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

Abstract

Background

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.

Questions/purposes

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.

Methods

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).

Results

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.

Conclusions

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.

References

  1. 1.
    Aglietti P, Baldini A, Buzzi R, Indelli PF. Patella resurfacing in total knee replacement: functional evaluation and complications. Knee Surg Sports Traumatol Arthrosc. 2001;9(suppl 1):S27–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson JA, Sculco PK, Heitkemper S, Mayman DJ, Bostrom MP, Sculco TP. An articulating spacer to treat and mobilize patients with infected total knee arthroplasty. J Arthroplasty. 2009;24:631–635.PubMedCrossRefGoogle Scholar
  3. 3.
    Arredondo J, Worland RL, Jessup DE. Nonunion after a tibial shaft fracture complicating tibial tubercule osteotomy. J Arthroplasty. 1998;13:958–960.PubMedCrossRefGoogle Scholar
  4. 4.
    Austin MS, Ghanem E, Joshi A, Lindsay A, Parvizi J. A simple, cost-effective screening protocol to rule out periprosthetic infection. J Arthroplasty. 2008;23:65–68.PubMedCrossRefGoogle Scholar
  5. 5.
    Barrack RL, Engh G, Rorabeck C, Sawhney J, Woolfrey M. Patient satisfaction and outcome after septic versus aseptic revision total knee arthroplasty. J Arthroplasty. 2000;15:990–993.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    Booth RE Jr, Lotke PA. The results of spacer block technique in revision of infected total knee arthroplasty. Clin Orthop Relat Res. 1989;248:57–60.PubMedGoogle Scholar
  8. 8.
    Borden LS, Gearen PF. Infected total knee arthroplasty: a protocol for management. J Arthroplasty. 1987;2:27–36.PubMedCrossRefGoogle Scholar
  9. 9.
    Bori G, Soriano A, García S, Gallart X, Mallofre C, Mensa J. Neutrophils in frozen section and type of microorganism isolated at the time of resection arthroplasty for the treatment of infection. Arch Orthop Trauma Surg. 2009;129:591–595.PubMedCrossRefGoogle Scholar
  10. 10.
    Bourne RB, Crawford HA. Principles of revision total knee arthroplasty. Orthop Clin North Am. 1998;29:331–337.PubMedCrossRefGoogle Scholar
  11. 11.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468:45–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Buller LT, Sabry FY, Easton RW, Klika AK, Barsoum WK. The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. J Arthroplasty. 2012;27:857–864.e1–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Cadambi A, Engh GA. Use of a semitendinosus tendon autogenous graft for rupture of the patellar ligament after total knee arthroplasty: a report of seven cases. J Bone Joint Surg Am. 1992;74:974–979.PubMedGoogle Scholar
  14. 14.
    Caldwell PE, Bohlen BA, Owen JR, Brown MH, Harris B, Wayne JS, Jiranek WA. Dynamic confirmation of fixation techniques of the tibial tubercle osteotomy. Clin Orthop Relat Res. 2004;424:173–179.PubMedCrossRefGoogle Scholar
  15. 15.
    Calton TF, Fehring TK, Griffin WL. Bone loss associated with the use of spacer blocks in infected total knee arthroplasty. Clin Orthop Relat Res. 1997;345:148–154.PubMedCrossRefGoogle Scholar
  16. 16.
    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;80:426–431.PubMedCrossRefGoogle Scholar
  17. 17.
    Chiang ER, Su YP, Chen TH, Chiu FY, Chen WM. Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop. 2011;82:460–464.PubMedCrossRefGoogle Scholar
  18. 18.
    Choi HR, Burke D, Malchau H, Kwon YM. Utility of tibial tubercle osteotomy in the setting of periprosthetic infection after total knee arthroplasty. Int Orthop. 2012;36:1609–1613.PubMedCrossRefGoogle Scholar
  19. 19.
    Choi HR, Kwon YM, Burke DW, Rubash HE, Malchau H. The outcome of sequential repeated tibial tubercle osteotomy performed in 2-stage revision arthroplasty for infected total knee arthroplasty. J Arthroplasty. 2012;27:1487–1491.PubMedCrossRefGoogle Scholar
