Tibial Tubercle Osteotomy With Screw Fixation for Total Knee Arthroplasty

This study investigated the efficacy of tibial tubercle osteotomy (TTO) with screw fixation as part of the surgical treatment of primary complicated total knee arthroplasty (TKA) and revision TKA. From January 2000 to April 2011, 15 patients (15 knees) underwent revision TKA and 20 patients (21 knees) underwent primary TKA. The average patient age was 68.7+/-8.7 years. Patients underwent follow-up at the authors' institution for an average of 60.6+/-32.9 months. Comparison of preoperative and postoperative Knee Society Scores and Knee Society Functional Scores showed significant postoperative improvement (P<.05). Moreover, postoperative range of motion of the knee improved from 88.5 degrees +/- 33.8 degrees to 104.3 degrees +/- 18.2 degrees (P<.05). Radiographic assessment showed that the average period to bone union was 10.8+/-5 weeks (range, 5-28 weeks), the average length of the bone fragment was 59.4+/-5.9 mm, the average width at the proximal end was 18.9+/-2.9 mm, and the average thickness at the proximal end of the osteotomy was 10.3+/-1.2 mm. Tibial tubercle osteotomy provided wide exposure for TKA while protecting the extensor mechanism. Solid bone-to-bone fixation was achieved using TTO with 2 screws, and although the overall complication rate was 8.3%, none of the complications were associated with TTO itself. It is recommended that the bone fragment be 60 mm long, 20 mm wide, and 10 mm thick at the proximal end. Appropriate size of the osteotomized bone and solid screw fixation are essential to prevent complications during this procedure.