Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2020; 11(6): 294-303
Published online Jun 18, 2020. doi: 10.5312/wjo.v11.i6.294
Tibial tubercle osteotomy in revision total knee arthroplasty: A systematic review
Byron Chalidis, Dimitrios Kitridis, Panagiotis Givissis
Byron Chalidis, Dimitrios Kitridis, Panagiotis Givissis, 1st Orthopaedic Department, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki 55210, Greece
Author contributions: Chalidis B designed the research; Kitridis D analyzed the data; Chalidis B and Kitridis D wrote the paper; Givissis P supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Byron Chalidis, MD, PhD, Surgeon, 1st Orthopaedic Department, Aristotle University of Thessaloniki, “George Papanikolaou” Hospital, Thessaloniki 55210, Greece. byronchalidis@gmail.com
Received: February 28, 2020
Peer-review started: February 28, 2020
First decision: April 25, 2020
Revised: May 8, 2020
Accepted: May 19, 2020
Article in press: May 19, 2020
Published online: June 18, 2020
Abstract
BACKGROUND

Tibial tubercle osteotomy (TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty (RTKA). However, several reports have described potential osteotomy-related complications such as non-union, tibial tubercle migration and fragmentation, and metalware related pain.

AIM

To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and complications.

METHODS

MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication rate.

RESULTS

Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases, respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were reported.

CONCLUSION

The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.

Keywords: Tibial tubercle osteotomy, Knee flexion, Extension lag, Union, Revision total knee arthroplasty, Stiff knee

Core tip: Tibial tubercle osteotomy (TTO) is a useful technique to deal with a stiff knee in revision total knee arthroplasty. However, several reports have described potential osteotomy-related complications such as non-union, tibial tubercle migration and fragmentation as well as metalware related pain. The purpose of the current systematic review was to evaluate the literature and estimate the efficacy of TTO in revision total knee arthroplasty in terms of osteotomy union, knee range of motion, and complication rate. TTO was found to result in high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.