The Outcome of Sequential Repeated Tibial Tubercle Osteotomy Performed in 2-Stage Revision Arthroplasty for Infected Total Knee Arthroplasty

The Harris Orthopedic Laboratory and Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
The Journal of arthroplasty (Impact Factor: 2.37). 05/2012; 27(8):1487-91. DOI: 10.1016/j.arth.2012.03.016
Source: PubMed

ABSTRACT Thirteen patients with infected total knee arthroplasty treated by 2-stage revision requiring tibial tubercle osteotomy in both stages for extensile exposure were retrospectively analyzed. The preoperative mean range of knee motion improved from 60° (range, 30°-90°) to 94° (range, 70°-120°) at latest follow-up. The Knee Society knee scores and function scores were 39 and 18 preoperatively and 78 and 67 at latest follow-up, respectively. Although proximal migration occurred in 3 cases and a partial proximal avulsion fracture of the osteotomy segment occurred in 1 case after the second-stage reimplantation, radiographic bony union was observed in all cases. Sequential repeated tibial tubercle osteotomy can be a useful extensile surgical approach in staged revision for infected total knee arthroplasty with satisfactory clinical and radiographic outcomes.

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    ABSTRACT: Background Difficulties in knee exposure during revision total knee arthroplasty (RTKA) may require tibial tubercle osteotomy (TTO). The main objective of this study was to assess union after TTO hinged on the lateral soft tissues and fixed using circumferential cable cerclage during RTKA. Hypothesis Non-union is uncommon with this technique. Patients and methods We retrospectively included consecutive patients who underwent RTKA between 2008 and 2010 with TTO. Chevron osteotomy was performed and the fragment was left hinged laterally on the tibialis anterior muscle then fixed using circumferential cerclage with one or two steel cables. The primary evaluation criterion was TTO union as assessed on radiographs. Secondary evaluation criteria were time to union, osteotomy fragment migration, patellar height, and the IKS score at last follow-up. We included 65 patients with a mean age of 72 ± 11.3 years including 39 (60%) undergoing septic revision and 26 (40%) aseptic revision. Mean follow-up was 27.8 ± 10.7 months; there was 1 early death, which was unrelated to the surgery, and another patient was lost to follow-up. Results TTO union was achieved in 59/63 (93.7%) patients. Fragment migration occurred in 4 (6.3%) patients. Mean time to union was 16.9 ± 5.1 weeks overall, 12.4 ± 2.0 in the aseptic revision group, and 18.9 ± 4.8 in the septic revision group (P = 0.0005). Patellar height at last follow-up was not significantly changed compared to the preoperative value (P = 0.09). At last follow-up, the mean IKS knee and function scores were significantly improved (P < 10–5). Conclusion TTO hinged on the lateral soft tissues and fixed by circumferential cable cerclage ensured union in the vast majority of patients, with a low rate of tubercle migration. Level of evidence IV, retrospective study.
    Orthopaedics & Traumatology Surgery & Research 09/2014; 100(5). DOI:10.1016/j.otsr.2014.02.012 · 1.17 Impact Factor
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    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.
    Clinical Orthopaedics and Related Research 01/2013; 471(4). DOI:10.1007/s11999-012-2763-z · 2.88 Impact Factor