EKLEM ÇİZGİSİ DEĞİŞİKLİĞİ VE AŞAĞI YERLEŞİMLİ PATELLA REVİZYON TOTAL DİZ PROTEZİ KLİNİK SONUÇLARINI ETKİLEMEKTEDİR

Öz

Amaç: Çalışmamızın amacı revizyon total diz artroplastisi (RTKA) sonrası eklem hattı (JL), posterior kondiler ofset oranı (PCOR) ve patellar yükseklik değişikliklerini belirlemek ve fonksiyonel sonuçlara etkisini literatürde tanımlanan kritik sınırlara göre değerlendirmektir. Gereç ve Yöntem: Takip süresi en az iki yıl olan 51 hasta retrospektif olarak incelendi. Demografik veriler ve ameliyat raporları değerlendirildi. JL değişimi Figgie'nin yöntemine göre ölçüldü. Patellar yükseklik hem Insall-Salvati İndeksi hem de Blackburn-Peel İndeksi kullanılarak ölçüldü. JL, patellar yükseklik değişikliği ve PCOR'un fonksiyonel sonuçlar üzerindeki etkisi, fonksiyonel sonuçlar olarak Knee Society Score (KSS), diz hareket açıklığı (ROM), SF-12 ve visüel analog skala skoru kullanılarak analiz edildi. Bulgular: JL'si kritik sınır olan 5 mm'ye göre yeniden yapılan hastaların KSS'larının, eklem seviyesi rekonstrükte edilemeyen hastalara göre anlamlı derecede yüksek olduğu belirlendi. Diğer fonksiyonel sonuçlar benzerdi. PCOR'u 0,44'ün altında olan hasta grubu ile PCOR'u 0,44'ün üzerinde olan hasta grubunun fonksiyonel sonuçlar benzerdi. Hem PCOR'u 0,5'in altında olan hasta grubu hem de PCOR'u 0,5'in üzerinde olan hasta grubu arasında fonksiyonel sonuçlarda da anlamlı fark yoktu. Patella baja'lı hastaların diz ROM'ları, KSS ve SF-12 PCS skorları patella baja'sız hastalara göre anlamlı derecede düşüktü (sırasıyla p:0,012, p:0,03 ve p:0,01). Sonuç: Bu çalışmada RTKA sonrası >5 mm eklem seviyesi değişikliği ve patella baja gelişmesinin fonksiyonel sonuçlara olumsuz etkisi bulunduğu tespit edilmiştir.

Anahtar Kelimeler

• Revizyon total diz protezi
• eklem seviyesi
• prognostik faktörler
• fonksiyonel sonuçlar
• patella baja

JOINT LINE CHANGES AND PATELLA BAJA INFLUENCE CLINICAL OUTCOMES OF REVISION TOTAL KNEE ARTHROPLASTY

Öz

Objective: The purpose of our study was to determine joint line (JL), posterior condylar offset ratio (PCOR), and patellar height alterations following revision total knee arthroplasty (RTKA) and evaluate the functional results according to the critical limits defined in the literature. Material and Method: Fifty-one patients with a minimum of two years of follow-up were retrospectively reviewed. Demographic data and operative reports were evaluated. Joint line change was measured according to the method of Figgie. Patellar height was measured using the Insall–Salvati Index and the Blackburn–Peel Index. The effect of JL, patellar height alteration, and PCOR on functional outcomes was analyzed using the Knee Society Score (KSS), knee range of motion (ROM), SF-12, and visual analog scale score as functional results. Result: Patients whose joint lines were not reconstructed had a lower KSS than those whose JLs were restored in accordance with the crucial limit of 5 mm. The other functional results were similar. Functional outcomes were similar between patients with PCORs under 0.44 and those with PCORs higher than 0.44. There was also no significant difference in functional results for the group of patients whose PCOR was lower than 0.5 and those whose PCOR was higher than 0.5. The patients with patella baja had significantly lower knee ROMs, KSS, and SF-12 PCS scores than those without patella baja (p:0.012,p:0.03, and p:0.01, respectively). Conclusion: In this study, joint line change >5 mm and patella baja negatively affected clinical outcomes after RTKA.

Anahtar Kelimeler

• Revision knee arthroplasty
• joint line
• prognostic factors
• functional results
• patella baja

Kaynakça

1. Bellemans J. Restoring the joint line in revision TKA: does it matter? Knee 2004;11(1):3-5. [CrossRef] google scholar
2. Khakharia S, Scuderi GR. Restoration of the distal femur impacts patellar height in revision TKA. Clin Orthop Relat Res 2012;470(1):205-10. [CrossRef] google scholar
3. Selvarajah E, Hooper G. Restoration of the joint line in total knee arthroplasty. J Arthroplasty 2009;24(7):1099-102. [CrossRef] google scholar
4. Victor J, Bellemans J. Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res 2006;452:53-8. [CrossRef] google scholar
5. Clave A, Le Henaff G, Roger T, Maisongrosse P, Mabit C, Dubrana F. Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up. Int Orthop 2016;40(8):1655-62. [CrossRef] google scholar
6. Porteous AJ, Hassaballa MA, Newman JH. Does the joint line matter in revision total knee replacement? J Bone Jt Surg - Ser B 2008;90(7):879-84. [CrossRef] google scholar
7. König C, Sharenkov A, Matziolis G, Taylor WR, Perka C, Duda GN, et al. Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 2010;28(1):1-5. [CrossRef] google scholar
8. Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J. Joint line restoration after revision total knee arthroplasty. Clin Orthop Relat Res 1999;367:165-71. [CrossRef] google scholar

