Yüksek ti̇bi̇al osteotomi̇ sonrasi total di̇z artroplasti̇si̇ yapilan hastalarin kli̇ni̇k ve radyoloji̇k olarak değerlendi̇ri̇lmesi̇

Introduction: High tibial osteotomy is a well established technique for the treatment of medial osteoarthritis in patients with varus malalignment. The results of ostetomy are known to detoriate over time, with majority of patients eventually resulting with total knee arthroplasty. The clinical outcomes and survivorship of total knee arthroplasty following high tibial osteotomy remains controversial. We aimed to evaluate clinical and radiographic outcome of total knee arthroplasty in patients who had undergone high tibial osteotomy, and to identify risk factors that may related to inferior outcome. Patients and Method: Between 2000 and 2018, among 3496 total knee arthroplasty, 61 were implanted in 48 patients who had had a previous high tibial osteotomy for the treatment of osteoarthritis. Surgical data and complications for both ostotomy and arthroplasty were evaluated. All revisions and reoperations were noted during follow-up. Clinical outcome was assessed using HSS and KSS knee scores, Radiographs were evaluated on anteroposterior, 30º lateral view and ortoroentgenograms. Results: Mean age was 55,1 at the time of ostotomy and 64,4 at the time of arthroplasty. Interval between two operation was 8,9 years. Osteotomy performed in %52,5 (n=32) with opening wedge, %47,5 (n=29) with closing wedge technique. Among all arthroplasty implants %68,9 (n=42) were CR, %31,1 (n=19) were PS type. Nine (%14,6) arthroplasty imlants had revision of components and 17 (%27,9) had undergone any other reoperation without component removal. Long stem for tibial component was used in 12 knees (%19,7), peroperative eversion problem was encountered in 7 knees (%11,5) and ligament laxity was encountered in 14 knees (%23,0) during arthroplasty. Conclusions: There was no relationship between osteotomy technique, arthroplasty implant type with survivorship free from revision and reoperation. Usage of long stem for tibial component and any other unstandart procedure was related with poorer survival. Tibial slope greater than -2.5º was related to lower range of motion in knee. Preoperative valgus alignment of femorotibial angle was also related to higher KSS scores and better functional outcome compared to varus alignment. Keywords: Medial osteoarthritis, High tibial osteotomy, Total knee arthroplasty, Survival, Opening wedge osteotomy, Closing wedge osteotomy