Total knee arthroplasty after dome vs closed wedge high tibial osteotomy: a comparative study

ABSTRACT: Introduction: Converting previously operated knees with high tibial osteotomy (HTO) to total knee arthroplasty (TKA) poses significant technical challenges due to the altered anatomy and geometry of the proximal tibia. Objectives: This study compared prosthetic component positioning in TKAs performed after closed wedge HTO (CWHTO) versus those performed after dome HTO (DHTO). Methods: A total of 36 TKAs performed with a history of HTO (19 CWHTO and 17 DHTO) were retrospectively reviewed. Demographic variables, anatomical femorotibial angle, and TKA components alignment were assessed. Patellar position was assessed using the Insall–Salvati ratio. Additionally, joint line height and posterior tibial slope were recorded. Tibial tubercle osteotomy, and perioperative complications were evaluated. Results: There were no differences in the demographic variables between both groups. The femorotibial angle and prosthesis alignment was comparable between the CWHTO and DHTO groups (P > .05). Tibial tubercle osteotomy was performed in the CWHTO group in 1 knee (5%) and in the DHTO group in 4 knees (24%), with no statistically significant difference between the groups (P = .17). The Insall–Salvati ratio was comparable between both groups preoperatively and postoperatively (P = .85, P = .58). No significant differences were observed between the groups in terms of joint line height, posterior tibial slope, or complication rates. Tibial augmentation utilized only in DHTO group (P = .04, ). Conclusions: Radiological outcomes and prosthesis alignment of TKA following both HTO were comparable; however, the intraoperative approach appeared to be more technically demanding in the DHTO group.