Application of quadriceps snip in complex total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Xiuhong ^1,2 , KONG Xiangpeng ¹ , CAO Zheng ^1,3 , CHEN Qunqun ^1,4 ,  CHAI Wei ¹

1. Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China;
2. Department of Orthopedics, the Shapingba District Hospital of Chongqing, Chongqing, 400030, P.R.China;
3. Medical School of Nankai University, Tianjing, 300071, P.R.China;
4. Department of Orthopedics, Guangzhou University of Traditional Chinese Medicine Third Affiliated Hospital, Guangzhou Guangdong, 510000, P.R.China;

Corresponding?author：

CHAI Wei, Email: chaiwei301@163.com

Keywords：

Total knee arthroplasty; operative field; quadriceps snip; Krackow tendon suture

DOI：

10.7507/1002-1892.202001075

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Objective To explore the safety and effectiveness of quadriceps snip in complex total knee arthroplasty (TKA).Methods A clinical data of 19 cases (29 knees) with complex TKA assisted with quadriceps snip between January 2016 and May 2017 were retrospectively analyzed. There were 9 males (13 knees) and 10 females (16 knees). The age of patients ranged from 34 to 66 years (mean, 50.2 years). Four patients (8 knees) were ankylosing spondylitis, 5 patients (7 knees) were rheumatoid arthritis, and 10 patients (14 knees) were knee osteoarthritis. The average disease duration was 10.9 years (range, 8-15 years). There were 12 knees of Kellgren-Lawrence grade Ⅲ and 17 knees of Kellgren-Lawrence grade Ⅳ. The range of motion (ROM) of knee was (19.86±7.23)°. The clinical and function scores of knee society score (KSS) were 47.86±11.26 and 15.52±11.21, respectively. Postoperative complications, ROM, KSS scores, extensor lag, and prosthesis loosening were observed to evaluate the effectiveness.Results All incisions healed by first intention, and no infection or cardiovascular and cerebrovascular accidents occurred. All patients were followed up 25-39 months (mean, 30.3 months). At last follow-up, the ROM of knee was (91.03±7.30) °, the KSS clinical score was 83.62±9.99 and functional score was 66.38±7.89, showing significant differences when compared with preoperative ones (P<0.05). Postoperative extensor lag (10°, 10°, 15°) occurred in 3 cases. There was no evidence of prosthesis loosening or osteolysis on X-ray films during follow-up.Conclusion The application of quadriceps snip in complex TKA can effectively improve the operative field exposure and reduce incidence of complications such as patella tendon tearing, patella fracture, and quadriceps tendon injury. The surgical technique of Krackow tendon suture can effectively guarantee early rehabilitation without occurrence of other complications.

Citation： TANG Xiuhong, KONG Xiangpeng, CAO Zheng, CHEN Qunqun, CHAI Wei. Application of quadriceps snip in complex total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1096-1100. doi: 10.7507/1002-1892.202001075 Copy

