POSTER ABSTRACTS - ISAKOS

months (16 to 112) following osteotomy. No
intra-operative difficulties were encountered with
these replacements.
The complication rate was acceptable at 8.81%.
One patient required early revision due to
inadequate initial correction and one developed a
transient peroneal nerve neuropraxia. There were
no other neurovascular or intra-operative
complications. All osteotomies united although 9
patients had delayed union taking a mean of 5.3
months for union to occur. 13 patients developed
symptomatic venous thrombo-embolism, 5 with
pulmonary emboli but there were no deaths.
Other complications included 4 patients who
required removal of staples due to irritation and
one deep wound infection which responded to
treatment.
Closing wedge high tibial osteotomy for medial
compartment osteoarthritis is a safe and reliable
procedure with a good early outcome and a low
complication rate of 8.81% in this series. This
compares favourably with the quoted
complication rates for opening wedge tibial
osteotomy.
E-poster w/ Standard #551
Total Knee Replacement Following High Tibial
Osteotomy: A Medium-term Review.
Alfredo Schiavone Panni, Rome, ITALY, Presenter
Mario Tartarone, Rome, ITALY
Giuseppe Bruno, Rome, ITALY
Mimmo Gallo, Rome, ITALY
ISpeO - Istituto Specialistico Ortopedico, Rome,
ITALY
Introduction
Total knee replacement is an effective treatment
for degenerative joint disorders. There have been
conflicting reports in the literature regarding the
results of post high tibial osteotomy knee
arthroplasty Aim of this study is to evaluate long
term data of total knee replacement following
high tibial osteotomy. Five years data are
presented.
Material and method
Of the patients with knee osteoarthritis treated by
cemented TKR in 1999, two groups were selected.
Group I consisted of 20 patients who had knee
replacement without previous tibial osteotomy;
the average age of the patients was 72.2 years and
the average follow-up was 5.4 years. Group II
comprised 20 patients with high tibial osteotomy
before total knee replacement. The average age
was 73.7 years and average follow-up was 5.2
years. The results of knee arthroplasty were
evaluated, in terms of function, according to the
Knee Society Clinical Rating System, using the
knee scoring system (KSS) and functional system
(FS). The length of the patella and patellar
ligament were measured, the Insall-Salvati index
was calculated and the height of the patella was
determined
Results
Intraoperativelly, no notable differences were
identified in the number of medial, lateral, or
lateral patellar releases required. However, less
lateral tibial bone was resected in the group with
a previous high tibial osteotomy (average, 3.3
millimeters) than in the group without a high
tibial osteotomy (average, 7.5 millimeters). The
average duration of follow-up was 5.2 years
(range, 4 to 6.5 years) in the group with a previous
high tibial osteotomy and 4.9 years (range, 3 to 6
years) in the group without a high tibial
osteotomy. At the time of the final follow-up, the
knee and function scores were similar for the two
groups. The average KSS scores were 87.3 and 82.1
points for groups I and II, respectively. Excellent
and good outcomes were achieved in 16 (group I)
and in 12 (group II). The average FS scores were
84.1 and 80.2 points in groups I and II,
respectively. The average Insall-Salvati index in
groups I and II were 1.07 and 0.93, respectively. No
patella infera was recorded in group I, but it was
found in 10 (50%) patients of group II. Although
more knees were free of pain in the group without
a previous high tibial osteotomy (16) than in the
group with a previous osteotomy (12), this
difference was not found to be significant with the
numbers available (p = 0.4810). Knee alignment
and stability, femoral and tibial component
alignment, and range of motion also were similar
in both groups postoperatively. There were no
deep infections.
Conclusions
While patients with a previous high tibial
osteotomy may have important differences
preoperatively, including valgus alignment,
patella infera, and decreased bone stock in the
proximal part of the tibia, the present study
suggests that the clinical and radiographic results
of primary total knee arthroplasty in knees with
and without a previous high tibial osteotomy are
not substantially different. In our relatively small
group of patients, the previous high tibial
osteotomy had no significant adverse effect on the
outcome of the subsequent total knee
replacement. The IKS function score and the HSS