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Hernandez PA, Bradford JC, Brahmachary P, Ulman S, Robinson JL, June RK, Cucchiarini M. Unraveling sex-specific risks of knee osteoarthritis before menopause: Do sex differences start early in life? Osteoarthritis Cartilage 2024; 32:1032-1044. [PMID: 38703811 DOI: 10.1016/j.joca.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females. DESIGN We compiled clinical data from multiple tissues within the knee joint-since OA is a whole joint disorder-aiming to reveal relevant factors behind the sex differences from different perspectives. RESULTS The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures. CONCLUSIONS We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life.
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Affiliation(s)
- Paula A Hernandez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | | | - Priyanka Brahmachary
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Sophia Ulman
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Movement Science Laboratory, Scottish Rite for Children, Frisco, TX 75034, USA.
| | - Jennifer L Robinson
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA; Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA 98109, USA.
| | - Ronald K June
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT 59717, USA.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg/Saar D-66421, Germany.
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Nguyen K, Perriman DM, Scarvell JM, Pickering MR, Galvin CR, Smith PN, Lynch JT. Shape modelling reveals age-related knee bony shape changes in asymptomatic knees. J Orthop Res 2024. [PMID: 38934296 DOI: 10.1002/jor.25923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
Osteoarthritis (OA) causes bony shape changes within the knee. Furthermore, the risk of developing OA increases with age. However, age alone does not cause OA. It is therefore important to understand the healthy age-related trajectories of knee shape before attributing these changes to OA. The aim of this study was to determine the association between bony knee shape and age using statistical-shape modelling (SSM). 96 participants received a CT scan of their knee. Three-dimensional models were created using manual segmentation. Separate SSM's for the distal femur and proximal tibia were created. Linear regression models were used to assess the association between age and femoral and tibial shape. Fourteen modes of the femoral and tibial SSM's captured 68% and 73% shape variation, respectively. Only femoral mode 3 and tibial mode 7 were associated with age. Increasing age was related to larger femoral bone volume and deepening of the femoral trochlear groove. Furthermore, increased age was associated with medial tibial plateau expansion. Aspects of bony femoral and tibial shape were significantly associated with aging, including femoral and tibial bone size, femoral trochlear groove, and medial tibial plateau area. Changes in knee morphology occur as a normal process of aging without osteoarthritis development. This may be a response to mechanical loading over time. Further research investigating the effect of these changes on loading in the knee may provide valuable information for knee health in older age.
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Affiliation(s)
- Katherine Nguyen
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - Diana M Perriman
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Trauma and Orthopaedic Research Unit (TORU), The Canberra Hospital, Canberra, Australia
| | | | - Mark R Pickering
- School of Engineering and Information Technology, UNSW Canberra, Canberra, Australia
| | - Catherine R Galvin
- College of Engineering, Computing and Cybernetics, Australian National University, Canberra, Australia
| | - Paul N Smith
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Trauma and Orthopaedic Research Unit (TORU), The Canberra Hospital, Canberra, Australia
| | - Joseph T Lynch
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Trauma and Orthopaedic Research Unit (TORU), The Canberra Hospital, Canberra, Australia
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Kavak S, Kaya S. Evaluation of the relationship of posterior tibial slope with gender and age in Turkish population with 3 different methods. BMC Musculoskelet Disord 2024; 25:102. [PMID: 38291387 PMCID: PMC10826083 DOI: 10.1186/s12891-024-07209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND This study aimed to reveal the posterior tibial slope (PTS) angle with 3 different methods in a large case group in the Turkish population. In addition, the reproducibility of the measurement methods used was questioned while determining the age groups, gender and side relationship of this angle. MATERIALS AND METHODS In our retrospective study, radiographs of both knees were evaluated in all 610 patients (344 women, 56.4%) aged 25-65 years. PTS angles were measured by a radiologist and an orthopedist using anterior tibial cortex (ATC), posterior tibial cortex (PTC) and proximal tibial anatomical axis (PTAA) methods. The relationship of these angles with age group and gender, and the intra-class and inter-class correlations of all three methods were evaluated. RESULTS The mean and standard deviation (SD) of PTS angle was 11.03 ± 2.33° with ATC method, 6.25 ± 2.22° with PTC and 8.68 ± 2.16° with PTAA, and the difference was significant (p < .001). In the evaluation according to age groups, the highest mean PTS angles were detected in cases aged 25-35 (9.63 ± 1.97° [mean ± SD] by PTAA method), and there was a significant difference in comparison with other age groups (p < .05). In comparison with age groups, higher mean PTS angles were found in women and on the right side, but the difference was not statistically significant (p > .05). The intraclass and interclass correlation coefficient (ICC) of all three methods was excellent (ICC > 0.91). CONCLUSION This study emphasizes that the mean PTS angle in Turkish population is higher than the angle values recommended by prosthesis manufacturers, and factors such as patient age and gender should be calculated in order to ensure more effective prostheses to be applied to patients.
