Results of revision knee arthroplasty in a patient with malposition of implant components (clinical case)

Endoprosthetics is currently the most effective treatment for terminal stages of knee gonarthritis. However, changes in knee kinematics after surgery sometimes lead to poor clinical outcomes. This article presents the treatment outcomes for patient A., 59, diagnosed with stage 3 right-sided idiopathic gonarthritis, pain syndrome, and varus deformity of the right lower extremity. She underwent right knee arthroplasty. For two years after surgery, the patient experienced pain in the anterior knee joint. She was diagnosed with malposition of the endoprosthesis components. Revision arthroplasty was performed with replacement of the endoprosthesis components and restoration of the joint line. A good functional outcome was achieved. Restoration of the joint line during endoprosthetics is a crucial part of normal knee biomechanics. The correct position of the joint line is determined using the joint line distalization coefficient.

1. De Carvalho RT, Santos DB Neto, Chammas V, Arrebola LS, Colombo ML, Scalizi C Junior. Influence of body mass index in revision total knee arthroplasty. Acta Ortop Bras. 2015 Nov-Dec;23(6):290-293. PMID: 27057139

2. Cherian JJ, Bhave A, Harwin SF, Mont MA. Outcomes and Aseptic Survivorship of Revision Total Knee Arthroplasty. Am J Orthop (Belle Mead NJ). 2016 Feb;45(2):79-85. PMID:26866318

3. Liddle AD, Pandit H, Judge A, Murray DW. Effect of Surgical Caseload on Revision Rate Following Total and Unicompartmental Knee Replacement. J Bone Joint Surg Am. 2016 Jan 6;98(1):1-8. PMID:26738897. https://doi.org/10.2106/JBJS.N.00487

4. Angelini FJ, Helito CP, Veronesi BA, Guimarães TM, Pécora JR, Demange MK. Knee arthroplasty revision with a constrained implant usin hinge and rotating tibial. Acta Ortop Bras. 2016 Jan-Feb;24(1):22-6. PMID:26997909. https://doi.org/10.1590/1413-785220162401153984

5. Matthew A. Popa, MD Glenn D. Wera, MD and Victor M. Goldberg, MD Surgical Management of the Unstable Total Knee Arthroplasty. AAOS http://www.aaos.org/AAOSNow/2014/May/clinical/clinical6/

6. Kim YH, Park JW, Kim JS. A Comparison of 5 Models of Total Knee Arthroplasty in Young Patients. J Arthroplasty. 2015 Nov 26:S0883-5403(15)01025-6. PMID: 26746570. https://doi.org/10.1016/j.arth.2015.11.015

7. Sancheti KH, Sancheti PK, Joshi RS, Patil KR, Shyam AK, Bhaskar RR. Midterm survivorship and clinical outcome of INDUS knee prosthesis: 5 year followup study. Indian J Orthop. 2016 Mar-Apr;50(2):131-5. PMID: 27053801. https://doi.org/10.4103/0019-5413.177583

8. Kornilov N.N., Kulyaba T.A., Fil' A.S., Murav'eva Yu.V. Dannye registra endoprotezirovaniya kolennogo sustava RNIITO IM. R.R. Vre-dena za 2011–2013 gody. Travmatologiya i ortopediya Rossii. 2015;1 (75):136–151. (In Russ.)

9. Cottino U, Sculco PK, Sierra RJ, Abdel MP. Instability After Total Knee Arthroplasty. Orthop Clin North Am. 2016 Apr;47(2):311-6. PMID: 26772939. https://doi.org/10.1016/j.ocl.2015.09.007

10. Gil-Martínez P, Sanz P, López-Torres I, Arnal-Burró J, Chana F, Vaquero J. Influence of the cause of the revision on the outcome after revision knee arthroplasty with condylar constrained implant. Rev Esp Cir Ortop Traumatol. 2016 May-Jun;60(3):184-191. Epub 2016 Mar 8. English, Spanish. PMID:26968375. https://doi.org/10.1016/j.recot.2015.12.003

11. Grayson CW, Warth LC, Ziemba-Davis MM, Michael Meneghini R. Functional Improvement and Expectations Are Diminished in Total Knee Arthroplasty Patients Revised for Flexion Instability Compared to Aseptic Loosening and Infection. J Arthroplasty. 2016 Mar 10: S0883-5403(16)00207-2. PMID: 27067166. https://doi.org/10.1016/j.arth.2016.03.001

12. Odum SM, Van Doren BA, Springer BD. National Obesity Trends in Revision Total Knee Arthroplasty. J Arthroplasty. 2016 Mar 15:S0883-5403(16)00257-6. PMID:27094246. https://doi.org/10.1016/j.arth.2015.12.055.

13. Polat G, Ceylan HH, Sayar S, Kucukdurmaz F, Erdil M, Tuncay I. Effect of body mass index on functional outcomes following arthroplasty procedures. World J Orthop. 2015 Dec 18;6(11):991-5. PMID: 26716096. https://doi.org/10.5312/wjo.v6.i11.991.eCollection 2015

14. Akbari Shandiz M, Boulos P, Saevarsson SK, Yoo S, Miller S, Anglin C. Changes in knee kinematics following total knee arthroplasty. Proc Inst Mech Eng H. 2016 Apr;230(4):265-78. Epub 2016 Mar 2. PMID: 26936959. https://doi.org/10.1177/0954411916632491

15. 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 Dec;21(8):1154-62. PMID: 17162175

16. Seon JK, Song EK. Joint line and patellar height restoration after revision total knee arthroplasty. Indian J Orthop. 2016 Mar-Apr;50(2):159-65. PMID:27053805. https://doi.org/10.4103/0019-5413.177569

17. Yoshii I, Whiteside LA, White SE, Milliano MT. Influence of prosthetic joint line position on knee kinematics and patellar position. J Arthroplasty. 1991 Jun;6(2):169-77. PMID: 1875209

18. Abdel MP, Della Valle CJ. The surgical approach for revision total knee arthroplasty. Bone Joint J. 2016 Jan;98-B(1 Suppl A):113-5. PMID: 26733655. https://doi.org/10.1302/0301-620X.98B1.36315

19. Clavé 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 Jan 8. PMID: 26744167

20. Zuiderbaan HA, van der List JP, Chawla H, Khamaisy S, Thein R, Pearle AD. Predictors of Subjective Outcome After Medial Unicompartmental Knee Arthroplasty. J Arthroplasty. 2016 Feb 25. pii: S0883-5403(16)00005-X. PMID:26928182. https://doi.org/10.1016/j.arth.2015.12.038

21. Servien E, Viskontas D, Giuffrè BM, Coolican MR, Parker DA. Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2008 Mar;16(3):263-9. PMID:18046537