Jae Ik Shim

Wire Fixation Technique for the Tibial Tubercle Osteotomy in Total Knee Arthroplasty

Purpose: The purpose of this study is to evaluate the clinical results of wire fixation technique for tibial tubercle osteotomy in total knee arthroplasty. Materials and Methods: Twenty-three cases who underwent TKA with tibial tubercle osteotomy and wire fixation technique for the extensile exposure between January, 1982 and April, 2001, were reviewed. Seventeen cases were male and six cases female. The average period of follow-up was 58 months. The average age was 62.3 years (minimal: 38, maximal: 74). Five cases underwent tibial tubercle osteotomy for primary TKA and the preoperative diagnoses were degenerative osteoarthritis in 2 cases, posttraumatic osteoarthritis in 1 case and rheumatoid arthritis in 2 cases. Eighteen cases underwent tibial tubercle osteotomy for revision TKA due to the infected TKA in 10 cases and aseptic loosening in 8 cases. Osteotomized tibial tubercle in size of cm was achieved by using oscillating saw and curved osteotome from the point of 2 cm distal to the articular surface of proximal tibia to 8 cm below the tibial tubercle. Six holes were drilled with 1 cm distance for 3 wires passage. The tubercle fragment was fixed with 3 wires and the wires were bent around the tibial stem in the medullary canal for passage through tubercle fragment. The passive range of motion was started within one week after the operation. We evaluated the preoperative and postoperative range of motion and the radiologic bony union was assessed by lateral radiograph. The clinical results were assessed by Knee Society Knee Score. Results: The bony union was achieved in twenty-two cases about 13 moths after the operation, and fixation loss was observed in one case. The average range of motion were postoperatively. The average clinical knee scores of pain and function were 51 (40-57) point, 58 (45-70) point preoperatively and 54 (50-65) point, 65 (54-78) point postoperatively. Two complications were noted with one case of infection and fixation loss due to injury in each. Conclusion: Wire fixation for tibial tubercle osteotomy in total knee arthroplasty results in firm fixation of tubercle fragment, therefore it seems to be an useful technique in exposure for total knee arthroplasty.