Abstract

Background:

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.

Conclusion:

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.
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