Does medullary diameter to stem width ratio and stem length affect outcomes of revision total knee arthroplasties? A case series

Abstract

Objectives: This study aimed to investigate the relationship between the ratio of stem size to intramedullary canal diameter, stem length, and functional outcome in revision total knee arthroplasty (RTKA) procedures, which remains largely unexplored in the current literature.

Patients and methods: A single surgeon series of RTKA procedures performed between October 2014 and November 2022 were included in this case series, and data were analyzed retrospectively. A total of 32 patients (27 females, 5 males; mean age: 73.2±8.1 years; range, 52 to 88 years) were identified, with a minimum follow-up period of five months and a maximum of eight years. Filtering the patients based on >24 month follow-up, we were left with 13 patients aged between 65 and 88 (mean 74.85±6,854) years. The latest X-rays of patients were analyzed, and the ratio of intramedullary canal diameter to stem width was calculated for both femur and tibia in both anteroposterior and lateral planes. Household income, preoperative C-reactive protein, erythrocyte sedimentation rate, comorbidities, body mass index, and implant dimensions were also recorded. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF-12) scores, and range of motion (ROM) measurements were used to evaluate functional outcome.

Results: A moderate negative relationship between the tibial canal fill ratio (CFR) in anteroposterior views and ROM of the patients was noted. Additionally, a significant positive correlation was found between SF-12 physical score and CFR in lateral view. A moderate level of correlation between femoral CFR in anteroposterior views was also established. Due to insufficient data, joint ROM data did not show normal distribution. Therefore, a cutoff value indicating the relationship between the stem size and knee ROM could not be calculated using receiver operating characteristic analysis. Multiple regression analysis did not yield significant results, suggesting that hypothesized predictor variables were not sufficient to predict the variation in functional scores. Otherwise, no clear statistical importance or correlation between functional scores, such as WOMAC or SF-12, and CFR was found.

Conclusion: In conclusion, the findings suggest that other factors, such as other patient characteristics, surgical techniques, or implant designs, may have a more substantial impact on the functional outcomes in RTKA patients.

Citation: Ozer H, Baymurat AC, Ahmadov A, Selek HY, Abdulaliyev F, Ozel T. Does medullary diameter to stem width ratio and stem length affect outcomes of revision total knee arthroplasties? A case series. Jt Dis Relat Surg 2024;35(1):244-248. doi: 10.52312/ jdrs.2023.1108.

Performed the measurements: A.A.; Were involved in planning and supervised the work: A.A., H.O., A.B., H.Y.S.; Processed the collected data, AA performed the analysis, drafted the manuscript and designed the figures: A.B., F.A., T.O.; Aided in interpreting the results and worked on the manuscript: A.A., A.B.; All authors discussed the results and commented on the manuscript.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

The data that support the findings of this study are available from the corresponding author upon reasonable request.