Timing of tibial tubercle osteotomy in two-stage revision of infected total knee arthroplasty does not affect union and reinfection rate. A systematic review.
Complications
Exposure
Infection
Outcomes
Revision total knee arthroplasty
Surgical approach
Tibial tubercle osteotomy
Journal
The Knee
ISSN: 1873-5800
Titre abrégé: Knee
Pays: Netherlands
ID NLM: 9430798
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
01
04
2020
revised:
16
06
2020
accepted:
11
09
2020
pubmed:
17
11
2020
medline:
13
5
2021
entrez:
16
11
2020
Statut:
ppublish
Résumé
Tibial tubercle osteotomy (TTO) in two-stage infected revision total knee arthroplasty (RTKA) could be applied at either first, second, or in both stages, and may remain preliminary fixed or unfixed until the second stage. The primary aim of the review was to identify any correlation between the timing of TTO and osteotomy union as well as reinfection rate. Medline, Scopus, and CENTRAL were searched up to March 2020. All TTO cases were divided into three groups; Group A: TTO in both stages, left unfixed in first stage; Group B: TTO in both stages, preliminary fixed in first stage; Group C: TTO only in second stage. Eight studies with 199 patients were included. Apart from two cases in Group C, all the osteotomies achieved bone healing (p = 0.99). There were 29 (15%) reinfections (nine percent in Group A, 13% in Group B, and 16% in Group C, p = 0.67) and 16 (nine percent) knees with proximal avulsion/migration of the tibial tubercle (8.7% in Group A, 16.7% in Group B, and 0.8% in Group C, p = 0.02). Seventeen patients (11%) complained of anterior knee pain and 14 (nine percent) of them underwent hardware removal. However, no difference between groups was identified. Preliminary fixation of the tibial tubercle with wires and/or screws at the first stage of RTKA does not increase the possibility of reinfection. Therefore, we propose that the tibial tubercle should be stable fixed from the first stage to maximize knee performance in the intermediate period.
Sections du résumé
BACKGROUND
BACKGROUND
Tibial tubercle osteotomy (TTO) in two-stage infected revision total knee arthroplasty (RTKA) could be applied at either first, second, or in both stages, and may remain preliminary fixed or unfixed until the second stage. The primary aim of the review was to identify any correlation between the timing of TTO and osteotomy union as well as reinfection rate.
METHODS
METHODS
Medline, Scopus, and CENTRAL were searched up to March 2020. All TTO cases were divided into three groups; Group A: TTO in both stages, left unfixed in first stage; Group B: TTO in both stages, preliminary fixed in first stage; Group C: TTO only in second stage.
RESULTS
RESULTS
Eight studies with 199 patients were included. Apart from two cases in Group C, all the osteotomies achieved bone healing (p = 0.99). There were 29 (15%) reinfections (nine percent in Group A, 13% in Group B, and 16% in Group C, p = 0.67) and 16 (nine percent) knees with proximal avulsion/migration of the tibial tubercle (8.7% in Group A, 16.7% in Group B, and 0.8% in Group C, p = 0.02). Seventeen patients (11%) complained of anterior knee pain and 14 (nine percent) of them underwent hardware removal. However, no difference between groups was identified.
CONCLUSIONS
CONCLUSIONS
Preliminary fixation of the tibial tubercle with wires and/or screws at the first stage of RTKA does not increase the possibility of reinfection. Therefore, we propose that the tibial tubercle should be stable fixed from the first stage to maximize knee performance in the intermediate period.
Identifiants
pubmed: 33197818
pii: S0968-0160(20)30316-1
doi: 10.1016/j.knee.2020.09.008
pii:
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1787-1794Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest None.