Tibial tubercle osteotomy in primary total knee arthroplasty: A safe procedure or not?

Artigo Publicado na revista “The Knee” na edição de dezembro 2008

Leia o artigo na integra: https://www.thekneejournal.com/article/S0968-0160(08)00116-6/abstract

Abstract

The objective of this study was to investigate the influence of tibial tubercle osteotomy on postoperative outcome, intra- and postoperative complications, as well as postoperative clinical results and failures in primary total knee arthroplasty (TKA). In a continuous, consecutive series of 1474 primary TKA, we analysed 126 cases where a tibial tubercle osteotomy approach was performed and 1348 cases without tibial tubercle osteotomy. Before surgery, all patients underwent a systematic assessment that included a clinical examination, radiographs (stress hip–knee–ankle film [pangonogram], weight bearing, anteroposterior knee view, schuss view, profile and patellar axial view at 30°, stress valgus and varus view) and International Knee Society scores. When analysing intraoperative complications, tibial plateau fissures or fractures and tibial tubercle fracture were considered as complications relating to the tibial tubercle osteotomy group (p<0.001, p=0.007). With a 2-year minimum follow-up, there was no statistical difference in the number of revisions carried out in the two study groups (p=0.084). However, postoperative tibial tubercle fracture and skin necrosis were significantly related to the osteotomy (p=0.001 and p≤0.001, respectively).

Tibial tubercle osteotomy cannot be considered an entirely safe procedure in primary TKA as it is associated with local complications, particularly skin necrosis and fracture of the tibial tubercle. Therefore, tibial tubercle osteotomy should be performed only when necessary, i.e. in cases where there are difficulties gaining adequate surgical exposure, ligament balance and correct implant positioning. The procedure also demands considerable surgical experience to achieve a good outcome.

Autors

• Sérgio Rocha Piedade
• Alban Pinaroli
• Elvire Servien
• Philippe Neyret

Publication

A revista The Knee é uma revista internacional que publica estudos sobre o tratamento clínico e as características biomecânicas fundamentais dessa articulação, sendo um veículo relevante para cirurgiões, engenheiros biomédicos, especialistas em imagem, cientistas de materiais, pessoal de reabilitação e todos aqueles interessados ​​no joelho. Os tópicos abordados incluem, mas não estão limitados a: • Anatomia, fisiologia, morfologia e bioquímica; • estudos biomecânicos; • Avanços no desenvolvimento de dispositivos protéticos, ortopédicos e de aumento; • técnicas de imagem e diagnóstico; Patologia; • trauma; • Cirurgia; Reabilitação.

KNEE, December 2008, Volume 15, Issue 6, Pages 439–446