Total knee revision arthroplasty: comparison between tibial tubercle osteotomy and quadriceps snip approach. Complication rate.

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Paolo Di Benedetto
Michele Buttironi
Piero Giardini
Francesco Mancuso
Vanni Cainero
Araldo Causero


Arthroplasty, Revision, Knee, Tibial Tuberosity Osteotomy, Quadriceps Snip, Complication


Background and aim of the work: The total knee arthroplasty (TKA) revision is not a second time
of primary implant surgery but is a very complex issue for orthopedic surgeon. When local conditions make
necessary a greater visualization, medial para-patellar access with quadriceps snip (QS) or the osteotomy of the
tibial tuberosity (TTO) can be the solutions. This work aims to compare the quadriceps snip and the detachment
of the tibial tubercle, focusing on possible complications. Materials and Methods: At our institution,
between January 2017 and February 2019 52 TKA revision for periprosthetic joint infection (PJI) or aseptic
mobilization were performed. In 43 cases an extensive surgical approach was required: for patients with range
of movement (ROM) < 60° was chosen TTO, while with ROM > 60° a QS was performed. Clinical and radiological
follow-up was available for all the 43 cases. Results: The data about clinical outcome in our study show
that both groups have a positive trend in KSS score over time with similar ROM results. Two partial avulsions
of patellar tendon during revision surgery were reported. Clinical outcome in both groups has shown good
results at the end of follow-up with no post-operative incidence of complications. Conclusion: We can assert
that both QS and TTO are good approach for TKA revision. Future studies will be needed to understand if
preparatory ROM is a good way to decide which surgical approach to use.(


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