Aim: The Low Contact Stress (LCS) Total Knee Replacements (TKR) is a well-established mobile bearing prosthesis with more than 25 year experience, while the Kinemax Plus is a well established fixed bearing prosthesis. We examined whether reproducing the joint line height to within 5 mm of the pre-operative joint line height had any impact on the clinical outcome in the two different types of Total Knee Replacements.

Method: 48 consecutive LCS knee replacements with a minimum of 2 years follow up had their pre and postoperative joint line (using Figgie’s method) and range of movement (ROM) measured. We used the Oxford Knee Score as a clinical outcome measurement tool.

A cohort group of 53 CR Kinemax plus TKR from the Bristol Knee group was matched for age and sex. They had the same parameters measured.

Results: Accurate joint line restoration was achieved significantly more frequently (P< 0.05) in the Kinemax group. Better post-operative ROM also occurred in the Kinemax group than the LCS, p = 0.03 and the former produced a bigger gain in ROM p < 0.01. However, no difference in the Oxford Knee Score existed between the two prostheses, p = 0.28.

Joint line: elevation K+ LCS

0–2 mm (16/48) = 33% (26/53) = 49% 2–5 mm (14/48) = 29% (14/53) = 26%> 5 mm (18/48) = 38% (12/53) = 25%

There was no significant difference in the ROM or Oxford Knee Score when the joint line was not elevated versus elevated for each prosthesis. However, there was suggestion that the ROM in LCS might be more sensitive to joint line changes, although this was not significant.

ROM

K+ LCS

Normal joint line 116° 105°

Elevated joint line 108° 101°

Conclusion: Accurate joint line restoration could not be shown to correlate with either improved ROM or Oxford knee score; probably because of the small mount of elevation encountered and the small study size. There was a significantly greater post-operative increase in ROM with the Kinemax Plus relative to the LCS, and a significantly closer restoration of the joint line with the Kinemax Plus, both with respect to the actual measurement and with respect to the proportion of cases in which the joint line was accurately reproduced. This is surprising since in most K+ cases additional distal femur had been resected to avoid a tight knee. While in the LCS group special efforts had been made to achieve accurate restoration of the joint level.