Timing of tibial tubercle osteotomy in two-stage revision of infected total knee arthroplasty does not affect union and reinfection rate. A systematic review

Kitridis, Dimitrios; Givissis, Panagiotis; Chalidis, Byron

doi:10.1016/j.knee.2020.09.008

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…The rate of complications linked to TTO was 10.3%, mainly because of migration of the tibial tubercle. These results were similar to those reported in the literature 22 . A small number of studies have reported complication rates following TTO for both primary and revision TKA, with a prevalence ranging from 3.8% to 22% 14,23,24 .…”

Section: Discussionsupporting

confidence: 93%

“…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 . The surgical technique of TTO is crucial to obtain bone healing and decrease the risk of complications.…”

Section: Discussionsupporting

confidence: 89%

“…Segur et al 23 performed TTO during RTKA for infection in a smaller cohort of 26 patients and found a 12% rate of recurrence of PJI. Similarly, Kitridis et al 22 , in a review of 8 studies pooling data on 199 patients, reported a rate of reinfection of 13% to 16%. Bongers et al 32 reported on RTKA for infection without TTO and found a similar rate of infection recurrence of 23% and a 17% rate of further revision.…”

Section: Discussionmentioning

confidence: 90%

“…The main complication in the systematic review by Divano et al was displacement of the osteotomy, with revision surgery in most cases not being required 24 . Repeat osteotomy has not been shown to significantly decrease the overall rate of union 22,25 , but it was associated with an increased risk of avulsion and displacement of the tubercle 22 . 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.…”

Section: Discussionmentioning

confidence: 99%

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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: 93%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…During the second-stage operation, the spacer and the pin were removed, a thorough surgical debridement was performed, and new culture samples were collected. In order to improve the exposure of the knee joint, a tibial tubercle osteotomy was performed [7]. The MUTARS® GenuX® MK Revision Knee System (Implantcast GmbH, Buxtehude, Germany) was used as a rotating hinge revision total knee arthroplasty system (Figure 4).…”

Section: Case Presentationmentioning

confidence: 99%

Prosthetic Knee Joint Infection by Brucella melitensis

Athanasiou¹,

Papagiannis²,

Sinos³

et al. 2022

Cureus

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Prosthetic joint infection following arthroplasty is a serious complication associated with high morbidity and prolonged hospitalization. Treatment consists of a combination of surgical intervention and longacting antibiotic therapy targeted to the responsible microorganism(s). Brucella species-related prosthetic joint infections are uncommon. Diagnosis can be challenging, especially in non-endemic countries, and is confirmed by serological studies and joint aspiration results. We present a rare case of a 78-year-old man with Brucella melitensis infection in a prosthetic right knee joint, seven years after the primary procedure. The patient was treated with a two-stage surgical intervention and a four-month period of antibiotic therapy. After a follow-up period of 12 months, no clinical or laboratory findings of infection were present and the patient was able to return to his everyday activities.

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