Objective To evaluate the effects of changes of the knee joint line position on the clinical function of knee after revision total knee arthroplasty (R-TKA).Methods Eighty-nine patients (89 knees) who underwent R-TKA were treated with LCCK condylar limited knee prosthesis for R-TKA.The changes of knee joint line were measured on the basis of X-ray before and 24 months after surgery.The knee score, function score, Feller patella score and knee range of motion (ROM) were measured before and after operation in patients with changes of knee joint line (≤2, >2-≤4, and>4 mm).The changes of joint line in patients between using tibia, femur metal augmentation or not were compared as well as the knee function-related indicators.Results Seventy cases elevated (range from 0.4 to 8.9 mm) and 19 cases declined (range from-4.1 to-0.3 mm), including 23 cases with joint line change of ≤2 mm, 42 cases with change of >2-≤4 mm and 31 cases with change of >4 mm.The postoperative knee score, function score, Feller score and knee range of motion in patient with the same joint line change were increased as compared with the preoperative ones (all P<0.01).However, the postoperative knee score, function score and Feller score in cases whose joint line change was less than 2 mm and more than 2 to less than 4 mm were higher than those of the cases whose joint line change was >4 mm (all P<0.01).Forty patients used the femur metal augmentation and 49 patients did not use in 89 patients.The postoperative joint line changes were-4.1-7.9 (1.9±3.4) mm and 2.2-8.9 (3.5±3.4) mm, respectively (P<0.05).Fourteen patients used the tibia metal augmentation and 75 patients did not use, and no significant difference was found in the joint line changes (P>0.05).Patients with femur metal augmentation had higher postoperative functional score and Feller patella score than those of the untreated ones (P<0.05 or P<0.01).There was no significant difference in knee score, function score, Feller patella score and knee ROM between patients with and without femur metal augmentation (all P>0.05).Conclusions The joint line changed within 4 mm can result in a better knee joint function after R-TKA.Intraoperative use of femur metal augmentation is conducive to reducing the joint line changes and improving knee function, while the tibial side of the metal augmentation has no significant effect.%目的 探讨膝关节翻修术后关节线变化对膝关节功能的影响.方法 选择拟行膝关节翻修术患者89例(共89膝),均植入LCCK髁限制性膝关节假体进行膝关节翻修术.术前及术后24个月,根据X线平片检查结果测量关节线,比较关节线变化≤2 mm、>2~≤4 mm、>4 mm者手术前后膝关节评分、功能评分、Feller髌骨评分及膝关节活动度.比较术中应用或未应用胫骨、股骨金属填充块者的关节线变化及上述膝关节功能相关指标.结果 患者术后关节线变化为-4.1~8.9 mm,上移70例、下移19例;关节线变化≤2 mm 23例,>2~≤4 mm 35例,>4 mm 31例.与术前比较,相同关节线变化者术后膝关节评分、功能评分、Feller髌骨评分及膝关节活动度均升高(P均<0.01);但关节线变化≤2 mm及>2~≤4 mm者术后膝关节评分、功能评分、Feller髌骨评分均高于关节线变化>4 mm者(P均<0.01).术中应用股骨金属填充块40例、未应用49例,其术后关节线变化分别为-4.1~7.9(1.9±3.4)、2.2~8.9(3.5±3.4)mm,二者比较P<0.05.术中应用胫骨金属填充块14例、未应用75例,二者术后关节线变化比较P>0.05.应用股骨金属填充块者术后功能评分、Feller髌骨评分均高于未应用者(P<0.05或<0.01),应用与未应用胫骨金属填充块者术后膝关节评分、功能评分、Feller髌骨评分、膝关节活动度比较差异均无统计学意义(P均>0.05).结论 膝关节翻修术后关节线变化>4 mm的患者膝关节功能较差,术中应用股骨金属填充块有利于减小关节线变化及提高膝关节功能,而胫骨金属填充块则无明显作用.
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