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• W2949596785 abstract "Commentary Traditionally, total knee arthroplasty following high tibial osteotomy has been reported as having inferior results to primary knee arthroplasty. The loss of tibial plateau height, patella baja, and either loss of correction or overcorrection of the varus deformity are known problems associated with the procedure. An article by Keenan et al. demonstrated a survival rate of 84% at 5 years, 65% at 10 years, and 55% at 15 years for opening-wedge high tibial osteotomy for the treatment of medial compartment osteoarthritis of the knee1. The 2 independent predictors of failure were female sex and older age. Older patients, with a threshold of 47 years, were more likely to require early conversion to total knee arthroplasty; at the age of ≥47 years, the failure risk was substantially increased. Forty of 111 knees were converted to total knee arthroplasty at a mean of 6.3 years. Women were more likely than men to undergo conversion. In the current article, Chalmers et al. note that some prior reports of total knee arthroplasty after high tibial osteotomy have shown high rates of aseptic loosening. Valgus-producing high tibial osteotomy has been historically used for young, active patients with isolated medial compartment disease. The rationale for high tibial osteotomy was to delay knee arthroplasty in younger, active patients. However, unicompartmental knee arthroplasty with long-term satisfactory results has become common, reducing the frequency of high tibial osteotomy. In a large, population-based 2018 study performed over a 10-year period and reported in the Danish Knee Arthroplasty Registry2, it was noted that younger age and male sex were associated with worse long-term survival for knee arthroplasty after high tibial osteotomy. Differences in the clinical outcome between total knee arthroplasty following high tibial osteotomy and total knee arthroplasty without prior high tibial osteotomy are unknown according to El-Galaly et al.2. After adjustment for male sex and younger age, total knee arthroplasty after high tibial osteotomy for medial compartment osteoarthritis had a survival similar to that of primary total knee arthroplasty. El-Galaly et al. concluded that high tibial osteotomy alone does not alter the survival of a subsequent total knee arthroplasty. The conversion from high tibial osteotomy to total knee arthroplasty has been noted to occur after failure of the high tibial osteotomy. Bae et al. reported on intermediate-term results of total knee arthroplasties after closing-wedge high tibial osteotomy compared with primary total knee arthroplasty3. Their results supported other studies confirming that converting high tibial osteotomy to total knee arthroplasty produced similar results when compared with primary total knee arthroplasty. Prior closing-wedge high tibial osteotomy had no detrimental effect on the intermediate-term outcome when converted to total knee arthroplasty, including patellar symptoms and the patellar position. In the current study by Chalmers et al. of 207 patients who underwent 231 total knee arthroplasties with a cemented prosthesis after high tibial osteotomy, a variety of implants were used, with survivorship free from aseptic loosening of 99% at 5 years and 97% at 10 years. Most patients were male, and the mean age of conversion was 64 years (range, 30 to 79 years). Patella baja was noted equally between medial and lateral osteotomies. At the time of knee arthroplasty, neither a rectus snip nor tibial tubercle osteotomy was required for knee exposure. Fibrosis behind the patellar tendon is frequent after high tibial osteotomy and may make exposure of the knee more difficult. The presence of patella baja without a tibial tuberosity osteotomy is to be expected. A study by Staubli et al. described a technique of medial opening-wedge osteotomy and a coronal plane osteotomy posterior to the tibial tuberosity to minimize the potential for patella baja4. A medial titanium locking plate is used to hold the correction and the technique does not require a fibular osteotomy. Opening-wedge high tibial osteotomies allow for the preservation of the tibial plateau and, when performed as described by Staubli et al., minimize patella baja. A 10-year follow-up by Darees et al. of medial opening-wedge high tibial osteotomy noted a survival rate of 87.9% with total knee arthroplasty as the end point5. They noted that the survival of their cohort was comparable with those in other studies. The patients who underwent conversion to total knee arthroplasty required no additional surgical steps, and none of those patients had complications related to the total knee arthroplasty. The need for the removal of previous high tibial osteotomy implants at the time of total knee arthroplasty depends on the position of the implant and whether it would interfere with a stemmed tibial component. Hernigou et al. compared fixed-bearing and mobile-bearing total knee arthroplasty after high tibial osteotomy and noted no difference6. They followed their patients for a mean of 15 years and found comparable results between the 2 groups. High tibial osteotomy did not adversely affect prosthetic component fixation in both devices. In a review of the literature, Rodriguez-Merchan noted that a previous high tibial osteotomy did not influence the function or survival of a total knee replacement in the long term7. Chalmers et al. used several different implants, with durable survivorship free from aseptic loosening at 10 years (97%) and free from any revision at 10 years (90%). Posterior-stabilized components were used for most of the surgical procedures and tibial stemmed components were more frequently used for medial osteotomies requiring implant removal. It seems safe to conclude that a previous high tibial osteotomy does not seem to alter the results of conversion to revision total knee arthroplasty if that is required." @default.
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• W2949596785 date "2019-06-05" @default.
• W2949596785 modified "2023-09-28" @default.
• W2949596785 title "Does High Tibial Osteotomy Still Have a Role in Knee Surgery?" @default.
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• W2949596785 doi "https://doi.org/10.2106/jbjs.19.00242" @default.
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