Incidence, indications, and risk factors for revision tibial tubercle osteotomy: A national database study

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-24 DOI:10.1002/jeo2.70339

Julia S. Retzky, William ElNemer, Nathan H. Varady, Vincentius J. Suhardi, Sabrina M. Strickland

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Abstract

Purpose

The aims of the present study are to describe the (1) incidence, (2) indications, and (3) risk factors for revision tibial tubercle osteotomy (rTTO) in a national sample of patients in the United States.

Methods

A retrospective review of the Mariner PearlDiver database was performed. Patients who underwent unilateral primary tibial tubercle osteotomy (TTO) from 2015 to 2021 with a minimum 2-year follow-up were included, and patients who required revision TTO were identified. Patients with insufficient information, history of total knee arthroplasty (TKA), or lower extremity fracture as indication for primary TTO excluded. Demographic variables including age, sex, Elixhauser comorbidity index (ECI), diagnosis and comorbidities were compared between the no revision (NR) and revision TTO groups. Continuous variables were compared via Student's t-test, and dichotomous variables were compared via chi-squared test. Multivariate Cox-proportional hazard modelling was utilized to identify predictors of revision TTO.

Results

4919 patients who underwent TTO were included, 105 of whom required revision TTO. The average age was 26.5 ± 11.5 years, and 3782 (77%) patients were female. The median follow-up time was 4.3 years (interquartile range [IQR]: 3.1–5.6 years). The most common indications for primary TTO included instability (62%) and chondromalacia/pain (33%). The most common indications for rTTO were instability (38%), chondromalacia/pain (28%) and fracture (24%). The median time to rTTO was 91 days [IQR: 20–219 days]. The following variables were associated with an increased risk for revision TTO: hypothyroidism (hazard ratio [HR] 1.8 [range: 1.1–3.0], p = 0.028), renal disease (HR = 3.3 [1.3–8.7], p = 0.014) and stroke (HR = 2.8 [1.3–5.8], p = 0.007).

Conclusion

Instability is the most common indication for rTTO, and most rTTO occur within 91 days of the primary procedure. History of hypothyroidism, renal disease and stroke are all independent risk factors for rTTO. These results highlight the importance close management of higher risk patients in the perioperative period following primary TTO. Preoperative medical optimisation of conditions such as hypothyroidism may mitigate postoperative complications following primary TTO.

Level of Evidence

Level III.

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发生率，适应症和危险因素翻修胫骨结节截骨：一项国家数据库研究

本研究的目的是描述(1)发生率，(2)适应症，(3)在美国全国患者样本中进行翻修胫骨结节截骨术（rTTO）的危险因素。方法对Mariner PearlDiver数据库进行回顾性分析。研究纳入了2015年至2021年接受单侧原发性胫骨结节截骨术（TTO）的患者，随访至少2年，并确定了需要翻修TTO的患者。排除信息不充分、有全膝关节置换术史或下肢骨折的患者作为原发性TTO的指征。比较无翻修组（NR）和翻修组（TTO）的年龄、性别、Elixhauser合并症指数（ECI）、诊断和合并症等人口学变量。连续变量比较采用Student's t检验，二分变量比较采用卡方检验。采用多变量cox -比例风险模型确定修正TTO的预测因子。结果纳入4919例行TTO的患者，其中105例需要重新行TTO。平均年龄26.5±11.5岁，女性3782例（77%）。中位随访时间为4.3年（四分位数间距[IQR]: 3.1-5.6年）。原发性TTO最常见的适应症包括不稳定（62%）和软骨软化/疼痛（33%）。rTTO最常见的适应症是不稳定（38%）、软骨软化/疼痛（28%）和骨折（24%）。到rTTO的中位时间为91天[IQR: 20-219天]。以下变量与修改TTO的风险增加相关：甲状腺功能减退（风险比[HR] 1.8[范围：1.1-3.0],p = 0.028）、肾脏疾病（HR = 3.3 [1.3-8.7], p = 0.014）和中风（HR = 2.8 [1.3-5.8], p = 0.007）。结论不稳定是rTTO最常见的适应症，大多数rTTO发生在首次手术后91天内。甲状腺功能减退史、肾脏疾病史和中风史都是rTTO的独立危险因素。这些结果强调了在原发性TTO后围手术期密切管理高危患者的重要性。术前医疗优化条件，如甲状腺功能减退可能减轻术后并发症后原发性TTO。证据等级三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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