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      Femoral anterior condyle height decreases as the distal anteroposterior size increases in total knee arthroplasty: A comparative study

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          Abstract

          Purpose

          The anterior flange height of the current femoral component increases with an increasing distal femoral anteroposterior dimension. During total knee arthroplasty (TKA), we have observed that a large femur may have a thinner anterior condyle, whereas a small femur may have a thicker anterior condyle. The first purpose of this study was to examine whether the femoral anterior condyle height decreases as the distal femoral anteroposterior size increases and whether gender differences exist in anterior condyle height.

          Methods

          A total of 1218 knees undergoing TKA intraoperative and computed tomography scans from 303 healthy knees were used to measure the anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and the lateral anteroposterior (LAP) and medial anteroposterior (MAP) dimensions of distal femurs. The LAP and MAP measurements were used for adjustments to determine whether gender differences exist in anterior condyle heights. Linear regression analysis was performed to determine correlations between ALCH and LAP or between AMCH and MAP.

          Results

          There were significant differences between males and females in ALCH in both the CT and TKA groups and AMCH in the CT group (all P<0.01). After adjusting for LAP and MAP, there were significant gender differences in the lateral and medial condylar heights in both groups (P<0.01). There were significant negative correlations between ALCH and LAP values and between AMCH and MAP values in both CT and TKA measurements, with the LAP and MAP values increasing as ALCH and AMCH decreased.

          Conclusions

          The results demonstrate that femoral anterior condylar height decreased with increasing anteroposterior dimension in both the medial and lateral condyle. In addition, this study also showed that anterior condylar heights are highly variable, with gender differences. The data may provide an important reference for designing femoral anterior flange thickness to precisely match the natural anterior condylar anatomy.

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          Most cited references22

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          Differences of knee anthropometry between Chinese and white men and women.

          Bing Yue, Kartik M Varadarajan, Songtao Ai … (2011)
          Whether there are differences in knee anthropometry between Asian and white knees remains unclear. Three-dimensional knee models were constructed using computed tomography or magnetic resonance imaging of healthy Chinese and white subjects. The morphologic measurements of the femur included mediolateral, anteroposterior dimensions, and aspect ratio. The tibial measurements included mediolateral, medial/lateral anteroposterior dimension, aspect ratio, and posterior slope of medial/lateral plateau. The results showed that Chinese knees were generally smaller than white knees. In addition, the femoral aspect ratio of Chinese females was significantly smaller than that of white females (1.24 ± 0.04 vs 1.28 ± 0.06). Tibial aspect ratio differences between Chinese and white males (1.82 ± 0.07 vs 1.75 ± 0.11), though significant, were likely a reflection of differences in knee size between races. These racial differences should be considered in the design of total knee arthroplasty prosthesis for Asian population. Copyright © 2011 Elsevier Inc. All rights reserved.
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            Rotational landmarks and sizing of the distal femur in total knee arthroplasty.

            P L Poilvache, J N Insall, G R Scuderi … (1996)
            In 100 knees undergoing a total replacement, the angles between the tangent line of the posterior condylar surfaces, the anteroposterior axis as described by Whiteside, the transepicondylar line, and the trochlear line were measured. Also measured were the sulcus angle, the transepicondylar width, the height of the condyles, and the thickness of the various cuts. Radiologic measurements made were: the mechanical angle, the hip center-femoral shaft angle, the transcondylar angle, and the tibial plateau-tibial shaft angle. The mean values of these measurements were calculated, and comparisons were made according to gender and the mechanical axis using the Student's t test. Correlations between the various measurements were calculated. The transepicondylar axis was found to be a reliable landmark to properly rotate the femoral component, and was easier to locate at surgery than the anteroposterior axis. In trochlear dysplasia and in some valgus knees, relying on the anteroposterior axis can induce an excessive external rotation of the femoral component, and the opposite can happen in some varus knees. The anterior extent of the condyles is highly variable in arthritic knees, and cannot be used to orient the prosthesis. The ratio between the transepicondylar width and the height of the condyles is constant, but some narrow femora could require narrower implants to avoid medial-lateral overhang of the femoral component.
            Article 0 comments Cited 55 times – based on 0 reviews     Review now
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              What Differences in Morphologic Features of the Knee Exist Among Patients of Various Races? A Systematic Review

              T. Kim, Mark Phillips, Mohit Bhandari … (2016)
              Background Most TKA prostheses are designed based on the anatomy of white patients. Individual studies have identified key anthropometric differences between the knees of the white population and other major ethnic groups, yet there is limited understanding of what these findings may indicate if analyzed collectively. Question/purpose What are the differences in morphologic features of the distal femur and proximal tibia among and within various ethnicities? Methods A systematic review of the PubMed database and a hand-search of article bibliographies identified 235 potentially eligible English-language studies. Studies were excluded if they did not include morphology results or had insufficient data for analysis, were unrelated to the distal femur or proximal tibia, were conducted in pediatric patients or those undergoing unicondylar knee arthroplasty, or bone surface measurements were obtained for trauma products. This left 30 eligible studies (9050 knees). Study quality was assessed and reported as good, fair, or poor according to the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Morphometric data for the distal femur and proximal tibia were available for four ethnic groups: East Asian (23 studies; 5543 knees), white (11 studies; 3111 knees), Indian (three studies; 283 knees), and black (three studies; 113 knees). Although relatively underrepresented, the knees from the Indian and black studies were maintained for hypothesis-generating purposes and to highlight crucial gaps in the data. The two key dimensions for selecting a suitable implant based on a patient’s unique anatomy—AP length and mediolateral (ML) width—were assessed for the femur and tibia, in addition to aspect ratio, calculated by dividing the ML width by the AP length. Study measurement techniques were compared visually when possible to ensure that each pooled study conducted a similar measurement process. Any significant measurement outliers were reviewed for eligibility to determine if the measurement techniques and landmarks used were comparable to the other studies included. Results White patients had larger femoral AP measurements than East Asians (62 mm, [95% CI, 57–66 mm] vs 59 mm, [95% CI, 54–63 mm]; mean difference, 3 mm; p < 0.001), a smaller femoral aspect ratio than East Asians (1.20, [95% CI, 1.11–1.29] vs 1.25, [95% CI, 1.16–1.34]; mean difference, 0.05; p = 0.001), and a larger tibial aspect ratio than black patients (1.55, [95% CI, 1.40–1.71] vs 1.49, [95% CI, 1.33–1.64]; mean difference, 0.06; p = 0.005). Conclusions This analysis uncovered differences of size (AP height and ML width of the femur and tibia) and shape (tibial and femoral aspect ratios) among knees from white, East Asian, and black populations. Future research is needed to understand the clinical implications of these discrepancies and to provide additional data with underrepresented groups.
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                Author and article information

