We have seen that stability in flexion is determined by the revision femoral component size and position. To fully stabilize the knee
requires a polyethylene tibial insert so that the combined height of the posterior condyles of the femoral component and the tibial insert match the dimensions of the flexion gap. The point at which the femoral component meets the tibial polyethylene is the joint line. Where then does the patella lie? (Fig. 8.5)
The challenge for the surgeon is to match the prosthetic joint line height as closely as possible to the anatomic joint line. What is the best remaining landmark for approximating the anatomic joint line? The location of the inferior pole of the patella, when the knee is flexed to 90 degrees is an easily identified and reliable indicator of desired joint line. Ideally, the joint line should lie distal to the inferior pole of the patella. In choosing between two femoral component sizes, both of which stabilize the knee in flexion, but each of which requires different thicknesses of tibial polyethylene, select the combination that gives the best patellar height.
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