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.

Keywords

tibial tubercle osteotomy - total knee arthroplasty - revision - surgical approach

• References

• 1 Dolin MG. Osteotomy of the tibial tubercle in total knee replacement. A technical note. J Bone Joint Surg Am 1983; 65 (05) 704-706
• 2 Wolff AM, Hungerford DS, Krackow KA, Jacobs MA. Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg Am 1989; 71 (06) 848-852
• 3 Whiteside LA, Ohl MD. Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res 1990; (260) 6-9
• 4 Whiteside LA. Exposure in difficult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res 1995; (321) 32-35
• 5 Mendes MW, Caldwell P, Jiranek WA. The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty 2004; 19 (02) 167-174
• 6 Ries MD, Richman JA. Extended tibial tubercle osteotomy in total knee arthroplasty. J Arthroplasty 1996; 11 (08) 964-967
• 7 Chalidis BE, Ries MD. Does repeat tibial tubercle osteotomy or intramedullary extension affect the union rate in revision total knee arthroplasty? A retrospective study of 74 patients. Acta Orthop 2009; 80 (04) 426-431
• 8 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
• 9 Zicat B, Engh CA, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am 1995; 77 (03) 432-439
• 10 Whaley AL, Trousdale RT, Rand JA, Hanssen AD. Cemented long-stem revision total knee arthroplasty. J Arthroplasty 2003; 18 (05) 592-599
• 11 Abbott LC, Carpenter WF. Surgical approaches to the knee joint. J Bone Joint Surg Am 1945; 27: 277-310
• 12 Younger AS, Duncan CP, Masri BA. Surgical exposures in revision total knee arthroplasty. J Am Acad Orthop Surg 1998; 6 (01) 55-64
• 13 Tarabichi S, Tarabichi Y. Can an anterior quadriceps release improve range of motion in the stiff arthritic knee?. J Arthroplasty 2010; 25 (04) 571-575
• 14 Sharkey PF, Homesley HD, Shastri S, Jacoby SM, Hozack WJ, Rothman RH. Results of revision total knee arthroplasty after exposure of the knee with extensor mechanism tenolysis. J Arthroplasty 2004; 19 (06) 751-756
• 15 Lahav A, Hofmann AA. The “banana peel” exposure method in revision total knee arthroplasty. Am J Orthop 2007; 36 (10) 526-529
• 16 Garvin KL, Scuderi G, Insall JN. Evolution of the quadriceps snip. Clin Orthop Relat Res 1995; (321) 131-137
• 17 Coonse KD, Adams JD. A new operative approach to the knee joint. Surg Gynecol Obstet 1943; 77: 344-347
• 18 Scott RD, Siliski JM. The use of a modified V-Y quadricepsplasty during total knee replacement to gain exposure and improve flexion in the ankylosed knee. Orthopedics 1985; 8 (01) 45-48
• 19 Smith PN, Parker DA, Gelinas J, Rorabeck CH, Bourne RB. Radiographic changes in the patella following quadriceps turndown for revision total knee arthroplasty. J Arthroplasty 2004; 19 (06) 714-719
• 20 van den Broek CM, van Hellemondt GG, Jacobs WC, Wymenga AB. Step-cut tibial tubercle osteotomy for access in revision total knee replacement. Knee 2006; 13 (06) 430-434
• 21 Halder AM. Tibial tubercle osteotomy [in German]. Oper Orthop Traumatol 2012; 24 (02) 85-94
• 22 Barrack RL, Smith P, Munn B, Engh G, Rorabeck C. The Ranawat Award. Comparison of surgical approaches in total knee arthroplasty. Clin Orthop Relat Res 1998; (356) 16-21
• 23 Young CF, Bourne RB, Rorabeck CH. Tibial tubercle osteotomy in total knee arthroplasty surgery. J Arthroplasty 2008; 23 (03) 371-375
• 24 Davis K, Caldwell P, Wayne J, Jiranek WA. Mechanical comparison of fixation techniques for the tibial tubercle osteotomy. Clin Orthop Relat Res 2000; (380) 241-249