Tibial tubercule osteotomy during medial approach to difficult knee arthroplasties

Abstract

This series shows that the indications are rare but invaluable, facilitating the approach and most particularly making it possible to modify the position of the patella, thus contributing to increasing the joint range of motion. Fixation with two screws carries no risk of disassembly if the technique is rigorous. Patellar translation is limited by the tibial tray.

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

“…Major procedure-related complications were defined as nonunion of the osteotomized fragment [69,99,103], progressive proximal displacement or migration of the osteotomized fragment greater than 5 mm [16,19,44,69,99,103], avulsion fracture of the osteotomized fragment [16,19], and fracture of the tibial metaphysis [88,99].…”

“…Pain at the osteotomy site [106], delayed wound healing, and superficial skin necrosis [44,88] not requiring surgical management were considered minor complications. Infection was considered to have recurred if at any evaluation patients had at least two of the following: (1) unexplained pain and discomfort with no implant malpositioning observed on radiographs; (2) CRP of 10 mg/L or greater without preexisting inflammatory joint disease [4,75,86]; (3) ESR of 30 mm/hour or greater without preexisting inflammatory joint disease [4,75,86]; (4) radiographic evidence of implant loosening, periosteal bone formation, and/or progressive nonfocal osteolysis without malpositioning [90]; or (5) a sinus tract or fistula communicating with the prosthesis.…”

Tibial Tubercle Osteotomy to Aid Exposure for Revision Total Knee Arthroplasty

“…Complications included 2 cases of extensor lag, 2 partial patellar tendon avulsion fractures, 3 cases of implant removal, and 3 postoperative tibial fractures. Numerous reports published since the article by Whiteside 10 all confirmed the success of the tibial tubercle osteotomy with regard to osseous union 5,9,[11][12][13][14][15][16][17][18] . Similarly, this osteotomy has led to a favorable postoperative range of motion 5,9,[11][12][13][14][15][16][17][18] , improvement in knee functional outcome scores 5,12,13,[15][16][17][18] , and minimal postoperative extensor lag 5,[14][15][16][17] .…”

“…Tibial tubercle osteotomy to aid in exposure during revision total knee arthroplasty has been reported to yield favorable outcomes in the orthopaedic literature [7][8][9][10][11][12][13][14][15][16][17][18] . Whiteside standardized the tibial tubercle osteotomy in difficult primary and revision total knee arthroplasty with good and reproducible outcomes 8,10 .…”

“…This allows preservation of muscular soft-tissue attachments to the osteotomized bone fragment, a well-vascularized osseous surface to promote union, and a large bone fragment available for fixation 8,9 . Studies have shown that, compared with alternative methods, tibial tubercle osteotomy is associated with an improved postoperative range of motion and functional outcome scores [8][9][10][11][12][13][14][15][16][17][18] , often with minimal-to-no changes in the postoperative rehabilitation protocol [8][9][10] .…”