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Affiliation(s)
- Seyhmus Kavak
- Department of Radiology, University of Health Sciences, Gazi Yasargil Training and Research Hospital, Elazig Road, 10th km Uçkuyular Location, Kayapınar, Diyarbakir, 21070, Turkey.
| | - Sehmuz Kaya
- Dursun Odabaşı Medicine Center, Department of Orthopedics and Traumatology, University of Yüzüncü Yıl, Van, Turkey
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Akçaalan S, Akkaya M, Dogan M, Valdivielso AA, Zeiton MA, Mohammad HR, Sangaletti R, Benazzo F, Kara S, Gehrke T, Citak M. Do age, gender, and region affect tibial slope? A multi-center study. Arch Orthop Trauma Surg 2023; 143:6983-6991. [PMID: 37438581 DOI: 10.1007/s00402-023-04976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Tibial slope is a parameter that is important to recognize in knee kinematics and knee surgery. A very wide range of values governing posterior tibial slope exist in the literature. This study is based on the hypothesis that age, gender and region may have an effect on the tibial slope. MATERIALS AND METHODS A total of 1800 lateral knee radiographies from five different countries [Turkey, Germany, Italy, Spain, and the United Kingdom (UK)] were utilized to measure the native posterior tibial slope. Participants were categorized in deciles with each decade of age after 40 years determined as a separate age group. Accordingly, four different age categories were formed in total, namely, the 40- to 49-, 50- to 59-, 60-69, and 70- to 79-year-old groups. Patients with severe knee osteoarthritis, those with a history of arthroscopic and open surgery around the knee, and those with severe morbid obesity and those outside the specified age group were excluded from the study. The angle between the line tangential to the medial tibial plateau and the proximal anatomical axis of the tibia was measured. RESULTS The tibial slope values of both males and females in the Turkish population were found to be higher than those in other populations. It was observed that tibial slope values increased with age in females in all populations, except for those in the Spanish and UK populations. In the male population, it was found that tibial slope values increased with age in all populations except in the Spanish population. CONCLUSIONS Region, age, and gender affect tibial slope in different populations in various ways. Our study shows that the region an individual lives in and living conditions affect the tibial slope.
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Affiliation(s)
- Serhat Akçaalan
- Orthopedics and Traumatology Clinics, Kirikkale Yuksek Ihtısas Hospital, Bağlarbaşı, Ahmet Ay Caddesi, 71300, Merkez/Kırıkkale, Turkey.
