Clavé Arnaud, Le Henaff Goulven, Roger Thomas, Maisongrosse Paul, Mabit Christian, Dubrana Frédéric
Orthopedic and Traumatologic Surgery Department, Brest University Hospital, Bd Tanguy Prigent, 29609, Brest, France.
Orthopedic and Traumatologic Surgery Department, Limoges University Hospital, 2 Bd Martin Luther King, 87042, Limoges, France.
Int Orthop. 2016 Aug;40(8):1655-1662. doi: 10.1007/s00264-015-3096-9. Epub 2016 Jan 8.
It has been shown that the distance between the joint line (JL) and the fibular head is constant in both knees in a given individual. We analysed the influence of the JL level difference between the revised knee and the native knee from the functional outcomes after TKR revision.
This multicentre study assessed retrospectively a consecutive series of 177 revised total knee replacements. Patients with contralateral knees that had undergone previous major surgery or trauma were excluded. The JL level difference between both knees was measured on Knee's AP standing X-rays and compared to the KSS Knee and Function scores at the final follow-up.
Eighty-five cases were analysed at a mean of seven years follow-up. There was a significant increase in KSS Knee and Function scores after surgery. The average elevation of the JL was 2.2 mm (s.d. 2.66 mm) compared with the healthy contralateral knee. When the JL was elevated more than 4 mm this correlated with a decreased KSS Function score and decreased post-operative knee flexion.
Poorer functional results are significantly associated with an elevation in the JL compared to the contralateral healthy knee. In those patients with a suitable contralateral knee the JL level to restore can be assessed by the distance between the femoral condyle and the apex of the fibular head of the contralateral knee.
研究表明，在特定个体中，双膝关节的关节线（JL）与腓骨头之间的距离是恒定的。我们从全膝关节置换术（TKR）翻修术后的功能结果分析了翻修膝关节与原生膝关节之间JL水平差异的影响。
这项多中心研究回顾性评估了连续177例翻修全膝关节置换术。排除对侧膝关节曾接受过重大手术或创伤的患者。在膝关节前后位站立X线片上测量双膝关节的JL水平差异，并与最终随访时的膝关节协会（KSS）膝关节和功能评分进行比较。
对85例患者进行了平均7年的随访分析。术后KSS膝关节和功能评分显著提高。与对侧健康膝关节相比，JL的平均升高为2.2毫米（标准差2.66毫米）。当JL升高超过4毫米时，这与KSS功能评分降低和术后膝关节屈曲度降低相关。
与对侧健康膝关节相比，JL升高与功能结果较差显著相关。对于对侧膝关节合适的患者，可通过对侧膝关节股骨髁与腓骨头尖之间的距离来评估需要恢复的JL水平。
