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
Processing time: 107 Days and 16.6 Hours
ARTICLE HIGHLIGHTS
Research background

Tibial tubercle osteotomy (TTO) is a useful technique to deal with a stiff knee in revision total knee arthroplasty (RTKA). It provides excellent exposure and visualization of the knee joint as it allows unforceful eversion or lateral subluxation of the patella. Complications such as non-union, tibial tubercle migration and fragmentation, and metalware related pain have been reported.

Research motivation

Although TTO is widely utilized in RTKA, several reports have reported potential osteotomy-related complications. There is currently a lack of synthesis of the evidence about TTO in RTKA.

Research objectives

The present review aims to evaluate the available literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility, and complications.

Research methods

Medline, Scopus, and the Cochrane Central Register of Controlled Trials were systematically screened for studies from inception to February 2020. The main outcome 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. The systematic review was conducted following the PRISMA recommendations.

Research results

Fifteen clinical studies were included in the systematic review. Eleven non-unions out of 593 TTOs were reported (union rate 98.1%). Proximal migration of the TT was observed in 41 cases (6.9%). Anterior knee pain was reported in 38 cases (6.4%), 13 of which required hardware removal (2.2%). Total knee range of motion improved from 73.4° preoperatively to 97° postoperatively and knee flexion increased from 82.9° before surgery to 100.1° after surgery. Stiffness requiring manipulation under anesthesia was evident in 27 cases (4.6%).

Research conclusions

TTO shows great clinical safety and efficacy in RTKA. Non-union is rare, and the most reported TTO-related complications are proximal migration and anterior knee pain. However, in the vast majority of cases they aren’t associated with secondary procedures.

Research perspectives

Further clinical studies are encouraged to determine the optimal extensile approach in RTKA. High quality randomized studies comparing different techniques using standardized protocols will need to be performed.