Tibial tubercle osteotomy (TTO) in total knee arthroplasty, is it worth it? A review of the literature

Introduction: Tibial tubercle osteotomy (TTO) is a well-established extensile approach to improve joint visualization and implant removal. Despite this, TTO is a challenging technique with a long learning curve and potential pitfalls. Complications are not infrequent, even if performing the correct surgical steps. Aim of this paper is to review the current literature about TTO, its safeness and reliability, and finally the complications rate. Materials and methods: We performed a systematic review of the available English literature, considering the outcomes and the complications of TTO. The combinations of keyword were \u201ctibial tubercle osteotomy\u201d, \u201ctotal knee arthroplasty\u201d, \u201ctotal knee revision\u201d, \u201coutcomes\u201d, \u201ccomplication\u201d and \u201csurgical approach\u201d. Results: From the starting 322 papers available, 26 manuscripts were finally included. Most of the papers show significant improvements in clinical outcomes, both in primary and in revision procedures. Radiographic fragment healing is close to 100%. Related complications can range from 3.8\u201320%. Conclusion: TTO may be necessary to correct pathological tuberosity position or patella tracking. However, TTO is a challenging technique to improve the surgical approach during total knee arthroplasty. A strict surgical technique can lead to better results and to minimize complications. However, it is not clear if the improved outcome can outweigh the longer surgery and the higher risk of pitfalls