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J.H. Healey and J.H. Schwab reply:

J.H. Healey and J.H. Schwab reply: 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 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Bone and Joint Surgery Wolters Kluwer Health

J.H. Healey and J.H. Schwab reply:

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2007 by The Journal of Bone and Joint Surgery, Inc.
ISSN
0021-9355
Publisher site
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Abstract

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

Journal

Journal of Bone and Joint Surgery – Wolters Kluwer Health

Published: Feb 1, 2007

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