Joint line restoration after revision total knee arthroplasty

In 99 patients, 107 knee replacements were revised in two centers by two su rgeons using a single revision total knee arthroplasty system. A retrospect ive radiographic review of joint line position before and after revision to tal knee arthroplasty was made, and compared with the joint line position b efore primary knee arthroplasty. Prospectively collected Knee Society Clini cal Rating Scores were correlated with radiographic findings. The joint lin e position in unreplaced knee replacements averaged 16 mm, and the joint li ne position in knee replacements before revision surgery averaged 17 mm, Th e 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 revi sion surgery averaged 131 points. If the joint line position was elevated m ore 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 point s. 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 i mplants used for revision surgery should have increased distal dimensions.