Jordy van Sambeeck

Chapter 3 48 total knee arthroplasty (TKA) were excluded from analysis. All procedures were performed by two experienced orthopedic surgeons. Complications related to the surgical procedure were classified as minor or major, according to the criteria used in Payne’s review article 4 . Major complications were defined as tibial fracture, osteotomy non-union, neurovascular complications and infection and wound complications that required surgical intervention. The scope of this article is to focus on complications specifically related to the bony procedure, being for example delayed union, nonunion, fractures and hardware removal. Complications which might also have a relation with additional procedures, such as infection, arthrofibrosis and thrombo-embolic events are addressed, but are not the main focus. Surgical technique and postoperative care: The surgical technique that was performed is previously described 5, 6 (figure 1). A lateral osteotomy of the tibial tubercles is performed in the frontal plane, the osteotomy is 5 cm in length and 0.75 cm thick. The medial soft tissue is released, but remains attached to the tubercle. In patients with patella alta, the patella is moved distally. The tubercle is then temporarily fixed with an AO 2.5 mm drill bit at its distal end, the knee is then flexed to 90°. The tibial tubercle will automatically rotate and align to its ‘neutral’ position due to the pull of the extensor apparatus and is then fixed with screws . Additional simultaneous procedures such as an MPFL reconstruction and/or trochleoplasty were performed when indicated. Post- operative care consisted of a removable brace with the knee in full extension for six weeks. Full weight bearing was allowed as tolerated whilst wearing the brace and full range of motion was advised without bearing weight. A low-molecular- weight heparin was prescribed during the first six weeks. Follow-up of these patients was routinely six weeks post operatively and 6 months after surgery at outpatient clinic of the surgeon who performed the surgery. On indication (e.g. when delayed or non-union at 6 months), the follow-up was longer.