title: Results and complications of single-stage total knee arthroplasty and high tibial osteotomy.
abstract: OBJECTIVE
  Long-term survival in total knee arthroplasty (TKA) depends on multiple factors, including restoration of mechanical alignment and obtaining optimal ligament balance. The aim of this study was to document the results of single-stage TKA combined with high tibial osteotomy for managing femorotibial arthrosis with significant frontal-plane deformity.
  
  
  METHODS
  Patients with osteoarthritis of the knee and extra-articular deformity in > 10° and operated between 1997 and 2001 were reviewed retrospectively. In each case, a high tibial osteotomy combined with a posterior stabilised TKA was performed. Patients were assessed using the Knee Society Score (KSS). The femorotibial mechanical angle was measured on radiographs pre- and postoperatively and at the most recent follow-up.
  
  
  RESULTS
  Fifteen knees in 12 patients were included in the study. Mean age was 68.2; average follow-up was 78 months (22.1-145.9). The KSS improved significantly from 47.1 (28-58) to 60.7 (40-94) points (p < 0.05), with the KSS functional score improving from 45.1 (21-69) to 72.3 (30-100) points (p < 0.05). The femorotibial mechanical axis (mFTA) also improved significantly, from 161.7° (156-170°) preoperatively to 175.8° (170-182°) postoperatively (p = 0.002). There were four intra-operative tibial plateau fractures and two revisions for nonunion at the osteotomy site. Survival at 22 months was 86.7% [95% confidence interval (CI) 64.5-99.5%].
  
  
  CONCLUSIONS
  The combination of a TKA and high tibial osteotomy is a valid option for treating arthrosis with large extra-articular frontal-plane deformity. Rigid fixation of the osteotomy is essential.
authors: Service de chirurgie orthopédique, centre Albert Trillat, Université Claude Bernard Lyon 1, Hôpital de la Croix-rousse, Hospices civils de Lyon, 103 grande rue de la Croix-rousse, 69004, Lyon, France, anya.madelaine@hotmail.fr.
authors: Anya
authors: A
authors: Madelaine
authors: Vincent
authors: V
authors: Villa
authors: Christian
authors: C
authors: Yela
authors: Timothy
authors: T
authors: Lording
authors: Sebastien
authors: S
authors: Lustig
authors: Elvire
authors: E
authors: Servien
authors: Philippe
authors: P
authors: Neyret
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D017760:Bone Malalignment / Q000601:surgery*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome