Total Knee Arthroplasty Conversion after Open-wedge High Tibial Osteotomy

Wataru Kusano1, Takatomo Mine1, *, Koichiro Ihara1, Yasuhiro Tominaga1, Hiroyuki Kawamura1, Michio Shinohara1, Ryutaro Kuriyama1
1 Department of Orthopaedic Surgery, National Hospital Organization Kanmon Medical Center, Shimonoseki, Japan

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© 2021 Kusano et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, National Hospital Organization Kanmon Medical Center, Shimonoseki, Japan Takatomo Mine, M.D., 1-1 Choufusotoura, Shimonoseki, Yamaguchi 752-8510 Japan; Tel: +81-83-241-1199; Fax: +81-83-241-1301; E-mail:



Open-wedge High Tibial Osteotomy (HTO) is an effective treatment for Osteoarthritis (OA) of the knee; however, postoperative changes due to HTO can make subsequent Total Knee Arthroplasty (TKA) technically difficult and can affect long-term survival.

Case Report:

Medio-lateral stability along with balanced flexion and extension gaps provides a good functional outcome.

A 71-year-old man underwent TKA conversion after open-wedge HTO 12 years earlier; the conversion was performed due to arthritic deterioration in the knee. Medial instability was noted because of poor ligament balancing. The residual medial instability was managed with a knee brace due to the unavailability of the constrained prosthesis. Management of persistent mediolateral instability persisting after soft tissue release and balancing ideally requires varus-valgus constraint.


TKA conversion after open-wedge HTO requires a special technique and careful preparation before surgery.

Keywords: Knee, Osteoarthritis, Opening-wedge high tibial osteotomy, Medial instability, Total knee arthroplasty, Poor ligament balancing.