In a series of 280 high tibial osteotomies performed for osteoarthritis
of the knee between 1969 and 1975, there were ten cases of pseudarthrosis,
an incidence of 3.6 per cent. These ten knees (and an additional two that
were referred to us) were reoperated on. In most cases the pseudarthrosis
was resected and stabilized with the Charnley transfixation-compression
method. Other procedures involved resection without compression (one knee),
compression blade-plate fixation, and arthroplasty with a hinge
endoprosthesis. All osteotomies healed eventually with the knee in
satisfactory position. In spite of the initial non-union and repeated
operation, all twelve patients eventually had satisfactory correction of
the preosteotomy deformity, and none had a loss in walking ability. All but
two patients had freedom from pain. We concluded that patients with
non-union following high tibial osteotomy for osteoarthritis of the knee
should undergo resection of the pseudarthrosis and transfixation
compression as the treatment of choice. Endoprosthetic replacement then can
be used as a salvage procedure if it is needed.