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.

Total knee arthroplasty with 4.4 mm of tibial polyethylene an update.

Three hundred eighty-seven one-piece, 8-mm tibial components were implanted in 313 patients. All tibial prostheses were manufactured with 4.4 mm of polyethylene. From this group, 116 patients underwent simultaneous bilateral total knee arthroplasty with an 8-mm tibial component on one side and a tibial component with at least 6.4 mm of polyethylene on the other side. Follow-up averaged 11.8 years. The average Knee Society knee score was 81, and the average pain score was 46. No polyethylene wear or osteolysis was identified radiographically. There were 7 knees with tibial radiolucencies, 5 knees with polyethylene failure of metal-backed patellae, and 1 tibial component failure. Survival rates for loosening or revision of any component for any reason were 98.9%, 97.5%, 95.1%, and 93.2% at 5-, 10-, 15-, and 18-years, respectively.

The clinical effect of gender on outcome of total knee arthroplasty.

The purpose of this study was to quantify the effect of sex on the clinical outcome and survivorship of a total knee arthroplasty (TKA) with clinical and radiographic follow-up. Seven thousand three hundred twenty-six primary AGC (Biomet, Warsaw, Ind) cruciate-retaining TKAs were performed from 1987 to 2004. Of these, 59.5% were performed on women. We examined preoperative and postoperative Knee Society knee score, function scores, pain scores, walking ability, stair-climbing ability, flexion, and implant survivorship based on sex. Female sex was associated with lower overall preoperative clinical scores for all parameters (P < .01). Improvement in Knee Society knee score and flexion was greater for women (P = .006), and there were equal pain relief and walking improvements for both sexes (P < .32). Stair and function score improvements were greater for men (P = .002). Implant survival was 98% for women and men at 15 years (P = .4684). We conclude that improvement after TKA is similar for men and women, with few clinically significant differences. Sex-specific implants would appear to offer no clinical advantage.

Total knee arthroplasty for isolated patellofemoral arthritis in younger patients.

UNLABELLED: Are the results of total knee arthroplasty for isolated patellofemoral osteoarthritis (OA) in younger patients as good as with patellofemoral arthroplasty? We retrospectively compared the outcomes of 33 TKAs in 27 patients with patellofemoral OA younger than 60 years of age (average, 52 years) to those for a matched group of patients with primarily tibiofemoral arthritis. A cemented posterior cruciate ligament-retaining prosthesis was used in 26 of the 27 knees. We recorded the intraoperative condition of the cartilage. Patients were followed a minimum of 2 years (average, 6.2 years). Average Knee Society knee scores improved from 49 preoperatively to 88 at final followup. Average pain scores from 5 to 44 with 29 knees rated with minimal or no pain; two patients reported anterior knee pain. There were no infections, revisions, reoperations, manipulations, patellar instabilities, patellar fractures, or component loosenings. The results in these patients were as good as those for younger historical control patients undergoing patellofemoral arthroplasty and the complication rates lower. The data were similar to those for our matched group of patients with primarily tibiofemoral OA. We believe our data should raise doubts about the use of patellofemoral arthroplasty in any patient. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.