Clinical Orthopaedics and Related Research®

, Volume 473, Issue 1, pp 90–93 | Cite as

The Risk of Revision After TKA Is Affected by Previous HTO or UKA

Symposium: 2014 Knee Society Proceedings

Abstract

Background

High tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) are reconstructive surgeries advocated for younger patients. In case of failure or progression of osteoarthritis, they can both be converted to a total knee arthroplasty (TKA).

Questions/purposes

We used registry data to answer if the risks of revision for TKAs after previous HTOs and UKAs differ and how these compare with that of de novo TKAs. Furthermore, we wanted to examine the extent of stemmed/revision implants being used for the conversions.

Methods

We identified HTOs performed during 1998 to 2007 with the help of the inpatient and outpatient care registries of the Swedish National Board of Health and Welfare and gathered relevant information from hospital records. The Swedish Knee Arthroplasty Register was then examined to find all de novo TKAs, TKAs performed after HTO, and TKAs performed after UKA through the end of 2012.

Results

For 920 TKAs after previous UKA and 356 TKAs after previous closed-wedge HTOs, we found the risk of revision significantly higher than for the 118,229 de novo TKAs (risk ratio, 2.8; confidence interval [CI], 2.2–3.5; p < 0.001, and 1.7 CI, 1.1–2.6; p < 0.001, respectively), whereas for the 482 open-wedge osteotomies, the difference was not significant (risk ratio, 1.2; CI, 0.8–1.8; p = 0.44). Stemmed implants were used in 663 of the 117,566 primary de novo TKAs (0.6%), in 22 of the 809 HTO conversions (4%) and in 136 of the 920 UKA conversions (17%).

Conclusions

TKAs after previous reconstructive surgery carry an increased risk for revision. However, our findings do not mitigate against the use of UKA and HTO in selected cases.

Level of Evidence

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

References

  1. 1.
    Amendola A, Rorabeck CH, Bourne RB, Apyan PM. Total knee arthroplasty following high tibial osteotomy for osteoarthritis. J Arthroplasty. 1989;4(Suppl):S11–17.PubMedCrossRefGoogle Scholar
  2. 2.
    Farfalli LA, Farfalli GL, Aponte-Tinao LA. Complications in total knee arthroplasty after high tibial osteotomy. Orthopedics. 2012;35:e464–468.PubMedCrossRefGoogle Scholar
  3. 3.
    Gill T, Schemitsch EH, Brick GW, Thornhill TS. Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy. Clin Orthop Relat Res. 1995;321:10–18.PubMedGoogle Scholar
  4. 4.
    Hang JR, Stanford TE, Graves SE, Davidson DC, de Steiger RN, Miller LN. Outcome of revision of unicompartmental knee replacement. Acta Orthop. 2010;81:95–98.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Jones HW, Chan W, Harrison T, Smith TO, Masonda P, Walton NP. Revision of medial Oxford unicompartmental knee replacement to a total knee replacement: similar to a primary? Knee. 2012;19:339–343.CrossRefGoogle Scholar
  6. 6.
    Katz MM, Hungerford DS, Krackow KA, Lennox DW. Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis. J Bone Joint Surg Am. 1987;69:225–233.PubMedGoogle Scholar
  7. 7.
    Madan S, Ranjith RK, Fiddian NJ. Total knee replacement following high tibial osteotomy. Bull Hosp Jt Dis. 2003;61:5–10.Google Scholar
  8. 8.
    Martin J, Wallace D, Woods D, Carr A, Murray D. Revision of unicondylar knee replacements to total knee replacement. Knee. 1995;2:121–125.CrossRefGoogle Scholar
  9. 9.
    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;82:1252–1259.PubMedGoogle Scholar
  10. 10.
    Mont MA, Antonaides S, Krackow KA, Hungerford DS. Total knee arthroplasty after failed high tibial osteotomy. A comparison with a matched group. Clin Orthop Relat Res. 1994;299:125–130.PubMedGoogle Scholar
  11. 11.
    Parvizi J, Hanssen AD, Spangehl MJ. Total knee arthroplasty following proximal tibial osteotomy: risk factors for failure. J Bone Joint Surg Am. 2004;86:474–479.PubMedGoogle Scholar
  12. 12.
    Pearse AJ, Hooper GJ, Rothwell A, Frampton C. Survival and functional outcome after revision of a unicompartmental to a total knee replacement: the New Zealand National Joint Registry. J Bone Joint Surg Br. 2010;92:508–512.PubMedCrossRefGoogle Scholar
  13. 13.
    Saldanha KA, Keys GW, Svard UC, White SH, Rao C. Revision of Oxford medial unicompartmental knee arthroplasty to total knee arthroplasty—results of a multicentre study. Knee. 2007;14:275–279.PubMedCrossRefGoogle Scholar
  14. 14.
    Staeheli JW, Cass JR, Morrey BF. Condylar total knee arthroplasty after failed proximal tibial osteotomy. J Bone Joint Surg Am. 1987;69:28–31.PubMedGoogle Scholar
  15. 15.
    The Swedish Knee Arthroplasty Register Annual Report 2012. Malmö, Sweden, 2012. Available at: http://www.myknee.se/pdf/117_SKAR_2012_Engl_1.0.pdf. Accessed March 5, 2014.
  16. 16.
    van Raaij TM, Bakker W, Reijman M, Verhaar JA. The effect of high tibial osteotomy on the results of total knee arthroplasty: a matched case control study. BMC Musculoskelet Disord. 2007;8:74.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    W-Dahl A, Robertsson O, Lohmander LS. High tibial osteotomy in Sweden, 1998–2007: a population-based study of the use and rate of revision to knee arthroplasty. Acta Orthop. 2012;83:244–248.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  1. 1.Department of Orthopaedics and Clinical SciencesSUS/Lund University HospitalLundSweden

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