Prior studies have reported a negative effect on both clinical outcomes and patient-reported outcome measures (PROMS) following joint line elevation (JLE) in cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior stabilized (PS) TKA designs. This experimental study was aimed to quantify the effect of JLE on in vivo knee kinematics in patients with bicruciate retaining (BCR) TKA during strenuous activities. Thirty unilateral BCR TKA patients were evaluated during single-leg deep lunge and sit-to-stand using a validated combined computer tomography and dual fluoroscopic imaging system. Correlation analysis was performed to quantify any correlations between JLE and in vivo kinematics, as well as PROMS. There was a significant negative correlation between JLE and maximum flexion angle during single-leg deep lunge (ρ = −0.34, p = 0.02), maximum varus joint angles during single-leg deep lunge (ρ = −0.37, p = 0.04), and sit-to-stand (ρ = −0.29, p = 0.05). There was a significant negative correlation between JLE and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (ρ = −0.39, p = 0.01) and knee disability and osteoarthritis outcome score physical function (KOOS-PS; ρ = −0.33, p = 0.03). The JLE that yields a significant loss in PROMS and maximum flexion angles were 2.6 and 2.3 mm, respectively. There was a linear negative correlation of JLE with both in vivo knee kinematics and PROMS, with changes in JLE of greater than 2.6 and 2.3 mm, leading to a clinically significant loss in PROMS and maximum flexion angles, respectively, suggesting an increased need to improve surgical precision to optimize patient outcomes following BCR TKA.
Keywords
total knee arthroplasty -
joint line elevation -
bicruciate retaining total knee arthroplasty -
in vivo knee kinematics -
patient-reported outcome measures
Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
References
1
Kurtz SM,
Lau E,
Ong K,
Zhao K,
Kelly M,
Bozic KJ.
Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467 (10) 2606-2612
2
Sloan M,
Premkumar A,
Sheth NP.
Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
3
Kurtz S,
Ong K,
Lau E,
Mowat F,
Halpern M.
Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
4
Arauz P,
Klemt C,
Limmahakhun S,
An S,
Kwon Y-M.
Stair climbing and high knee flexion activities in bi-cruciate retaining total knee arthroplasty: in vivo kinematics and articular contact analysis. J Arthroplasty 2018; 34 (03) 570-576
5
Kwon Y-M,
Arauz P,
Peng Y,
Klemt C.
In vivo kinematics of deep lunges and sit-to-stand activities in patients with bicruciate-retaining total knee arthroplasty. BJI 2020; 102-B (6_Supple_A): 59-65
6
Tsai T-Y,
Liow MHL,
Li G.
et al.
Bi-cruciate retaining total knee arthroplasty does not restore native tibiofemoral articular contact kinematics during gait. J Orthop Res 2019; 37 (09) 1929-1937
7
Bourne RB,
Chesworth BM,
Davis AM,
Mahomed NN,
Charron KDJ.
Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
8
Alnachoukati OK,
Emerson RH,
Diaz E,
Ruchaud E,
Ennin KA.
Modern day bicruciate-retaining total knee arthroplasty: a short-term review of 146 knees. J Arthroplasty 2018; 33 (08) 2485-2490
9
Cloutier JM,
Sabouret P,
Deghrar A.
Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year follow-up study. J Bone Joint Surg Am 1999; 81 (05) 697-702
10
Christensen JC,
Brothers J,
Stoddard GJ.
et al.
Higher frequency of reoperation with a new bicruciate-retaining total knee arthroplasty. Clin Orthop Relat Res 2017; 475 (01) 62-69
11
Pelt CE,
Sandifer PA,
Gililland JM,
Anderson MB,
Peters CL.
Mean three-year survivorship of a new bicruciate-retaining total knee arthroplasty: are revisions still higher than expected?. J Arthroplasty 2019; 34 (09) 1957-1962
13
Arauz P,
Peng Y,
Kwon Y-M.
