Total knee arthroplasty following medial opening wedge tibial osteotomy: technical issues early clinical radiological results

Medial opening wedge high tibial osteotomy is a popular treatment option for medial compartment osteoarthritis of the knee. One of the proposed advantages is easier conversion to a total knee replacement compared to lateral closing wedge osteotomies, although there are few studies to support this. We reviewed the technical considerations in 36 knees in which conversion of a medial opening wedge osteotomy to total knee arthroplasty was performed, and contrasted these to previously reported studies of knee arthroplasty after closing lateral wedge or dome osteotomies. The clinical results in 33 patients (34 knees) with minimum 2 year follow-up (mean 3.4 years, range 2 to 8 years) were compared to a control group of 1315 knee arthroplasties performed without prior tibial osteotomy. Total knee arthroplasty after a medial opening wedge osteotomy is relatively straightforward, although we encountered patella baja in 27% of cases, and an increased posterior tibial slope of over 15° in 21%. There was a lower Knee Society score and a lower pain score (more pain) in the study group compared to the control group. While technically straightforward in most cases, knee arthroplasty following medial opening wedge osteotomy in this study group yielded inferior clinical results compared to a group of knee arthroplasties performed without prior tibial osteotomy.