Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2019

01-07-2019 | Knee-TEP | KNEE

Femoral joint line restoration is a major determinant of postoperative range of motion in revision total knee arthroplasty

Authors: Hyuk-Soo Han, Cheol Hwan Yu, Nari Shin, Sungho Won, Myung Chul Lee

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2019

Login to get access

Abstract

Purpose

The purpose of this study was to comprehensively analyze the effects of femoral or tibial joint line elevation and patella height change on the clinical results after revision total knee arthroplasty (RTKA) and to determine which one is the significant factor that should be restored.

Methods

One hundred and sixty-six RTKA cases (144 patients) with a minimum 2-year follow-up were retrospectively analyzed. Demographic, operative, and clinical data were collected. Tibial and femoral joint line elevations were measured based on the distance from the tibial tubercle and from the adductor tubercle to the distal end of the femoral component, respectively. The patellar position was evaluated using the Insall-Salvati ratio and Blackburne-Peel index. The effects of clinical and radiological variables on the changes of range of motion (ROM) and clinical scores after RTKA were analyzed.

Results

Fourteen knees (8.4%) showed a femoral joint line elevation of more than 5 mm, and 79 knees (47.6%) showed a tibial joint line elevation of more than 5 mm. Patella baja after RTKA was observed in 33 knees (19.9%), and pseudo-patella baja after RTKA was observed in 90 knees (54.2%). The linear mixed model revealed that the femoral joint line position was the only significant factor that affected the change of ROM after RTKA. No statistically significant correlation was observed between variables and postoperative clinical scores.

Conclusions

Restoration of femoral joint line was the significant factor that increased postoperative ROM of the knee after RTKA. In complicated revision situations, surgeons should give priority to the restoration of distal femoral joint line to increase postoperative ROM.

Level of evidence

IV.
Literature
1.
Babazadeh S, Dowsey MM, Swan JD, Stoney JD, Choong PF (2011) Joint line position correlates with function after primary total knee replacement: a randomised controlled trial comparing conventional and computer-assisted surgery. J Bone Jt Surg Br 93:1223–1231CrossRef
2.
3.
4.
Bieger R, Huch K, Kocak S, Jung S, Reichel H, Kappe T (2014) The influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods. Arch Orthop Trauma Surg 134:537–541CrossRefPubMed
5.
Chen AF, Tetreault MW, Levicoff EA, Fedorka CJ, Rothenberg AC, Klatt BA (2014) Increased incidence of patella baja after total knee arthroplasty revision for infection. Am J Orthop (Belle Mead NJ) 43:562–566
6.
Chonko DJ, Lombardi AV Jr, Berend KR (2004) Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 12:231–238PubMed
7.
Engh GA, Ammeen DJ (1999) Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect 48:167–175PubMed
8.
Figgie HE, Goldberg VM, Heiple KG, Moller HS, Gordon NH (1986) The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Jt Surg Am 68:1035–1040CrossRef
9.
Grelsamer RP (2002) Patella baja after total knee arthroplasty: is it really patella baja? J Arthroplasty 17:66–69CrossRefPubMed
10.
Hofmann AA, Kurtin SM, Lyons S, Tanner AM, Bolognesi MP (2006) Clinical and radiographic analysis of accurate restoration of the joint line in revision total knee arthroplasty. J Arthroplasty 21:1154–1162CrossRefPubMed
11.
Iacono F, Lo Presti M, Bruni D, Raspugli GF, Bignozzi S, Sharma B, Marcacci M (2013) The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line. Knee Surg Sports Traumatol Arthrosc 21:2725–2729CrossRefPubMed
12.
13.
Kazemi SM, Daftari Besheli L, Eajazi A, Miniator Sajadi MR, Okhovatpoor MA, Farhang Zanganeh R, Minaei R (2011) Pseudo-patella baja after total knee arthroplasty. Med Sci Monit 17:CR292–C296CrossRefPubMedPubMedCentral
14.
Konig C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, Heller MO (2010) Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 28:1–5PubMed
15.
Koshino T, Ejima M, Okamoto R, Morii T (1990) Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis. J Arthroplasty 5:323–327CrossRefPubMed
16.
Laskin RS (2002) Joint line position restoration during revision total knee replacement. Clin Orthop Relat Res 404:169–171CrossRef
17.
Martin JW, Whiteside LA (1990) The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 259:146–156
18.
Noyes FR, Wojtys EM, Marshall MT (1991) The early diagnosis and treatment of developmental patella infera syndrome. Clin Orthop Relat Res 265:241–252
19.
Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 367:165–171CrossRef
20.
Paulos LE, Wnorowski DC, Greenwald AE (1994) Infrapatellar contracture syndrome. diagnosis, treatment, and long-term followup. Am J Sports Med 22:440–449CrossRefPubMed
21.
Porteous AJ, Hassaballa MA, Newman JH (2008) Does the joint line matter in revision total knee replacement? J Bone Jt Surg Br 90:879–884CrossRef
22.
Rand JA (1998) Modular augments in revision total knee arthroplasty. Orthop Clin North Am 29:347–353CrossRefPubMed
23.
Sato T, Koga Y, Sobue T, Omori G, Tanabe Y, Sakamoto M (2007) Quantitative 3-dimensional analysis of preoperative and postoperative joint lines in total knee arthroplasty: a new concept for evaluation of component alignment. J Arthroplasty 22:560–568CrossRefPubMed
24.
Selvarajah E, Hooper G (2009) Restoration of the joint line in total knee arthroplasty. J Arthroplasty 24:1099–1102CrossRefPubMed
25.
Singerman R, Davy DT, Goldberg VM (1994) Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech 27:1059–1065CrossRefPubMed
26.
27.
Wyss TF, Schuster AJ, Munger P, Pfluger D, Wehrli U (2006) Does total knee joint replacement with the soft tissue balancing surgical technique maintain the natural joint line? Arch Orthop Trauma Surg 126:480–486CrossRefPubMed
28.
Yoshii I, Whiteside LA, White SE, Milliano MT (1991) Influence of prosthetic joint line position on knee kinematics and patellar position. J Arthroplasty 6:169–177CrossRefPubMed
Metadata
Title
Femoral joint line restoration is a major determinant of postoperative range of motion in revision total knee arthroplasty
Authors
Hyuk-Soo Han
Cheol Hwan Yu
Nari Shin
Sungho Won
Myung Chul Lee
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Keywords
Knee-TEP
Knee-TEP
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05361-1

Other articles of this Issue 7/2019

Knee Surgery, Sports Traumatology, Arthroscopy 7/2019 Go to the issue

KNEE

High tibial osteotomy increases patellofemoral pressure if adverted proximal, while open-wedge HTO with distal biplanar osteotomy discharges the patellofemoral joint: different open-wedge high tibial osteotomies compared to an extra-articular unloading device

KNEE

Open posterior capsular release with an osteotome in total knee arthroplasty does not place important neurovascular structures at risk

KNEE

Robotic-assisted unicompartmental knee replacement offers no early advantage over conventional unicompartmental knee replacement

KNEE

Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management

Knee

Mid- to long-term results of allograft–prosthesis composite reconstruction after removal of a distal femoral malignant tumor are comparable to those of the proximal tibia

KNEE

Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities