The Effect of Joint Line Elevation on Patient-Reported Outcomes After Contemporary Revision Total Knee Arthroplasty

Buller, Leonard T.; Metzger, Cameron; Deckard, Evan R.; Meneghini, R. Michael

doi:10.1016/j.arth.2022.02.062

Cited by 7 publications

(6 citation statements)

References 37 publications

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“…Review of the PI positions from the current cohort frequently revealed a larger distal femoral cut and overresection of the posterior femoral condyles during the index surgeries. The resultant instability arises from the subtle elevation of the joint line and decreased PCO of the femoral component leading to decreased ligamentous balance [ 5 , [12] , [13] , [14] ]. The ensuing flexion instability was further amplified when excess posterior slope was added to the primary tibial component.…”

Section: Discussionmentioning

confidence: 99%

“…The MAKO robotic arm system establishes boundaries for restricted kinematic alignment during the procedure where the implants are positioned within 3° to 5° of the mechanical axis within the coronal, sagittal, and axial planes [ 18 ]. Re-establishment of the joint line within 5 mm of the native location has been correlated with improved knee-joint function and satisfaction [ 12 ]. Joint line measurements were not obtained during this study because current robotic software (Version 1.0) cannot directly determine the joint line in a revision scenario.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Three-dimensional Comparison of Pre- and Post-component Position in a Series of Off-label Robotic-assisted Revision Total Knee Arthroplasties

MacAskill,

Peluso,

Lash

et al. 2024

Arthroplasty Today

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Three-dimensional Comparison of Pre- and Post-component Position in a Series of Off-label Robotic-assisted Revision Total Knee Arthroplasties

MacAskill,

Peluso,

Lash

et al. 2024

Arthroplasty Today

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“…The current retrospective analysis conducted in Indianapolis (Indiana, USA) encompassed over 1,300 patients, and provides an intriguing perspective on the impact of obesity on patient-reported outcome measures (PROMs) following primary total knee arthroplasty (TKA). 1 The study team under- This observation persisted even in the absence of differential rates of infection or instances of aseptic loosening necessitating revision surgery among the obese cohort. In terms of design, the demographic profiles of the groups were not evenly matched with the higher BMI groups characterized by a younger age, more female patients, and a greater burden of comorbid conditions.…”

Section: Obesity Is Associated With Greater Improvement In Patient-re...mentioning

confidence: 97%

Knee

2023

Bone &Amp; Joint 360

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The December 2023 Knee Roundup360 looks at: Obesity is associated with greater improvement in patient-reported outcomes following primary total knee arthroplasty; Does mild flexion of the femoral prosthesis in total knee arthroplasty result in better early postoperative outcomes?; Robotic or manual total knee arthroplasty: a randomized controlled trial; Patient-relevant outcomes following first revision total knee arthroplasty, by diagnosis: an analysis of implant survivorship, mortality, serious medical complications, and patient-reported outcome measures using the National Joint Registry data set; Sagittal alignment in total knee arthroplasty: are there any discrepancies between robotic-assisted and manual axis orientation?; Tourniquet use does not impact recovery trajectory in total knee arthroplasty; Impact of proximal tibial varus anatomy on survivorship after medial unicondylar knee arthroplasty; Bone cement directly to the implant in primary total knee arthroplasty?; Maintaining joint line obliquity optimizes outcomes in patients with constitutionally varus knees.

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“…A critical threshold of anywhere from 2 to 8 mm, most commonly 4-5 mm, of joint alteration has been described for maintenance of optimal outcomes. 7,8,13,25,30,31,36…”

Section: Introductionmentioning

confidence: 99%

“…A critical threshold of anywhere from 2 to 8 mm, most commonly 4-5 mm, of joint alteration has been described for maintenance of optimal outcomes. 7,8,13,25,30,31,36 In regard to the TTJL and ankle arthroplasty, Harnroongroj et al 19 described the first method for measuring the TTJL before and after TAA termed "joint line height ratio." The authors reported excellent inter-and intrarater reliability of their radiographic measurements (r > 0.9).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Tibiotalar Joint Line Level Alterations on Tibiotalar Range of Motion Following Total Ankle Arthroplasty

Fletcher,

Campbell,

Maloney

et al. 2023

Foot Ankle Int.

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Background: The effect of tibiotalar joint line level (TTJL) on patient outcomes following total ankle arthroplasty (TAA) remains unclear. It was previously reported that patients with end-stage ankle arthritis have an elevated TTJL compared with nonarthritic ankles, and the TTJL post-TAA remains elevated compared with nonarthritic ankles. The objectives of this study were to (1) propose a reliable radiographic method to measure the TTJL absolute value and (2) determine the effect of TTJL alterations on tibiotalar range of motion (ROM) following TAA. Methods: A retrospective review was performed on patients who underwent TAA between January 2018 and April 2021 with a minimum of 1-year postoperative follow-up and complete perioperative ROM radiographs. Radiographic TTJL and ROM measurements were performed by 2 observers. The proposed TTJL measuring technique computes 4 measurements: high, low, center of the talus (center), and center of the axis (axis). Reliability of measurements and correlation between TTJL measurements and ROM were assessed. Results: A total of 33 patients were included. Postoperatively, 22 patients had a lowered TTJL compared to 11 patients with an elevated TTJL (2.2 ± 1.3 mm lowered vs 1.9 ± 1.2 mm elevated; P < .0001). Of the 4 TTJL measurements, 3 (low, center, axis) demonstrated a significant positive correlation between lowering the TTJL and improved tibiotalar dorsiflexion and 2 (low, axis) for total ROM (all P < .05). Plantarflexion was not significantly affected by TTJL alterations. Compared to patients with an elevated TTJL, patients with a lowered TTJL had improved tibiotalar dorsiflexion (8.8 vs 2.5 degrees; P = .0015) and total ROM (31.0 vs 22.9 degrees; P = .0191), respectively. The interrater reliability was nearly perfect (intraclass correlation r = 0.96-0.99). Conclusion: In this small series, we found that lowering the TTJL level may more closely reestablish the native TTJL and correlates with improved tibiotalar dorsiflexion and total ROM following TAA. Level of Evidence: Level IV, case series.

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The Effect of Joint Line Elevation on Patient-Reported Outcomes After Contemporary Revision Total Knee Arthroplasty

Cited by 7 publications

References 37 publications

A Three-dimensional Comparison of Pre- and Post-component Position in a Series of Off-label Robotic-assisted Revision Total Knee Arthroplasties

A Three-dimensional Comparison of Pre- and Post-component Position in a Series of Off-label Robotic-assisted Revision Total Knee Arthroplasties

Knee

The Effect of Tibiotalar Joint Line Level Alterations on Tibiotalar Range of Motion Following Total Ankle Arthroplasty

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