  20. 20.
    Coonse GK, Adams JD. A new operative approach the knee joint. Surg Gynecol Obstet. 1943;77:344–347.Google Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    Deane CR, Ferran NA, Ghandour A, Morgan-Jones RL. Tibial tubercle osteotomy for access during revision knee arthroplasty: Ethibond suture repair technique. BMC Musculoskelet Disord. 2008;9:98.PubMedCrossRefGoogle Scholar
  23. 23.
    Deburge A, Guepar. Guepar hinge prosthesis: complications and results with two years’ follow-up. Clin Orthop Relat Res. 1976;120:47–53.PubMedGoogle Scholar
  24. 24.
    Deehan DJ, Murray JD, Birdsall PD, Pinder IM. Quality of life after knee revision arthroplasty. Acta Orthop. 2006;77:761–766.PubMedCrossRefGoogle Scholar
  25. 25.
    Dolin MG. Osteotomy of the tibial tubercle in total knee replacement: a technical note. J Bone Joint Surg Am. 1983;65:704–706.PubMedGoogle Scholar
  26. 26.
    Dolin MG. Osteotomy of the tibial tubercle during total knee replacement: a report of twenty-six cases. J Bone Joint Surg Am. 1990;72:790.PubMedGoogle Scholar
  27. 27.
    Emerson RH Jr, Head WC, Malinin TI. Extensor mechanism reconstruction with an allograft after total knee arthroplasty. Clin Orthop Relat Res. 1994;303:79–85.PubMedGoogle Scholar
  28. 28.
    Emerson RH Jr, Muncie M, Tarbox TR, Higgins LL. Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res. 2002;404:132–138.PubMedCrossRefGoogle Scholar
  29. 29.
    Evans RP. Successful treatment of total hip and knee infection with articulating antibiotic components: a modified treatment method. Clin Orthop Relat Res. 2004;427:37–46.PubMedCrossRefGoogle Scholar
  30. 30.
    Fehring TK, Odum S, Calton TF, Mason JB. Articulating versus static spacers in revision total knee arthroplasty for sepsis: the Ranawat Award. Clin Orthop Relat Res. 2000;380:9–16.PubMedCrossRefGoogle Scholar
  31. 31.
    Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin Orthop Relat Res. 2001;392:315–318.PubMedCrossRefGoogle Scholar
  32. 32.
    Feldman DS, Lonner JH, Desai P, Zuckerman JD. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg Am. 1995;77:1807–1813.PubMedGoogle Scholar
  33. 33.
    Freeman MG, Fehring TK, Odum SM, Fehring K, Griffin WL, Mason JB. Functional advantage of articulating versus static spacers in 2-stage revision for total knee arthroplasty infection. J Arthroplasty. 2007;22:1116–1121.PubMedCrossRefGoogle Scholar
  34. 34.
    Frost HM. The biology of fracture healing: an overview for clinicians. Part I. Clin Orthop Relat Res. 1989;248:283–293.PubMedGoogle Scholar
  35. 35.
    Fukunaga K, Kobayashi A, Minoda Y, Iwaki H, Hashimoto Y, Takaoka K. The incidence of the patellar clunk syndrome in a recently designed mobile-bearing posteriorly stabilised total knee replacement. J Bone Joint Surg Br. 2009;91:463–468.PubMedCrossRefGoogle Scholar
  36. 36.
    Garvin KL, Scuderi G, Insall JN. Evolution of the quadriceps snip. Clin Orthop Relat Res. 1995;321:131–137.PubMedGoogle Scholar
  37. 37.
    Gerber C, Schneeberger AG, Beck M, Schlegel U. Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br. 1994;76:371–380.PubMedGoogle Scholar
  38. 38.
    Goldstein WM, Kopplin M, Wall R, Berland K. Temporary articulating methylmethacrylate antibiotic spacer (TAMMAS): a new method of intraoperative manufacturing of a custom articulating spacer. J Bone Joint Surg Am. 2001;83(suppl 2 pt 2):92–97.PubMedGoogle Scholar
  39. 39.
    Gooding CR, Masri BA, Duncan CP, Greidanus NV, Garbuz DS. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res. 2011;469:985–993.PubMedCrossRefGoogle Scholar
  40. 40.
    Gristina AG, Kolkin J. Current concepts review: total joint replacement and sepsis. J Bone Joint Surg Am. 1983;65:128–134.PubMedGoogle Scholar
  41. 41.
    Haasper C, Kendoff D, Gebauer M, Gehrke T, Klauser W. [Revision of unconstrained total knee arthroplasty: a technical analysis][in German]. Z Orthop Unfall. 2012;150:290–295.PubMedCrossRefGoogle Scholar
