RESUMO
BACKGROUND: Tibial crest osteotomy is an established extensile knee approach. Complications include mal-union, non-union, and fixation problems.We have designed a technique aimed at reducing complications through the principles of low-energy osteotomy and suture repair. METHODS: We reviewed our clinical and radiological results in 159 consecutive patients 181 osteotomies with a mean age of 66 years, and an average follow up of 22 months. RESULTS: Union occurred in all osteotomies (100%) at a mean period of 11 weeks. Proximal migration averaging 11.5 mm occurred in 6 osteotomies (3%). Crest fragmentation occurred in 11 osteotomies (6%), with all cases resulting in uncomplicated union. No extensor mechanism failure or complications related to the suture material occurred. CONCLUSION: We conclude that this technique results in satisfactory outcomes whilst avoiding hardware-related problems.
Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Osteotomia/métodos , Tíbia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Técnicas de SuturaRESUMO
Periprosthetic knee fractures and their complications are expected to increase as the numbers of knee arthroplasties continue to rise. We report our experience with revision knee arthroplasty for failure of primary fracture treatment. Five periprosthetic knee non-unions and 1 mal-union in 6 patients, with ages ranging from 65 to 83years (average 74.6years) were treated with revision total knee arthroplasty, and were followed up for 3 to 10years (average 4.5years). Union occurred in 8 to 18weeks (average 12.5weeks). All patients were ambulatory at the latest follow-up, with a range of motion averaging 84.2° (P = 0.03), and an Oxford Knee Score averaging 35 (P = 0.03). We conclude that union complications of periprosthetic knee fractures can be satisfactorily addressed with revision arthroplasty.
Assuntos
Artroplastia do Joelho/efeitos adversos , Fraturas do Fêmur/etiologia , Articulação do Joelho , Fraturas Periprotéticas/cirurgia , Fraturas da Tíbia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Fêmur/cirurgia , Fixação de Fratura/efeitos adversos , Fraturas Mal-Unidas/etiologia , Fraturas Mal-Unidas/cirurgia , Fraturas não Consolidadas/etiologia , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Fraturas Periprotéticas/etiologia , Reoperação , Estudos Retrospectivos , Fraturas da Tíbia/etiologiaRESUMO
BACKGROUND: Tibial Tubercle Osteotomy has shown much promise in revision total knee replacement. Methods of repair previously described include screw and wire fixation. Both methods have significant complications. METHODS: This article describes suture fixation of the osteotomy using Ethibond sutures placed medially with a lateral periosteal hinge. RESULTS: This method of fixation relies upon an adequate osteotomy segment including the entire insertion of the patella tendon. The lateral periosteal hinge is maintained and adds to the stability of the construct. A minimum of two number 5 Ethibond sutures are passed medially through drill holes to secure the osteotomy segment. No post-operative immobilisation is required. CONCLUSION: Ethibond sutures provide adequate fixation of the tibial tubercle osteotomy segment in revision knee arthroplasty with reduced risk of complication as compared to conventional fixation methods.