Knee motion symmetry was not restored in patients with unilateral bi-cruciate retaining total knee arthroplasty-in vivo three-dimensional kinematic analysis. Int Orthop 2018; 42 (12) 2817-2823
14
Luyckx T,
Vandenneucker H,
Ing LS,
Vereecke E,
Ing AV,
Victor J.
Raising the joint line in TKA is associated with mid-flexion laxity: a study in cadaver knees. Clin Orthop Relat Res 2018; 476 (03) 601-611
15
König C,
Sharenkov A,
Matziolis G.
et al.
Joint line elevation in revision TKA leads to increased patellofemoral contact forces. J Orthop Res 2010; 28 (01) 1-5
16
Aguirre-Pastor A,
Ortolá DJ,
Lizaur-Utrilla A,
Rosa MA,
Lopez-Prats FA.
Is pseudo-patella baja really a serious complication of total knee arthroplasty?. J Arthroplasty 2020; 35 (02) 557-562
17
van Lieshout WAM,
Valkering KP,
Koenraadt KLM,
van Etten-Jamaludin FS,
Kerkhoffs GMMJ,
van Geenen RCI.
The negative effect of joint line elevation after total knee arthroplasty on outcome. Knee Surg Sports Traumatol Arthrosc 2019; 27 (05) 1477-1486
18
Fornalski S,
McGarry MH,
Bui CNH,
Kim WC,
Lee TQ.
Biomechanical effects of joint line elevation in total knee arthroplasty. Clin Biomech (Bristol, Avon) 2012; 27 (08) 824-829
19
Takayama K,
Ishida K,
Muratsu H.
et al.
The medial tibial joint line elevation over 5 mm restrained the improvement of knee extension angle in unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (06) 1737-1742
20
Davis AM,
Perruccio AV,
Canizares M.
et al.
Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis Cartilage 2009; 17 (07) 843-847
21
Khanna D,
Krishnan E,
Dewitt EM,
Khanna PP,
Spiegel B,
Hays RD.
The future of measuring patient-reported outcomes in rheumatology: patient-reported outcomes measurement information system (PROMIS). Arthritis Care Res (Hoboken) 2011; 63 (Suppl. 11) S486-S490
22
Bellamy N,
Buchanan WW,
Goldsmith CH,
Campbell J,
Stitt LW.
Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15 (12) 1833-1840
23
Bentley G,
Biant LC,
Carrington RWJ.
et al.
A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 2003; 85 (02) 223-230
24
Nilsdotter AK,
Lohmander LS,
Klässbo M,
Roos EM.
Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement. BMC Musculoskelet Disord 2003; 4: 10
25
Yost KJ,
Eton DT,
Garcia SF,
Cella D.
Minimally important differences were estimated for six patient-reported outcomes measurement information system-cancer scales in advanced-stage cancer patients. J Clin Epidemiol 2011; 64 (05) 507-516
27
Bingham J,
Li G.
An optimized image matching method for determining in-vivo TKA kinematics with a dual-orthogonal fluoroscopic imaging system. J Biomech Eng 2006; 128 (04) 588-595
29
Li G,
Van de Velde SK,
Bingham JT.
Validation of a non-invasive fluoroscopic imaging technique for the measurement of dynamic knee joint motion. J Biomech 2008; 41 (07) 1616-1622
30
Wu G,
van der Helm FCT,
Veeger HEJ.
et al;
International Society of Biomechanics.
ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion--part II: shoulder, elbow, wrist and hand. J Biomech 2005; 38 (05) 981-992
32
Wang H-Y,
Yu G-S,
Li J-H,
Zhang S-X,
Lin Y-B.
An updated meta-analysis evaluating limb management after total knee arthroplasty-what is the optimal method?. J Orthop Surg Res 2019; 14 (01) 97
33
Grieco TF,
Sharma A,
Dessinger GM,
Cates HE,
Komistek RD.
In vivo kinematic comparison of a bicruciate stabilized total knee arthroplasty and the normal knee using fluoroscopy. J Arthroplasty 2018; 33 (02) 565-571
34
Liow MHL,
Xia Z,
Wong MK,
Tay KJ,
Yeo SJ,
Chin PL.
Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty 2014; 29 (12) 2373-2377
35
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; 40 (08) 1655-1662
36
Peng Y,
Arauz P,
An S,
Limmahakhun S,
Klemt C,
Kwon Y-M.
Does component alignment affect patient reported outcomes following bicruciate retaining total knee arthroplasty? An in vivo three-dimensional analysis. J Knee Surg 2020; 33 (08) 798-803
37
Mendez JH,
Mehrani A,
Randolph P,
Stagg S.
Throughput and resolution with a next-generation direct electron detector. IUCrJ 2019; 6 (Pt 6): 1007-1013
38
Mehrani A,
Ahmadvand P,
Mehdizadeh Barforushi M,
Mehrani K.
Double functionalized nanoporous magnetic gadolinium–silica composite for doxorubicin delivery. J Inorg Organomet Polym Mater 2016; 26 (01) 226-232
39
Rahmatullah H,
Abd B,
Hee R,
Pang N.
Joint line changes in cruciate-retaining versus posterior-stabilized computer-navigated total knee arthroplasty. 2013; 133 (06) 853-859
40
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 Surg Sports Traumatol Arthrosc 2019; 27 (07) 2090-2095
41
Ji S-J,
Zhou Y-X,
Jiang X.
et al.
Effect of joint line elevation after posterior-stabilized and cruciate-retaining total knee arthroplasty on clinical function and kinematics. Chin Med J (Engl) 2015; 128 (21) 2866-2872
43
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 (08) 1154-1162
44
Narayanan R,
Lenz MSN,
Jordan MS.
et al.
Effect of the distal femoral joint line on ligament tensions in flexion with cruciate-retaining total knee prostheses. 2019; 32 (03) 284-289
45
Tsai T-Y,
Liow MHL,
Peng Y,
Arauz P,
Li G,
Kwon Y-M.
In-vivo elongation of anterior and posterior cruciate ligament in bi-cruciate retaining total knee arthroplasty. J Orthop Res 2018; 36 (12) 3239-3246
46
Song SJ,
Bae DK,
Kim Il K,
Jeong HY.
Changes in femoral posterior condylar offset, tibial posterior slope angle, and joint line height after cruciate-retaining total knee arthroplasty. 2016; 28 (01) 27-33
47
Martin JW,
Whiteside LA.
The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 1990; (259) 146-156
48
Snider MG,
Macdonald SJ.
The influence of the posterior cruciate ligament and component design on joint line position after primary total knee arthroplasty. J Arthroplasty 2009; 24 (07) 1093-1098
49
Figgie III HE,
Goldberg VM,
Heiple KG,
Moller III 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 Joint Surg Am 1986; 68 (07) 1035-1040
50
Wimmer MA,
Nechtow W,
Schwenke T,
Moisio KC.
Knee flexion and daily activities in patients following total knee replacement: a comparison with ISO standard 14243. Biomed Res Int 2015; 2015: 157541
52
Nosrati M,
Dey D,
Mehrani A.
et al.
Functionally critical residues in the aminoglycoside resistance-associated methyltransferase RmtC play distinct roles in 30S substrate recognition. J Biol Chem 2019; 294 (46) 17642-17653
53
Iacono F,
Lo Presti M,
Bruni D.
et al.
The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line. Knee Surg Sports Traumatol Arthrosc 2013; 21 (12) 2725-2729
54
Bae DK,
Song SJ,
Park CH,
Liang H,
Bae JK.
Comparison of mid-term results between conversion total knee arthroplasties following closed wedge high tibial osteotomy and primary total knee arthroplasties: A matched pair study including patellar symptom and position. J Orthop Sci 2017; 22 (03) 495-500
58
Fornalski S,
Mcgarry MH,
Bui CNH,
Kim WC,
Lee TQ.
Biomechanical effects of joint line elevation in total knee arthroplasty. Clin Biomech (Bristol, Avon) 2012; 27 (08) 824-829
