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Osteotomy and subsequent TKA may be effective for treating varus osteoarthritis in younger patients

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SAN DIEGO — An orthopedic surgeon from France reported good results at an average 30-years follow-up in younger patients with varus deformity who underwent high tibial osteotomy followed by total knee arthroplasty at a later stage.

Philippe Hernigou

Philippe Hernigou, PhD, presented his team’s findings here at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

“This two-step strategy — isolated valgus osteotomy with total knee arthroplasty at a later stage — allowed obtaining good results with 94% survivorship 30 years after the first operation and 15 years after the arthroplasty,” Hernigou said.

Study methods

Hernigou and colleagues’ retrospective study included 143 patients who underwent high tibial osteotomy at their institution between 1985 and 1990, and total knee arthroplasty (TKA) between 1992 and 2000. Average patient age was 45 years at the time of the initial procedure. These patients were compared to a randomly chosen group of 150 patients who underwent only TKA. All patients in the study received the same cemented posterior stabilized implant.

Hernigou reported significantly lower functional and quality of life scores in patients who first underwent high tibial osteotomy. Flexion improved postoperatively in the osteotomy group from 83° to 108° compared with 115° to 127° in the TKA-only group.

“However, 15-year survivorship after the arthroplasty showed no significant difference between the two groups,” Hernigou said.

“Our results confirmed the clinical impression that no bridges are burned by performing a high tibial ostetomy, despite significant lower functional results,” he said.

Pitfalls to avoid

Hernigou clarified that it is only when high tibial osteotomy is correctly performed that it has no “deleterious effect” on the TKA and encouraged the audience to visit his group’s scientific exhibit on display at the meeting for more information.

According to information from the exhibit, complications and technical difficulties during TKA following high tibial osteotomy include location of skin incision, difficulty with operative exposure, patella eversion and abnormal patellar tracking.

“Above all, proximal tibia deformity due to a previous osteotomy was commonly observed in high tibial osteotomy, and tibial component alignment during subsequent TKA was difficult to achieve,” the authors wrote.

References:

• Hernigou P, et al. Long term outcome (30 years) following TKA after HTO in young patients with varus deformity. Paper #009. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-18, 2011. San Diego.
• Lachaniette CHF, et al. TKA after HTO (a 30 years experience): how to plan and resolve the problems. Scientific Exhibit #21. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-18, 2011. San Diego.

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