Management of bone defect and joint line restoration in revision total knee arthroplasty

Abstract Background: Bone stock reconstruction is one of the greatest difficulties while performing revision total knee arthroplasty (TKA). Joint line (JL) changes due to bone defects can affect the clinical outcome. Our study aimed to identify the rate and reasons leading to primary TKA failure and to evaluate the JL restoration using adequate augments in revision TKA patients with Anderson Orthopaedic Research Institute Grade 2 bone defects. Materials and Methods: A total of 82 consecutive patients (88 knees), operated on with revision TKA between November 2013 and December 2023 at a single institution, were retrospectively reviewed. After excluding seven patients who lost follow-up, 75 patients (81 knees) were evaluated in the study. In terms of radiology, the JL position after initial and postrevision TKA was assessed and compared by Figgie’s method. Clinical evaluation was done with the Knee Society Scoring (KSS) system along with the final range of motion (ROM). Results: Postrevision TKA JL was found elevated in 22 knees and restored in 59 knees. The mean JL position increased from 16.08 mm prerevision to 19.80 mm postrevision, representing a mean elevation of 3.72 mm. ROM and knee function scores both significantly improved comparing postrevision to prerevision TKA ( P < 0.05). Conclusion: In cases of revision TKA, distal femoral augments of adequate thickness should be used often for bone loss reconstruction to effectively restore the JL position and improve clinical outcome.