Article

Tibial tubercle osteotomy (TTO) is an established
surgical technique for exposing the stiff kneein revision total knee arthroplasty
(RTKA). The osteotomy is usually performed through the anterior metaphyseal
cancellous bone of the tibia but it can be extended into the intramedullary canal
if tibial stem and cement removal are necessary. Furthermore, repeat osteotomy
may be required in another RTKA. We assessed whether intramedullary extension of
TTO or repeat osteotomy affected the healing rate in RTKA. METHODS: We
retrospectively evaluated 74 consecutive patients (39 women) with an average age
of 60 (29-89) years who underwent 87 TTOs during RTKA. 1 patient had bilateral
TTO.10 patients had repeat TTO and 1 patient received 3 TTOs in the same knee.
The osteotomy was extramedullary in 57 knees and intramedullary in 30 knees.
Osteotomy repair was performed with bicortical screws and/or wires. RESULTS: Bone
healing occurred in all the cases. The median time to union was 15 (6-47) weeks.
The median healing time for the extramedullary osteotomy group was 12 weeks and
for the intramedullary osteotomy group it was 21 weeks (p = 0.002). Repeat
osteotomy was not associated with delayed union. Neither intramedullary nor
repeat osteotomy was found to increase the complication rate of the procedure.
INTERPRETATION: Reliable bone healing can be expected with intramedullary
extension or repeat TTO in RTKA. However, intramedullary extension of the
osteotomy prolongs the union time of the tibial tubercle.

Langue : ANGLAIS