Joint line restoration after revision total knee arthroplasty

In 99 patients, 107 knee replacements were revised in two centers by two surgeons using a single revision total knee arthroplasty system. A retrospective radiographic review of joint line position before and after revision total knee arthroplasty was made, and compared with the joint line position before primary knee arthroplasty. Prospectively collected Knee Society Clinical Rating Scores were correlated with radiographic findings. The joint line position in unreplaced knee replacements averaged 16 mm, and the joint line position in knee replacements before revision surgery averaged 17 mm. The joint line was elevated by the revision total knee arthroplasty in 85 of 107 knees (79%). After the revision total knee replacement, the joint line elevation averaged 24 mm. The Knee Society Clinical Rating Score after revision surgery averaged 131 points. If the joint line position was elevated more than 8 mm, the Knee Society Clinical Rating Score averaged 125 points, if the joint line was elevated less than 8 mm, the score averaged 141 points. Joint line elevation after revision total knee replacement is a problem. Excessive elevation may result in worse clinical outcomes. Distal femoral augments should be used more often and with greater thicknesses. Standard implants used for revision surgery should have increased distal dimensions.