                Contributors
                Bo Yang:
                ORCID: https://orcid.org/0009-0000-4844-782X
                Role: Data curationRole: Writing – original draft
                Fu-zhen Yuan: Role: Writing – review & editing
                Hai-jun Wang: Role: Supervision
                Xi Gong: Role: ConceptualizationRole: Supervision
                Yan-hai Chang: Role: Writing – review & editing
                Jia-Kuo Yu:
                ORCID: https://orcid.org/0000-0001-6260-7017
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Gennaro Pipino: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 26 February 2024
                Publication date Collection: 2024
                Volume: 19
                Issue: 2
                Electronic Location Identifier: e0297634
                Affiliations
                [1 ] Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
                [2 ] Department of Orthopaedics, Shaanxi Provincial People’s Hospital, The Third Affiliated hospital of Xi’an jiaotong University, Xi’an, China
                [3 ] Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Changping District, Beijing, China
                San Raffaele University Milan, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                [¤]

                Current address: Department of Orthopaedics, Shaanxi Provincial People’s Hospital, The Third Affiliated hospital of Xi’an jiaotong University, Xi’an, China

                Author information
                https://orcid.org/0009-0000-4844-782X
                https://orcid.org/0000-0001-6260-7017
                Article
                Publisher ID: PONE-D-23-04989
                DOI: 10.1371/journal.pone.0297634
                PMC ID: 10896507
                PubMed ID: 38408088
                SO-VID: abcb28bd-c6fa-4a1b-ad97-840422a5da31
                Copyright © © 2024 Yang et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 28 March 2023
                Date accepted : 8 January 2024
                Page count
                Figures: 4, Tables: 2, Pages: 10
                Funding
                Funded by: Instrument Research Project of the National Natural Science Foundation
                Award ID: 81327001
                Award Recipient :
                ORCID: https://orcid.org/0000-0001-6260-7017
                Funded by: funder-id http://dx.doi.org/10.13039/501100011710, Shaanxi Provincial Science and Technology Department;
                Award ID: 2022SF-049
                Award Recipient :
                ORCID: https://orcid.org/0009-0000-4844-782X
                Funded by: Capital’s Funds for Health Improvement and Researc
                Award ID: 2022-1-4091
                Funded by: National Natural Science Foundation-Beijing Natural Science Foundation Regional Innovation Union Development Fund
                Award ID: U22A20283
                We declare that this study was approved by institute review board of author’ hospital (No: IRB00006761-2011073). This research was funded by Instrument Research Project of the National Natural Science Foundation (No. 81327001), which took part in study design, data collection and analysis, preparation and decision to publish the manuscript; Science and Technology Program of Shaanxi Province (No.2022SF-049), which took part in preparation and revised the manuscript; Capital’s Funds for Health Improvement and Research (No.2022-1-4091) and National Natural Science Foundation-Beijing Natural Science Foundation Regional Innovation Union Development Fund (No.U22A20283).
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Skeletal Joints
                Subject: Knees
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Skeletal Joints
                Subject: Knees
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Knees
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Knees
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Femur
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Femur
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Musculoskeletal System Procedures
                Subject: Arthroplasty
                Subject: Total Knee Arthroplasty
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Neuroimaging
                Subject: Computed Axial Tomography
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Neuroimaging
                Subject: Computed Axial Tomography
                Subject: Medicine and Health Sciences
                Subject: Diagnostic Medicine
                Subject: Diagnostic Radiology
                Subject: Tomography
                Subject: Computed Axial Tomography
                Subject: Research and Analysis Methods
                Subject: Imaging Techniques
                Subject: Diagnostic Radiology
                Subject: Tomography
                Subject: Computed Axial Tomography
                Subject: Medicine and Health Sciences
                Subject: Radiology and Imaging
                Subject: Diagnostic Radiology
                Subject: Tomography
                Subject: Computed Axial Tomography
                Subject: Biology and Life Sciences
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Engineering and Technology
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Medicine and Health Sciences
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Skeletal Joints
                Subject: Knees
                Subject: Knee Joints
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Skeletal Joints
                Subject: Knees
                Subject: Knee Joints
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Knees
                Subject: Knee Joints
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Body Limbs
                Subject: Legs
                Subject: Knees
                Subject: Knee Joints
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Skeletal Joints
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Skeletal Joints
                Subject: Physical Sciences
                Subject: Physics
                Subject: Classical Mechanics
                Subject: Kinematics
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                Data Availability All relevant data are within the manuscript and its Supporting Information files.

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