Tibial tubercle osteotomy (TTO) in total knee arthroplasty, is it worth it? A review of the literature

Divano, Stefano; Camera, Andrea; Biggi, Stefano; Tornago, Stefano; Formica, Matteo; Felli, Lamberto

doi:10.1007/s00402-018-2888-y

Cited by 22 publications

(12 citation statements)

References 41 publications

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“…17) The success of revision surgery depends on various factors such as operative techniques, as well as the postoperative rehabilitation protocol. 18) There are various options related to closing TTO such as screws, cerclage wires, and absorbable sutures. Previous studies already showed results of different options of closing TTO.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Backgroud Due to extensive fibrosis during revision surgery, adequate exposure is essential and it can be achieved with several extensile approach options, such as tibial tubercle osteotomy. Information regarding surgical exposure during revision arthroplasty is limited in developing countries, such as Pakistan, due to the lack of adequate data collection and follow-up. Therefore, the purpose of this study was to evaluate the impact of tibial tubercle osteotomy on final outcome of revision total knee arthroplasty (TKA). Methods A total of 231 revision TKAs were performed between January 2008 and December 2017. Twenty-nine patients underwent tibial tubercle osteotomy for adequate exposure during revision surgery. Of these, 27 patients with complete follow-up were included in our study. Factors examined include age at the time of revision surgery, gender, comorbidities, arthroplasty site (right or left), body mass index (BMI), and primary indications for the tibial tubercle osteotomy during revision TKA. Functional outcome was measured by using Knee Society score (KSS) at 3 months and the final follow-up. All statistical analysis was done using SPSS version 20.0 with a p -value < 0.05 considered significant. Results Out of 27 patients, 6 patients (22.2%) were men and 21 patients (77.7%) were women. Right knee revision arthroplasty was performed in 15 patients (55.5%), left knee revision arthroplasty was performed in 12 patients (44.4%), and bilateral revision surgery was performed in only 1 patient (3.7%). The mean BMI was 29.2 kg/m 2 . We used a constrained condylar knee in 20 patients (74%), a rotating hinge knee in 5 patients (18.5%), and mobile bearing tray plus metaphyseal sleeves in 2 patients (7.4%). The KSS was 52.21 ± 4.05 preoperatively, and 79.42 ± 2.2 and 80.12 ± 1.33 at 3 months and 12 months, respectively. Radiological union was achieved in all patients at 3 months. Of 27 patients, only 1 patient (3.7%) had proximal migration of the osteotomy site at 6 months: the patient was asymptomatic and union was also achieved and, therefore, no surgical intervention was performed. Conclusions Tibial tubercle osteotomy during revision TKA can be a safe and reliable technique with superior outcomes and minimal complication rates.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Divano et al [14] evaluated TTO in total knee arthroplasty (TKA), both primary and revision procedures. Their results showed that the use of a TTO in total knee arthroplasty did not influence the knee scoring and function, with a union rate close to 100%.…”

Section: Discussionmentioning

confidence: 99%

A detaching, V-shaped tibial tubercle osteotomy is a safe procedure with a low complication rate

Rood

Sambeeck

Koëter

et al. 2020

Arch Orthop Trauma Surg

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Introduction In patients with recurrent patellar dislocations, a tibial tubercle osteotomy (TTO) can be indicated to correct patella alta or an increased trochlear groove-tibial tubercle distance. Several surgical techniques are described. Previous studies emphasize that detaching osteotomies results in devascularisation, which can lead to non-union and tibial shaft fractures. The aim of this study was to report the complication rates directly related to the surgical technique of a V-shaped TTO, where the tubercle is completely released from its periosteum using a step-cut osteotomy. Methods The retrospective case series comprised a large cohort of 263 knees with patella alta in 203 patients who underwent a V-shaped TTO, with or without additional realignment procedures, between March 2004 and October 2017. Data were obtained from available patient files. Complications were defined as minor or major. Results Thirteen major complications were registered (4.9%) including two tibial fractures (0.75%) and one non-union (0.37%). Five complications (1.9%) were defined as minor. Removal of the screws because of irritation or pain was seen in 22 cases (8.2%). Conclusion A V-shaped TTO is a safe procedure. The presumed higher risk for tibial fractures or pseudo-arthrosis could not be confirmed.

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“…Although tibial tubercle osteotomy and medialization is a wellestablished treatment for recurrent patellar dislocation, this is a challenging technique to use in conjunction with TKA, and related complications range from 4% to 20%. Tibial plateau fractures, tibial tubercle fractures, skin necrosis, and nonunion are the most common complications associated with this procedure [22,23]. Figueroa et al published a case of chronic patellar dislocation associated with tricompartmental arthritis treated with TKA, tibial tubercle osteotomy, and vastus medialis advancement [1].…”

Section: Discussionmentioning

confidence: 99%

Combined Total Knee Arthroplasty and Medial Patellofemoral Ligament Reconstruction for Chronic Patellar Dislocation and Severe Osteoarthritis

2021

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Tibial tubercle osteotomy (TTO) in total knee arthroplasty, is it worth it? A review of the literature

Cited by 22 publications

References 41 publications

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

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

A detaching, V-shaped tibial tubercle osteotomy is a safe procedure with a low complication rate

Combined Total Knee Arthroplasty and Medial Patellofemoral Ligament Reconstruction for Chronic Patellar Dislocation and Severe Osteoarthritis

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