Abstract
Purpose
The restoration of the physiological femoro-tibial joint line (JL) is important to obtain a good outcome in revision total knee arthroplasty (RTKA). However, its assessment is challenging. The ratio of the distance between the adductor tubercle (AT) JL (ATJL) and the trans-epicondylar femoral width (FW) was proposed as a reliable method. The purpose of this study was to check whether this ratio is a reliable tool to restore the prosthetic JL height in challenging prosthetic revision cases.
Methods
Twenty-one patients (mean age 65.8 years) were recruited. During surgery, FW was measured and ATJL distance was calculated using 0.53 (SD 0.03) as the ratio. After implant positioning, the obtained ATJL line was measured to verify the accuracy of the surgical procedure. Thirteen patients presented a healthy contralateral knee: a comparative radiograph examination was performed to verify the appropriateness of the restored JL height.
Results
The intra-operatively calculated ATJL was not significantly different with respect to the measured ATJL obtained after prosthetic component implantation. The comparative analysis between the restored JL and the JL of the contralateral not operated knee was also not statistically significant, thus confirming the appropriateness of the restored JL height.
Conclusions
This study shows that the method which uses an AT to JL distance/FW ratio to determine the JL level, previously applied in primary TKA, is valid when using intra-operatively acquired measurements in RTKA. This is clinically relevant since it represents a reliable tool which helps surgeons to restore the JL level in challenging prosthetic revision cases.
Level of evidence
Case series, Level IV.
Similar content being viewed by others
References
Bourne RB, Crawford HA (1998) Principles of revision total knee arthroplasty. Orthop Clin North Am 29(2):331–337
Carpenter CW, Cummings JF, Grood ES, Leach D, Paganelli JV, Manley MT (1994) The influence of joint line elevation in total knee arthroplasty. Am J Knee Surg 4:164–167
Dennis DA (2007) A stepwise approach to revision total knee arthroplasty. J Arthroplasty 22(4 Suppl 1):32–38
Gofton WT, Tsigaras H, Butler RA, Patterson JJ, Barrack RL, Rorabeck CH (2002) Revision total knee arthroplasty: fixation with modular stems. Clin Orthop Relat Res 404:158–168
Howell SM, Chen J, Hull ML (2013) Variability of the location of the tibial tubercle affects the rotational alignment of the tibial component in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(10):2288–2295
Iacono F, Lo Presti M, Bruni D, Raspugli GF, Bignozzi S, Sharma B, Marcacci M (2013) The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line. Knee Surg Sports Traumatol Arthrosc 21(12):2725–2729
Iacono F, Raspugli GF, Bruni D, Filardo G, Zaffagnini S, Luetzow WF, Lo Presti M, Akkawi I, Marcheggiani Muccioli GM, Marcacci M (2014) The adductor tubercle as an important landmark to determine the joint line level in total knee arthroplasty: from radiographs to surgical theatre. Knee Surg Sports Traumatol Arthrosc 22(12):3034–3038
Insall J, Goldberg V, Salvati E (1972) Recurrent dislocation and the high-riding patella. Clin Orthop Relat Res 88:67–69
Insall JN (1984) Total knee replacement. In: Insall JN (ed) Surgery of the knee. Churchil Livingstone, New York, pp 587–696
König C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, Heller MO (2010) Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 28(1):1–5
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785
Laskin RS (2002) Joint line position restoration during revision total knee replacement. Clin Orthop Relat Res 404:169–171
Lee HJ, Lee JS, Jung HJ, Song KS, Yang JJ, Park CW (2011) Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques. Knee Surg Sports Traumatol Arthrosc 19(12):2027–2032
Luyckx T, Beckers L, Colyn W, Vandenneucker H, Bellemans J (2014) The adductor ratio: a new tool for joint line reconstruction in revision TKA. Knee Surg Sports Traumatol Arthrosc 22(12):3028–3033
Maderbacher G, Keshmiri A, Zeman F, Grifka J, Baier C (2014) Assessing joint line positions by means of the contralateral knee: a new approach for planning knee revision surgery? Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3157-3164
Martin JW, Whiteside LA (1990) The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 259:146–156
Oztürkmen Y, Uzümcügil O, Karamehmetoğlu M, Leblebici C, Caniklioğlu M (2014) Total knee arthroplasty for the management of joint destruction in tuberculous arthritis. Knee Surg Sports Traumatol Arthrosc 22(5):1076–1083
Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 367:165–171
Porteous AJ, Hassaballa MA, Newman JH (2008) Does the joint line matter in revision total knee replacement? J Bone Joint Surg Br 90(7):879–884
Scuderi GR (2001) Revision total knee arthroplasty: how much constraint is enough? Clin Orthop Relat Res 392:300–305
Servien E, Viskontas D, Giuffrè BM, Coolican MR, Parker DA (2008) Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16(3):263–269
Stiehl JB, Abbott BD (1995) Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty. J Arthroplasty 10(6):785–789
Suarez J, Griffin W, Springer B, Fehring T, Mason JB, Odum S (2008) Why do revision knee arthroplasties fail? J Arthroplasty 23(6 Suppl 1):99–103
Tao K, Cai M, Zhu Y, Lou L, Cai Z (2014) Aligning the tibial component with medial border of the tibial tubercle—is it always right? Knee 21(1):295–298
Vince K (1993) Revision knee arthroplasty. In: Chapma MW (ed) Operative orthopaedics. JB Lippincott, Philadelphia, pp 1981–2010
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Iacono, F., Raspugli, G.F., Filardo, G. et al. The adductor tubercle: an important landmark to determine the joint line level in revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 3212–3217 (2016). https://doi.org/10.1007/s00167-015-3556-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-015-3556-1