Tibial Crest Osteotomy in Extensile Knee Exposure—A Modified, Low-Energy, Suture Technique

Abbas, Ammar M.I.; Williams, R. G.; Khan, Wasim; Ghandour, A.; Morgan–Jones, Rhidian

doi:10.1016/j.arth.2015.08.030

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…The rate of nonunion was also low in the present cohort, and both of the nonunions were associated with the establishment of a chronic PJI. Previous studies in the literature have highlighted similar results, with union rates ranging from 90% to 100% 13,15,23,26-29 both in septic and aseptic TKA and RTKA. The mean time to union in the present cohort was also similar to the time described in the literature 22,25,26,30 .…”

Section: Discussionsupporting

confidence: 68%

Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty for Periprosthetic Infection

Cance

Batailler

Shatrov

et al. 2023

Journal of Bone and Joint Surgery

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Background: Adequate exposure is essential in revision total knee arthroplasty (RTKA). Tibial tubercle osteotomy (TTO) enhances exposure, but its use is controversial in the setting of periprosthetic infection. The purposes of this study were to determine (1) the rates of complications and revisions due to TTO during RTKA in the setting of a periprosthetic infection, (2) the rate of septic failure, and (3) functional outcomes at a minimum 2-year follow-up. Methods: A single-center retrospective study from 2010 to 2020 was performed. The cases of a total of 68 patients who received a TTO during RTKA in the setting of periprosthetic infection with a minimum follow-up of 2 years (mean, 53.3 months; range, 24 to 117 months) were analyzed. Complications and revisions due to TTO were reported. The functional outcomes were assessed using the Knee Society Score (KSS) and range of motion. Results: Seven knees (10.3%) had complications secondary to the TTO (3 had fracture-displacement of the TTO; 2, nonunion; 1, delayed union; and 1, wound dehiscence). The mean time to union (and standard deviation) was 3.8 ± 3.2 months (range, 1.5 to 24 months). Two knees (2.9%) underwent a TTO-related revision (1 had wound debridement, and 1 had tibial tubercle osteosynthesis). Eighteen knees (26.5%) had recurrence of infection requiring revision: 17 were managed with debridement, antibiotics, and implant retention (DAIR), and 1 had 2-stage RTKA. Flexion improved after surgery (from a mean of 70° to a mean of 86°; p = 0.009), as did the KSS knee (46.6 to 79; p < 0.001) and function (35.3 to 71.5; p < 0.001) subscores. Overall, 42.6% of infected knees managed with RTKA with the TTO procedure were considered successful without any complication at the last follow-up. Only 2 knees (2.9%) required revision related to the TTO. Conclusions: TTO in RTKA involving periprosthetic infection is an effective surgical exposure aid and has excellent rates of union (97.1%) despite the presence of infection. However, the risk of failure because of persistent or recurrent infection remains high in the first 2 years following RTKA for infection. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 68%

Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty for Periprosthetic Infection

Cance

Batailler

Shatrov

et al. 2023

Journal of Bone and Joint Surgery

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“…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 ,…”

Section: Resultsmentioning

confidence: 99%

“…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 ,…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Abbas et al, in a study that included 159 patients, observed no complication of extensor mechanism after revision TKA [ 78 ]. Young et al, in both revision and primary TKA, showed improvement in KSS ( p < 0.0001) and ROM.…”

Section: Resultsmentioning

confidence: 99%

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

Kulinski

Tramś

Pomianowski

et al. 2022

Life

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Total knee replacement (TKA) is a frequent modality performed in patients with osteoarthritis. Specific circumstances can make it much more difficult to execute successfully, and additional procedures such as osteotomy may be required. The aim of this study was to perform a meta-analysis and systematic review of osteotomies combined with TKA. Methods: In June 2022, a search PubMed, Embase, Cochrane, and Clinicaltrials was undertaken, adhering to PRISMA guidelines. The search included the terms “osteotomy” and “total knee arthroplasty”. Results: Two subgroups (tibial tubercle osteotomy and medial femoral condyle osteotomy) were included in the meta-analysis. Further subgroups were described as a narrative review. The primary outcome showed no significant difference in favor to TTO. Secondary outcomes showed improved results in all presented subgroups compared to preoperative status. Conclusion: This study showed a significant deficit of randomized control trials treated with osteotomies, in addition to TKA, and a lack of evidence-based surgical guidelines for the treatment of patients with OA in special conditions: posttraumatic deformities, stiff knee, severe varus, and valgus axis or patella disorders.

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

Divano

Camera

Biggi

et al. 2018

Arch Orthop Trauma Surg

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Tibial Crest Osteotomy in Extensile Knee Exposure—A Modified, Low-Energy, Suture Technique

Cited by 10 publications

References 28 publications

Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty for Periprosthetic Infection

Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty for Periprosthetic Infection

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

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

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