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

被引:37
作者
Piedade, Sergio Rocha [2 ,3 ]
Pinaroli, Alban
Servien, Elvire
Neyret, Philippe [1 ]
机构
[1] Hosp Civils Lyon, Ctr Livet, Hop Croix Rousse, Dept Orthopedie Genou, F-69300 Caluire Et Cuire, France
[2] Univ Estadual Campinas, UNICAMP, Sch Med Sci, Dept Orthoped & Traumatol, Campinas, SP, Brazil
[3] CNPq, Natl Council Sci & Technol Dev, Campinas, SP, Brazil
关键词
Tibial tubercle osteotomy; Total knee replacement; TKA;
D O I
10.1016/j.knee.2008.06.006
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
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 tibia] 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 degrees, stress valgus and varus view) and International Knee Society scores. When analysing intraoperative complications, tibial plateau fissures or fractures and tibia] 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. (C) 2008 Elsevier B.V. All rights reserved.
引用
收藏
页码:439 / 446
页数:8
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