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Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy

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Abstract

Purpose

High tibial osteotomy (HTO) is frequently used to treat varus osteoarthritis in younger patients with the goal of delaying the need for total knee arthroplasty (TKA). While it has been reported that the results of TKA following HTO are worse than those in patients without prior knee surgery, the influence of osteotomy technique (medial opening-wedge versus lateral closing-wedge) has not been explored. The purpose of this study was to evaluate the influence of HTO technique on the performance and results of TKA.

Methods

A total of 141 TKA’s performed in 118 patients with prior HTO (24 opening wedge and 117 closing wedge) were reviewed at a mean follow-up of two years. Reviewed data included intra-operative factors (tourniquet time, the need for additional exposure, and intra-operative complications), clinical results (International Knee Score (IKS)) and radiographic assessment of limb alignment.

Results

The average IKS knee and function scores improved from 54.0 and 60.3 to 87.0 and 79.5 (p <  0.0001). There was no significant difference in IKS scores based on osteotomy technique. There was a trend toward an increased need for tibial tubercle osteotomy in the closing wedge group. There was an increased need for extensive medial release in the opening wedge group and extensive lateral release in the closing wedge group. No differences in tourniquet time, complication rates, or hip-knee-ankle angle were noted between the two groups.

Conclusions

Radiographic limb alignment, patient-reported outcomes, and complication rates are equal in patients undergoing TKA after opening and closing wedge HTO.

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Conflicts of interest

One of the authors receives royalties from Tornier. Three authors have received research and travel support from Tornier.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hôpital de la Croix-Rousse, Centre Albert Trillat, Lyon, France

    Ricardo Bastos Filho, Victoria Duthon, Guillaume Demey, Elvire Servien & Philippe Neyret

  2. CAPES Foundation, Ministry of Education, Brasília, Brazil

    Ricardo Bastos Filho

  3. Post-graduate Program, Fluminense Federal University, Rio de Janeiro, Brazil

    Ricardo Bastos Filho

  4. Department of Orthopaedics, Sports Health and Performance Institute, The Ohio State University, 2050 Kenny Rd, Columbus, OH, 43221, USA

    Robert A. Magnussen

  5. Dental School, Fluminense Federal University, Rio de Janeiro, Brazil

    José Mauro Granjeiro

  6. Bioengeneering Division, National Institute of Metrology, Quality, and Technology, Brasilia, Brazil

    José Mauro Granjeiro

Authors
  1. Ricardo Bastos Filho
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  2. Robert A. Magnussen
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  3. Victoria Duthon
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  4. Guillaume Demey
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  5. Elvire Servien
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  6. José Mauro Granjeiro
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  7. Philippe Neyret
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Corresponding author

Correspondence to Robert A. Magnussen.

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Filho, R.B., Magnussen, R.A., Duthon, V. et al. Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy. International Orthopaedics (SICOT) 37, 427–431 (2013). https://doi.org/10.1007/s00264-012-1765-5

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  • DOI: https://doi.org/10.1007/s00264-012-1765-5

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