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Exposure in difficult total knee arthroplasty using coronal tibial tubercle osteotomy.
W J Bruce1, J Rooney, S R Hutabarat
1Concord Hospital, Hospital Road, Concord, NSW, Australia.
Journal of Orthopaedic Surgery (Hong Kong)
|December 7, 2002
Summary
Coronal tibial tubercle osteotomy offers a viable solution for challenging total knee arthroplasty exposures. This technique improved patient outcomes, including knee function and range of motion, with minimal complications.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Surgical Techniques
Background:
- Total knee arthroplasty (TKA) can present significant exposure challenges, particularly in revision cases or those with preoperative knee flexion contractures.
- Traditional methods for improving exposure, such as patellar eversion, may not always be feasible.
- Alternative techniques are crucial for optimizing surgical access and patient outcomes in TKA.
Purpose of the Study:
- To evaluate the efficacy and safety of the coronal tibial tubercle osteotomy (TTO) technique for improving exposure during total knee arthroplasty.
- To assess the functional outcomes and complication rates associated with this specific TTO approach.
Main Methods:
- A retrospective review of 10 knees in 9 patients undergoing TKA with a coronal TTO, based on the Whiteside technique.
- The technique involves a lateral musculoperiosteal flap incorporating the tibial tubercle, with osteotomy of the anterior tibial crest and reattachment with wires.
- Preoperative and postoperative assessments included the Hospital for Special Surgery (HSS) knee score and range of motion (ROM).
Main Results:
- Significant improvement in HSS scores from an average of 43.6 preoperatively to 79.2 postoperatively.
- Mean ROM increased from 59.5 degrees to 78.0 degrees, with no cases of extension lag.
- Average union times were 8 weeks (proximal) and 24 weeks (distal), with no nonunions or major complications reported. Three cases had postoperative fixed flexion deformity.
Conclusions:
- The coronal tibial tubercle osteotomy is a safe and effective technique for achieving adequate exposure in challenging total knee arthroplasty cases.
- This method demonstrates favorable functional outcomes and a low complication profile, making it a valuable option for difficult primary or revision TKAs.