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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Funding

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI18C2396).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, South Korea

    Hyuk-Soo Han, Cheol Hwan Yu & Myung Chul Lee

  2. Department of Public Health Sciences, Seoul National University, Seoul, South Korea

    Nari Shin & Sungho Won

Authors
  1. Hyuk-Soo Han
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  2. Cheol Hwan Yu
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  3. Nari Shin
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Correspondence to Myung Chul Lee.

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Conflict of interest

The authors certify that they have no commercial associations that might pose a conflict of interest in connection with this article.

Ethical approval

The study protocol was approved by the Institutional Review Board (Protocol No. H-1808-071-965).

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Han, HS., Yu, C.H., Shin, N. et al. Femoral joint line restoration is a major determinant of postoperative range of motion in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 2090–2095 (2019). https://doi.org/10.1007/s00167-019-05361-1

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