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Total knee arthroplasty performed after failed high tibial osteotomy is an important subgroup encompassing close to 10% of replacements performed and may be difficult in 20% to 40% of these patients. The problems in this group can be different from those encountered with primary of revision total knee arthroplasty. The authors present a review of the literature on this subject including assessments of variables affecting outcome. Preoperative clinical and radiographic factors to be considered are discussed and surgical technical factors are delineated.
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