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

Abstract

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.

Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty for Periprosthetic Infection

“…In the present study, no patient required a manipulation under anesthesia, whereas it has previously been reported to be required in approximately 5% of aseptic RTKA procedures 33 . The improvement in KSS knee and function subscores in this cohort was similar to that in previous studies 23,34,35 , with a postoperative KSS gain to between 70 and 80 points. These results are not dissimilar to those after primary TKA with TTO or RTKA with TTO for an aseptic reason described in the series by Biggi et al 36 : mean knee flexion of 95° and a mean KSS score of 75 points.…”

“…None were observed in this series. This complication usually occurs in 0% 34 to 1% 36 of patients with TKA and TTO. An accurate and reproducible surgical technique with strict compliance with postoperative restrictions is crucial to avoid extension lag after TTO.…”

The Unusual Cause of Prosthetic Joint Infection: Outcomes of Nontuberculous Mycobacteria Treatment Following Primary Total Knee Arthroplasty

“…An extensile approach such as tibial tubercle osteotomy (TTO) was performed in cases when the patella was unable to evert with the knee at 90 degree flexion. 15) A constrained implant was used during revision surgery. 16) Knee Society Score (KSS) was assessed at final follow-up in all patients who underwent revision surgery.…”