Tibial Tubercle Osteotomy (TTO) in Revision Knee Replacement by Dr. Anoop Jhurani

Description

This video presentation by Dr. Anoop Jhurrani focuses on revision surgery for decay in an infected knee, specifically in a 60-year-old patient with a history of multiple knee surgeries and infections. The patient underwent a primary total knee replacement three years prior, which was followed by repeated infections, necessitating a series of procedures including the placement of spacers and extensive debridement to manage MRSA infection.



The presentation highlights the challenges of dealing with extra-articular deformities and significant scarring resulting from multiple surgeries, as well as patella baja—a condition where the kneecap is positioned lower than normal. Dr. Jhurrani explains the surgical approach to correcting these issues by focusing on intra-articular deformities rather than performing additional extra-articular osteotomies, which could complicate the case further due to the high position of the deformity.



Key aspects of the surgery include meticulous exposure of the knee joint, especially managing scarring, performing a tibial tubercle osteotomy to aid in knee flexion and addressing patella baja, and careful removal of all infected tissue to prevent reinfection. The operative strategy involves assessing and balancing the extension and flexion gaps of the joint, upsizing components as necessary to restore proper alignment, and ensuring correct placement of the tibial and femoral implants with the goal of optimizing knee movement and stability.



The expected outcomes of this surgical intervention are discussed, including the range of motion expectations moving from an initial 0 to 30 degrees to potentially 0 to 90 degrees post-rehabilitation, depending on the patient's recovery and the success of the proximalization of the tibial tubercle. The video concludes with an optimistic outlook for the patient, emphasizing the importance of sterile cultures obtained during surgery for better prognosis.

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