Does high tibial osteotomy affect the success or survival of a total knee replacement?

Background: Whether a previous high tibial osteotomy (HTO) influences the long-term function or survival of a total knee arthroplasty (TKA) is controversial.

Questions/purposes: We compared long-term functional scores and survival of bilateral TKAs in patients who had a previous HTO in one of the knees.

Patients And Methods: From 1980 to 1995, we performed 5043 primary TKAs; 39 of these patients had bilateral TKAs at an average of 8.7 years after unilateral HTO. Surgery was simultaneous in 32 patients and staged in seven. There were 12 women and 27 men with an average age of 66.9 years at the time of surgery. At last followup, 19 of the 39 patients were living and had been reevaluated since our previous study. We determined function with Knee Society scores. The length of followup for patients who had HTOs averaged 14 years (range, 3-21 years); for patients without HTOs, the average followup was 13.9 years (range, 3-22 years).

Results: We observed no differences in Knee Society function and radiographic and pain scores between the knees without and with previous HTO. Terminal extension and flexion, arc of motion, and knee alignment were similar between the knees. There were no femorotibial revisions in either group of knees. Survival at 15 years was 100% for knees without previous HTO and 97% for knees with previous HTO.

Conclusions: Our observations suggest a previous high tibial osteotomy does not influence the function or survival of a knee long term.

Level Of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.