  42. 42.
    Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP. The PROSTALAC functional spacer in two-stage revision for infected knee replacements: prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br. 2000;82:807–812.PubMedCrossRefGoogle Scholar
  43. 43.
    Haenle M, Skripitz C, Mittelmeier W, Skripitz R. Economic impact of infected total knee arthroplasty. ScientificWorldJournal. 2012;2012:198515.CrossRefGoogle Scholar
  44. 44.
    Halder AM. [Tibial tubercle osteotomy][in German]. Oper Orthop Traumatol. 2012;24:85–94.PubMedCrossRefGoogle Scholar
  45. 45.
    Haleem AA, Berry DJ, Hanssen AD. Mid-term to long-term follow-up of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res. 2004;428:35–39.PubMedCrossRefGoogle Scholar
  46. 46.
    Hanssen AD, Trousdale RT, Osmon DR. Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty. Clin Orthop Relat Res. 1995;321:55–67.PubMedGoogle Scholar
  47. 47.
    Heppenstall R. Fracture healing. In: Heppenstall RB, ed. Fracture Treatment and Healing. Philadelphia, PA: WB Saunders. 1980:35–64.Google Scholar
  48. 48.
    Hirschmann MT, Hoffmann M, Krause R, Jenabzadeh R-A, Arnold MP, Friederich NF. Anterolateral approach with tibial tubercle osteotomy versus standard medial approach for primary total knee arthroplasty: does it matter? BMC Musculoskelet Disord. 2010;11:167.PubMedCrossRefGoogle Scholar
  49. 49.
    Hofmann AA, Goldberg T, Tanner AM, Kurtin SM. Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res. 2005;430:125–131.PubMedCrossRefGoogle Scholar
  50. 50.
    Hofmann AA, Kane KR, Tkach TK, Plaster RL, Camargo MP. Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop Relat Res. 1995;321:45–54.PubMedGoogle Scholar
  51. 51.
    Iacono F, Bruni D, Lo Presti M, Raspugli G, Bondi A, Sharma B, Marcacci M. Knee arthrodesis with a press-fit modular intramedullary nail without bone-on-bone fusion after an infected revision TKA. Knee. 2012;19:555–559.PubMedCrossRefGoogle Scholar
  52. 52.
    Insall JN. Surgical approaches to the knee. In Insall JN, Windsor RE, Scott WN, Kelley MA, Aglietti P. Surgery of the Knee. Ed 2, Vol 1. New York, NY: Churchill Livingstone; 1993;135–148.Google Scholar
  53. 53.
    Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.PubMedGoogle Scholar
  54. 54.
    Insall JN, Thompson FM, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am. 1983;65:1087–1098.PubMedGoogle Scholar
  55. 55.
    Jämsen E, Huotari K, Huhtala H, Nevalainen J, Konttinen YT. Low rate of infected knee replacements in a nationwide series: is it an underestimate? Acta Orthop. 2009;80:205–212.PubMedCrossRefGoogle Scholar
  56. 56.
    Jämsen E, Stogiannidis I, Malmivaara A, Pajamäki J, Puolakka T, Konttinen YT. Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop. 2009;80:67–77.PubMedCrossRefGoogle Scholar
  57. 57.
    Jones RE, Huo MH. The infected knee: all my troubles now. J Arthroplasty. 2006;21(4 Suppl 1):50–53.PubMedCrossRefGoogle Scholar
  58. 58.
    Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis: a follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop. 2010;81:413–419.PubMedCrossRefGoogle Scholar
  59. 59.
    Keats AS. The ASA classification of physical status: a recapitulation. Anesthesiology. 1978;49:233–236.PubMedCrossRefGoogle Scholar
  60. 60.
    Kelly MA, Clarke HD. Stiffness and ankylosis in primary total knee arthroplasty. Clin Orthop Relat Res. 2003;416:68–73.PubMedCrossRefGoogle Scholar
  61. 61.
    Klett R, Kordelle J, Stahl U, Khalisi A, Puille M, Steiner D, Bauer R. Immunoscintigraphy of septic loosening of knee endoprosthesis: a retrospective evaluation of the antigranulocyte antibody BW 250/183. Eur J Nucl Med Mol Imaging. 2003;30:1463–1466.PubMedCrossRefGoogle Scholar
  62. 62.
    Leopold SS, Greidanus N, Paprosky WG, Berger RA, Rosenberg AG. High rate of failure of allograft reconstruction of the extensor mechanism after total knee arthroplasty. J Bone Joint Surg Am. 1999;81:1574–1579.PubMedGoogle Scholar
