• Seong Yun Park, Hyun Jin Yoo, Ho Won Jeong, Samuel Jaeyoon Won, and Yong Seuk Lee.
• Department of Orthopaedic Surgery, Seoul National University College of Medicine, Bundang Hospital, 166 Gumi-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 463-707, South Korea.
• Arch Orthop Trauma Surg. 2024 Jan 1; 144 (1): 357367357-367.

IntroductionControversy regarding which variables should be prioritized for better outcomes in revision total knee arthroplasty (RTKA) exists. This study aimed to comprehensively analyze the variables affecting RTKA outcomes.Materials And MethodsWe retrospectively identified 87 RTKAs in 82 patients who were performed between March 2014 and February 2020. Range of motion (ROM), including flexion contracture (FC) and further flexion (FF), was analyzed according to the covariates. The covariates included mode of failure, joint line position, anteroposterior (AP) position, rotational alignment of the femoral component, and patellofemoral alignment. The differences between the final follow-up values of each RTKA variable and those of the native knee were evaluated. The clinical outcomes were evaluated.ResultsNo significant differences were observed between the joint line positions of the RTKA and native knees. The patellar and AP positions of the femoral component were restored to pre-TKA values. The femoral component had an external rotation of 2.78° compared with the native knee. In multivariable stepwise regression analysis, restoration of the adductor tubercle joint line and posterior condylar offset (PCO) were significant variables affecting ROM. Septic RTKA (33 knees) resulted in poor FF outcomes (p = 0.030) and Western Ontario and McMaster Universities Osteoarthritis Index stiffness (WOMAC S) scores (p < 0.001), compared with aseptic RTKA (54 knees).ConclusionsRestoration of the joint line position and PCO are crucial factors for improved ROM in RTKA. Joint line elevation in RTKA resulted in worse ROM than joint line lowering. In addition, RTKA due to septic failure had inferior ROM and WOMAC S scores compared with RTKA due to aseptic failure.Level Of EvidenceLevel III, cohort study.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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