We present the philosophy and variation of the standard surgical technique for the Triathlon TS system that we use at our institution which focuses on maintenance of JL restoration and PCO that we believe promotes enhanced patient function.
The technique of short cemented stems allows femoral flexion and posterior translation thereby increasing the PCO while maintaining JL. The short cemented stems in the tibia allow offsetting to gain maximum coverage.
We present new data which demonstrates a significant improvement in Oxford Knee Score and very high postoperative patient satisfaction scores at 1 year. These findings echo those of previous reports7,8 and support the notion that maintenance of JL and increasing PCO in revision arthroplasty is associated with improved outcomes.8
1. Hamilton DF, Burnett R, Howie CR, et al. Dealing with the predicted increase in demand for revision total knee arthroplasty challenges, risks and opportunities. Bone Joint J. 2015;97-B:723–728.
2. Cram P, Lu X, Kates SL, et al. Total knee arthroplasty volume, utilization and outcomes among Medicare beneficiaries. 1991-2010. JAMA. 2012;308:1227–1236.
3. Kurtz S, Mowat F, Ong K, et al. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87-A:1487–1497.
4. Friedman RJ, Poss R. Revision total knee arthroplasty in patients with osteoarthritis. Rheum Dis Clin North Am. 1988;14:537–544.
5. Hardeman F, Londers J, Favril A, et al. Predisposing factors which are relevant for the clinical outcome after revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20:1049–1056.
6. Dahm DL, Barnes SA, Harrington JR, et al. Patient reported activity after revision total knee arthroplasty. J Arthroplasty. 2007;22(suppl 2):106–110.
7. Clement ND, MacDonald DJ, Hamilton DF, et al. Posterior condylar offset
is an independent predictor of functional outcome after revision total knee arthroplasty. Bone Joint Res. 2017;6:172–178.
8. Hamilton DF, Simpson PM, Patton JT, et al. Aseptic revision knee arthroplasty
with total stabilizer prostheses achieves similar functional outcomes to primary total knee arthroplasty at 2 years: a longitudinal cohort study. J Arthroplasty. 2017;32:1234–1240.
9. Partington PF, Sawhney J, Rorabeck CH, et al. Joint line
restoration after revision total knee arthroplasty. Clin Orthop Relat Res. 1999;367:165–171.
10. Porteous AJ, Hassaballa MA, Newman JH. Does the joint line
matter in revision total knee replacement. J Bone Joint Surg B. 2008;90:879–884.
11. Figgie HE, Goldberg VM, Heiple KG, et al. The influence of tibial-patellofemoral location on function of the knee in patients with posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am. 1986;68:1035–1040.
12. Martin JW, Whiteside LA. The influence of joint line
position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res. 1990;259:146–156.
13. Hoffman AA, Kurtin SM, Lyons S, et al. Clinical and radiographic analysis of accurate restoration of the joint line
in revision total knee arthroplasty. J Arthroplasty. 2006;21:1154–1162.
14. Bellemans J, Banks S, Victor J, et al. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset
. J Bone Joint Surg Br. 2002;84-B:50–53.
15. Bellemens J. Restoring the joint line
in revision TKA: does it matter? Knee. 2004;11:3–5.
16. Kannan A, O’Connell RS, Kalore N, et al. Revision TKA for flexion instability improves patient reported outcomes. J Arthroplasty. 2015;30:818–821.
17. Conlisk N, Gray H, Pankaj P, et al. The influence of stem length and fixation on initial femoral component stability in revision total knee replacement. Bone Joint Res. 2012;1:281–288.
18. Patel A, Barlow B, Ranawat A. Stem length in revision knee arthroplasty
. Curr Rev Musculoskelet Med. 2015;8:407–412.
19. Morgan-Jones R, Oussedik SIS, Graichen H, et al. Zonal fixation in revision total knee arthroplasty. Bone Joint J. 2015;97-B:147–149.
20. Luo CF. Reference axes for reconstruction of the knee. Knee. 2004;11:251–257.
21. Figgie HE III, Goldberg VM, Heiple KG, et al. The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am. 1986;68-A:1035–1040.
22. Bauer T, Biau D, Colmar M, et al. Influence of posterior condylar offset
on knee flexion after cruciate-sacrificing mobile-bearing total knee replacement: a prospective analysis of 410 consecutive cases. Knee. 2010;17:375–380.
23. Clement ND, Hamilton DF, Burnett R. A technique of predicting radiographic joint line
and posterior femoral condylar offset of the knee. Arthritis. 2014;11:121069.