  63. 63.
    Lombardi AV Jr, Karnes JM, Berend KR. A motion maintaining antibiotic delivery system. J Arthroplasty. 2007;22(4 suppl 1):50–55.PubMedCrossRefGoogle Scholar
  64. 64.
    Macheras GA, Kateros K, Galanakos SP, Koutsostathis SD, Kontou E, Papadakis SA. The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg Br. 2011;93:1487–1492.PubMedCrossRefGoogle Scholar
  65. 65.
    Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN, Osmon DR. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis. 2006;46:471–478.CrossRefGoogle Scholar
  66. 66.
    Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Osmon DR. Prosthetic joint infection diagnosed postoperatively by intraoperative culture. Clin Orthop Relat Res. 2005;439:38–42.PubMedCrossRefGoogle Scholar
  67. 67.
    Maruyama M. Tibial tubercle osteotomy in revision total knee arthroplasty. Arch Orthop Trauma Surg. 1997;116:400–403.PubMedCrossRefGoogle Scholar
  68. 68.
    Meek RM, Masri BA, Dunlop D, Garbuz DS, Greidanus NV, McGraw R, Duncan CP. Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer. J Bone Joint Surg Am. 2003;85:1888–1892.PubMedCrossRefGoogle Scholar
  69. 69.
    Mendes MW, Caldwell P, Jiranek WA. The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty. 2004;19:167–174.PubMedCrossRefGoogle Scholar
  70. 70.
    Morgan J, Leighton R. Radiographic appearance of fracture healing. In: Morgan J, Leighton R, eds. Radiology of Small Animal Fracture Management. Philadelphia, PA: WB Saunders; 1995:34–43.Google Scholar
  71. 71.
    Morrey BF, Westholm F, Schoifet S, Rand JA, Bryan RS. Long-term results of various treatment options for infected total knee arthroplasty. Clin Orthop Relat Res. 1989;248:120–128.PubMedGoogle Scholar
  72. 72.
    Mortazavi SM, Molligan J, Austin MS, Purtill JJ, Hozack WJ, Parvizi J. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop. 2011;35:1157–1164.PubMedCrossRefGoogle Scholar
  73. 73.
    Nazarian DG, Booth RE Jr. Extensor mechanism allografts in total knee arthroplasty. Clin Orthop Relat Res. 1999;367:123–129.PubMedCrossRefGoogle Scholar
  74. 74.
    Ogata K, Ishinishi T, Hara M. Evaluation of patellar retinacular tension during total knee arthroplasty: special emphasis on lateral retinacular release. J Arthroplasty. 1997;12:651–656.PubMedCrossRefGoogle Scholar
  75. 75.
    Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RS, Barrack RL. Diagnosis of infected total knee: findings of a multicenter database. Clin Orthop Relat Res. 2008;466:2628–2633.PubMedCrossRefGoogle Scholar
  76. 76.
    Pedersen AB, Mehnert F, Odgaard A, Schrøder HM. Existing data sources for clinical epidemiology: The Danish Knee Arthroplasty Register. Clin Epidemiol. 2012;4:125–135.PubMedGoogle Scholar
  77. 77.
    Petty W, Bryan RS, Coventry MB, Peterson LF. Infection after total knee arthroplasty. Orthop Clin North Am. 1975;6:1005–1014.PubMedGoogle Scholar
  78. 78.
    Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008;466:1710–1715.PubMedCrossRefGoogle Scholar
  79. 79.
    Rand JA, Morrey BF, Bryan RS. Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res. 1989;244:233–238.PubMedGoogle Scholar
  80. 80.
    Ries MD, Richman JA. Extended tibial tubercle osteotomy in total knee arthroplasty. J Arthroplasty. 1996;11:964–967.PubMedCrossRefGoogle Scholar
  81. 81.
    Ritter MA, Carr K, Keating EM, Faris PM, Meding JB. Tibial shaft fracture following tibial tubercle osteotomy. J Arthroplasty. 1996;11:117–119.PubMedCrossRefGoogle Scholar
  82. 82.
    Salgado CD, Dash S, Cantey JR, Marculescu CE. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res. 2007;461:48–53.PubMedGoogle Scholar
  83. 83.
    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;8:45–48.PubMedGoogle Scholar
  84. 84.
    Singer J, Merz A, Frommelt L, Fink B. High rate of infection control with one-stage revision of septic knee prostheses excluding MRSA and MRSE. Clin Orthop Relat Res. 2012;470:1461–1471.PubMedCrossRefGoogle Scholar
  85. 85.
    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;19:714–719.PubMedCrossRefGoogle Scholar
  86. 86.
    Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999;81:672–683.PubMedGoogle Scholar
  87. 87.
    Stern SH, Insall JN. Posterior stabilized prosthesis: results after follow-up of nine to twelve years. J Bone Joint Surg Am. 1992;74:980–986.PubMedGoogle Scholar
  88. 88.
    Tabutin J, Morin-Salvo N, Torga-Spak R, Cambas PM, Vogt F. Tibial tubercule osteotomy during medial approach to difficult knee arthroplasties. Orthop Traumatol Surg Res. 2011;97:276–286.PubMedCrossRefGoogle Scholar
  89. 89.
    Thabe H, Schill S. Two-stage reimplantation with an application spacer and combined with delivery of antibiotics in the management of prosthetic joint infection. Oper Orthop Traumatol. 2007;19:78–100.PubMedCrossRefGoogle Scholar
  90. 90.
    Toms AD, Davidson D, Masri BA, Duncan CP. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br. 2006;88:149–155.PubMedCrossRefGoogle Scholar
  91. 91.
    Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117:556–562.PubMedCrossRefGoogle Scholar
  92. 92.
    Trousdale RT, Hanssen AD, Rand JA, Cahalan TD. V-Y quadricepsplasty in total knee arthroplasty. Clin Orthop Relat Res. 1993;286:48–55.PubMedGoogle Scholar
  93. 93.
    Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty: a study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78:512–523.PubMedGoogle Scholar
  94. 94.
    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;13:430–434.PubMedCrossRefGoogle Scholar
  95. 95.
    Vanhegan IS, Morgan-Jones R, Barrett DS, Haddad FS. Developing a strategy to treat established infection in total knee replacement: a review of the latest evidence and clinical practice. J Bone Joint Surg Br. 2012;94:875–881.PubMedCrossRefGoogle Scholar
  96. 96.
    Vessely MB, Whaley AL, Harmsen WS, Schleck CD, Berry DJ. The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res. 2006;452:28–34.PubMedCrossRefGoogle Scholar
  97. 97.
    Wall SJ, Rose DM, Khanuja HS, Sutter EG, Knight TA, Belkoff SM, Mears SC. Biomechanical comparison of extensile exposures in total knee arthroplasty. Orthopedics. 2010;33:387.PubMedGoogle Scholar
  98. 98.
    Wentworth SJ, Masri BA, Duncan CP, Southworth CB. Hip prosthesis of antibiotic-loaded acrylic cement for the treatment of infections following total hip arthroplasty. J Bone Joint Surg Am. 2002; 84(suppl 2):123–128.PubMedGoogle Scholar
  99. 99.
    Whiteside LA. Exposure in difficult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res. 1995;321:32–35.PubMedGoogle Scholar
  100. 100.
    Whiteside LA, Nayfeh TA, LaZear R, Roy ME. Reinfected revised TKA resolves with an aggressive protocol and antibiotic infusion. Clin Orthop Relat Res.2012;470:236–243.PubMedCrossRefGoogle Scholar
  101. 101.
    Whiteside LA, Ohl MD. Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res.1990;260:6–9.PubMedGoogle Scholar
  102. 102.
    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;71:848–852.PubMedGoogle Scholar
  103. 103.
    Young CF, Bourne RB, Rorabeck CH. Tibial tubercle osteotomy in total knee arthroplasty surgery. J Arthroplasty. 2008;23:371–375.PubMedCrossRefGoogle Scholar
  104. 104.
    Younger AS, Duncan CP, Masri BA. Surgical exposures in revision total knee arthroplasty. J Am Acad Orthop Surg. 1998;6:55–64.PubMedGoogle Scholar
  105. 105.
    Zanotti RM, Freiberg AA, Matthews LS. Use of patellar allograft to reconstruct a patellar tendon-deficient knee after total joint arthroplasty. J Arthroplasty. 1995;10:271–274.PubMedCrossRefGoogle Scholar
  106. 106.
    Zonnenberg CB, Lisowski LA, van den Bekerom MP, Nolte PA. Tuberositas osteotomy for total knee arthroplasty: a review of the literature. J Knee Surg. 2010;23:121–129.PubMedCrossRefGoogle Scholar

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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