| | - Mustafa Akkaya
- Orthopedics and Traumatology Department, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Metin Dogan
- Orthopedics and Traumatology Department, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Ainhoa Alvarez Valdivielso
- Orthopaedic Surgery and Traumatology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Moez Asaid Zeiton
- Orthopedics and Traumatology Department, Royal Bolton Hospital, Minerva Rd, Farnworth, Bolton, United Kingdom
| | - Hasan Raza Mohammad
- Orthopedics and Traumatology Department, Royal Bolton Hospital, Minerva Rd, Farnworth, Bolton, United Kingdom
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
- IUSS, Istituto di Studi Superiori, Pavia, Italy
| | - Seher Kara
- Helios ENDO-Klinik, Holstenstr, Hamburg, Germany
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Abdelnasser MK, Abdelhameed MA, Bassem M, Adam MF, Bakr HM, Khalifa YE. Sexual dimorphism of the posterior condylar offset of the femur and the medial posterior slope of the tibia in non-arthritic knees of Egyptian adults: an MRI study. J Orthop Surg Res 2023; 18:353. [PMID: 37173701 PMCID: PMC10176775 DOI: 10.1186/s13018-023-03833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The aim of this magnetic resonance imaging (MRI) study was to investigate controversial sexual dimorphism of the posterior condylar offset of the femur (the offset) and the posterior slope of the tibia (the slope) in non-arthritic knees of Egyptian adults. METHODS On 100 male and 100 female MRIs of non-arthritic knees, linear measurements of the distal part of the femur (the offset) and the angular measurements of the proximal part of the tibia (the slope) were performed and compared regarding sex and ethnicity. The intraclass correlation coefficient (ICC) was used to test the interrater agreement. RESULTS Both offsets and the lateral offset ratio were larger in males (p < 0.001), the medial offset ratio, and the medial slope in females (p from < 0.001 to 0.007), whereas the lateral slope was sex-free (p = 0.41). Irrespective of sex, however, the medial offset with its ratio, and the medial slope were larger than their counterparts (p < 0.001). Our means of the offsets, their ratios, and the slopes mostly differed from those of other ethnicities (p from ≤ 0.001 to 0.004). ICCs > 0.8 proved MRI's precision was high. CONCLUSION There was a sexual dimorphism of both the offset and the medial slope in non-arthritic knees of Egyptian adults. We believe future designs of knee implants should consider these differences in order to improve postoperative range of motion and patients' satisfaction after total knee arthroplasty. Level of evidence Level III Retrospective Cohort Study. Trial registration ClinicalTrials.gov identifier: NCT03622034, registered on July 28, 2018.
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Affiliation(s)
| | | | - Micheal Bassem
- Orthopedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Mahmoud Faisal Adam
- Orthopedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Hatem M Bakr
- Orthopedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Yaser E Khalifa
- Orthopedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
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Hassa E, Uyanik SA, Kosehan D, Alic T. CT-based analysis of posterior tibial slope in a Turkish population sample: A retrospective observational study. Medicine (Baltimore) 2023; 102:e33452. [PMID: 37000049 PMCID: PMC10063256 DOI: 10.1097/md.0000000000033452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
Posterior tibial slope (PTS) is important for the success of high tibial osteotomy and unicondylar knee arthroplasty applications, as it provides anterior cruciate ligament function. In the literature, different studies have been carried out with various imaging methods to measure PTS in populations of different ethnic origins. In this study, it was aimed to detect PTS in the medial (MPTS) and lateral (LPTS) tibial condyles with computed tomography in a Turkish population sample and to compare the results between age groups (<65, ≥ 65), genders, sides, and literature data. In our sample, 39 left and 33 right knee images of 37 men and 35 women with a mean age of 52.01 ± 21.27 were evaluated. The tibial proximal anatomical axis was determined by the midpoint method. The MPTS and LPTS was evaluated by two different observers according to this axis. Thereby the global PTS (GPTS) was calculated as an arithmetic mean of MPTS and LPTS values. Measurements were repeated 2 weeks after the first measurement and values were analyzed. A significant difference was found between the mean of MPTS, LPTS, and GPTS in the whole population (P = .002), in men (P = .02) and in women (P = .02). On the other hand, there was no significant difference compared according to age, gender, and side by mean of same parameters. In comparison of the results of our Turkish population sample with other studies in the literature, MPTS and LPTS were similar to Chinese (P = .22, P = .07) and Japanese (P = .96, P = .67) populations, while different to White Asian (P < .001, P < .001) and Korean (P < .001, P < .001) populations. The midpoint method is a safe measurement method in computed tomography-based studies for the evaluation of PTS. Implant designs produces for different populations may not be suitable for the Turkish population. More comprehensive and detailed studies are needed to represent the Turkish population.
