Introduction A tibial tubercle osteotomy can provide reliable and safe exposure during revision total knee arthroplasty with a high union rate, low complication rate, and predictable outcomes.
Indications & Contraindications
Step 1: Preoperative Planning (Figs. 1-A through 2-B) Determine the need for an extensile approach on the basis of the preoperative knee range of motion; position of the patella; bone quality; medical comorbidities; and cement mantle, tibial keel or stem, and thickness of the anterior tibial cortex.
Step 2: Incision and Arthrotomy Create full-thickness subcutaneous flaps and perform a medial parapatellar arthrotomy with complete synovectomy and careful excision of scar tissue from the medial and lateral gutters.
Step 3: Incision Extension and Preparation for Tibial Tubercle Osteotomy (Figs. 3 and 4; Videos 1, 2, and 3) Extend the skin and subcutaneous dissection distal to the tibial tubercle and mark the chevron osteotomy using electrocautery.
Step 4: Tibial Tubercle Osteotomy (Fig. 5; Videos 4 and 5) Perform the osseous cut for the tibial tubercle osteotomy with a thin saw blade in a medial-to-lateral direction, such that the fragment hinges on the lateral soft tissue and musculature.
Step 5: Revision Total Knee Arthroplasty (Videos 6 and 7) With the knee maximally flexed and lateral subluxation of the extensor mechanism, for full visualization of the femoral and tibial components, remove the components and perform the knee revision.
Step 6: Preparation for Insertion of Tibial Component The final tibial component should have a diaphyseal stem long enough to bypass the distal extent of the tibial tubercle osteotomy by at least 2 cortical diameters.
Step 7: Trialing and Insertion of Final Tibial Component (Figs. 6 and 7; Videos, 8, 9, and 10) When cementing the final tibial component, take care to remove cement …
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