1.	Sezgin EA, Robertsson O, W-Dahl A, et al. Nonagenarians qualify for total knee arthroplasty: a report on 329 patients from the Swedish Knee Arthroplasty Register 2000-2016. Acta Orthop, 2019, 90(1): 53-59.
2.	尚延春, 陳海龍, 王戰朝. 全膝關節置換術后伸膝裝置并發癥分析. 中國矯形外科雜志, 2007, 15(11): 869-871.
3.	Coonse KAJ. A new operative approach to the knee joint. Surg Gynecol Obstet, 1943, (77): 344-347.
4.	Insall JN, Windsor RE, Scott WN, et al. Surgery of the knee. New York: Churchill Livingstone, 1993: 135-148.
5.	Abdel MP, Viste A, Salib CG, et al. Quadriceps snip in 321 revision total knee arthroplasties: A safe technique in a matched cohort study. J Arthroplasty, 2019, 34(12): 3004-3011.
6.	Wooshin Cho. 膝關節置換術策略與技巧. 錢齊榮, 姚振均, 柴偉, 等譯. 上海: 上海科學技術出版社, 2015: 7.
7.	張子琦, 梁佳林, 左小莉, 等. 氣壓止血帶對人工全膝關節置換術圍術期失血量的影響. 中國修復重建外科雜志, 2019, 33(6): 681-684.
8.	胡水清, 陳樑, 曾敏, 等. 人工全膝關節置換術間斷縫合與美容縫合療效比較研究. 中國修復重建外科雜志, 2019, 33(9): 1121-1126.
9.	Bradley GW, Freeman MA, Albrektsson BE. Total prosthetic replacement of ankylosed knees. J Arthroplasty, 1987, 2(3): 179-183.
10.	McAuley JP, Harrer MF, Ammeen D, et al. Outcome of knee arthroplasty in patients with poor preoperative range of motion. Clin Orthop Relat Res, 2002, (404): 203-207.
11.	Rajgopal A, Ahuja N, Dolai B. Total knee arthroplasty in stiff and ankylosed knees. J Arthroplasty, 2005, 20(5): 585-590.
12.	Mullen JO. Range of motion following total knee arthroplasty in ankylosed joints. Clin Orthop Relat Res, 1983, (179): 200-203.
13.	呂厚山, 關振鵬, 袁燕林, 等. 屈曲位骨性強直的人工全膝關節置換技術與臨床效果. 中華骨科雜志, 2002, 22(9): 525-530.
14.	Montgomery WH 3rd, Insall JN, Haas SB, et al. Primary total knee arthroplasty in stiff and ankylosed knees. Am J Knee Surg, 1998, 11(1): 20-23.
15.	童培建, 何幫劍, 儲小兵, 等. 伸直位骨性強直膝的全膝關節置換術. 中華骨科雜志, 2012, 32(6): 551-556.
16.	Kim HJ, Mun JU, Kim KH, et al. Total knee arthroplasty conversion for patients with ankylosed knees. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499016684095.
17.	Ayers DC, Dennis DA, Johanson NA, et al. Instructional course lectures, the American Academy of Orthopaedic surgeons—Conlmon complications of total knee arthroplasty. J Bone Joint Surg (Am), 1999, 79(2): 278-311.
18.	邊焱焱, 翁習生. 人工全膝關節置換術中髕韌帶損傷的預防和修復. 中國修復重建外科雜志, 2013, 27(9): 1076-1079.
19.	Dolin MG. Osteotomy of the tibial tubercle in total knee replacement. A technical note. J Bone Joint Surg (Am), 1983, 65(5): 704-706.
20.	Whiteside LA. Exposure in difficult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res, 1995, (321): 32-35.
21.	Whiteside LA. Surgical exposure in revision total knee arthroplasty. Instr Course Lect, 1997, 46: 221-225.
22.	Whiteside LA, Ohl MD. Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res, 1990, (260): 6-9.
23.	DeHaan A, Shukla S, Anderson M, et al. Tibial tubercle osteotomy to aid exposure for revision total knee arthroplasty. JBJS Essent Surg Tech, 2016, 6(3): e32.
24.	Tabutin J, Morin-Salvo N, Torga-Spak R, et al. Tibial tubercle osteotomy during medial approach to difficult knee arthroplasties. Orthop Traumatol Surg Res, 2011, 97(3): 276-286.
25.	呂厚山, 李虎, 關振鵬, 等. 人工全膝關節置換術治療膝關節伸直位強直畸形. 中華外科雜志, 2007, 45(6): 405-408.
26.	Camanho GL. Total arthroplasty in ankylosed knees: a case series. Clinics (Sao Paulo), 2009, 64(3): 183-187.
27.	Sun Z, Patil A, Song EK, et al. Comparison of quadriceps snip and tibial tubercle osteotomy in revision for infected total knee arthroplasty. Int Orthop, 2015, 39(5): 879-885.
28.	Bruni D, Iacono F, Sharma B, et al. Tibial tubercle osteotomy or quadriceps snip in two-stage revision for prosthetic knee infection? A randomized prospective study. Clin Orthop Relat Res, 2013, 471(4): 1305-1318.
29.	Trousdale RT, Hanssen AD, Rand JA, et al. V-Y quadricepsplasty in total knee arthroplasty. Clin Orthop Relat Res, 1993, (286): 48-55.
30.	Strauss AC, Goldmann G, Schmolders J, et al. Impact of preoperative knee stiffness on the postoperative outcome after total knee arthroplasty in patients with haemophilia. Z Orthop Unfall, 2015, 153(5): 526-532.
31.	Garvin KL, Scuderi G, Insall JN. Evolution of the quadriceps snip. Clin Orthop Relat Res, 1995, (321): 131-137.
32.	Barrack RL, Smith P, Munn B, et al. The Ranawat Award. Comparison of surgical approaches in total knee arthroplasty. Clin Orthop Relat Res, 1998, (356): 16-21.

