Letters to the Editor   |    
J.H. Healey and J.H. Schwab reply:
John H. Healey, MD; Joseph H. Schwab, MD
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These letters originally appeared, in slightly different form, on jbjs.org. They are still available on the web site in conjunction with the article to which they refer.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Feb 01;89(2):455-455
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


We are delighted that our article sparked discussion of the importance of reestablishing the joint line in knee replacements after tumor resection. Dr. Springfield presents a clear tutorial on how to accomplish this: match the femoral resection and replacement lengths, and then match the tibial resection and replacement lengths. This tautology is everyone's goal. For various reasons, we were not always able to achieve it.Nevertheless, discussion of the average technical adequacy of the procedure misses the point. Citing the high joint line in our patients as the cause ("their mean LT/HI... ratio of 1.3 is clearly abnormal and indicates that, on the average, the joint lines are abnormally high"), Dr. Springfield overlooks the paradox that the LT/HI ratio was low in patients with impingement (0.9). This vitiates his argument. Curiously, the high ratios that he understandably criticizes (1.4) were found in patients without any impingement. When the reader looks at the data, it is clear that the ratios are not so important and another cause for patellar impingement should be sought. Even when the joint line is reproduced accurately (in our case, with a minimum 15 to 17-mm tibial cut, 3-mm metal-backed tray, and either a 12 or 14-mm polyethylene tibial bearing), the problem still occurs. Why?
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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