Elsevier

The Journal of Arthroplasty

Volume 13, Issue 8, December 1998, Pages 847-853
The Journal of Arthroplasty

Original article
Total knee replacement after failed tibial osteotomy: Results of a matched-pair study

https://doi.org/10.1016/S0883-5403(98)90188-7Get rights and content

Abstract

Sixty-three total knee replacements were performed after a failed tibial osteotomy. The goal of this study was to compare the perioperative problems and the outcome of this group of patients (study group) to a group of patients with primary arthroplasties matched for age, gender, length of follow-up, weight, and preoperative Charnley class. Operative problems were more frequently encountered in the study group, with 7 tibial tubercle elevations and 15 lateral retinaculum releases needed, whereas lateral retinaculum release was necessary for only 1 knee in the control group. Outcome was assessed using both the International Knee Society (IKS) scoring system and Hospital for Special Surgery (HSS) knee score. The follow-up period averaged 4.6 years. The IKS score of the control group was significantly higher, averaging 80.9 ± 13.8, whereas it was 74.4 ± 14.8 for the study group (P = .0001). Among the parameters included in the knee score, only pain was significantly different with the control group (P = .03). The IKS function score and the HSS score were not statistically different. Conversion of a failed tibial osteotomy is a technically demanding procedure. Careful preoperative planning is needed. Results, especially on pain, appeared to be inferior to those for primary arthroplasties.

References (32)

  • JN Insall et al.

    High tibial osteotomy for varus gonarthrosis: a long-term follow-up study

    J Bone Joint Surg Am

    (1984)
  • MJ Stuart et al.

    Late recurrence of varus deformity after proximal tibial osteotomy

    Clin Orthop

    (1990)
  • MB Coventry et al.

    Proximal tibial osteotomy: a critical long-term study of eighty-seven cases

    J Bone Joint Surg Am

    (1993)
  • I Ivarsson et al.

    High tibial osteotomy for medial osteoarthritis of the knee: a 5 to 7 and 11 year follow-up

    J Bone Joint Surg Br

    (1990)
  • BA Tjornstrand et al.

    High tibial osteotomy: a seven-year clinical and radiographic follow-up

    Clin Orthop

    (1981)
  • S Odenbring et al.

    Revision after osteotomy for gonarthrosis: a 10–19-year follow-up of 314 cases

    Acta Orthop Scand

    (1990)
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