Tuberositas osteotomy for total knee arthroplasty: a review of the literature

Tibial tubercle osteotomy (TTO) is a well-known technique for improving exposure in difficult total knee arthroplasty (TKA). We have performed a review of the literature concerning this procedure with the purpose of evaluation using the clinical results and complication rates in primary and revision TKA using TTO. We conducted a search limited to the following databases: PubMed/Medline, Cochrane Database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase. These were searched from 1979 to May 2009 to identify studies relating to the primary and revisions of TKA using a tuberositas osteotomy. Eighteen studies met the inclusion criteria including 823 cases. In 762 cases, a medial TTO was performed. Most patients had an improved knee function after TKA. Proximal migration of the osteotomized site (n=18), TTO-related pain (n=17), and avulsion fractures of the tubercle (n=13) were the most reported complications of this technique. TTO is a relatively safe and reproducible procedure for the enhancement of surgical exposure in difficult primary or revision TKA. Serious complications related to TTO were reported in 8 to 9% of all cases. Future studies should compare different fixation methods in a prospective randomized controlled way.