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Tibial Tubercle Osteotomy
Algorithm
The algorithm presents an approach to tibial tubercle osteotomy in revision total knee arthroplasty (TKA).
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Chapter Synopsis
This chapter reviews the indications, surgical technique, complications, and outcomes of tibial tubercle osteotomy (TTO) for revision TKA. Particular attention is paid to technique, which creates a long osteotomy for wide exposure and is followed by rigid fixation that allows for early motion and reproducible healing. TTO is a reliable method to achieve the best possible revision outcome.
Introduction
Exposure presents a difficult challenge in revision TKA. Adequate visualization is often achieved by resection of fibrotic scar, release of the lateral retinaculum, or quadriceps snip as needed to obtain access to component interfaces for removal and subsequent reconstruction. However, deformity, long-standing joint contracture, and scarring may obviate a more extensile approach in revision surgery. Without careful handling of the soft tissues, rupture of the extensor mechanism and consequent problems become a risk.
Extensile exposures may be used either proximally through the quadriceps mechanism or distally at the patellar tendon insertion to the tibial tubercle. These maneuvers allow access to the knee by displacing the extensor mechanism away from the surgical field. Each of these approaches has specific advantages and potential complications.
This chapter focuses on tibial tubercle osteotomy (TTO) for extended exposure in revision TKA. Specifically, we discuss indications and contraindications, surgical technique, and outcomes of TTO, and we include specific advice to increase success and avoid potential complications.
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