Dataset Information

Tibial tubercule osteotomy during the revision of total knee arthroplasty: The technique of a referral center with 10 years of experience.

ABSTRACT:

Introduction

The Tibial Tubercle Osteotomy (TTO) technique, by lifting the distal bony attachment of the extensor mechanism, allows efficient knee exposure while preserving soft tissues and tendinous attachments. The surgical technique seems essential to obtain satisfying outcomes with a low rate of specific complications. Several tip sand tricks can be used to improve this procedure during the revision of total knee arthroplasty (RTKA).

Technique

The osteotomy should be at least: 60 mm in length and 20 mm in width to allow fixation with 2 screws; and 10-15 mm thick to resist to screw compression. The proximal cut of the osteotomy must keep a proximal buttress spur of 10 mm to get primary stability and avoid the tubercle ascension. A smooth end of the TTO distally reduces the risk of a tibial shaft fracture. The strongest fixation is obtained using two bicortical 4.5 mm screws slightly ascendant.

Results

From January 2010 to September 2020, 135 patients received an RTKA with concomitant TTO and a mean follow-up of 51 ± 26 months [24-121]. The osteotomy was healed in 95% of patients (n = 128) with a mean delay of 3.4 ± 2.7 months [1.5-24]. However, there are some specific and significant complications related to the TTO. Twenty complications (15%) related to the TTO were recorded, with 8 (6%) requiring surgery.

Conclusion

Tibial tubercle osteotomy in RTKA is an efficient procedure to improve knee exposure. To avoid tibial tubercle fracture or non-union, a rigorous surgical technique is primordial with a sufficient length and thickness of the tibial tubercle, a smooth end, a proximal step, a final good bone contact, and a strong fixation.

SUBMITTER: Cance N

PROVIDER: S-EPMC10259203 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Tibial tubercule osteotomy during the revision of total knee arthroplasty: The technique of a referral center with 10 years of experience.

Cance Nicolas N Batailler Cecile C Canetti Robin R Servien Elvire E Lustig Sébastien S

SICOT-J 20230613

<h4>Introduction</h4>The Tibial Tubercle Osteotomy (TTO) technique, by lifting the distal bony attachment of the extensor mechanism, allows efficient knee exposure while preserving soft tissues and tendinous attachments. The surgical technique seems essential to obtain satisfying outcomes with a low rate of specific complications. Several tip sand tricks can be used to improve this procedure during the revision of total knee arthroplasty (RTKA).<h4>Technique</h4>The osteotomy should be at least: ...[more]

PMID: 37306497

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Project description:PurposeThis study aimed to compare the clinical outcomes, mechanical axis, component positioning, leg length discrepancy (LLD), and polyethylene liner thickness between robotic-assisted total knee arthroplasty (TKA) and conventional TKA in patients with failed high tibial osteotomy (HTO).MethodsA total of 30 patients (30 knees) with failed HTO who underwent TKA using a robot-assisted system between June 2020 and December 2023 were included in this study (robotic group). Additionally, 60 patients (60 knees) with failed HTO who underwent conventional TKA were included as controls (conventional group). Propensity score matching was performed using a 2:1 ratio between the matched participants. The mean follow-up period was 2.1 years in the robotic group and 2.2 years in the conventional group. Clinical evaluations were performed using the Knee Society Score (KSS) rating system. Mechanical axis, component coronal and sagittal positioning, and LLD were evaluated using postoperative radiographs. The thickness of the polyethylene liner was also determined. The mean error values and outliers were calculated and compared between the two groups to determine the accuracy of the mechanical axis, postoperative component positioning, and LLD.ResultsThe postoperative KSSs in the robotic and conventional groups were not statistically different. The robotic group achieved better accuracy than the conventional group in terms of postoperative mean mechanical axis (1.7° vs. 2.4°, p < 0.05), femur coronal inclination (90.0° vs. 91.6°, p < 0.05), tibial coronal inclination (90.3° vs. 91.3°, p < 0.05), tibial sagittal inclination (90.5° vs. 91.4°, p < 0.05), and LLD (2.2 vs. 7.0 mm, p < 0.05). A significant difference in polyethylene liner thickness was observed between the two groups (p < 0.05).ConclusionsRobotic-assisted TKA showed improved mechanical axis, higher accuracy of component positioning and polyethylene liner thickness, and reduced LLD compared with those of conventional TKA in patients with failed HTO. Further studies with a larger sample size and long-term follow-up are warranted to ascertain whether the accuracy of robotic-assisted TKA can translate into better clinical outcomes and patient satisfaction.

Project description:BackgroundHigh tibial osteotomy (HTO) is a treatment option for younger, active patients with medial compartment knee osteoarthritis. Clinical results of HTO have been shown to deteriorate over time despite initial satisfactory results, requiring patients to eventually undergo conversion to total knee arthroplasty (TKA). Evidence monitoring survivorship of HTO remains scarce and potentially outdated.PurposeTo investigate the impact of concomitant cartilage repair procedures, conversion to TKA, and associated complications for HTO.Study designSystematic review; Level of evidence, 4.MethodsWe searched MEDLINE, Embase, Cochrane Library, and SCOPUS from inception to July 18, 2023, for studies reporting on survivorship and associated complications after medial opening-wedge HTO. Pooled analysis of conversion to TKO was categorized as occurring at <5 years, 5 to 10 years, or >10 years postoperatively. Further subgrouping was performed on studies reporting on HTO with concomitant cartilage repair procedures.ResultsOverall, 59 studies comprising 5162 patients were included. Rates of conversion to TKA were 4.5% at <5 years, 8.3% at 5 to 10 years, and 11.2% at >10 years. When comparing patients with isolated HTO versus HTO with concomitant cartilage procedures (including mesenchymal stem cell augmentation, osteochondral allograft transplantation, microfracture, abrasion arthroplasty, and autologous chondrocyte implantation), there was no significant difference in survival rates at <5 years (relative risk, 0.78 [95% CI, 0.45-1.33]; P = .36) or 5 to 10 years (relative risk = 0.76 [95% CI, 0.32-1.83]; P = .55). The overall complication rate was 12.1%; intraoperative lateral hinge and tibial plateau fractures had pooled complication rates of 1.6% and 2.0%, respectively. The rate of nonunion was 1.7%, and pooled rates of superficial and deep infections were 2.6% and 2.0% respectively.ConclusionRates of conversion to TKA and complications were low and acceptable, although survival rates decreased with time. Concomitant cartilage repair procedures as a whole did not significantly improve survivorship; however, more high-quality studies are warranted to determine the impact of individual concomitant cartilage repair procedures.

Dataset Information

Tibial tubercule osteotomy during the revision of total knee arthroplasty: The technique of a referral center with 10 years of experience.

Introduction

Technique

Results

Conclusion

Publications

Tibial tubercule osteotomy during the revision of total knee arthroplasty: The technique of a referral center with 10 years of experience.

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