Tibial Tubercle Osteotomy in Total Knee Arthroplasty: Midterm Results Experience of a Monocentric Study

Abstract

Purpose Difficult primary total knee arthroplasty (TKA) and revision TKA may be high demanding, especially during joint exposure. Aim of this article is to evaluate the clinical and radiological outcomes of a series of patients, who underwent TKA and revision TKA, where tibial tubercle osteotomy (TTO) was performed. Methods We retrospectively reviewed a cohort of 79 consecutives TKAs where TTO was performed. Patients were assessed clinically and radiographically at their last follow-up (mean, 7.4 ± 3.7 years). Clinical evaluation included the Knee Society Score (KSS), the pain visual analogue scale (VAS), and range of motion. Radiological assessment included the evaluation of radiolucent lines, osteolysis, cortical bone hypertrophy, time of bone healing of the TTO fragment, and the hardware complication. Results KSS raised from 40.7 ± 3.1 to 75 ± 4.3 ( p < 0.0001). Knee flexion increased from 78.7 ± 9.9° to 95.0 ± 9.5° ( p < 0.0001), and VAS improved from 7.9 ± 0.9 to 3.8 ± 1 ( p < 0.0001). No signs of loosening or evolutive radiolucency lines were found. Osteolytic areas around the stem were detected. No significant association was found between the implant design and the outcomes, while aseptic loosening showed significantly better results. Complications were: 4 painful hardware, 3 late periprosthetic infections, 1 extension lag of 5°, and 3 flexion lag. Conclusion Our experience suggests the use of TTO to improve the surgical approach in difficult primary TKA or revision TKA. A precise surgical technique leads to good results with low risk of complications. Level of Evidence Level IV, therapeutic case series.

Impact of Tibial Tubercle Osteotomy on Final Outcome in Revision Total Knee Arthroplasty: Our Experience and Technique in Pakistan

“… 3) Adequate exposure during revision TKA is one of the challenges among arthroplasty surgeons because of underlying contracture of the extensor mechanism or limited mobility, which might cause difficulty in eversion of the patella and could lead to a rupture of the patellar tendon from its insertion. 4 5) There are various extensile approaches used during revision TKA in order to provide adequate exposure and allow easy implant removal such as the quadriceps snip approach (QS), 6) quadriceps turndown technique, 7) V-Y quadricepsplasty, 8) and tibial tubercle osteotomy (TTO). 9) Among all these approaches, the TTO and QS are commonly performed in complicated revision cases.…”

Osteotomies and Total Knee Arthroplasty: Systematic Review and Meta-Analysis

“…Twenty-one articles were excluded from the meta-analysis of TTO because they did not include a control group ( Table 5 ) [ 5 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ]. For reattachment osteotomy, most authors used cerclage wires [ 56 , 64 , 67 , 68 , 69 , 70 , 73 , 74 , 75 , 77 ], the second most common type of fixation were screws [ 62 , 63 , 65 , 66 , 70 , 71 , 76 ] and only two studies reported suture repair [ 72 , 78 ]. TTO approach was applied in both primary TKA, for knees with severe valgus deformity [ 69 , 73 , 76 , 77 ], patella disease [ 62 , 65 , 74 ] or revision surgery (aseptic or septic) [ 63 , 64 , 65 ,…”

“…For reattachment osteotomy, most authors used cerclage wires [ 56 , 64 , 67 , 68 , 69 , 70 , 73 , 74 , 75 , 77 ], the second most common type of fixation were screws [ 62 , 63 , 65 , 66 , 70 , 71 , 76 ] and only two studies reported suture repair [ 72 , 78 ]. TTO approach was applied in both primary TKA, for knees with severe valgus deformity [ 69 , 73 , 76 , 77 ], patella disease [ 62 , 65 , 74 ] or revision surgery (aseptic or septic) [ 63 , 64 , 65 , 66 , 67 , 68 , 70 , 71 , 72 , 73 , 75 , 78 ]. Eight studies presented 100% bone healing after osteotomy at the last follow-up [ 62 , 65 , 66 , 70 , 71 , 77 , 78 ], another nine reported cases of malunion, however single cases were mentioned (1–4 patients) [ 64 , 67 , 68 , 69 , 72 , 73 ,…”

“…TTO approach was applied in both primary TKA, for knees with severe valgus deformity [ 69 , 73 , 76 , 77 ], patella disease [ 62 , 65 , 74 ] or revision surgery (aseptic or septic) [ 63 , 64 , 65 , 66 , 67 , 68 , 70 , 71 , 72 , 73 , 75 , 78 ]. Eight studies presented 100% bone healing after osteotomy at the last follow-up [ 62 , 65 , 66 , 70 , 71 , 77 , 78 ], another nine reported cases of malunion, however single cases were mentioned (1–4 patients) [ 64 , 67 , 68 , 69 , 72 , 73 , 74 , 75 , 76 ]. Clinical and functional outcomes presented in articles improved significantly from baseline scores.…”

“…Furthermore, Chalidis et al ( p < 0.001) [ 70 ] and Biggi et al ( p < 0.0001) reported increases in KSS and the VAS scale. There was also one extension lag and three cases with flexion lag [ 71 ]. Another retrospective study of non-correctable valgus deformity presented significant improvements in knee extension ( p = 0.002), flexion ( p = 0.006), KSS ( p = 0.001), and WOMAC ( p = 0.001) [ 70 ].…”