Department of Orthopaedic Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Department of Orthopaedic Surgery, Patel Hospital, Karachi, Pakistan.
Clin Orthop Surg. 2021 Mar;13(1):53-59. doi: 10.4055/cios20057. Epub 2020 Dec 8.
Due to extensive fibrosis during revision surgery, adequate exposure is essential and it can be achieved with several extensile approach options, such as tibial tubercle osteotomy. Information regarding surgical exposure during revision arthroplasty is limited in developing countries, such as Pakistan, due to the lack of adequate data collection and follow-up. Therefore, the purpose of this study was to evaluate the impact of tibial tubercle osteotomy on final outcome of revision total knee arthroplasty (TKA).
A total of 231 revision TKAs were performed between January 2008 and December 2017. Twenty-nine patients underwent tibial tubercle osteotomy for adequate exposure during revision surgery. Of these, 27 patients with complete follow-up were included in our study. Factors examined include age at the time of revision surgery, gender, comorbidities, arthroplasty site (right or left), body mass index (BMI), and primary indications for the tibial tubercle osteotomy during revision TKA. Functional outcome was measured by using Knee Society score (KSS) at 3 months and the final follow-up. All statistical analysis was done using SPSS version 20.0 with a -value < 0.05 considered significant.
Out of 27 patients, 6 patients (22.2%) were men and 21 patients (77.7%) were women. Right knee revision arthroplasty was performed in 15 patients (55.5%), left knee revision arthroplasty was performed in 12 patients (44.4%), and bilateral revision surgery was performed in only 1 patient (3.7%). The mean BMI was 29.2 kg/m. We used a constrained condylar knee in 20 patients (74%), a rotating hinge knee in 5 patients (18.5%), and mobile bearing tray plus metaphyseal sleeves in 2 patients (7.4%). The KSS was 52.21 ± 4.05 preoperatively, and 79.42 ± 2.2 and 80.12 ± 1.33 at 3 months and 12 months, respectively. Radiological union was achieved in all patients at 3 months. Of 27 patients, only 1 patient (3.7%) had proximal migration of the osteotomy site at 6 months: the patient was asymptomatic and union was also achieved and, therefore, no surgical intervention was performed.
Tibial tubercle osteotomy during revision TKA can be a safe and reliable technique with superior outcomes and minimal complication rates.
在翻修手术中，由于广泛的纤维化，充分的暴露是至关重要的，可以通过几种广泛的入路选择来实现，如胫骨结节截骨术。由于缺乏足够的数据收集和随访，在巴基斯坦等发展中国家，有关翻修关节置换术中手术暴露的信息有限。因此，本研究的目的是评估胫骨结节截骨术对翻修全膝关节置换术（TKA）最终结果的影响。
2008 年 1 月至 2017 年 12 月期间共进行了 231 例翻修 TKA。29 例患者因翻修手术中需要充分暴露而行胫骨结节截骨术。其中，27 例患者完成了完整的随访，纳入本研究。检查的因素包括翻修手术时的年龄、性别、合并症、关节置换部位（右侧或左侧）、体重指数（BMI）和翻修 TKA 时胫骨结节截骨术的主要适应证。功能结果采用膝关节学会评分（KSS）在 3 个月和最终随访时进行测量。所有统计分析均使用 SPSS 版本 20.0 进行，-值<0.05 认为具有统计学意义。
27 例患者中，6 例（22.2%）为男性，21 例（77.7%）为女性。右侧膝关节翻修置换术 15 例（55.5%），左侧膝关节翻修置换术 12 例（44.4%），仅 1 例（3.7%）行双侧翻修手术。平均 BMI 为 29.2kg/m。我们使用了 20 例（74%）限制性髁间膝关节、5 例（18.5%）旋转铰链膝关节和 2 例（7.4%）活动衬垫加干骺端袖套。术前 KSS 为 52.21±4.05，术后 3 个月和 12 个月分别为 79.42±2.2 和 80.12±1.33。所有患者在 3 个月时均达到影像学愈合。27 例患者中，仅 1 例（3.7%）在 6 个月时出现截骨部位近端迁移：患者无症状，且愈合也已实现，因此未进行手术干预。
胫骨结节截骨术在翻修 TKA 中是一种安全可靠的技术，具有较好的结果和较低的并发症发生率。
