Is there a difference in joint line restoration in revision Total knee arthroplasty according to prosthesis type?

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Abstract

Background

The aim of this study is (1) to compare joint line (JL) restoration and clinical outcomes in revision TKA based on the contemporary prosthesis type and (2) to determine the restoration of posterior condylar offset (PCO) according to the use of a femoral offset stem.

Methods

Sixty knees that underwent revision TKA from April 2003 to December 2013 with a minimum of 1 year follow up were included. These were further subdivided into three groups according to prosthesis type: group I (2 mm offset), group II (4.5 mm offset), group III (2, 4, and 6 mm offset). The JL position change was defined as a change in the adductor tubercle distance, preoperatively versus postoperatively. We also collected the change of PCO in distal femur and clinical outcomes including range of motion (ROM) and knee scores at the preoperative and last follow-up periods.

Results

The JL elevation for group III was significantly lower than that of the other groups. Usage of the tibial and femoral offset stem in group III was more frequent than in the other groups. PCO in revision TKA with a femoral offset stem was significantly greater than in those with a femoral straight stem. The JL position in revision TKA with a femoral offset stem was less elevated than in those with a femoral straight stem.

Conclusions

More recent developed revision prosthesis with various sizes option of offset stem may be effective in restoring the native joint line as using the femoral offset stem more convenience in revision TKAs.

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Most cited references 26

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Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002.

Steven Kurtz, Fionna Mowat, Kevin Ong … (2005)

The purpose of this study was to quantify the procedural rate and revision burden of total hip and knee arthroplasty in the United States and to determine if the age or gender-based procedural rates and overall revision burden are changing over time. The National Hospital Discharge Survey (NHDS) for 1990 through 2002 was used in conjunction with United States Census data to quantify the rates of primary and revision arthroplasty as a function of age and gender within the United States with use of methodology published by the American Academy of Orthopaedic Surgeons. Poisson regression analysis was used to evaluate the procedural rate and to determine year-to-year trends in primary and revision arthroplasty rates as a function of both age and gender. Both the number and the rate of total hip and knee arthroplasties (particularly knee arthroplasties) increased steadily between 1990 and 2002. Over the thirteen years, the rate of primary total hip arthroplasties per 100,000 persons increased by approximately 50%, whereas the corresponding rate of primary total knee arthroplasties almost tripled. The rate of revision total hip arthroplasties increased by 3.7 procedures per 100,000 persons per decade, and that of revision total knee arthroplasties, by 5.4 procedures per 100,000 persons per decade. However, the mean revision burden of 17.5% for total hip arthroplasty was more than twice that for total knee arthroplasty (8.2%), and this did not change substantially over time. The number and prevalence of primary hip and knee replacements increased substantially in the United States between 1990 and 2002, but the trend was considerably more pronounced for primary total knee arthroplasty. The reported prevalence trends have important ramifications with regard to the number of joint replacements expected to be performed by orthopaedic surgeons in the future. Because the revision burden has been relatively constant over time, we can expect that a greater number of primary replacements will result in a greater number of revisions unless some limiting mechanism can be successfully implemented to reduce the future revision burden.

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The anatomy of the medial part of the knee.

Robert F LaPrade, Anders Hauge Engebretsen, Thuan V Ly … (2007)

While the anatomy of the medial part of the knee has been described qualitatively, quantitative descriptions of the attachment sites of the main medial knee structures have not been reported. The purpose of the present study was to verify the qualitative anatomy of medial knee structures and to perform a quantitative evaluation of their anatomic attachment sites as well as their relationships to pertinent osseous landmarks. Dissections were performed and measurements were made for eight nonpaired fresh-frozen cadaveric knees with use of an electromagnetic three-dimensional tracking sensor system. In addition to the medial epicondyle and the adductor tubercle, a third osseous prominence, the gastrocnemius tubercle, which corresponded to the attachment site of the medial gastrocnemius tendon, was identified. The average length of the superficial medial (tibial) collateral ligament was 94.8 mm. The superficial medial collateral ligament femoral attachment was 3.2 mm proximal and 4.8 mm posterior to the medial epicondyle. The superficial medial collateral ligament had two separate attachments on the tibia. The distal attachment of the superficial medial collateral ligament on the tibia was 61.2 mm distal to the knee joint. The deep medial collateral ligament consisted of meniscofemoral and meniscotibial portions. The posterior oblique ligament femoral attachment was 7.7 mm distal and 6.4 mm posterior to the adductor tubercle and 1.4 mm distal and 2.9 mm anterior to the gastrocnemius tubercle. The medial patellofemoral ligament attachment on the femur was 1.9 mm anterior and 3.8 mm distal to the adductor tubercle. The medial knee ligament structures have a consistent attachment pattern.

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The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis.

K G Heiple, Marcia Gordon, Alina V. Goldberg … (1986)

Function of the knee and patellofemoral symptoms were correlated with the position of the implant in 101 consecutive patients with 116 posterior stabilized condylar knee prostheses. All of the patients were followed for a minimum of two and a half years with sequential physical examinations, radiographs, and functional evaluation of the knee. In sixteen knees (14 per cent), clicking or catching of the patella in terminal extension or painless crepitation throughout the arc of flexion developed without lowering the functional knee-evaluation score. Pain or mechanical problems, or both, that lowered the functional knee-evaluation score occurred in another fourteen knees (12 per cent), within the first postoperative year. Of these fourteen, eight required revision solely for patellofemoral complaints. Critical analysis of the tibial-patellofemoral mechanical axis identified three surgical variables that were found to markedly affect the functional result of the prosthesis: the distance from the center line of the tibial prosthesis to the center line of the tibial plateau, a change in the position of the joint line of the prosthesis relative to the hip and ankle, and the patellar height, measured as the perpendicular distance from the inferior pole of the patellar implant to the joint line of the prosthesis. Functional knee scores, range of motion, patellofemoral pain or mechanical symptoms, the need for revision, and the necessity of manipulation could all be statistically significantly correlated with the three independent variables. In addition, a range of neutral alignment was developed.(ABSTRACT TRUNCATED AT 250 WORDS)

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Author and article information

Contributors

JuHong Lee: jhl55@chonbuk.ac.kr

SungIl Wang: tibikim77@gmail.com

KiBum Kim:

ORCID: http://orcid.org/0000-0003-0990-4017

tibikim@naver.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 20 October 2018

Publication date PMC-release: 20 October 2018

Publication date Collection: 2018

Volume: 19

Electronic Location Identifier: 382

Affiliations

ISNI 0000 0004 0647 1516, GRID grid.411551.5, Department Of Orthopaedic Surgery, , Chonbuk National University Hospital, ; 20, Geonji-ro, Deokjin-gu, Jeonju, 54907 South Korea

Author information

KiBum Kim http://orcid.org/0000-0003-0990-4017

Article

Publisher ID: 2295

DOI: 10.1186/s12891-018-2295-0

PMC ID: 6195685

PubMed ID: 30342515

SO-VID: 4dfac8b4-d1ad-4110-bb18-fb4cc4f993d6

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 12 March 2018

Date accepted : 4 October 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100002864, Chonbuk National University Hospital;

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: revision total knee arthroplasty,joint line restoration,offset stem,posterior condylar offset

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: revision total knee arthroplasty, joint line restoration, offset stem, posterior condylar offset

Is there a difference in joint line restoration in revision Total knee arthroplasty according to prosthesis type?

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Abstract

Background

Methods

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Orthopedics

Most cited references 26

Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002.

The anatomy of the medial part of the knee.

The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis.

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