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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

Abstract

Background

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).

Questions/Purpose

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).

Results

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).

Conclusions

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.

Keywords

total knee arthroplasty high tibial osteotomy posterior-stabilized arthroplasty 

Notes

Disclosures

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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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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