Total Knee Arthroplasty Conversion after Open-wedge High Tibial Osteotomy

Wataru Kusano,Koichiro Ihara,Yasuhiro Tominaga,Ryutaro Kuriyama,Takatomo Mine,Hiroyuki Kawamura,Michio Shinohara

doi:10.2174/1874325002115010053

Abstract

Background: Open-wedge High Tibial Osteotomy (HTO) is an effective treatment for Osteoarthritis (OA) of the knee; however, postoperative changes due to HTO can make subsequent Total Knee Arthroplasty (TKA) technically difficult and can affect long-term survival. Case Report: Medio-lateral stability along with balanced flexion and extension gaps provides a good functional outcome. A 71-year-old man underwent TKA conversion after open-wedge HTO 12 years earlier; the conversion was performed due to arthritic deterioration in the knee. Medial instability was noted because of poor ligament balancing. The residual medial instability was managed with a knee brace due to the unavailability of the constrained prosthesis. Management of persistent mediolateral instability persisting after soft tissue release and balancing ideally requires varus-valgus constraint. Conclusion: TKA conversion after open-wedge HTO requires a special technique and careful preparation before surgery.

Highlights

Surgical treatment options for Osteoarthritis (OA) of the knee are High Tibial Osteotomy (HTO), unicomponental knee arthroplasty, and Total Knee Arthroplasty (TKA)
In relatively young patients who are very physically active and have significant symptoms of medial compartment knee OA, HTO may delay the indication for TKA [1, 2], but postoperative changes due to HTO can make subsequent TKA technically difficult and affect the long-term survival
We present a case of TKA after open-wedge HTO with residual imbalance during the operation that gradually improved

Summary

INTRODUCTION

Surgical treatment options for Osteoarthritis (OA) of the knee are High Tibial Osteotomy (HTO), unicomponental knee arthroplasty, and Total Knee Arthroplasty (TKA). A 71-year-old man underwent open-wedge HTO for OA of the right knee 12 years previously. He had no symptoms in his right knee after HTO for 9 years He developed progressive pain in both knees. He underwent TKA of the left knee one year later. After the left TKA, his right knee pain worsened. He was referred to our department for surgery. Right TKA was performed using a balance knee system Trimax PS type and stem extension of 3 cm (Japan Medical Dynamic Marketing, INC., Tokyo, Japan) with cement. He had mild pain in his right knee joint 1 year and 9 months after right TKA, and the ROM was from 5 to 110°.

DISCUSSION

CONCLUSION

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