人工膝関節再置換術の経験－脛骨結節骨切り術の適応と合併症について－

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  • Experience of Revision Total Knee Arthroplasty Indication and Complications of Tibial Tuberosity Osteotomy
  • ジンコウ シツカンセツ サイチカンジュツ ノ ケイケン ケイコツ ケッセツ コツキリ ジュツ ノ テキオウ ト ガッペイショウ ニ ツイテ

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Objective: Indications of revision total knee arthroplasty (TKA) combined with tibial tubercle osteotomy (TTO) at our facility and the complications of this procedure are investigated.<br>Method: Revision TKA was performed on 39 knees, and was combined with TTO for 24 knees. The operation was conducted via the parapatellar approach. The tibial tubercle (TT) was everted, with the anterior tibial muscle kept attached as far as possible (Whiteside, 1990). This procedure was applied to: (1) delayed two-stage exchange arthroplasty for infected TKA (13 knees), (2) cases with poor preoperative range of flexion (7 knees), and (3) cases with patella infera (4 knees).<br>Results: Revision TKA combined with TTO allowed a good operative field of view. In 4 knees, the patellar tendon became detached, necessitating reconstruction. Combined TTO appeared to be necessary for 28 knees (72%). Bone union was obtained in 21 knees (83%). Complications occurred in 3 knees (dislocation and fracture of the TT), and one of these 3 knees was fixed again. Dislocation of the TT occurred in the remaining 2 knees for which re-fixation was not performed, however, no clinically significant extension lag was observed.<br>Conclusion: If arthroplasty with an augmentation-type prosthesis is combined with TTO, the basal cancellous bone of the TT is sometimes lost. Dislocation and fracture of the TT are more likely to occur in the absence of the basal cancellous bone. TTO performed by the technique reported by Whiteside was not associated with any clinically significant extension lag.

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