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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2019

Open Access 01-05-2019 | Knee

The negative effect of joint line elevation after total knee arthroplasty on outcome

Authors: Willem A. M. van Lieshout, Kars P. Valkering, Koen L. M. Koenraadt, Faridi S. van Etten-Jamaludin, Gino M. M. J. Kerkhoffs, Rutger C. I. van Geenen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2019

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Abstract

Purpose

Total knee arthroplasty (TKA) is widely used as a treatment for knee osteoarthritis. However, still up to 20% of the patients are dissatisfied. Joint line elevation after TKA might be a contributing factor as it alters knee kinematics. The aim of this study was to investigate the effect of joint line elevation on outcome.

Methods

A systematic review of the literature was performed to select studies that reported on joint line alterations after primary or revision TKA and outcome. Studies with comparable outcome parameters were included in a correlation analysis.

Results

In total, 396 studies were identified, of which 27 met the inclusion criteria. 8 studies could be included in the correlation analysis. Mean joint line elevation after primary TKA was 3.0 mm and after revision TKA this was 3.6 mm. A statistically significant negative correlation was found between joint line elevation and the postoperative Knee Society Score (KSS) function score (ρ = − 0.496, p < 0.001). In a pooled analysis, the maintained joint line revision TKA group had statistically significant better postoperative KSS total scores compared to an elevated joint line group (p < 0.001).

Conclusion

In this systematic review, a negative correlation between joint line elevation and outcome was found. Furthermore, revision TKAs with a maintained joint line have statistically significant better postoperative KSS scores compared to an elevated joint line group. To achieve optimal outcome after TKA, restoration of the joint line is one of the parameters that should be pursued and introduced elevation should not exceed 4 mm.

