Chun, J Arthroplasty 2019 - Tibial Tubercle Osteotomy vs. the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach?

Tibial Tubercle Osteotomy vs. the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach?

Chun, et al.·J Arthroplasty·2019·17 citations

Background

As the frequency of total knee arthroplasty (TKA) is increasing, long-term follow-up of patients has become essential, and the frequency of revision total knee arthroplasty (R-TKA) due to the occurrence of various complications has also increased. There is controversy regarding which approach has minimal complications and an adequate visual field in R-TKA. Therefore, we compared the clinical and radiological results between the extensile medial parapatellar (EMP) approach and tibial tubercle osteotomy (TTO) for R-TKA.

Methods

Between March 1, 2000, and December 31, 2015, we compared 35 patients who underwent the EMP approach and 31 who underwent the TTO approach for R-TKA.
In this study, the preoperative range of motion (ROM) was an important criterion for the choice of approach in R-TKA.
The EMP approach was applied to patients with a ROM above 60°.
The TTO approach was applied to patients with knee flexion limited to 0°-30°.
We clinically assessed knee ROM, Knee Society scores, and Hospital for Special Surgery scores at the time of the last follow-up.
We radiographically measured femorotibial alignment and patellar height.
We also examined the complication rates.
The average length of the TTO was 1.0 × 2.5 cm × 10 cm.
We used 3 or more 3.5-mm half-threaded screws.

Results

The mean postoperative ROM of the knee joint at the time of the last follow-up was 103° (flexion contracture 5° and further flexion 108°) in the group that underwent the EMP approach and 101° (flexion contracture 4° and further flexion 109°) in the group that underwent the TTO approach.
The mean Knee Society scores were 86 (71-96) and 85 (72-94), and the mean Hospital for Special Surgery scores were 82 (70-93) and 83 (68-92) for the 2 groups, respectively, with no statistically significant difference.
The mean femorotibial angles were 0.6° (±3.3°) and 0.1° (±2.9°), and the mean Insall-Salvati ratios were 1.0 (±0.34) and 0.8 (±0.14), respectively, with no statistically significant difference.
The group that underwent TTO achieved bone union at an average of 11.8 weeks after surgery.
In the group that underwent the EMP approach, 2 patients had extensor lag of more than 10°.
In the group that underwent TTO, 2 subjects had skin necrosis at the operative site.

Conclusions

The clinical and radiological outcomes were similar in the 2 groups after R-TKA. To increase the ROM and obtain adequate exposure, TTO is also considered a useful surgical approach. However, complications related to TTO should be minimized.

Level of evidence: Therapeutic level III, retrospective comparative study. Copyright remains with the authors and publisher.

Supplemental

Tibial Tubercle Osteotomy vs. the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach?