Frank A. B. Gottschalk, M.D.

Total knee arthroplasty after proximal tibial osteotomy has inferior functional results similar to revision surgery. Patella infera is noted in many cases, which is thought to contribute to altered biomechanics of the patellofemoral joint of the arthroplasty. The surgical exposure of the proximal tibia and the eversion of the patella during arthroplasty for a failed proximal tibial osteotomy is more difficult.

Preservation of the tibial plateau while maintaining the normal relationship of the patella to femur can be obtained by completing an oblique osteotomy in the proximal tibia. In addition, newer, less invasive internal fixation devices provide for excellent stability. Oblique osteotomy with adequate internal fixation preserves the relationship of patella to femur as well as maintaining heat of the tibial plateau.

Dallas, Texas, orthopaedic surgeon Dr. Frank Gottschalk has been successfully employing this unique approach to tibial osteotomy over the past four years. Twenty-five oblique osteotomies have been completed with an average valgus correction of eight degrees. Tibial height has been maintained in all the cases as well as the patella to femur relationship. No shortening of the patella ligament has occurred. Only one delayed union has been observed.

References
1. Katz MM, Hungerford DS, Krackow KA, Lennox DW Results of total knee arthroplasty after failed proximal tibial osteotomy for osteoarthritis JBJS 1987;69-A:225-233
2. Scuderi GR, Windsor RE, Insall JN Observations on patellar height after proximal tibial osteotomy JBJS 1989;71-A:245-248
3. Staehli JW, Cass JR, Morrey BF Condylar total knee arthroplasty after failed proximal tibial osteotomy JBJS 1987;69-A:28-31
4. Windsor RE, Insall JN, Vince KG Technical Considerations of Total Knee Arthroplasty After Failed Proximal Tibial Osteotomy JBJS 1988;70-A:547-555

• Total Run Time: 14:40 minutes
• Catalog Number: 6012
• Publication Date: February 1994

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