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Blackburne–Peel ratio predicts patients’ outcomes after total knee arthroplasty

Knee Surgery, Sports Traumatology, Arthroscopy volume 27, pages 1562–1569 (2019)Cite this article

Abstract

Purpose

Alterations in patellar height and posterior tibial slope (PTS) are frequently measured radiographic parameters associated with postoperative impairments after total knee arthroplasty (TKA). Few studies correlate the clinical outcome of TKA with the radiological indices. Both the modified Insall–Salvati ratio (mISR) and the Blackburne–Peel ratio (BPR) were hypothesised to correlate with the clinical outcome after TKA.

Methods

A total of 282 computer navigated primary LCS®-TKAs, implanted in our institution from 2008 to 2012, were included. Data (ROM, FJS-12, WOMAC, and revision surgery) were collected independently and prospectively. Patellar height (mISR, BPR), joint-line position, and PTS were measured on pre- and postoperative radiographs. Bivariate and multiple regression analyses were performed.

Results

Mean mISR (1.5–1.4) and BPR (0.8–0.6) decreased from preoperatively to 1 year follow-up. Mean joint-line shift in a cranial direction was 2 mm after TKA implantation. Analysis of dichotomous variables (presence of PB and PPB or not) only showed significantly lower flexion in patients with PPB (p < 0.001). However, multiple regression revealed that BPR was a significant positive independent predictor for FJS-12 (p = 0.016) and flexion (p < 0.001) at 1 year follow-up. Postoperative PTS (p < 0.01) and initial patella height (p < 0.001) were both predictive for BPR at follow-up, while the joint-line height was not.

Conclusions

The BPR is a useful and reliable radiographic parameter to predict patient outcomes 1 year after primary navigated TKA. Lowering the BPR should be avoided, as this may lead to significant restrictions in terms of ROM and PROMs.

Level of evidence

Level 3.

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Abbreviations

AKP:

Anterior knee pain

BPR:

Blackburne–Peel ratio

FJS-12:

Forgotten joint score 12

mISR:

Modified Insall–Salvati ratio

PB:

Patella baja

PPB:

Pseudo-patella baja

PROM:

Patient-reported outcome measurement

PTS:

Posterior tibial slope

ROM:

Range of motion

TKA:

Total knee arthroplasty

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Affiliations

  1. Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Henrik Behrend, Rene Gerlach, Christian Spross & Andreas Ladurner

  2. Trauma Department, Hannover Medical School, Hannover, Germany

    Tilman Graulich

Authors
  1. Henrik Behrend
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  2. Tilman Graulich
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  3. Rene Gerlach
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  4. Christian Spross
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  5. Andreas Ladurner
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Contributions

BH and SC conceived the study and developed the study design. GT, LA, and GR acquired data and radiographic measurements. All authors participated in drafting the article and have approved the final version of the manuscript.

Corresponding author

Correspondence to Henrik Behrend.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Behrend, H., Graulich, T., Gerlach, R. et al. Blackburne–Peel ratio predicts patients’ outcomes after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 1562–1569 (2019). https://doi.org/10.1007/s00167-018-5016-1

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Keywords

  • Total knee arthroplasty (TKA)
  • Total knee replacement
  • Patellar height
  • Posterior tibial slope
  • Anterior knee pain
  • Forgotten joint score-12
  • Patella baja
  • Pseudo-patella baja