{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:21:15Z","timestamp":1791199275401,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,6,5]]},"abstract":"\n Background:<\/jats:title>\n Some prior reports of total knee arthroplasty after high tibial osteotomy have shown high rates of aseptic loosening. As such, the goal of this study was to analyze the outcomes of contemporary total knee arthroplasty after high tibial osteotomy, with particular emphasis on survivorship free from aseptic loosening, any revision, and any reoperation; complications; radiographic results; and clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n We retrospectively reviewed 207 patients who underwent 231 total knee arthroplasties using cemented prostheses after high tibial osteotomy from 2000 to 2012 through our total joint registry: 87% were after a closing-wedge osteotomy and 13% were after an opening-wedge osteotomy. The mean follow-up from total knee arthroplasty was 8 years. At the time of the total knee arthroplasty, the mean age was 64 years and the mean body mass index was 31 kg\/m\n 2<\/jats:sup>\n . The majority of total knee arthroplasties had a posterior-stabilized design (93%), and 4% had a varus-valgus constraint design. Tibial stems were utilized in 8% of cases. Bivariate and multivariate Cox regression analyses were utilized to analyze risk factors for poorer survival.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n At 10 years, survivorship free from aseptic loosening was 97%, survivorship free from any revision was 90%, and survivorship free from any reoperation was 85%. Fifteen patients (15 total knee arthroplasties [6%]) underwent aseptic revision, most commonly for instability (3%), aseptic loosening (2%), and periprosthetic fracture (1%). On bivariate analysis, patient age of <60 years was a significant risk factor for poorer revision-free survival (hazard ratio, 2.9; p = 0.02); on multivariate analysis, younger age was the only significant risk factor for revision (p = 0.04). There were 14 complications (6%), the most common being a manipulation under anesthesia in 9 cases (4%). No unrevised total knee arthroplasties had definitive radiographic evidence of loosening. Knee Society scores improved from a mean preoperative score of 59 points to a mean postoperative score of 93 points (p < 0.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Contemporary total knee arthroplasty with a cemented prosthesis after high tibial osteotomy demonstrated excellent long-term durability, with 10-year survivorship free from aseptic loosening of 97%. There was reliable improvement in clinical outcomes, but perfect knee balance was sometimes challenging, as reflected by a 4% prevalence of manipulation under anesthesia and a 3% prevalence of revision for instability.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level IV<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.18.01060","type":"journal-article","created":{"date-parts":[[2019,6,6]],"date-time":"2019-06-06T09:38:25Z","timestamp":1559813905000},"page":"970-978","source":"Crossref","is-referenced-by-count":57,"title":["Total Knee Arthroplasty After High Tibial Osteotomy Results in Excellent Long-Term Survivorship and Clinical Outcomes"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4195-8648","authenticated-orcid":false,"given":"Brian P.","family":"Chalmers","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4772-663X","authenticated-orcid":false,"given":"Afton K.","family":"Limberg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-1353","authenticated-orcid":false,"given":"Meagan E.","family":"Tibbo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1457-442X","authenticated-orcid":false,"given":"Kevin I.","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1679-0046","authenticated-orcid":false,"given":"Mark W.","family":"Pagnano","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2398-1724","authenticated-orcid":false,"given":"Matthew P.","family":"Abdel","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"11","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1302\/0301-620X.96B11.33617","article-title":"The outcome at ten years of lateral closing-wedge high tibial osteotomy: determinants of survival and functional outcome","volume":"96-B","author":"Howells","year":"2014","journal-title":"Bone Joint J."},{"issue":"17","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.2106\/JBJS.M.00786","article-title":"Comparison of closing-wedge and opening-wedge high tibial osteotomy for medial compartment osteoarthritis of the knee: a randomized 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Aggarwal, et al.: \u201cRevision total knee arthroplasty in the young patient: is there trouble on the horizon?\u201d","volume":"96","author":"Vince","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"10","key":"bib27-20230810","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1302\/0301-620X.93B10.27100","article-title":"Age at hip or knee joint replacement surgery predicts likelihood of revision surgery","volume":"93","author":"Wainwright","year":"2011","journal-title":"J Bone Joint Surg Br."},{"issue":"1","key":"bib28-20230810","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.arth.2017.08.002","article-title":"Risk factors, outcomes, and timing of manipulation under anesthesia after total knee arthroplasty","volume":"33","author":"Newman","year":"2018","journal-title":"J Arthroplasty."},{"issue":"7","key":"bib29-20230810","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1007\/s11999-017-5316-7","article-title":"Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades?","volume":"475","author":"Dyrhovden","year":"2017","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib30-20230810","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1302\/0301-620X.100B7.BJJ-2017-1473.R1","article-title":"A randomized controlled trial of fixed- versus mobile-bearing total knee arthroplasty","volume":"100-B","author":"Abdel","year":"2018","journal-title":"Bone Joint J."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201906050-00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:36:27Z","timestamp":1787751387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201906050-00003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,5]]},"references-count":30,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.18.01060","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,5]]}}}