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, 陈海龙, 王战朝. 全膝关节置换术后伸膝装置并发症分析. 中国矫形外科杂志, 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. 膝关节置换术策略与技巧. 钱齐荣, 姚振均, 柴伟, 等译. 上海: 上海科学技术出版社, 2015: 7.
7.	张子琦, 梁佳林, 左小莉, 等. 气压止血带对人工全膝关节置换术围术期失血量的影响. 中国修复重建外科杂志, 2019, 33(6): 681-684.
8.	胡水清, 陈樑, 曾敏, 等. 人工全膝关节置换术间断缝合与美容缝合疗效比较研究. 中国修复重建外科杂志, 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.	吕厚山, 关振鹏, 袁燕林, 等. 屈曲位骨性强直的人工全膝关节置换技术与临床效果. 中华骨科杂志, 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, 何帮剑, 储小兵, 等. 伸直位骨性强直膝的全膝关节置换术. 中华骨科杂志, 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.	边焱焱, 翁习生. 人工全膝关节置换术中髌韧带损伤的预防和修复. 中国修复重建外科杂志, 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.	吕厚山, 李虎, 关振鹏, 等. 人工全膝关节置换术治疗膝关节伸直位强直畸形. 中华外科杂志, 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, 陈海龙, 王战朝. 全膝关节置换术后伸膝装置并发症分析. 中国矫形外科杂志, 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. 膝关节置换术策略与技巧. 钱齐荣, 姚振均, 柴伟, 等译. 上海: 上海科学技术出版社, 2015: 7.
7. 张子琦, 梁佳林, 左小莉, 等. 气压止血带对人工全膝关节置换术围术期失血量的影响. 中国修复重建外科杂志, 2019, 33(6): 681-684.
8. 胡水清, 陈樑, 曾敏, 等. 人工全膝关节置换术间断缝合与美容缝合疗效比较研究. 中国修复重建外科杂志, 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. 吕厚山, 关振鹏, 袁燕林, 等. 屈曲位骨性强直的人工全膝关节置换技术与临床效果. 中华骨科杂志, 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, 何帮剑, 储小兵, 等. 伸直位骨性强直膝的全膝关节置换术. 中华骨科杂志, 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. 边焱焱, 翁习生. 人工全膝关节置换术中髌韧带损伤的预防和修复. 中国修复重建外科杂志, 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. 吕厚山, 李虎, 关振鹏, 等. 人工全膝关节置换术治疗膝关节伸直位强直畸形. 中华外科杂志, 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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