title: Joint line level in revision total knee replacement: assessment and functional results with an average of seven years follow-up.
abstract: It has been shown that the distance between the joint line (JL) and the fibular head is constant in both knees in a given individual. We analysed the influence of the JL level difference between the revised knee and the native knee from the functional outcomes after TKR revision.
  
  
  
  This multicentre study assessed retrospectively a consecutive series of 177 revised total knee replacements. Patients with contralateral knees that had undergone previous major surgery or trauma were excluded. The JL level difference between both knees was measured on Knee's AP standing X-rays and compared to the KSS Knee and Function scores at the final follow-up.
  
  
  
  Eighty-five cases were analysed at a mean of seven years follow-up. There was a significant increase in KSS Knee and Function scores after surgery. The average elevation of the JL was 2.2 mm (s.d. 2.66 mm) compared with the healthy contralateral knee. When the JL was elevated more than 4 mm this correlated with a decreased KSS Function score and decreased post-operative knee flexion.
  
  
  
  Poorer functional results are significantly associated with an elevation in the JL compared to the contralateral healthy knee. In those patients with a suitable contralateral knee the JL level to restore can be assessed by the distance between the femoral condyle and the apex of the fibular head of the contralateral knee.
authors.affiliation: Orthopedic and Traumatologic Surgery Department, Brest University Hospital, Bd Tanguy Prigent, 29609, Brest, France. arnaud.clave@orange.fr.
authors.forename: Arnaud
authors.identifier: 0000-0002-9961-463X
authors.initials: A
authors.lastname: Clavé
authors.affiliation: Orthopedic and Traumatologic Surgery Department, Brest University Hospital, Bd Tanguy Prigent, 29609, Brest, France.
authors.forename: Goulven
authors.initials: G
authors.lastname: Le Henaff
authors.affiliation: Orthopedic and Traumatologic Surgery Department, Limoges University Hospital, 2 Bd Martin Luther King, 87042, Limoges, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Roger
authors.affiliation: Orthopedic and Traumatologic Surgery Department, Toulouse Purpan University Hospital, Place du Docteur Baylac, 31059, Toulouse, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Maisongrosse
authors.affiliation: Orthopedic and Traumatologic Surgery Department, Limoges University Hospital, 2 Bd Martin Luther King, 87042, Limoges, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Mabit
authors.affiliation: Orthopedic and Traumatologic Surgery Department, Brest University Hospital, Bd Tanguy Prigent, 29609, Brest, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dubrana
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005269:Femur / Q000601:surgery*; D005360:Fibula / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies
keywords: Functional outcomes; Joint line; Knee; Revision knee arthroplasty