9. Martin JW, Whiteside LA. The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 1990;259:146-56. [CrossRef] google scholar
10. Figgie HE, Goldberg VM, Heiple KG, Moller HS, Gordon NH. The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Jt Surg - Ser A 1986;68(7):1035-40. [CrossRef] google scholar
11. Hofmann AA, Kurtin SM, Lyons S, Tanner AM, Bolognesi MP. Clinical and radiographic analysis of accurate restoration of the joint line in revision total knee arthroplasty. J Arthroplasty 2006;21(8):1154-62. [CrossRef] google scholar
12. Chen AF, Tetreault MW, Levicoff EA, Fedorka CJ, Rothenberg AC, Klatt BA. Increased incidence of patella baja after total knee arthroplasty revision for infection. Am J Orthop (Belle Mead NJ) 2014;43(12):562-6. google scholar
13. 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. [CrossRef] google scholar
14. Han HS, Yu CH, Shin N, Won S, Lee MC. Femoral joint line restoration is a major determinant of postoperative range of motion in revision total knee arthroplasty. Knee Surgery, Sport Traumatol Arthrosc 2019;27(7):2090-5. [CrossRef] google scholar
15. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. J Bone Jt Surg - Ser B 2002;84(1):50-3. [CrossRef] google scholar
16. Johal P, Hassaballa MA, Eldridge JD, Porteous AJ. The posterior condylar offset ratio. Knee 2012;19(6):843-5. [CrossRef] google scholar
17. Malviya A, Lingard EA, Weir DJ, Deehan DJ. Predicting range of movement after knee replacement: The importance of posterior condylar offset and tibial slope. Knee Surgery, Sport Traumatol Arthrosc 2009;17(5):491-8. [CrossRef] google scholar
18. Engh GA, Ammeen DJ. Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect 1999;48:167-75. google scholar
19. Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971;101(1):101-4. [CrossRef] google scholar
20. Chonko DJ, Lombardi A V., Berend KR. Patella baja and total knee arthroplasty (TKA): etiology, diagnosis, and management. Surg Technol Int 2004;12:231-8. google scholar
21. Grelsamer RP. Patella baja after total knee arthroplasty: Is it really patella baja? J Arthroplasty 2002;17(1):66-9. [CrossRef] google scholar
22. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;(248):13-4. [CrossRef] google scholar
23. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34(3):220-33. [CrossRef] google scholar
24. Benazzo F, Ghiara M, Rossi SMP, Pruneri E, Tiwari V, Perelli S. Clinical and radiological analysis of a personalized total knee arthroplasty system design. Int Orthop 2019;43(5):1113-21. [CrossRef] google scholar
25. Cross MB, Nam D, Plaskos C, Sherman SL, Lyman S, Pearle AD, et al. Recutting the distal femur to increase maximal knee extension during TKA causes coronal plane laxity in mid-flexion. Knee 2012;19(6):875-9. [CrossRef] google scholar
26. Matziolis G, Brodt S, Windisch C, Roehner E. Changes of posterior condylar offset results in midflexion instability in single-radius total knee arthroplasty. Arch Orthop Trauma Surg 2017;137(5):713-7. [CrossRef] google scholar
27. Clement ND, MacDonald DJ, Hamilton DF, Burnett R. Posterior condylar offset is an independent predictor of functional outcome after revision total knee arthroplasty. Bone Jt Res 2017;6(3):172-8. [CrossRef] google scholar
28. Seon JK, Song EK. Joint line and patellar height restoration after revision total knee arthroplasty. Indian J Orthop 2016;50(2):159-65. [CrossRef] google scholar
29. Paulos LE, Wnorowski DC, Greenwald AE. Infrapatellar contracture syndrome: diagnosis, treatment, and long-term followup. Am J Sports Med 1994;22(4):440-9. [CrossRef] google scholar
30. Vandeputte FJ, Vandenneucker H. Proximalisation of the tibial tubercle gives a good outcome in patients undergoing revision total knee arthroplasty who have pseudo patella baja. Bone Joint J 2017;99B(7):912-6. [CrossRef] google scholar
31. Ishii Y, Noguchi H, Takeda M, Sato J, Toyabe SI. Posterior condylar offset does not correlate with knee flexion after TKA. Clin Orthop Relat Res 2013;471(9):2995-3001. [CrossRef] google scholar
32. Rand JA. Modular augments in revision total knee arthroplasty. Orthop Clin North Am 1998;29(2):347-53. [CrossRef] google scholar