignment Jeopardize the Results when Using a Posterior-Stabilized Arthroplasty?

  • Philippe Hernigou
  • Pascal Duffiet
  • Didier Julian
  • Issac Guissou
  • Alexandre Poignard
  • Charles Henri Flouzat-Lachaniette
Original Article



The controversy regarding the outcome of total knee arthroplasties after high tibial osteotomy may relate to malalignment secondary to overcorrection after high tibial osteotomy (HTO) [1, 2] and to the type of arthroplasty itself (posterior-stabilized arthroplasty or posterior cruciate ligament-retaining prosthesis).


We asked two questions: (1) Would a posterior-stabilized arthroplasty provide sufficient constrain and improve pain and function in patients with severe malalignment due to a previous HTO? (2) Will malalignment of the previous HTO jeopardize the long-term results of a total knee reconstruction with a posterior-stabilized implant?

Patients and Methods

We retrospectively reviewed 25 posterior-stabilized TKAs in 25 patients with severe valgus deformity after HTO (ranging from 10° to 20° of valgus) and compared the results with a series of matched 25 posterior-stabilized TKAs in 25 patients with normocorrection after HTO ranging from 5° of valgus to 5° of varus. Clinical, operative, and radiographic data were reviewed. Minimum follow-up was 10 years after the arthroplasty (average, 15 years; range, 10–20 years).


All the knees had standard posterior-stabilized total knee arthroplasty implants. Patients with an overcorrected HTO were more likely to require a soft tissue release to balance the knee. However, Average Knee Society and Function Score improved, respectively, from 48 to 85 and from 50 to 90 points in the severely overcorrected group, versus, respectively, 50 to 89 and 52 to 97 in the normocorrected group, but the range of mobility was superior for patients with normal alignment. Fifteen-year survivorship after the arthroplasty comparison showed no significant difference between the two groups (one revision in each group).


Patients with an overcorrected HTO are more likely to require a soft tissue release to balance the knee. However, both groups show improvements in function and pain. With a posterior-stabilized arthroplasty, the degree of deformity has no impact on the longevity of the TKA.


total knee arthroplasty high tibial osteotomy posterior-stabilized arthroplasty 



Conflict of Interest:

Philippe Hernigou, MD, Pascal Duffiet, MD, Didier Julian, MD, Issac Guissou, MD, Alexandre Poignard, MD, and Charles Henri Flouzat-Lachaniette, MD have declared that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

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  1. 1.
    Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A. High tibial valgus osteotomy for medial gonarthrosis: a 10- to 21-year study. J Knee Surg. 2003;16(1):21-26.PubMedGoogle Scholar
  2. 2.
    Buechel FF. A sequential three-step lateral release for correcting fixed valgus knee deformities during total knee arthroplasty. Clin Orthop Relat Res. 1990;260:170-175.PubMedGoogle Scholar
  3. 3.
    Caton J. Patella Infera. Apropos of 128 cases. Rev Chir Orthop Réparatrice Appar Mot. 1982;68(5):317-325.PubMedGoogle Scholar
  4. 4.
    Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis: indications, operative technique, and results. J Bone Joint Surg Am. 1973;55(1):23-48.PubMedGoogle Scholar
  5. 5.
    Ewald FC. The Knee Society total arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9-12.PubMedGoogle Scholar
  6. 6.
    Garvin KL, Scuderi GR, Insall JN. Evolution of the quadriceps snip. Clin Orthop Relat Res. 1995;321:131-137.PubMedGoogle Scholar
  7. 7.
    Haddad FS, Bentley G. Total Knee arthroplasty after high tibial osteotomy. A medium term review. J Arthroplasty. 2000;15(5):597-603.PubMedCrossRefGoogle Scholar
  8. 8.
    Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am. 1987;69(3):332-354.PubMedGoogle Scholar
  9. 9.
    Insall JN, Joseph DM, Msika C. High tibial osteotomy for varus gonarthrosis. A long-term follow-up study. J Bone Joint Surg Am. 1984;66(7):1040-1048.PubMedGoogle Scholar
  10. 10.
    Katz MM, Hungerford DS, Krackow KA, Lennox DE. Results of knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis. J Bone Joint Surg Am. 1987;69(2):225-233.PubMedGoogle Scholar
  11. 11.
    KrackowKA HJL. Experience with a new technique for managing severely overcorrected valgus high tibial osteotomy at total knee arthroplasty. Clin Orthop Relat Res. 1990;258:213-224.Google Scholar
  12. 12.
    Meding JB, Keating EM, Ritter MA, Faris PM. Total knee arthroplasty after high tibial osteotomy. A comparison study in patients who had bilateral total knee replacement. J Bone Joint Surg Am. 2000;82(9):1252-1259.PubMedGoogle Scholar
  13. 13.
    Mont MA, Alexander N, Krackow KA, Hungerford DS. Total knee arthroplasty after failed proximal tibial valgus osteotomy. A comparison with a matched group. Clin Orthop Relat Res. 1994;299:125-130.PubMedGoogle Scholar
  14. 14.
    Nelson CL, Haas SB. Total knee arthroplasty following high tibial osteotomy. In: Sculco TP, Martucci EA, eds. Knee arthroplasty. Wien: Springer; 2002:91-10123.Google Scholar
  15. 15.
    Scuderi GR, Windsor RE, Insall JN. Observation on patellar height after proximal tibial osteotomy. J Bone Joint Surg Am. 1989;71(2):245-248.PubMedGoogle Scholar
  16. 16.
    Whiteside LA, Ohl MD. Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res. 1990;260:6-9.PubMedGoogle Scholar
  17. 17.
    Whiteside LA. Selective ligament release in total knee arthroplasty of the knee in valgus. Clin Orthop Relat Res. 1999;367:130-140.PubMedCrossRefGoogle Scholar
  18. 18.
    Windsor RE, Insall JN, Vince KG. Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg Am. 1988;70(4):547-555.PubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2013

Authors and Affiliations

  • Philippe Hernigou
    • 1
    • 2
  • Pascal Duffiet
    • 1
    • 2
  • Didier Julian
    • 1
    • 2
  • Issac Guissou
    • 1
    • 2
  • Alexandre Poignard
    • 1
    • 2
  • Charles Henri Flouzat-Lachaniette
    • 1
    • 2
  1. 1.Hospital Henri MondorCreteilFrance
  2. 2.University Paris EastCreteilFrance

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