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Affiliation(s)
- Ercan Hassa
- Department of Orthopaedics and Traumatology, Memorial Ankara Hospital, Ankara, Turkey
| | | | - Dilek Kosehan
- Department of Radiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Taner Alic
- Department of Orthopaedics and Traumatology, Hitit University Faculty of Medicine, Corum, Turkey
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Gültekin MZ, Keskin Z, Dinçel YM, Arslan T. Effect of demographic features on morphometric variables of the knee joint: Sample of a 20 to 40-year-old Turkish population. Medicine (Baltimore) 2023; 102:e33253. [PMID: 36930108 PMCID: PMC10019148 DOI: 10.1097/md.0000000000033253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
This study aimed to investigate the relationship between body mass index (BMI), age, and sex and morphological risk factors that may cause internal knee injuries. The magnetic resonance images of 728 participants who met the inclusion criteria and had a mean age of 34.4 ± 6.8 years were analyzed retrospectively. Demographic differences were analyzed by measuring 17 morphological parameters known to be associated with internal knee injuries. Men had a higher anterior cruciate ligament length (ACLL), anterior cruciate ligament width, (ACLW) lateral femoral condylar width (LFCW), medial femoral condylar width (MFCW), lateral femoral condylar depth (LFCD), distal femoral width (DFW), and intercondylar femoral width (IFW) than women (P < .05). By contrast, the medial meniscus bone angle (MMBA) was lower in men than in women (P < .05). Women aged 31 to 40 years had a lower Insall-Salvati index (ISI) and lateral tibial posterior slope (LTPS) than those aged 21 to 30 years (P < .05), whereas men aged 31 to 40 years had a lower ISI than those aged 21 to 30 years (P < .05). Women with BMI ≥ 30 had a higher LFCW and MFCW but a lower ISI than those with BMI < 30 (P < .05). Men with BMI ≥ 30 had a higher LFCW, MFCW, DFW, and MMBA than those with BMI < 30 (P < .05). The use of value ranges structured according to demographic characteristics, rather than a single value range for all patient groups, may contribute to the evaluation and treatment of the morphological features that are thought to be effective in the development of internal knee injuries. These values may also shed light on future radiological risk scoring systems and artificial intelligence applications in medicine.
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Affiliation(s)
| | - Zeynep Keskin
- Department of Radiology, Konya City Hospital, Konya, Turkey
| | - Yaşar Mahsut Dinçel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Tuğba Arslan
- Department of Occupational Therapy, Faculty of Health Sciences, Karatekin University, Çankiri, Turkey
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Chen Y, Ding J, Dai S, Yang J, Wang M, Tian T, Deng X, Li B, Cheng G, Liu J. Radiographic measurement of the posterior tibial slope in normal Chinese adults: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:386. [PMID: 35473639 PMCID: PMC9040249 DOI: 10.1186/s12891-022-05319-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/11/2022] [Indexed: 01/16/2023] Open
Abstract
Background Measurement of the posterior tibial slope (PTS) angle has important applications in total knee replacement surgery, high tibial osteotomy, and anterior cruciate ligament reconstruction. This study aimed to determine the mean PTS of knee joints in healthy Chinese adults, and provide data to guide knee surgery in China. Methods A retrospective analysis of 1257 (n = 1233, 50.4% male) plain X-ray films of participants aged 25–59 years was performed. The picture archiving and communication system was used for PTS measurement. The PTS was defined as the angle between the vertical line of the tangent of the anterior tibial cortex of the proximal tibia, and the tangent line of the tibial cortex. Two imaging physicians conducted the PTS measurements independently, and both the inter- and intraclass correlation coefficients (ICCs) were calculated. Results The mean PTS value was 7.68 ± 3.84° (range: 0–21°). The left PTS was significantly smaller in males than in females (7.22 ± 3.89 vs 8.05 ± 3.60; P = 0.005). Additionally, the PTS in participants aged 25–29 years was significantly larger than that in the other age groups (Left side: 8.64 ± 3.73 vs 6.92 ± 3.42, 7.42 ± 3.75, 7.53 ± 3.98; P < 0.001 and Right side: 8.68 ± 3.84 vs 7.48 ± 4.21, 7.13 ± 3.64, 7.66 ± 3.80; P = 0.004). There were no significant differences in PTS between the left and right sides. Two-way analysis of variance suggested that the differences in PTS between age groups were not affected by sex. The interobserver ICC was 0.91 (95% confidence interval [CI]: 0.85–0.94), and the intraobserver ICC was 0.90 (95% CI: 0.82–0.94). Conclusions This study demonstrated that there were significant differences in PTS based on sex and age, highlighting the need to provide individualized treatment for knee surgery. It provided valuable information regarding the normal PTS values in Chinese adults and presented regionalised data to guide knee surgery.
