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The Journal of Bone and Joint Surgery, Vol 70, Issue 4 547-555, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Technical considerations of total knee arthroplasty after proximal tibial osteotomy
RE Windsor, JN Insall and KG Vince
Hospital for Special Surgery, New York Hospital-Cornell University Medical College, New York City.
Forty-five total knee replacements in forty-one patients who had continued
to have progressive osteoarthritis after a proximal tibial osteotomy were
evaluated prospectively. There were 51 per cent excellent, 29 per cent
good, 4 per cent fair, and 16 per cent poor results after a minimum
follow-up of two years. The resection of tibial bone that was produced by
the osteotomy could not be related causally to the fair or poor clinical
results that were found after arthroplasty. Radiographic study, however,
showed that 80 per cent of the knees had patella infera before the
arthroplasty, which may contribute to altered biomechanics of the
patellofemoral joint of the arthroplasty. The procedure for total knee
replacement is made more difficult by the previous osteotomy, and a
custom-made prosthesis may be required. The clinical results that were
obtained in this series are similar to those for the revision total knee
arthroplasties that have been done at this institution, but they were not
as satisfactory as those that were obtained after primary total knee
replacement. Our results should be considered when a surgeon compares the
advantages and disadvantages of proximal tibial osteotomy with those of
total knee arthroplasty for an older patient who has unicompartmental
osteoarthritis of the knee.
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