Total knee revision arthroplasty: comparison between tibial tubercle osteotomy and quadriceps snip approach. Complication rate.

Main Article Content

Paolo Di Benedetto
Michele Buttironi
Piero Giardini
Francesco Mancuso
Vanni Cainero
Araldo Causero

Keywords

Arthroplasty, Revision, Knee, Tibial Tuberosity Osteotomy, Quadriceps Snip, Complication

Abstract

Background and aim of the work: The total knee arthroplasty (TKA) revision is not a second time
of primary implant surgery but is a very complex issue for orthopedic surgeon. When local conditions make
necessary a greater visualization, medial para-patellar access with quadriceps snip (QS) or the osteotomy of the
tibial tuberosity (TTO) can be the solutions. This work aims to compare the quadriceps snip and the detachment
of the tibial tubercle, focusing on possible complications. Materials and Methods: At our institution,
between January 2017 and February 2019 52 TKA revision for periprosthetic joint infection (PJI) or aseptic
mobilization were performed. In 43 cases an extensive surgical approach was required: for patients with range
of movement (ROM) < 60° was chosen TTO, while with ROM > 60° a QS was performed. Clinical and radiological
follow-up was available for all the 43 cases. Results: The data about clinical outcome in our study show
that both groups have a positive trend in KSS score over time with similar ROM results. Two partial avulsions
of patellar tendon during revision surgery were reported. Clinical outcome in both groups has shown good
results at the end of follow-up with no post-operative incidence of complications. Conclusion: We can assert
that both QS and TTO are good approach for TKA revision. Future studies will be needed to understand if
preparatory ROM is a good way to decide which surgical approach to use.(www.actabiomedica.it)

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References

1. Registro Italiano ArtroProtesi - Annual Report. 2018, Istituto Superirore di Sanità.
2. Fehring, T.K., et al., Early failures in total knee arthroplasty. Clin Orthop Relat Res, 2001(392): p. 315-8.
3. Delanois, R.E., et al., Current Epidemiology of Revision Total Knee Arthroplasty in the United States. J Arthroplasty, 2017. 32(9): p. 2663-2668.
4. Di Benedetto, P., et al., Two-stage revision after total knee arthroplasty. Acta Biomed, 2017. 88(2S): p. 92-97.
5. Mancuso, F., et al., Management of metaphyseal bone loss in revision knee arthroplasty. Acta Biomed, 2017. 88(2S): p. 98-111.
6. Della Valle, C.J., R.A. Berger, and A.G. Rosenberg, Surgical exposures in revision total knee arthroplasty. Clin Orthop Relat Res, 2006. 446: p. 59-68.
7. Ryan, J.A., et al., Failure of the Patellar Tendon with the Patella Everted versus Noneverted in a Matched-Pair Cadaver Model. HSS J, 2010. 6(2): p. 134-7.
8. Coonse KD, A.J., A new operative approach to the knee joint. Surg Gynecol Obstet, 1943. 77: p. 344.
9. Lavernia, C., J.S. Contreras, and J.C. Alcerro, The peel in total knee revision: exposure in the difficult knee. Clin Orthop Relat Res, 2011. 469(1): p. 146-53.
10. Garvin, K.L., G. Scuderi, and J.N. Insall, Evolution of the quadriceps snip. Clin Orthop Relat Res, 1995(321): p. 131-7.
11. Dolin, M.G., Osteotomy of the tibial tubercle in total knee replacement. A technical note. J Bone Joint Surg Am, 1983. 65(5): p. 704-6.
12. Di Benedetto, P., et al., Acute periprosthetic knee infection: is there still a role for DAIR? Acta Biomed, 2017. 88(2S): p. 84-91.
13. Vaienti E., Scita G., Ceccarelli F., Pogliacomi F. Understanding the human knee and its relationship to total knee replacement. Acta Biomed. 2017 Jun 7; 88(2 -S): 6-16.
14. Barrack, R.L., Specialized surgical exposure for revision total knee: quadriceps snip and patellar turndown. Instr Course Lect, 1999. 48: p. 149-52.
15. Mendes, M.W., P. Caldwell, and W.A. Jiranek, The results of tibial tubercle osteotomy for revision total knee arthroplasty. J Arthroplasty, 2004. 19(2): p. 167-74.
16. Rand, J.A., et al., Intraoperative assessment in revision total knee arthroplasty. J Bone Joint Surg Am, 2003. 85-A Suppl 1: p. S26-37.
17. Denham, R.A. and R.E. Bishop, Mechanics of the knee and problems in reconstructive surgery. J Bone Joint Surg Br, 1978. 60-B(3): p. 345-52.
18. Whiteside, L.A. and M.D. Ohl, Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res, 1990(260): p. 6-9.
19. Bruni, D., et al., Tibial tubercle osteotomy or quadriceps snip in two-stage revision for prosthetic knee infection? A randomized prospective study. Clin Orthop Relat Res, 2013. 471(4): p. 1305-18.
20. Caldwell, P.E., et al., Dynamic confirmation of fixation techniques of the tibial tubercle osteotomy. Clin Orthop Relat Res, 2004(424): p. 173-9.
21. Anand, S., et al., Management of Patellar Tendon Rupture after Total Knee Arthroplasty using Hamstring graft: A Case Report. J Orthop Case Rep, 2018. 8(2): p. 57-60.