To The Editor:
With interest we read the paper "Total Knee Arthroplasty
After High Tibial Osteotomy" (82-A: 1252-1259, Sept. 2000),
by Meding et al. After investigating a consecutive series of thirty-nine bilateral
total knee arthroplasties in patients who had had a unilateral high
tibial osteotomy, the authors concluded that a previous high tibial
osteotomy had no adverse effect on the outcome of subsequent total
knee arthroplasty. After reviewing the results of total knee arthroplasty in
our patients with previous high tibial osteotomies, we fully agree
with their conclusion and would like to point out an additional
detail.
Out of a group of 128 high tibial osteotomies, we followed seventeen
of twenty patients who had had a bilateral high tibial osteotomy
(thirty-four osteotomies) for a mean of fourteen years (range, seven
to nineteen years). In six patients a unilateral total knee arthroplasty
was performed and in two, a bilateral total knee arthroplasty was
performed after an average of 7.9 years with average knee and function
scores of 79 and 71 points, respectively. Meding et al. reported
on arthroplasty performed after unilateral high tibial osteotomy
at an average of 8.7 years. From the results in our group of patients,
we conclude that bilateral high tibial osteotomy also has no adverse effect
on the outcome of subsequent total knee replacement.
J.B. Meding, E.M. Keating, M.A. Ritter, and P.M. Faris reply:
We appreciate the response from Drs. Trieb, Cetin, Bitzan, and Wanivenhaus.
Their results lend support to an ever-growing body of evidence that,
in general, a previous high tibial osteotomy does not adversely
affect the results of a subsequent total knee arthroplasty. We would
like to emphasize, however, that knee arthroplasty subsequent to
high tibial osteotomy is indeed more technically demanding.