인공 슬관절 재치환술시 경골 조면 절골술
Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty
인공슬관절 재치환술 슬관절 경골조면 절골술;
- 원문 URL
The revision surgery of total knee arthroplasty has been increased due to the increase of primary total knee arthroplasty. The revision is more difficult in procedure and worse in result than primary arthroplasty. The exposure is also difficult due to contracture of soft tissues surrounding the prosthesis. The purpose of this study is to review the result and effect of tibial tubercle osteotomy in revision total knee arthroplasty in terms of surgical exposure and postoperative function. From January 1996 to June 2001, tibial tubercle osteotomy was performed in twenty cases of revision total knee arthroplasty. The mean age at the time of surgery was 63 years (range, 48-74 years). The follow-up was average 45.2 months (range, 24-90 months). All 20 cases were divided into two groups(nine non-infective and eleven infective groups). The causes of revision were infection in eleven, aseptic loosening in seven, subluxation in one and femoral periprosthetic fracture in one. Three out of all twenty cases required re-revision. Tibial tubercle osteotomy provided wide surgical field, and thereby, enabled easy removal of the old prosthesis and cement, meticulous debridement, augmentation for bony defect and correct alignment of the revision prosthesis. Rigid screw fixation of the osteotomized tibial tubercle enabled early start of passive knee motion from the third postoperative day. There was a significant improvement of range of motion, Hospital for Special Surgery score and Knee Society Knee score at the final follow-up compared with the pre-revision status. These three evaluation criteria showed no significant difference between preoperative non-infective and infective groups except higher final further flexion obtained by non-infective than infective group. There was one complication of tibial tubercle avulsion, which was refixed by screws and wires fixation. Tibial tubercle osteotomy is recommended in revision total knee arthroplasty with many technical advantages and functional results.