Tibial tubercle osteotomy in primary total knee arthroplasty: A safe procedure or not?

Purpose Difficult primary total knee arthroplasty (TKA) and revision TKA may be high demanding, especially during joint exposure. Aim of this article is to evaluate the clinical and radiological outcomes of a series of patients, who underwent TKA and revision TKA, where tibial tubercle osteotomy (TTO) was performed. Methods We retrospectively reviewed a cohort of 79 consecutives TKAs where TTO was performed. Patients were assessed clinically and radiographically at their last follow-up (mean, 7.4 ± 3.7 years). Clinical evaluation included the Knee Society Score (KSS), the pain visual analogue scale (VAS), and range of motion. Radiological assessment included the evaluation of radiolucent lines, osteolysis, cortical bone hypertrophy, time of bone healing of the TTO fragment, and the hardware complication. Results KSS raised from 40.7 ± 3.1 to 75 ± 4.3 (p < 0.0001). Knee flexion increased from 78.7 ± 9.9° to 95.0 ± 9.5° (p < 0.0001), and VAS improved from 7.9 ± 0.9 to 3.8 ± 1 (p < 0.0001). No signs of loosening or evolutive radiolucency lines were found. Osteolytic areas around the stem were detected. No significant association was found between the implant design and the outcomes, while aseptic loosening showed significantly better results. Complications were: 4 painful hardware, 3 late periprosthetic infections, 1 extension lag of 5°, and 3 flexion lag. Conclusion Our experience suggests the use of TTO to improve the surgical approach in difficult primary TKA or revision TKA. A precise surgical technique leads to good results with low risk of complications. Level of Evidence Level IV, therapeutic case series.

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Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1042 ◽

2014 ◽

Vol 4 (1) ◽

pp. 8-12

Author(s):

Andrea Baldini ◽

Pier Francesco Indelli ◽

PT Luca Manfredini ◽

Massimiliano Marcucci

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Primary Total Knee Arthroplasty ◽

Surface Curvature ◽

Rotational Alignment ◽

Tibial Tubercle ◽

Anterior Tibial ◽

Total Knee ◽

Primary Total Knee

ABSTRACT Purpose We hypothesized that the anterior tibial surface curvature is a more reliable landmark for correct tibial component rotational positioning in TKA respect to the ‘Akagi’ line and the medial third of the tibial tubercle. Methods Three independent investigators reviewed 124 knee MRI scans, identifying independently the femoral transepicondylar axis (TEA), the femoral posterior condylar axis (PCA), a line connecting the middle of the posterior cruciate ligament and the medial edge of the patellar tendon attachment (Akagi's line), the medial third of the tibial tubercle and the anterior tibial surface curvature. The most appropriate tibial baseplate tracing for the NexGen Total Knee System (Zimmer, Warsaw, USA) was superimposed matching the anterior tibial cortex with its anterior surface. At this point, the rotation of the tibial plate tracing was calculated in respect to the TEA, the medial third of the tibial tubercle line, the Akagi's line and the PCA. Customized software was created and used for analysis of the MRI datasets. Results: The investigators agreed on the localization of the Akagi's line in 64% of the cases within 3° and in 85% of the cases within 5° (minimum –16°, maximum –7°): this landmark might lead to internal rotation of the tibial component. The observers agreed on the localization of the medial third of the tibial tubercle in 29% of the cases within 3° and, in 70% of the cases, within 5° (minimum –4°, maximum +4°): this landmark might lead to external rotation of the tibial component. The investigators agreed on the localization of the anterior tibial surface curvature in 89% of the cases within 3° and in 99% of the cases within 5° (minimum –1°, maximum +4°): component alignment along the anterior cortex guaranteed full matching ±3° to the epicondylar axis in 75% of the knees. Conclusion Alignment of the tibial component, when based on the anterior tibial surface, was more reliable and easier identifiable than either the Akagi's line or the medial third of the tibial tubercle. Level of evidence Level 3 (Retrospective cohort study). Indelli PF, Baldini A, Manfredini L, Marcucci M. Rotational Alignment Landmarks in Primary Total Knee Arthroplasty. The Duke Orthop J 2014;4(1):8-12.

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