The use of the knee joint-line balancer to control patella position in revision total knee arthroplasty

Comparison of joint line position changes after primary bilateral total knee arthroplasty performed using the navigation-assisted measured gap resection or gap balancing techniques

“…The elevation of joint line position by more than 5 mm can have a detrimental effect on final results [16]. However, the majority of published studies examined the results of joint line changes in revision cases [2,13,[15][16][17]22]. In recent comparative study of gap balancing technique and measured resection technique, Tigani et al [23] also reported that measured technique was more desirable than gap technique in regard to restoration of the joint line.…”

“…Restoration of the preoperative joint line is one of the key factors for a satisfactory outcome, in terms of maintaining a normal joint line position, which means the restoration of normal knee kinematics and appropriate ligamentous balance. Failing to restore the preoperative joint line position can have significant adverse effects on posterior cruciate ligament function, collateral ligament function, the patellofemoral joint mechanism and eventually compromise clinical outcomes [19,20,22,24]. The majority of studies on the joint line position in TKA have concentrated on revision situations rather than primary situations [2,13,[15][16][17]22].…”

“…Failing to restore the preoperative joint line position can have significant adverse effects on posterior cruciate ligament function, collateral ligament function, the patellofemoral joint mechanism and eventually compromise clinical outcomes [19,20,22,24]. The majority of studies on the joint line position in TKA have concentrated on revision situations rather than primary situations [2,13,[15][16][17]22]. However, a few have addressed the restoration of the preoperative joint line position in primary TKA [18].…”

Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty

“…The proximal limit of the tibial tubercle (ATT) is another possible landmark that can be used, and the method described by Figgie [3] is indeed still used [10].This method requires sagittal x-rays to determine the distance between the anterior TT and the tibial plateau or the tibial insert. However use of this method in revision TKA, implies the assumption that the joint line was accurately restored in the primary procedure and has not been affected by subsequent wear or other pathology.…”

“…The proximal limit of the tibial tubercle (ATT) is another possible landmark that can be used, and the method described by Figgie [3] is indeed still used [10]. This method requires sagittal x‐rays to determine the distance between the anterior TT and the tibial plateau or the tibial insert.…”