Feasibility of repeat tibial tubercle osteotomy in re-revision knee arthroplasty

Tibial Tubercle osteotomy (TTO) is used as an extensile approach to gain exposure in revision knee arthroplasty. Healing of sequential TTO in re-revision arthroplasty may be compromised, because of vascular compromise, poor bone quality, and loss of bone stock. This study was conducted to assess the healing and complications of sequential repeat TTO in re-revision knee arthroplasty.

We reviewed our clinical and radiological results in a cohort of 58 consecutive patients who had 134 TTOs for complex revision knee replacement. Out of these exposures, 86 (86/134) were sequential repeat osteotomies after the first TTO. The mean age of patients was 62.8 yrs. From clinical and radiographs, union of TTO, proximal migration, extensor lag and range of motion was evaluated.

Radiographic Union occurred in 97.6% of sequential repeat osteotomies. There were two nonunion (2/86). Proximal migration averaging 6 mm occurred in 8 osteotomies (8/86). Crest fragmentation occurred in 2 osteotomies (2/86), with one healing without complications and the other developing into nonunion. There were no soft tissue complications, no extension lag and no complications related to the suture material.

We conclude that sequential repeat TTO in re-revision surgeries is associated with high union rate and a low complication rate. Our technique for the osteotomy is described in detail.