Combined Total Knee Arthroplasty and High Tibial Osteotomy

Total knee arthroplasty (TKA) in patients with established knee osteoarthritis and major varus, mostly due to constitutional proximal deformity, remains a challenging procedure. Orthogonal cuts result in asymmetric bone resection and subsequent bone related laxity in the convex side. This situation requires a major release of the medial collateral ligament to achieve good ligament balancing, but is sometime excessive with subsequent residual medial laxity. A technique was developed that combines high tibial osteotomy and TKA in the same sitting to address such major deformities. It allows achievement of good realignment without excessive release. Opening osteotomy is performed first and the TKA is then placed, with stem augmentation, to ensure stability of the construct. Preliminary results of this original demanding method are encouraging, and it is suggested that this option be considered in severe varus osteoarthritic knees.