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Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up

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Abstract

Introduction

It has been shown that the distance between the joint line (JL) and the fibular head is constant in both knees in a given individual. We analysed the influence of the JL level difference between the revised knee and the native knee from the functional outcomes after TKR revision.

Methods

This multicentre study assessed retrospectively a consecutive series of 177 revised total knee replacements. Patients with contralateral knees that had undergone previous major surgery or trauma were excluded. The JL level difference between both knees was measured on Knee’s AP standing X-rays and compared to the KSS Knee and Function scores at the final follow-up.

Results

Eighty-five cases were analysed at a mean of seven years follow-up. There was a significant increase in KSS Knee and Function scores after surgery. The average elevation of the JL was 2.2 mm (s.d. 2.66 mm) compared with the healthy contralateral knee. When the JL was elevated more than 4 mm this correlated with a decreased KSS Function score and decreased post-operative knee flexion.

Conclusions

Poorer functional results are significantly associated with an elevation in the JL compared to the contralateral healthy knee. In those patients with a suitable contralateral knee the JL level to restore can be assessed by the distance between the femoral condyle and the apex of the fibular head of the contralateral knee.

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Acknowledgments

The authors are very grateful to Professor Bonnevialle (Toulouse University Hospital, France), Professor Mertl (Amiens University Hospital, France), Professor Rouvillain (Fort de France University Hospital, France), Professor Bizot (Angers University Hospital, France), Dr Dalmay (Amiens University Hospital) for contributing as investigators to this work.

The authors are very grateful to Professor Simon Donell (Norfolk & Norwich University Hospital, UK) and to Mr Max Gibbons (Nuffield Orthopedic Centre, Oxford, UK) for providing language help and proof reading of the article.

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Authors and Affiliations

  1. Orthopedic and Traumatologic Surgery Department, Brest University Hospital, Bd Tanguy Prigent, 29609, Brest, France

    Arnaud Clavé, Goulven Le Henaff & Frédéric Dubrana

  2. Orthopedic and Traumatologic Surgery Department, Limoges University Hospital, 2 Bd Martin Luther King, 87042, Limoges, France

    Thomas Roger & Christian Mabit

  3. Orthopedic and Traumatologic Surgery Department, Toulouse Purpan University Hospital, Place du Docteur Baylac, 31059, Toulouse, France

    Paul Maisongrosse

Authors
  1. Arnaud Clavé
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  2. Goulven Le Henaff
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  3. Thomas Roger
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  4. Paul Maisongrosse
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  5. Christian Mabit
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  6. Frédéric Dubrana
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Correspondence to Arnaud Clavé.

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Level of evidence: Retrospective study, level IV.

All authors were fully involved in the study and preparation of the manuscript and the material within has not been and will not be submitted for publication elsewhere.

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Clavé, A., Le Henaff, G., Roger, T. et al. Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up. International Orthopaedics (SICOT) 40, 1655–1662 (2016). https://doi.org/10.1007/s00264-015-3096-9

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  • DOI: https://doi.org/10.1007/s00264-015-3096-9

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