Abstract
Purpose
The incidence of revision knee arthroplasty for infection is increasing and the required surgical approach for the revision is a challenge for surgeons. Extensile approaches are frequently used when it is impossible to evert the extensor mechanism. The aim of this paper is to report our experience with tibial tubercle osteotomy (TTO) and the functional results in patients who underwent a two-stage revision due to prosthesis infection.
Methods
Twenty-six patients underwent a TTO as a surgical approach in the second stage of revision for infection. The patients were clinically assessed by means of functional scales (the Knee Society Score and WOMAC) and X-rays.
Results
The TTO healed without complications in 22 patients (84.6 %) and the average length of follow-up was 3.4 years. Non-union was observed in two patients. One patient presented an extension lag of 5°. A total of 23 patients (88.4 %) were free from infection. Twenty-five patients (96.1 %) had better scores on the Knee Society Score and WOMAC after the procedure.
Conclusions
In patients undergoing the second stage of revision total knee arthroplasty for infection, the TTO approach provides a large operating field. This enables surgeons to withdraw spacers and position new implants without damaging the extensor mechanism of the knee or altering the postoperative rehabilitation process. The complications that have been reported as a result of this procedure could be reduced by performing a meticulous surgical technique.
Level of evidence
Retrospective case series, Level IV.
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References
Del Pozo JL, Patel R (2009) Clinical practice. Infection associated with prosthetic joints. N Engl J Med 361:787–794. doi:10.1056/NEJMcp0905029
Barrack RL, Smith P, Munn B, Engh G, Rorabeck C (1998) The Ranawat Award. Comparison of surgical approaches in total knee arthroplasty. Clin Orthop Relat Res 356:16–21
Whiteside LA (1995) Exposure in difficult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res 321:92–97
Whiteside LA, Ohl MD (1990) Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res 260:6–9
Dolin MG (1983) Osteotomy of the tibial tubercle in total knee replacement. A technical note. J Bone Joint Surg Am 65(5):704–706
Mendes MW, Caldwell P, Jiranek WA (2004) The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty 19(2):167–174
Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840
Brooks P (2009) Extensor mechanism ruptures. Orthopedics 32(9). doi:10.3928/01477447-20090728-31
Choi HR, Burke D, Malchau H, Kwon YM (2012) Utility of tibial tubercle osteotomy in the setting of periprosthetic infection after total knee arthroplasty. Int Orthop 36:1609–1613
Wishart M, Arnold MP, Huegli RW, Amsler F, Friederich NF, Hirschmann MT (2012) Anterolateral approach using tibial tubercle osteotomy for total knee arthroplasty: can we predict failure? Int Orthop 36:2485–2490
Zonnenberg CBL, van den Bekerom MPJ, de Jong T, Nolte PA (2014) Tibial tubercle osteotomy with absorbable suture fixation in revision total knee arthroplasty: a report of 23 cases. Arch Orthop Trauma Surg 134:667–672
Bruni D, Iacono F, Sharma B, Zaffagnini S, Marcacci M (2013) Tibial tubercle osteotomy or quadriceps snip in two-stage revision for prosthetic knee infection? A randomized prospective study. Clin Orthop Relat Res 471:1305–1318
Chinzei N, Ishida K, Kuroda R, Matsumoto T, Kubo S, Iguchi T, Chin T, Akisue T, Nishida K, Kurosaka M, Tsumura N (2014) Tibial tubercle osteotomy with screw fixation for total knee arthroplasty. Orthopedics 37(4):367–373
Wolff AM, Hungerford DS, Krackow KA, Jacobs MA (1989) Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg Am 71(6):848–852
Young CF, Bourne RB, Rorabeck CH (2008) Tibial tubercle osteotomy in total knee arthroplasty surgery. J Arthroplasty 23(3):371–375. doi:10.1016/j.arth.2007.02.019
Manopoulos P, Havet E, Pearce O, Lardanchet JF, Mertl P (2012) Mid- to long-term results of revision total knee replacement using press-fit intramedullary stems with cemented femoral and tibial components. J Bone Joint Surg Br 94(7):937–940. doi:10.1302/0301-620X.94B7.26943
Deane CR, Ferran NA, Ghandour A, Morgan-Jones RL (2008) Tibial tubercle osteotomy for access during revision knee arthroplasty: Ethibond suture repair technique. BMC Musculoskelet Disord 30(9):98. doi:10.1186/1471-2474-9-98
Davis K, Caldwell P, Wayne J, Jiranek WA (2000) Mechanical comparison of fixation techniques for the tibial tubercle osteotomy. Clin Orthop Relat Res 380:241–249
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Segur, J.M., Vilchez-Cavazos, F., Martinez-Pastor, J.C. et al. Tibial tubercle osteotomy in septic revision total knee arthroplasty. Arch Orthop Trauma Surg 134, 1311–1315 (2014). https://doi.org/10.1007/s00402-014-2064-y
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DOI: https://doi.org/10.1007/s00402-014-2064-y