1. Sezgin EA, Robertsson O, W-Dahl A, et al. Nonagenarians qualify for total knee arthroplasty: a report on 329 patients from the Swedish Knee Arthroplasty Register 2000-2016. Acta Orthop, 2019, 90(1): 53-59.
2. 尚延春, 陳海龍, 王戰朝. 全膝關節置換術后伸膝裝置并發癥分析. 中國矯形外科雜志, 2007, 15(11): 869-871.
3. Coonse KAJ. A new operative approach to the knee joint. Surg Gynecol Obstet, 1943, (77): 344-347.
4. Insall JN, Windsor RE, Scott WN, et al. Surgery of the knee. New York: Churchill Livingstone, 1993: 135-148.
5. Abdel MP, Viste A, Salib CG, et al. Quadriceps snip in 321 revision total knee arthroplasties: A safe technique in a matched cohort study. J Arthroplasty, 2019, 34(12): 3004-3011.
6. Wooshin Cho. 膝關節置換術策略與技巧. 錢齊榮, 姚振均, 柴偉, 等譯. 上海: 上海科學技術出版社, 2015: 7.
7. 張子琦, 梁佳林, 左小莉, 等. 氣壓止血帶對人工全膝關節置換術圍術期失血量的影響. 中國修復重建外科雜志, 2019, 33(6): 681-684.
8. 胡水清, 陳樑, 曾敏, 等. 人工全膝關節置換術間斷縫合與美容縫合療效比較研究. 中國修復重建外科雜志, 2019, 33(9): 1121-1126.
9. Bradley GW, Freeman MA, Albrektsson BE. Total prosthetic replacement of ankylosed knees. J Arthroplasty, 1987, 2(3): 179-183.
10. McAuley JP, Harrer MF, Ammeen D, et al. Outcome of knee arthroplasty in patients with poor preoperative range of motion. Clin Orthop Relat Res, 2002, (404): 203-207.
11. Rajgopal A, Ahuja N, Dolai B. Total knee arthroplasty in stiff and ankylosed knees. J Arthroplasty, 2005, 20(5): 585-590.
12. Mullen JO. Range of motion following total knee arthroplasty in ankylosed joints. Clin Orthop Relat Res, 1983, (179): 200-203.
13. 呂厚山, 關振鵬, 袁燕林, 等. 屈曲位骨性強直的人工全膝關節置換技術與臨床效果. 中華骨科雜志, 2002, 22(9): 525-530.
14. Montgomery WH 3rd, Insall JN, Haas SB, et al. Primary total knee arthroplasty in stiff and ankylosed knees. Am J Knee Surg, 1998, 11(1): 20-23.
15. 童培建, 何幫劍, 儲小兵, 等. 伸直位骨性強直膝的全膝關節置換術. 中華骨科雜志, 2012, 32(6): 551-556.
16. Kim HJ, Mun JU, Kim KH, et al. Total knee arthroplasty conversion for patients with ankylosed knees. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499016684095.
17. Ayers DC, Dennis DA, Johanson NA, et al. Instructional course lectures, the American Academy of Orthopaedic surgeons—Conlmon complications of total knee arthroplasty. J Bone Joint Surg (Am), 1999, 79(2): 278-311.
18. 邊焱焱, 翁習生. 人工全膝關節置換術中髕韌帶損傷的預防和修復. 中國修復重建外科雜志, 2013, 27(9): 1076-1079.
19. Dolin MG. Osteotomy of the tibial tubercle in total knee replacement. A technical note. J Bone Joint Surg (Am), 1983, 65(5): 704-706.
20. Whiteside LA. Exposure in difficult total knee arthroplasty using tibial tubercle osteotomy. Clin Orthop Relat Res, 1995, (321): 32-35.
21. Whiteside LA. Surgical exposure in revision total knee arthroplasty. Instr Course Lect, 1997, 46: 221-225.
22. Whiteside LA, Ohl MD. Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop Relat Res, 1990, (260): 6-9.
23. DeHaan A, Shukla S, Anderson M, et al. Tibial tubercle osteotomy to aid exposure for revision total knee arthroplasty. JBJS Essent Surg Tech, 2016, 6(3): e32.
24. Tabutin J, Morin-Salvo N, Torga-Spak R, et al. Tibial tubercle osteotomy during medial approach to difficult knee arthroplasties. Orthop Traumatol Surg Res, 2011, 97(3): 276-286.
25. 呂厚山, 李虎, 關振鵬, 等. 人工全膝關節置換術治療膝關節伸直位強直畸形. 中華外科雜志, 2007, 45(6): 405-408.
26. Camanho GL. Total arthroplasty in ankylosed knees: a case series. Clinics (Sao Paulo), 2009, 64(3): 183-187.
27. Sun Z, Patil A, Song EK, et al. Comparison of quadriceps snip and tibial tubercle osteotomy in revision for infected total knee arthroplasty. Int Orthop, 2015, 39(5): 879-885.
28. Bruni D, Iacono F, Sharma B, et al. Tibial tubercle osteotomy or quadriceps snip in two-stage revision for prosthetic knee infection? A randomized prospective study. Clin Orthop Relat Res, 2013, 471(4): 1305-1318.
29. Trousdale RT, Hanssen AD, Rand JA, et al. V-Y quadricepsplasty in total knee arthroplasty. Clin Orthop Relat Res, 1993, (286): 48-55.
30. Strauss AC, Goldmann G, Schmolders J, et al. Impact of preoperative knee stiffness on the postoperative outcome after total knee arthroplasty in patients with haemophilia. Z Orthop Unfall, 2015, 153(5): 526-532.
31. Garvin KL, Scuderi G, Insall JN. Evolution of the quadriceps snip. Clin Orthop Relat Res, 1995, (321): 131-137.
32. Barrack RL, Smith P, Munn B, et al. The Ranawat Award. Comparison of surgical approaches in total knee arthroplasty. Clin Orthop Relat Res, 1998, (356): 16-21.

Chinese Journal of Reparative and Reconstructive Surgery

Application of quadriceps snip in complex total knee arthroplasty

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