To The Editor:I read with interest "Total Knee Arthroplasty Following Proximal
Tibial Osteotomy: Risk Factors for Failure"
(2004;86:474-9) by Parvizi et
al. The authors reviewed the results of 166 cemented condylar knee
replacements done in 118 patients who had previously had a proximal tibial
osteotomy. These knee replacements had relatively inferior results, and the
authors identified risk factors for early failure.The problems cited by the authors were malalignment, patella baja,
instability, periarticular scarring, proximal tibial bone deficiency, and
retained hardware. The great detail about the knee arthroplasty, the long
follow-up, and the meticulous study design are all severely compromised by the
absence of any detail regarding the technique of osteotomy. Were these opening
or closing wedge corrections? Was the fibula osteotomized or was the proximal
tibiofibular joint sprung? Was there internal, external, or no fixation? Were
casts applied or were the patients allowed to move their knees? Were the
corrections done acutely or gradually?