Abstract
Purpose
Controversies exist regarding the ideal approach in a revision total knee arthroplasty for infection, providing adequate exposure with minimum complications. The purpose of this study was to compare the results of second stage revision total knee arthroplasty (TKA) between tibial tubercle osteotomy (TTO) and quadriceps snip (QS) approaches for infected TKA.
Methods
The clinical and radiological outcomes of 27 patients of TTO and 21 patients of QS in second stage revision TKA for infected TKA were compared with an average follow up of 51 months. We evaluated the clinical outcomes including HSS score, WOMAC score, flexion contracture, and maximal flexion between two groups. The radiological outcomes in terms of femorotibial alignment, patellar height and complications were also compared.
Results
At the final follow-up, KSS score, HSS score, WOMAC score, flexion contracture, and maximal flexion showed no statistically significant differences between the two groups. The femorotibial alignment and patellar height also showed no differences between the two groups. During the surgery, patellar tendon partial avulsion was more commonly observed in the QS group than in the TTO group (five vs two cases).
Conclusion
Both tibial tubercle osteotomy and quadriceps snip in revision TKA were considered as good approaches without significant complications. However, cautious exposure of patellar tendon or strong fixation of the osteotomy is needed to minimize the complications.
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References
Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC (2004) Infection after total knee arthroplasty. J Bone Joint Surg (Br) 86(5):688–691
Peersman G, Laskin R, Davis J, Peterson M (2001) Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 392:15–23
Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M (2001) Early failures in total knee arthroplasty. Clin Orthop Relat Res 392:315–318
Haasper C, Kendoff D, Gebauer M, Gehrke T, Klauser W (2012) Revision of unconstrained total knee arthroplasty: a technical analysis [in German]. Z Orthop Unfall 150:290–295
Haenle M, Skripitz C, Mittelmeier W, Skripitz R (2012) Economic impact of infected total knee arthroplasty. Sci World J 2012:196515
Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468(1):45–51
Jamsen E, Huotari K, Huhtala H, Nevalainen J, Konttinen YT (2009) Low rate of infected knee replacements in a nationwide series: is it an underestimate? Acta Orthop 80(2):205–212
James A, Rand MD, Ries GH, Landis AG, Rosenberg SH (2003) Intraoperative assessment in revision total knee arthroplasty. J Bone Joint Surg Am 85-A(Suppl 1):S26–S37
Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 367:165–171
Younger AS, Duncan CP, Masri BA (1998) Surgical exposures in revision total knee arthroplasty. J Am Acad Orthop Surg 6(1):55–64
Della Valle CJ, Berger RA, Rosenberg AG (2006) Surgical exposures in revision total knee arthroplasty. Clin Orthop Relat Res 446:59–68
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(4):1305–1318
Hofmann AA, Goldberg T, Tanner AM, Kurtin SM (2005) Treatment of infected total knee arthroplasty using an articulating spacer 2- to 12-year experience. Clin Orthop Relat Res 430:125–131
Jones RE, Huo MH (2006) The infected knee: all my troubles now. J Arthroplasty 21(4 Suppl 1):50–53
Coonse GK, Adams JD (1943) A new operative approach the knee joint. Surg Gynecol Obstet 77:344–347
Insall JN (1993) Surgical approaches to the knee. In: Insall JN, Windsor RE, Scott WN, Kelley MA, Aglietti P (eds) Surgery of the Knee, vol 1, 2nd edn. Churchill Livingstone, New York, pp 135–148
Windsor RE, Insall JN (1988) Exposure in revision total knee arthroplasty: the femoral peel. Tech Orthop 3:1–4
Garvin KL, Scuderi G, Insall JN (1995) Evolution of the quadriceps snip. Clin Orthop Relat Res 321:131–137
Dolin MG (1983) Osteotomy of the tibial tubercle in total knee replacement: a technical note. J Bone Joint Surg Am 65(5):704–706
Whiteside LA (1995) Exposure in difficult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res 321:32–35
Zanotti RM, Freiberg AA, Matthews LS (1995) Use of patellar allograft to reconstruct a patellar tendon-deficient knee after total joint arthroplasty. J Arthroplasty 10(3):271–274
Mendes MW, Caldwell P, Jiranek WA (2004) The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty 19(2):167–174
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
Trousdale RT, Hanssen AD, Rand JA, Cahalan TD (1993) V-Y quadricepsplasty in total knee arthroplasty. Clin Orthop Relat Res 286:48–55
Insall JN, Thompson FM, Brause BD (1983) Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am 65(8):1087–1098
Barrack RL (1999) Specialized exposure for revision total knee arthroplasty: quadriceps snip and patellar turndown. Instr Course Lect 48:149–152
Clarke HD (2003) Tibial tubercle osteotomy. J Knee Surg 16(1):58–61
Wolf 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
Whiteside LA, Ohl MD (1990) Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res 260:6–9
Denham RA, Bishop RE (1978) Mechanics of the knee and problems in reconstructive surgery. J Bone Joint Surg (Br) 60-B(3):345–352
Ritter MA, Carr K, Keating EM, Faris PM, Meding JB (1996) Tibial shaft fracture following tibial tubercle osteotomy. J Arthroplasty 11(1):117–119
Caldwell PE, Bohlen BA, Owen JR, Brown MH, Harris B, Wayne JS, Jiranek WA (2004) Dynamic confirmation of fixation techniques of the tibial tubercle osteotomy. Clin Orthop Relat Res 424:173–179
Tabutin J, Morin-Salvo N, Torga-Spak R, Cambas PM, Vogt F (2011) Tibial tubercule osteotomy during medial approach to difficult knee arthroplasties. Orthop Traumatol Surg Res 97(3):276–286
Arredondo J, Worland RL, Jessup DE (1998) Nonunion after a tibial shaft fracture complicating tibial tubercule osteotomy. J Arthroplasty 13(8):958–960
Halder AM (2012) Tibial tubercle osteotomy. Oper Orthop Traumatol 24(2):85–94
Zonnenberg CB, Lisowski LA, van den Bekerom MP, Nolte PA (2010) Tuberositas osteotomy for total knee arthroplasty: a review of the literature. J Knee Surg 23(3):121–129
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(8):1609–1613
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
Rand JA, Morrey BF, Bryan RS (1989) Patellar tendon rupture after total knee arthroplasty. Clin Orthop Relat Res 244:233–238
Brooks P (2009) Extensor mechanism ruptures. Orthopedics 32(9)
Chalidis BE, Ries MD (2009) 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 80(4):426–431
Acknowledgments
This research was funded by Chonnam National University Hospital (CRI11018-1).
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Sun, Z., Patil, A., Song, EK. et al. Comparison of quadriceps snip and tibial tubercle osteotomy in revision for infected total knee arthroplasty. International Orthopaedics (SICOT) 39, 879–885 (2015). https://doi.org/10.1007/s00264-014-2546-0
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DOI: https://doi.org/10.1007/s00264-014-2546-0