Background:Tibial tubercle osteotomy (TTO) is rarely required to achieve adequate exposure during complex revision total knee arthroplasty (TKA). Although generally considered a salvage option, concerns persist regarding its potential complications and impact on postoperative function, and clinical data remain limited. This study aimed to describe the clinical and radiographic outcomes of aseptic revision TKA requiring TTO; outcomes from cases revised without TTO are reported as contextual, exploratory data. Methods:A retrospective review was conducted on 128 patients who underwent aseptic revision TKA between May 2009 and December 2020. The cohort included 50 TTO and 78 standard parapatellar arthrotomy without TTO (non-TTO). The decision to perform a TTO was made intraoperatively when standard exposure techniques did not permit adequate patellar mobilization without excessive tension on the extensor mechanism. Clinical and radiographic outcomes were assessed within each group and, on an exploratory basis, between groups including revision and complication rates, postoperative range of motion, patellar height ratios, and osteotomy union. Results:The TTO group achieved a union rate of 98%, with 14% of patients experiencing TTO-related complications (mainly hardware irritation). Revision was required in 18% of TTO and 15% of non-TTO cases. Flexion significantly improved in both groups; exploratory analysis suggested no significant differences between groups (p = 0.97). Patellar height remained stable. Conclusions:TTO is an uncommon but reliable salvage exposure in aseptic revision TKA, with high union and low reoperation risk. It did not compromise knee flexion or patellar height at mid-term follow-up. Prospective studies with patient-reported outcomes and higher-complexity cases are needed.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.