Clinical Orthopaedics and Related Research®

, Volume 471, Issue 4, pp 1305–1318

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

  • Danilo Bruni
  • Francesco Iacono
  • Bharat Sharma
  • Stefano Zaffagnini
  • Maurilio Marcacci
Clinical Research



Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate.


We compared The Knee Society Score© (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation.


We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8–15 years).


Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113° versus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups.


We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections.

Level of Evidence

Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Danilo Bruni
    • 1
    • 2
  • Francesco Iacono
    • 1
    • 2
  • Bharat Sharma
    • 1
  • Stefano Zaffagnini
    • 1
    • 2
  • Maurilio Marcacci
    • 1
    • 2
  1. 1.Biomechanics and Technological Innovation Laboratory, Codivilla-Putti Research CenterBologna UniversityBolognaItaly
  2. 2.Orthopaedics and Traumatology Clinic, Rizzoli Orthopaedic InstituteBologna UniversityBolognaItaly

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