Total knee arthroplasty after dome vs closed wedge high tibial osteotomy: a comparative study

Introduction: Converting previously operated knees with high tibial osteotomy (HTO) to total knee arthroplasty (TKA) poses significant technical challenges due to the altered anatomy and geometry of the proximal tibia.Objectives: This study compared prosthetic component positioning in TKAs performed after closed wedge HTO (CWHTO) versus those performed after dome HTO (DHTO).Methods: A total of 36 TKAs performed with a history of HTO (19 CWHTO and 17 DHTO) were retrospectively reviewed.Demographic variables, anatomical femorotibial angle, and TKA components alignment were assessed.Patellar position was assessed using the Insall-Salvati ratio.Additionally, joint line height and posterior tibial slope were recorded.Tibial tubercle osteotomy, and perioperative complications were evaluated.Results: There were no differences in the demographic variables between both groups.The femorotibial angle and prosthesis alignment was comparable between the CWHTO and DHTO groups (P > .05).Tibial tubercle osteotomy was performed in the CWHTO group in 1 knee (5%) and in the DHTO group in 4 knees (24%), with no statistically significant difference between the groups (P = .17).The Insall-Salvati ratio was comparable between both groups preoperatively and postoperatively (P = .85,P = .58).No significant differences were observed between the groups in terms of joint line height, posterior tibial slope, or complication rates.Tibial augmentation utilized only in DHTO group (P = .04,).Conclusions: Radiological outcomes and prosthesis alignment of TKA following both HTO were comparable; however, the intraoperative approach appeared to be more technically demanding in the DHTO group.