Total knee replacement after high tibial osteotomy. Retrospective comparative study between subtractive and additive osteotomies
Abstract
Introduction: Total knee replacement (TKR) after a high tibial osteotomy presents additional technical difficulties. The objective of this study was to analyze the clinical and radiological outcomes of conversion to TKR after a high tibial osteotomy and to compare the evolution of patients with a history of a closing (subtractive) versus opening (additive) osteotomy. Materials and Methods: A series of 46 knee arthroplasties performed between 1997 and 2019 in 39 patients with a history of a high tibial osteotomy was retrospectively analyzed. The clinical and radiographic parameters were evaluated before and after the arthroplasty by measuring the femorotibial axis, the posterior tibial slope, the Insall Salvati value, and the Knee Society Score. At the same time, the results were compared in patients with a history of subtractive versus additive tibial osteotomy. Results: In the series of 46 patients, an average follow-up of 5.72 years was achieved (minimum 1, maximum 19). The Knee Society Score for the entire series had an average improvement from 42.3 to 79.8 points. The posterior tibial slope and the IS value did not show great modifications after surgery. In this series, the average survival of additive osteotomy until conversion to TKR was 5.5 years, while for the subtractive one it was 13.5 years. Conclusions: Despite the technical difficulty that it may present, TKR after a valgus high tibial osteotomy presented a good clinical-radiological evolution in the short and medium term and the type of osteotomy did not affect the results obtained after arthroplasty.Downloads
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