SIMULTANEOUS TOTAL KNEE PROSTHESIS AND HIGH TIBIAL OSTEOTOMY IN GONARTHROSIS AND TIBIA VARUM DEFORMITY

Abstract

It is hard to achieve a stabile total knee prosthesis with standard techniques of soft tissue releases and intra-articular bone resection in knees with severe extra-articular tibial deformity and gonarthrosis. In this study, we present the result of simultaneous high tibial osteotomy and total knee prosthesis in a case with severe tibia vara and osteoarthritis of the knee. A sixty seven years old female patient admitted to our outpatient clinic with a deformity and pain on her left knee. Clinical and radiologic examination demonsrated that severe gonarthrosis and tibia varum deformity on her left knee. Body mass index was 42 (greater than 30). We performed a total knee prosthesis, simultaneous high tibial osteotomy with opening wedge and autogenous grafting. Femorotibial alignment angle was 6° valgus postoperatively. The autogenous graft was nearly cooperated at sixth month on radiologic examination. One year after operation the patient admitted to our emergency service with deformity and pain on the same knee after falling down when stepping. There was a fractured tibial stem and impaction of graft site on radiologic examination. Simultaneous high tibial osteotomy and total knee arthroplasty said to be a technically satisfying alternative in patients with gonarthrosis and severe varus deformity of the proximal tibia, but it must be remembered that refracture at the osteotomy site can occur with minor trauma especially in obese patients.