title: Tibial tubercle osteotomy or quadriceps snip in two-stage revision for prosthetic knee infection? A randomized prospective study.
abstract: BACKGROUND
  Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate.
  
  
  OBJECTIVE
  We compared The Knee Society Score(©) (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation.
  
  
  METHODS
  We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years).
  
  
  RESULTS
  Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113° versus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups.
  
  
  CONCLUSIONS
  We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections.
  
  
  METHODS
  Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Biomechanics and Technological Innovation Laboratory, Codivilla-Putti Research Center, Bologna University, Via Di Barbiano 1-10, 40136, Bologna, Italy. d.bruni@biomec.ior.it
authors.forename: Danilo
authors.initials: D
authors.lastname: Bruni
authors.forename: Francesco
authors.initials: F
authors.lastname: Iacono
authors.forename: Bharat
authors.initials: B
authors.lastname: Sharma
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaffagnini
authors.forename: Maurilio
authors.initials: M
authors.lastname: Marcacci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000601:surgery*; D013530:Surgical Wound Infection / Q000601:surgery*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome