DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20173199

Influence of prosthetic joint line position on outcome after total knee replacement

Preetesh Choudhary, Skand Bahre

Abstract


Background: The current study had been designed so as to assess whether joint line elevation and change in patellar tendon length influences knee flexion after primary cruciate retaining TKR.

Methods: This prospective study involved patients with advanced degenerative joint disease involving one or both knees who presented to the outpatient department of a tertiary care hospital. Exclusion criteria were any prior knee surgery. Surgery was performed under tourniquet with standard medial para-patellar arthrotomy to expose all our knees. In the study radiological assessment was done by true lateral X-ray view of knee in 30 degree of flexion. We choose Caton-Deschamps indices (CI) for diagnosis of post TKR patella infera and joint line elevation. CI<0.6 was defined as patella infera (normal range of CI 0.60-1.45). After all data collection comparison was done between joint line elevation versus without joint line elevation patients (with/without patellar tendon shortening) range of movement.

Results: Total of 100 patients (72 females and 28 males) with 176 knees (bilateral=76, unilateral=24) who fulfilled the above said criteria involved in study. The mean age of the patients at the time of surgery was 64.4 years with range of 54 years to 80 years. The average follow up of 24 months, with minimum follow up of 18 months. Average range of motion (ROM) in NO Joint line elevation/patella tendon shortening patient measured 107.2°, and joint line elevation with patellar tendon shortening (prior patella infera) and joint line elevation without patella tendon shortening(prior patella infera) patient average ROM was measured 86.7 and 87.8 degree respectively.

Conclusions: In our study patellar tendon shortening and joint line elevation reduces ROM knee. Mechanical factors also explain the association between joint line elevation and patellar tendon length with range of motion. Reduction in length of extensor apparatus reduces the range of flexion.

Keywords


Patella tendon length, Patella infera, Total knee replacement, Total knee arthroplasty, Pseudo-patella infera, Jointline elevation

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References


Sharma V, Tsailas PG, Maheshwari AV, Ranawat AS, Ranawat CS. Does patellar eversion in total knee arthroplasty cause patella baja? Clin Orthop Relat Res. 2008;466(11):2763-8.

Chonko DJ, Lombardi Jr AV, Berend KR. Patella baja and total knee arthroplasty (TKA):etiology, diagnosis, and management. Surg Technol Int 2004;12:231–8.

Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br. 1977;59(2):241-2.

Blumensaat C. The positional deviation and dislocation of the knee disc. Ergebn Chir Orthop 1938;31:149–223.

Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot. 1982;68(5):317-25.

Grelsamer RP, Meadows S. The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res. 1992;(282):170-6.

Kazemi SM, Besheli LD, Eajazi A, Miniator Sajadi MR, Okhovatpoor MA, Farhang Zanganeh R, et al. Pseudo-Patella Baja after total knee arthroplasty. Medical Science Monitor. Int Med J Experimental Clin Res. 2011;17(5):292-6.

Cameron HU, Jung YB. Patella baja complicating total knee arthroplas¬ty. A report of two cases. J Arthroplasty. 1988;3(2):177–80.

Koshino T, Ejima M, Okamoto R, Morii T. Gradual low riding of the patella during postoperative course after total knee arthroplasty in osteoarthritis and rheumatoid arthritis. J Arthroplasty. 1990;5(4):323-7.

Weale AE, Murray DW, Newman JH, Ackroyd CE. The length of the patellar ten¬don after unicompartmental and total knee replacement. J Bone Joint Surg Br. 1999;81(5):790–5.

Flören M, Davis J, Peterson MG, Laskin RS. A mini-midvastus capsular approach with patellar displacement decreases the prevalence of pa¬tella baja. J Arthroplasty. 2007;22(6):51-7.

Yang JH, Seo JG, Moon YW, Kim MH. Joint line changes after navigation-assisted mobile-bearing TKA. Orthopedics. 2009;32(10):35–9.

Grelsamer RP. Patella baja after total knee arthroplasty:is it really patella baja? J Arthroplasty 2002;17(1):66–9.

Grelsamer RP. Patellar mal-alignment. J Bone Joint Surg Am. 2000;82(11):1639-50.

Yoshii I, Whiteside LA, White SE, Milliano MT. Influence of prosthetic joint line position on knee kinematics and patellar position. J Arthroplasty. 1991;6:169–77.

Thornton-Bott PJ, Unitt L, Johnstone DJ, Sambatakakis A. Pseudo-patella baja following soft tissue balancing in total knee arthroplasty. Presented at the British Orthopaedic Association Annual Congress; Birmingham, England; 2012;94(2):119.

Insall J, Salvati E. Patella position in the normal knee. Radiology. 1971;101(1):101-4.

Phillips CL, Silver DAT, Schranz PJ, Mandalia V. The measurement of patellar height a review of the methods of imaging. J Bone Joint Surg Br. 2010;92(8):1045-53.

Schwab JH, Agarwal P, Boland PJ, Kennedy JG, Healey JH. Patellar complications follow-ing distal femoral replacement after bone tumor resection. J Bone Joint Surg Am. 2006;88(10):2225-30.

Schlenzka D, Schwesinger G. The height of the patella:An anatomical study. Eur J Radiol. 1990;11:19–21.

Kazemi SM, Daftari Besheli L, Eajazi A, Miniator Sajadi MR, Okhovatpoor MA, Farhang Zanganeh R, et al. Pseudo-Patella Baja after total knee arthroplasty. Med Sci Monit. 2011;17(5):292-6.

Seil R, Muller B, Georg T, Kohn D, Rupp S. Reliability and inter observer variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc. 2000;8(4):231-6.

Maloney WJ. The stiff total knee arthroplasty: evaluation and management. J Arthroplasty. 2000;8(7):694–706.

Schiavone Panni A, Cerciello S, Vasso M, Tartarone M. Stiffness in total knee arthroplasty. J Orthop Traumatol. 2009;10(3):111-8.