Total knee arthroplasty following medial opening wedge tibial osteotomy: technical issues early clinical radiological results.
Medial opening wedge high tibial osteotomy is a popular treatment option for medial compartment osteoarthritis of the knee. One of the proposed advantages is easier conversion to a total knee replacement compared to lateral closing wedge osteotomies, although there are few studies to support this. We reviewed the technical considerations in 36 knees in which conversion of a medial opening wedge osteotomy to total knee arthroplasty was performed, and contrasted these to previously reported studies of knee arthroplasty after closing lateral wedge or dome osteotomies. The clinical results in 33 patients (34 knees) with minimum 2 year follow-up (mean 3.4 years, range 2 to 8 years) were compared to a control group of 1315 knee arthroplasties performed without prior tibial osteotomy. Total knee arthroplasty after a medial opening wedge osteotomy is relatively straightforward, although we encountered patella baja in 27% of cases, and an increased posterior tibial slope of over 15° in 21%. There was a lower Knee Society score and a lower pain score (more pain) in the study group compared to the control group. While technically straightforward in most cases, knee arthroplasty following medial opening wedge osteotomy in this study group yielded inferior clinical results compared to a group of knee arthroplasties performed without prior tibial osteotomy.
Division of Orthopaedic Surgery, London Health Sciences Centre, University Campus, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada, N6A 5A5. sanierak@iinet.net.au
Sani
S
Erak
Douglas
D
Naudie
Steven J
SJ
MacDonald
Richard W
RW
McCalden
Cecil H
CH
Rorabeck
Robert B
RB
Bourne
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D017760:Bone Malalignment; D005260:Female; D006304:Health Status; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D010027:Osteotomy / Q000009:adverse effects*; D010329:Patella / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology*; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome