2015 ISAKOS Biennial Congress ePoster #1714

Total Knee Arthroplasty After High Tibial Osteotomy: A Comparison of Opening and Closing Wedge Osteotomy

Ricardo P. Bastos-Filho, MD, PhD, Prof., Rio De Janeiro, RJ BRAZIL
Elvire Servien, MD, PhD, Prof., Lyon, Rhône Alpes FRANCE
Robert A. Magnussen, MD, MPH, Columbus, OH UNITED STATES
Guillaume Demey, MD, Lyon, Rhône Alpes FRANCE
Sebastien Lustig, MD, PhD, Prof., Lyon, Rhône Alpes FRANCE
Philippe N. Neyret, MD, PhD, Prof., Lyon La Tour De Salvagny FRANCE

Hôpital de la Croix-Rousse, Lyon, Lyon, FRANCE

FDA Status Not Applicable

Summary: 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.

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Abstract:

Background

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

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 2 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.