Level of evidence

IV.
Literature
1.
Bin Abd Razak HR, Pang HN, Yeo SJ, Tan MH, Lo NN, Chong HC (2013) Joint line changes in cruciate-retaining versus posterior-stabilized computer-navigated total knee arthroplasty. Arch Orthop Trauma Surg 133:853–859CrossRefPubMed
2.
Babazadeh S, Dowsey MM, Stoney JD, Choong PFM (2014) Gap balancing sacrifices joint-line maintenance to improve gap symmetry: a randomized controlled trial comparing gap balancing and measured resection. J Arthroplast 29:950–954CrossRef
3.
Babazadeh S, Dowsey MM, Swan JD, Stoney JD, Choong PFM (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
4.
Bae DK, Song SJ, Park CH, Liang H, Bae JK (2017) Comparison of mid-term results between conversion total knee arthroplasties following closed wedge high tibial osteotomy and primary total knee arthroplasties: a matched pair study including patellar symptom and position. J Orthop Sci 22:495–500CrossRefPubMed
5.
6.
Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans a (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Jt Surg Br 84:50–53CrossRef
7.
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
8.
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63CrossRefPubMed
9.
10.
Clavé A, Le Henaff G, Roger T, Maisongrosse P, Mabit C, Dubrana F (2016) Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up. Int Orthop 40:1655–1662CrossRefPubMed
11.
Clement N, MacDonald D (2017) Posterior condylar offset is an independent predictor of functional outcome after revision total knee arthroplasty. J Bone Jt Surg 6:172–178CrossRef
12.
Clement ND (2013) Patient factors that influence the outcome of total knee replacement: a critical review of the literature. Open Access Orthop 1:11
13.
Clement ND, Bardgett M, Weir D, Holland J, Deehan DJ (2018) Increased symptoms of stiffness 1 year after total knee arthroplasty are associated with a worse functional outcome and lower rate of patient satisfaction. Knee Surg Sport Traumatol Arthrosc 0:1–8
14.
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Routledge, New York
15.
Cross MB, Nam D, Plaskos C, Sherman SL, Lyman S, Pearle AD, Mayman DJ (2012) Recutting the distal femur to increase maximal knee extension during TKA causes coronal plane laxity in mid-flexion. Knee 19:875–879CrossRefPubMed
16.
Feller J, Bartlett RJ, Lang DM (1996) Patellar resurfacing versus retention in total knee arthroplasty. J Bone Jt Surg Br 78:226–228CrossRef
17.
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
18.
Freisinger GM, Hutter EE, Lewis J, Granger JF, Glassman AH, Beal MD, Pan X, Schmitt LC, Siston RA, Chaudhari AMW (2017) Relationships between varus–valgus laxity of the severely osteoarthritic knee and gait, instability, clinical performance, and function. J Orthop Res 35:1644–1652CrossRefPubMed
19.
Goh GSH, Liow MHL, Lim WSR, Tay DKJ, Yeo SJ, Tan MH (2016) Accelerometer-based navigation is as accurate as optical computer navigation in restoring the joint line and mechanical axis after total knee arthroplasty. A prospective matched study. J Arthroplast 31:92–97CrossRef
20.
21.
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 Arthroplast 21:1154–1162CrossRef
22.
Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Hodgkinson M (2011) The Oxford 2011 levels of evidence. Oxford Centre Evidence-Based Medicine. Group, Oxford
23.
Huang T-W, Lee C-Y, Lin S-J, Peng K-T, Huang K-C, Lee MS, Hsu RW-W, Shen W-J (2014) Comparison of computer-navigated and conventional total knee arthroplasty in patients with Ranawat type-II valgus deformity: medium-term clinical and radiological results. BMC Musculoskelet Disord 15:390CrossRefPubMedPubMedCentral
24.
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 Sport Traumatol Arthrosc 21:2725–2729CrossRef
25.
Ji S-J, Zhou Y-X, Jiang X, Cheng Z-Y, Wang G-Z, Ding H, Yang M-L, Zhu Z-L (2015) Effect of joint line elevation after posterior-stabilized and cruciate-retaining total knee arthroplasty on clinical function and kinematics. Chin Med J 128:2866CrossRefPubMedPubMedCentral
26.
Kannan A, O’Connell RS, Kalore N, Curtin BM, Hull JR, Jiranek WA (2015) Revision TKA for flexion instability improves patient reported outcomes. J Arthroplast 30:818–821CrossRef
27.
Kawamura H, Bourne RB (2001) Factors affecting range of flexion after total knee arthroplasty. J Orthop Sci 6:248–252CrossRefPubMed
28.
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 17:CR292–C6
29.
Lange JK, Lee YY, Spiro SK, Haas SB (2018) Satisfaction rates and quality of life changes following total knee arthroplasty in age-differentiated cohorts. J Arthroplast 33:1373–1378CrossRef
30.
Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW (2011) Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc 19:2027–2032CrossRefPubMed
31.
Lee K-J, Moon J-Y, Song E-K, Lim H-A, Seon J-K (2012) Minimum two-year results of revision total knee arthroplasty following infectious or non-infectious causes. Knee Surg Relat Res 24:227–234CrossRefPubMedPubMedCentral
32.
Liow MHL, Xia Z, Wong MK, Tay KJ, Yeo SJ, Chin PL (2014) Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplast 29:2373–2377CrossRef
33.
Luyckx T, Beckers L, Colyn W, Vandenneucker H, Bellemans J (2014) The adductor ratio: a new tool for joint line reconstruction in revision TKA. Knee Surg Sports Traumatol Arthrosc 22:3028–3033CrossRefPubMed
34.
Luyckx T, Vandenneucker H, Ing LS, Vereecke E, Ing AV, Victor J (2018) Raising the joint line in TKA is associated with mid-flexion laxity: a study in cadaver knees. Clin Orthop Relat Res 476:601–611CrossRefPubMedPubMedCentral
35.
Mahoney OM, Kinsey TL (2006) Modular femoral offset stems facilitate joint line restoration in revision knee arthroplasty. Clin Orthop Relat Res U S 446:93–98CrossRef
36.
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
37.
Matziolis G, Brodt S, Windisch C, Roehner E (2017) Changes of posterior condylar offset results in midflexion instability in single-radius total knee arthroplasty. Arch Orthop Trauma Surg 137:713–717CrossRefPubMed
38.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Reprint–preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther 89:873–880PubMed
39.
Pang H-N, Yeo S-J, Chong H-C, Chin P-L, Chia S-L, Lo N-N (2013) Joint line changes and outcomes in constrained versus unconstrained total knee arthroplasty for the type II valgus knee. Knee Surg Sports Traumatol Arthrosc 21:2363–2369CrossRefPubMed
40.
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
41.
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
42.
Ryu J, Saito S, Yamamoto K, Sano S (1993) Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Jt Dis 53:35–40PubMed
43.
Sadaka C, Kabalan Z, Hoyek F, Abi Fares G, Lahoud JC (2015) Joint line restoration during revision total knee arthroplasty: an accurate and reliable method. Springerplus 4:1–5CrossRef
44.
Selvarajah E, Hooper G (2009) Restoration of the joint line in total knee arthroplasty. J Arthroplast 24:1099–1102CrossRef
45.
46.
Snider MG, Macdonald SJ (2009) The influence of the posterior cruciate ligament and component design on joint line position after primary total knee arthroplasty. J Arthroplast 24:1093–1098CrossRef
47.
Vera-Aviles FA, Jimenez-Aquino JM (2012) Total knee arthroplasty. Prognosis after restoring the joint line. Acta Ortop Mex 26:362–368PubMed
48.
Vince KG, Droll K, Chivas D (2008) New concepts in revision total knee arthroplasty. J Surg Orthop Adv 17:165–172PubMed
49.
Yang J-H, Seo J-G, Moon Y-W, Kim M-H (2009) Joint line changes after navigation-assisted mobile-bearing TKA. Orthopedics 32:35–39CrossRefPubMed
Metadata
Title
The negative effect of joint line elevation after total knee arthroplasty on outcome
Authors
Willem A. M. van Lieshout
Kars P. Valkering
Koen L. M. Koenraadt
Faridi S. van Etten-Jamaludin
Gino M. M. J. Kerkhoffs
Rutger C. I. van Geenen
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5099-8

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