title: Tibial tubercle osteotomy with absorbable suture fixation in revision total knee arthroplasty: a report of 23 cases.
abstract: OBJECTIVE
  Tibial tubercle osteotomy (TTO) is a well-known technique for improving exposure in difficult total knee arthroplasty (TKA). We have performed 23 revision TKAs with TTO. The tibial tubercle was fixated with only absorbable sutures afterwards. The aim of this study is to report on the clinical results and complications of this procedure.
  
  
  METHODS
  We retrospectively evaluated 23 patients (mean age 69.6 years, range 43-84 years) who underwent TTO with only absorbable suture fixation. Clinic charts were reviewed to identify any complications that occurred. Obvious proximal migration and union of the tibial tubercle was evaluated on the postoperative radiographs. Knee Society scores and SF-36 were assigned at latest follow-up.
  
  
  RESULTS
  The mean follow-up was 16.1 months (1-43). Two patients died of causes unrelated to surgery. In one case a fracture of the TTO occurred. No obvious migration of the osteotomy was detected. In two cases there was partial consolidation of the osteotomy, but without clinical consequences of pain or extension lag. In five patients a tibial plateau fracture occurred intraoperative which allowed partial weight bearing during 6 weeks. These fractures were not related to the surgical technique of the TTO. In 15 out of 23 patients a Knee Society Score could be assigned. The mean total knee score (maximum 200 points) after revision was 99.5 (17-166) (clinical KSS 52.1, functional KSS 47.3) at latest follow-up. SF-36 scores could be assigned to 16 patients; the mean SF-36 (maximum 100) was 88 (range 74-98).
  
  
  CONCLUSIONS
  Tibial tubercle osteotomy with only absorbable suture fixation is a reliable and simple method of fixation and provides adequate stability. It is a straightforward surgical technique which is less time-consuming and expensive compared with screw and cerclage wire fixation and no hardware removal will be necessary. Therefore, this method is a beneficial technique for the enhancement of surgical exposure in difficult revision TKA.
authors.affiliation: Department of Orthopaedic Surgery, Spaarne Hospital, Spaarnepoort 1, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands, zon36@hotmail.com.
authors.forename: Christian B L
authors.initials: CB
authors.lastname: Zonnenberg
authors.forename: Michel P J
authors.initials: MP
authors.lastname: van den Bekerom
authors.forename: Tjitte
authors.initials: T
authors.lastname: de Jong
authors.forename: Peter A
authors.initials: PA
authors.lastname: Nolte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001863:Bone Screws; D001864:Bone Wires; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery; D016896:Treatment Outcome