The negative effect of joint line elevation after total knee arthroplasty on outcome

Lieshout, W. A. M. van; Valkering, Kars P.; Koenraadt, Koen L. M.; Etten-Jamaludin, Faridi S. van; Kerkhoffs, Gino M. M. J.; Geenen, Rutger C. I. van

doi:10.1007/s00167-018-5099-8

Cited by 50 publications

(50 citation statements)

References 50 publications

(116 reference statements)

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“…Furthermore, there is still a lack of a standardized measurement procedure in TKA. In a systematic review by van Lieshout et al recent studies with regards to joint line elevation after TKA were analyzed [ 33 ]. The majority of the authors rely on three different bony landmarks as a reference point to calculate the joint line height: the fibular head, the tibial tubercle and the adductor tubercle [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic review by van Lieshout et al recent studies with regards to joint line elevation after TKA were analyzed [ 33 ]. The majority of the authors rely on three different bony landmarks as a reference point to calculate the joint line height: the fibular head, the tibial tubercle and the adductor tubercle [ 33 ]. Several authors already showed that the fibular head is not a reliable bony landmark for JL assessment [ 9 , 15 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have already been conducted to define reproducible techniques to quantify absolute JL alteration [ 15 – 17 , 22 , 25 , 26 , 33 , 35 ]. Most frequently used bony landmarks within these techniques are the adductor tubercle, medial and lateral epicondyle, tip of the fibular head and the tibial tubercle [ 8 , 9 , 15 , 16 , 18 , 26 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

“…In recent studies, two principles of JL assessment in native radiographs are used most frequently. The tibial referenced method uses the distance from the tip of the fibula head to the distal femoral joint line [ 1 , 22 , 33 ]. The distance between the level of the adductor tubercle and the distal femoral joint line (ATJL) serves as a femoral referenced method [ 15 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

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3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty

et al. 2021

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Purpose This study aimed to validate a new joint line measurement technique in total knee arthroplasty for separated assessment of the medial and lateral femoral joint line alteration with 3D-surface scan technology. Separate assessment of the medial and lateral joint line alteration may improve TKA alignment assessment regarding to joint line restoration in kinematic alignment and use of robotic-assisted TKA surgery. Methods The medial and lateral joint line difference after TKA implantation on an artificial bone model was analyzed and compared with a 3D-scan and full femoral radiographs pre- and postoperatively. Radiographic analysis included the perpendicular distance between the most distal point of the medial and lateral condyle and the reproduced preoperative lateral distal femoral angle (LDFA). For evaluation of validity and reliability, radiographs were captured initially with true anteroposterior view and subsequently with combined flexion and rotation malpositioning. Reliability of the introduced measurement technique in between three observers was tested with intraclass correlation coefficient (ICC). Results Radiographic measurement showed a mean difference of 0.9 mm on the medial side and 0.6 mm on the lateral side when compared to the 3D-surface scan measurement. The reliability of measurement accuracy was ≤ 1 mm in x-rays with < 10° flexion error regardless to malrotation in these images. The ICC test showed very good reliability for the medial joint line evaluation and good reliability for lateral joint line evaluation (ICC 0.92, ICC 0.86 respectively). Conclusion The new introduced joint line measurement method showed a sufficient reliability, accuracy and precision. It provides separated information about medial and lateral joint line alteration in TKA surgery in absolute values. Level of evidence V - Experimental Study

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty

et al. 2021

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“… 19 Preoperative planning using radiographs of the contralateral knee can help the surgeon to determine the exact native joint line before surgery. 20 In a TKA, the joint line position can be measured using Figgie’s method on a lateral knee radiograph: the distance from the superior face of the tibial component to the top of the tibial tubercle. 21 Porteous et al modified the method using the distance between the most distal part of the femoral component and the top of the tibial tubercle.…”

Section: How To Avoid Extensor Mechanism Failurementioning

confidence: 99%

Extensor mechanism failure in total knee arthroplasty

Balcells-Nolla

James

et al. 2021

EFORT Open Reviews

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Extensor mechanism failure in total knee arthroplasty (TKA) can present as quadriceps tendon rupture, patella fracture or patella tendon rupture. Component malrotation, excessive joint line elevation and previous lateral release are some of the risk factors contributing to extensor mechanism failure in TKA. Partial quadriceps tendon rupture and undisplaced patella fracture with intact extensor mechanism function can be treated conservatively. Extensor mechanism failure in TKA with disruption of the extensor mechanism function should be treated operatively as it is associated with poor function and extensor lag. It is recommended that acute repair of patella or quadriceps tendon rupture are augmented due to the high risk of re-rupture. Chronic ruptures of the extensor mechanism must be reconstructed as repair has a high failure rate. Reconstruction can be performed using autograft, allograft or synthetic graft. Cite this article: EFORT Open Rev 2021;6:181-188. DOI: 10.1302/2058-5241.6.200119

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Joint line elevation and tibial slope are associated with increased polyethylene wear in cruciate‐retaining total knee replacement

Pourzal

Cip²,

Rad

et al. 2020

Journal Orthopaedic Research

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The purpose of this retrieval study was to determine the effect of implant positioning on wear, taking patient‐related factors into account. Therefore, the volumetric material loss of 59 retrieved tibial liners was quantitatively determined using a coordinate measuring‐machine. All retrievals were made of the same polyethylene and design by a single manufacturer. Using time in‐situ and linear regression, a wear rate for each liner was determined and corrected for bedding‐in. Backside damage was qualitatively scored. The following implant positioning parameters were obtained from radiographs: anatomical lateral‐distal femoral angle, anatomical medial‐proximal tibial angle, femoral tilt angle, and posterior tibial slope. The patella position was assessed by the Blackburne‐Peel index and the Insall‐Salvati ratio. Unlike the Insall‐Salvati ratio, the Blackburne‐Peel index is known to detect surgical joint line elevation. Using general linear modeling the most impactful factors on wear rate and backside damage was determined, thereby taking patient demographic factors into account. The mean volumetric wear rate was 11.6 mm3/y. Wear decreased with older age (P = .021) and female sex (P = .001). The wear rate increased with joint line elevation as indicated from a decreased Blackburne‐Peel index (P = .019), and increased with increased posterior tibial slope (P = .026). The backside damage score also increased with joint line elevation (P = .036). A Blackburne‐Peel index decrease of 0.1, signifying joint line elevation, was found to increase the wear rate by 1.8 mm3/y and increase back‐sided wear. A high tibial slope (>7°) led to a 9.3 mm3/y increase in wear rate compared with a low tibial slope (<3°). The results of this study demonstrate that tibial liner positioning has a significant impact on polyethylene wear with potential implications on osteolysis over time.

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The negative effect of joint line elevation after total knee arthroplasty on outcome

Cited by 50 publications

References 50 publications

3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty

3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty

Extensor mechanism failure in total knee arthroplasty

Joint line elevation and tibial slope are associated with increased polyethylene wear in cruciate‐retaining total knee replacement

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