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Extended Exposure in Difficult Total Knee Arthroplasty Using Tibial Tubercle Osteotomy

  Radulescu Radu, Manolescu Robert, Japie Ioan Mihai, Ninulescu Cristian and Badila Adrian

In some total knee arthroplasty cases, the usual medial parapatellar approach does not allow the appropriate patellar eversion and the desired exposure of the knee joint. In this study we analysed the post-operative results of 11 cases of primary total knee arthroplasty in which a frontal plane osteotomy of the tibial tubercle was performed. Out of the 11 patients, 5 patients had rheumatoid arthritis and presented an extension deficit of at least 15º, 2 patients previously underwent knee synovectomy, 3 patients had a varum deviation higher than 15º, 2 patients previously underwent proximal tibial osteotomy for varus knee and other 2 had a vicious patellar consolidation of a previous fracture. The results display an increased knee mobility from a mean of 63,3º (limits 35º to 90º) to 84,1º (limits of 70º to 100º). The Knee Society Scores increased from a pre-operative mean value of 43,5 (limits 34 to 53) to a post-operative mean value of 78,7 (limits 69 to 90). The average time of consolidation of the tibial osteotomy was 14,7 weeks. In one case a late fracture of the tubercular fragment occured and a reintervention was necessary.