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Maintenance of the joint line and posterior condylar offset are the most notable variables for successful outcomes of revision total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Controversy regarding which variables should be prioritized for better outcomes in revision total knee arthroplasty (RTKA) exists. This study aimed to comprehensively analyze the variables affecting RTKA outcomes.

Materials and methods

We retrospectively identified 87 RTKAs in 82 patients who were performed between March 2014 and February 2020. Range of motion (ROM), including flexion contracture (FC) and further flexion (FF), was analyzed according to the covariates. The covariates included mode of failure, joint line position, anteroposterior (AP) position, rotational alignment of the femoral component, and patellofemoral alignment. The differences between the final follow-up values of each RTKA variable and those of the native knee were evaluated. The clinical outcomes were evaluated.

Results

No significant differences were observed between the joint line positions of the RTKA and native knees. The patellar and AP positions of the femoral component were restored to pre-TKA values. The femoral component had an external rotation of 2.78° compared with the native knee. In multivariable stepwise regression analysis, restoration of the adductor tubercle joint line and posterior condylar offset (PCO) were significant variables affecting ROM. Septic RTKA (33 knees) resulted in poor FF outcomes (p = 0.030) and Western Ontario and McMaster Universities Osteoarthritis Index stiffness (WOMAC S) scores (p < 0.001), compared with aseptic RTKA (54 knees).

Conclusions

Restoration of the joint line position and PCO are crucial factors for improved ROM in RTKA. Joint line elevation in RTKA resulted in worse ROM than joint line lowering. In addition, RTKA due to septic failure had inferior ROM and WOMAC S scores compared with RTKA due to aseptic failure.

Level of evidence

Level III, cohort study.

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Data availability

Every data was transparency.

Code availability

Not applicable.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-707, South Korea

    Seong Yun Park, Hyun Jin Yoo, Ho Won Jeong, Samuel Jaeyoon Won & Yong Seuk Lee

  2. Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea

    Hyun Jin Yoo

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  1. Seong Yun Park
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  2. Hyun Jin Yoo
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  4. Samuel Jaeyoon Won
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Contributions

All authors were involved in drafting the article or revising it critically for important intellectual content. All authors read and approved the final version to be published. Detailed contributions: SYP, HJY, SJW and YSL contributed to the study conception and design. Material preparation, data collection and analysis were performed by SYP, HJY, HWJ and SJW. The first draft of the manuscript was written by SYP, HJY and YSL and all authors commented on previous versions of the manuscript.

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Correspondence to Yong Seuk Lee.

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Park, S.Y., Yoo, H.J., Jeong, H.W. et al. Maintenance of the joint line and posterior condylar offset are the most notable variables for successful outcomes of revision total knee arthroplasty. Arch Orthop Trauma Surg 144, 357–367 (2024). https://doi.org/10.1007/s00402-023-05063-x

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