Knee alignment in failed high tibial osteotomy does not influence functional outcomes after revision total knee arthroplasty
ESSKA Academy. Chen J. Nov 8, 2019; 284393; epEKA-63 Topic: Joint Replacement
Dr. Jerry Chen
Dr. Jerry Chen
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Knee alignment in failed high tibial osteotomy does not influence functional outcomes after revision total knee arthroplasty

ePoster - epEKA-63

Topic: HTO

Chen J., Ang B., Song J., Liow L., Mitra A.K., Koh J., Howe T.S., Yeo S.J., Lim J.
Singapore General Hospital, Singapore, Singapore

Introduction: High tibial osteotomy (HTO) has an overall failure rate as high as 24% at 10 years. Under correction during HTO can cause loss of correction angle and recurrence of varus deformity, while over correction can lead to lateral compartment osteoarthritis.
Objectives: The literature offers little insight into how failed HTO in varus, neutral or valgus alignments can influence surgical techniques and clinical outcomes of revision total knee arthroplasty (TKA), hence our study is designed to address this.
Aims: Our study aims to compare the functional outcomes of revision TKA for HTO that failed in: (1) varus alignment; (2) neutral alignment; and (3) valgus alignment.
Methods: Between 2001 and 2014, 164 patients who underwent revision TKA after failed HTO at our tertiary hospital were included in this study. Using the femoral tibial angle from standing anterior-posterior (AP) radiographs, failed HTO in varus alignment was defined as £2° valgus; neutral alignment as 3°-9° valgus; valgus alignment as ³10° valgus. All patients underwent revision TKA using medial parapatellar approach and received fixed bearing implants. They were assessed at 24 months after TKA using Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), Physical and Mental Component Scores (PCS and MCS) of Short-Form 36.
Results: Ninety-three patients failed in varus alignment; 47 in neutral alignment; and 24 in valgus alignment. The time between initial HTO and revision TKA was comparable between the three groups (p>0.05). All three groups of patients showed significant improvement in KSFS, KSKS, OKS and PCS at 6 and 24 months after revision TKA (all p< 0.05). However, there was no significant difference in these scores at 6 and 24 months after revision TKA when compared between the three group of patients (all p>0.05). Twenty-three patients (14%) had significant proximal tibia bone defect that was treated intraoperatively with cement. The functional outcome scores of these 23 patients at 24 months after revision TKA were comparable to those without significant bone defect (all p>0.05).
Conclusions: The time from failed HTO to revision TKA was comparable among patients who failed in varus, neutral or valgus alignment. The functional outcome scores were also similar among these three groups. Cement can be used to fill bone defect after failed HTO without compromising the functional outcomes of revision TKA.
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