Total knee arthroplasty conversion after open-wedge high tibial osteotomy: A report of three cases.

Abstract

The changes in the anatomy that occur due to a high tibial osteotomy (HTO), including the ligament release, can affect the clinical results after a subsequent total knee arthroplasty (TKA). We present three cases in which patients underwent conversion to a TKA after an open-wedge HTO. Of particular interest is the medial instability that was noted during the TKA procedures. Three patients underwent conversion to a TKA after an open-wedge HTO. One case was converted to a TKA using a conventional posterior-stabilized type implant, and the other case was converted to a TKA using varus-valgus constraint-type implants due to the medial instability. The final case was converted to TKA using a conventional posterior-stabilized type implant, but a revision TKA using constrained-type implant was performed due to neglected medial instability. Conversion to a TKA after open-wedge HTO requires careful preparation and a constrained-type implant should be prepared to address the medial structure release. Furthermore, medial structures should be repaired during open-wedge HTO, in case the patient requires a future TKA conversion.