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 Adult Knee Reconstruction Test 5: Knee Arthroplasty
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:474-479 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Total Knee Arthroplasty Following Proximal Tibial Osteotomy: Risk Factors for Failure

Javad Parvizi, MD1, Arlen D. Hanssen, MD2 and Mark J. Spangehl, MD3

1 The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address: parvj{at}aol.com
2 Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
3 Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259. E-mail address: spangehl.mark{at}mayo.edu

Investigation performed at the Mayo Clinic, Rochester, Minnesota

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available from the Video Jour- nal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Background: The results of proximal tibial osteotomy are known to deteriorate over time, with the majority of patients eventually requiring total knee arthroplasty. The outcome of total knee arthroplasty in patients who have had a proximal tibial osteotomy, compared with that of routine primary total knee arthroplasty, remains controversial. The purpose of the present study was to evaluate the long-term clinical and radiographic outcome of total knee arthroplasty in patients who had undergone a previous proximal tibial osteotomy and to identify the risk factors that may result in an inferior outcome.

Methods: Between 1980 and 1990, 166 cemented condylar total knee prostheses were implanted in 118 patients who had had a previous proximal tibial osteotomy for the treatment of osteoarthritis. The study group included seventy-seven men and forty-one women who had a mean age of 69.1 years at the time of knee arthroplasty. The average interval between the osteotomy and the total knee arthroplasty was 8.6 years. The average duration of clinical follow-up was 15.1 years, and the average duration of radiographic follow-up was 9.2 years.

Results: The mean Knee Society pain score improved from 34.5 to 82.9 points, and the mean function score improved from 44.6 to 88.1 points. There was also a substantial improvement in the mean arc of motion. Thirteen knees (8%) were revised at a mean of 5.9 years. At the time of the final follow-up, progressive complete radiolucent lines indicating a loose prosthesis were present around seventeen tibial components and seven femoral components.

Conclusions: There was a very high rate of radiographic evidence of loosening. Male gender, increased weight, young age at the time of total knee arthroplasty, coronal laxity, and preoperative limb malalignment were identified as risk factors for early failure. Despite these findings, total knee arthroplasty can provide reliable and durable pain relief and improvement in function for patients who have had a previous proximal tibial osteotomy.

Level of Evidence: Prognostic study. Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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Related articles in JBJS:

Total Knee Arthroplasty Following Proximal Tibial Osteotomy • J. Parvizi, A.D. Hanssen, and M.J. Spangehl reply:
S. Robert Rozbruch, Javad Parvizi, Arlen D. Hanssen, and Mark J. Spangehl
JBJS 2004 86: 2571. [Extract] [Full Text]  



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Letters to the Editor:

Read all Letters to the Editor

Not all Osteotomies are the Same
S. Robert Rozbruch, MD, et al.
JBJS Online, 7 Apr 2004 [Full text]
Dr. Spangehl responds:
Mark J. Spangehl, et al.
JBJS Online, 7 Apr 2004 [Full text]