Tibial Tubercle Osteotomy to Aid Exposure for Revision Total Knee Arthroplasty

JBJS Essential Surgical Techniques
Alexander DeHaanMichael D Ries

Abstract

A tibial tubercle osteotomy can provide reliable and safe exposure during revision total knee arthroplasty with a high union rate, low complication rate, and predictable outcomes. Determine the need for an extensile approach on the basis of the preoperative knee range of motion; position of the patella; bone quality; medical comorbidities; and cement mantle, tibial keel or stem, and thickness of the anterior tibial cortex. Create full-thickness subcutaneous flaps and perform a medial parapatellar arthrotomy with complete synovectomy and careful excision of scar tissue from the medial and lateral gutters. Extend the skin and subcutaneous dissection distal to the tibial tubercle and mark the chevron osteotomy using electrocautery. Perform the osseous cut for the tibial tubercle osteotomy with a thin saw blade in a medial-to-lateral direction, such that the fragment hinges on the lateral soft tissue and musculature. With the knee maximally flexed and lateral subluxation of the extensor mechanism, for full visualization of the femoral and tibial components, remove the components and perform the knee revision. The final tibial component should have a diaphyseal stem long enough to bypass the distal extent of the tibial tubercle oste...Continue Reading

References

Dec 1, 1996·The Journal of Arthroplasty·M D Ries, J A Richman
Jan 26, 1999·Clinical Orthopaedics and Related Research·R L BarrackC Rorabeck
Nov 7, 2000·Clinical Orthopaedics and Related Research·K DavisW A Jiranek
Dec 4, 2003·Clinical Orthopaedics and Related Research·Michael A Kelly, Henry D Clarke
Feb 20, 2004·The Journal of Arthroplasty·Michael W MendesWilliam A Jiranek
Jul 9, 2004·Clinical Orthopaedics and Related Research·Paul E CaldwellWilliam A Jiranek
Sep 3, 2004·The Journal of Arthroplasty·Paul N SmithRobert B Bourne
May 5, 2006·Clinical Orthopaedics and Related Research·Craig J Della ValleAaron G Rosenberg
Mar 25, 2008·The Journal of Arthroplasty·Claire F YoungCecil H Rorabeck
Sep 6, 2008·The Knee·Sérgio Rocha PiedadePhilippe Neyret
Apr 15, 2011·Orthopaedics & Traumatology, Surgery & Research : OTSR·J TabutinF Vogt
Apr 26, 2014·Orthopedics·Nobuaki ChinzeiNobuhiro Tsumura

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Citations

Jul 17, 2021·EFORT Open Reviews·Paolo Salari, Andrea Baldini

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