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Before the surgery, all the patients underwent
a systematic assessment that included a clini-
cal and radiological evaluation and
International Knee Society (IKS) scores.
The decision to perform tibial tubercle osteo-
tomy was defined pre-operatively (clinical and
radiological examinations) and, intra operati-
vely, if tibial exposure was mediocre or the
patella dislocation difficult when the knee was
flexed at 90° and there was a risk of patellar
tendon avulsion.
With regard to surgical treatment, 50 Primary
TKA (39.7%) from the tibial tubercle osteoto-
my group had previously undergone surgery
on the same knee, while 308 Primary TKA
(22.9%) in the group A.
In the group A, the medial approach was used
in 1232 cases (91.4%) and the lateral approach
in 109 cases (8.1%) and anterolateral approach
in 7 cases (0.5%). However, in the tibial
tubercle osteotomy group, the lateral approach
was used in 103 cases (81.8%) that included
98 cases of peduncle tibial tubercle osteotomy;
the medial approach in 18 cases (14.3%) that
included 16 cases of peduncle tibial tubercle
osteotomy; and anterolateral approaches in
5 cases (4%).
RESULTS
During the postoperative follow-up, in the
tibial tubercle osteotomy group of 126 cases,
113 patients were clinically reassessed after a
mean follow-up period of 31.78 months (24-
85). In the group of 1348 patients without tibial
tubercle osteotomy, the mean follow-up period
of 1252 patients was 44.19 months (24-193).
COMPLICATIONS
During the postoperative follow up, in the
group A
, we identified 172 complications that
represents 12.8% of the cases in this group. A
second surgical intervention was performed in
83.6% of these cases and prosthetic compo-
nent replacement in 41.9% of the cases.
In
group B
, we registered 26 cases (20.6%) of
complications. 82.6% of these cases under-
went another surgical intervention and in 21%
of cases, the prosthetic components were
replaced, while in 79%, the prosthetic compo-
nents were not replaced. Considering prosthe-
tic components replacement, statistical analy-
sis showed no difference between both study
groups (p=0.084).
Complications related to total knee arthroplas-
ty procedure in the both study groups were
local complications: tibial tubercle fracture,
clunk, tibial plateau fissure, femur fracture,
patella infera, undiagnosed pain, skin necrosis,
TKA loosening, laxity, stiffness, infection.
Statistical analysis showed that tibial tubercle
fracture (p=0.001) and skin necrosis (p≤0.001)
were complications related to group B, while;
no difference was found related to postoperati-
ve infection.
DISCUSSION
The literature presents several authors who
report their experiences with tibial tubercle
osteotomy as the technique of choice for the
best surgical approach in total knee arthroplas-
ty. However, the majority of these studies refer
to revision TKA series. In our work we have
reported a continuous series of 1474 cases of
primary total knee arthroplasty, where 8.5% of
the cases (126) underwent tibial tubercle
osteotomy to obtain adequate exposure.
Within this context, prior surgical treatment on
the same knee represents one of the factors fre-
quently associated with difficulties of surgical
exposure. Similarly, in our series of patients,
Group B
(tibial tubercle osteotomy) presented
a statistically significant relation with previous
surgical treatment, representing 42% more
than Group A (p≤0.001).
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