Aim: A study to determine the results of tibial tubercle osteotomy in a series of revision and difficult primary total knee replacements.

Method: A consecutive series of total knee replacements in which tibial tubercle osteotomy was performed were reviewed retrospectively. 18 revision knees and 5 primary knee replacements were identified. All of the operations performed were by the senior author.

The technique was the same in all cases, involving 9cm osteotomy with screw fixation. In cases with marked restricted flexion and patella baja, the tubercle was deliberately moved proximally to gain length in the extensor mechanism.

Results: All osteotomies had united by 8–12 weeks as assessed on a lateral radiograph.

Range of movement increased on average 45° in the revisions, and by 60° in the primaries.

An active extensor lag in 4 cases (all deliberate proximalisations) post operatively which all recovered.

5 patients underwent MUA for stiffness at 12 weeks.

Conclusion: Tibial tubercle osteotomy allows predictable extensile exposure in primary and revision total knee replacement. It also allows lengthening of a contracted extensor mechanism. Union rate was excellent and complications low. It allows preservation of the quadriceps mechanism and a normal post-operative rehabilitation.