The risk of revision after TKA is affected by previous HTO or UKA

Otto Robertsson, Annette W-Dahl
Clinical Orthopaedics and related Research 2015, 473 (1): 90-3

BACKGROUND: High tibial osteotomy (HTO) and unicompartmental arthroplasty (UKA) are reconstructive surgeries advocated for younger patients. In case of failure or progression of osteoarthritis, they can both be converted to a total knee arthroplasty (TKA).

QUESTIONS/PURPOSES: We used registry data to answer if the risks of revision for TKAs after previous HTOs and UKAs differ and how these compare with that of de novo TKAs. Furthermore, we wanted to examine the extent of stemmed/revision implants being used for the conversions.

METHODS: We identified HTOs performed during 1998 to 2007 with the help of the inpatient and outpatient care registries of the Swedish National Board of Health and Welfare and gathered relevant information from hospital records. The Swedish Knee Arthroplasty Register was then examined to find all de novo TKAs, TKAs performed after HTO, and TKAs performed after UKA through the end of 2012.

RESULTS: For 920 TKAs after previous UKA and 356 TKAs after previous closed-wedge HTOs, we found the risk of revision significantly higher than for the 118,229 de novo TKAs (risk ratio, 2.8; confidence interval [CI], 2.2-3.5; p<0.001, and 1.7 CI, 1.1-2.6; p<0.001, respectively), whereas for the 482 open-wedge osteotomies, the difference was not significant (risk ratio, 1.2; CI, 0.8-1.8; p=0.44). Stemmed implants were used in 663 of the 117,566 primary de novo TKAs (0.6%), in 22 of the 809 HTO conversions (4%) and in 136 of the 920 UKA conversions (17%).

CONCLUSIONS: TKAs after previous reconstructive surgery carry an increased risk for revision. However, our findings do not mitigate against the use of UKA and HTO in selected cases.

LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"