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Affiliation(s)
- Yong Chen
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Wenzhoulu, Gongshu District, Hangzhou City, 310000, Zhejiang Province, China
| | - Jianping Ding
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Siyu Dai
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Jiao Yang
- Department of Radiology, the Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Mengke Wang
- The Second People's Hospital of Chun'an County, Hangzhou, China
| | - Tian Tian
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Xiaolong Deng
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Boyi Li
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Guohua Cheng
- Hangzhou Jianpei Technology Co., Ltd, Hangzhou, China
| | - Jie Liu
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Wenzhoulu, Gongshu District, Hangzhou City, 310000, Zhejiang Province, China.
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Xu Y, Feng B, Dong Y, Zheng Z, Bian Y, Weng X. Morphology characters of resected femoral and tibial surface in chinese population: intraoperative anthropometric study in patients at a tertiary hospital. BMC Surg 2022; 22:144. [PMID: 35440033 PMCID: PMC9019938 DOI: 10.1186/s12893-022-01584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS Mismatch between knee surface and prosthesis components is related to postoperative complications. Morphological differences between ethnicity and gender may affect prosthesis coverage. The purpose of this study is to describe morphological characters of resected knee surface (distal femur, proximal tibia) in the Chinese population, analyze the influence of gender and other demographical factors, and validate the effect of ethnic difference by calculating the coverage of Western-designed knee prostheses on Chinese knee surface. METHODS Intraoperative anthropometries were performed during total knee arthroplasty performed by one single team. After screening out severe deformities and bone defects, data were separated via prosthesis system. Multiple linear regression and partial correlation analysis of morphological parameters on age, gender, height, weight were used to find out independent factors influencing morphology. Based on the 5 mm-tolerance in the prosthesis, simulation on scatter plots was brought out to calculate the prosthesis coverage to the resected bone surface. RESULTS A total of 865 cases of total knee arthroplasty were involved in this study. Though gender differences were found in all knee morphological parameters regardless of the type of prosthesis, significant association was only found between gender and mediolateral width of femoral surface after adjusting demographical factors (p < 0.001). The two included prosthesis systems, Genesis-II and Scorpio NRG covered most cases in at least one dimension. Males had lower complete coverage and higher no coverage rate on femurs. Asymmetry prostheses had higher lateral coverage on tibiae. CONCLUSIONS Based on our analysis, the only confirmed demographical factor in knee morphology is gender on femoral mediolateral length. Wider femoral prostheses for males may improve results of gender-specific prostheses. The overall fitness between Western-designed prostheses and Chinese knee surface is appliable, but the ratio of complete coverage is low. Further modification of prostheses systems can aim at the number of sizes and geometrical shapes.
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Affiliation(s)
- Yiming Xu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Wangfujing Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Bin Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Wangfujing Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yulei Dong
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Wangfujing Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhibo Zheng
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yanyan Bian
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Wangfujing Shuaifuyuan, Dongcheng District, Beijing, 100730, China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Wangfujing Shuaifuyuan, Dongcheng District, Beijing, 100730, China. .,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China.
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Castoldi M, Cavaignac M, Marot V, Reina N, Mouarbes D, Berard E, Cavaignac E. Femoral Positioning of the Anterolateral Ligament Graft With and Without Ultrasound Location of the Lateral Epicondyle. Am J Sports Med 2022; 50:415-422. [PMID: 34846220 DOI: 10.1177/03635465211061137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In anterior cruciate ligament (ACL) reconstruction with anterolateral ligament (ALL) reconstruction, precise positioning of the ALL graft on the femur and tibia is key to achieve rotational control. The lateral femoral epicondyle is often used as a reference point for positioning of the ALL graft and can be located by palpation or with ultrasound guidance. PURPOSE To compare the ALL graft positioning on the femoral side between an ultrasound-guided technique and a palpation technique for the location of the lateral epicondyle. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 120 patients receiving a primary combined ACL and ALL reconstruction between June and December 2019 were included. The location of the lateral epicondyle was determined by palpation in the palpation group (n = 60) and with preoperative ultrasound guidance in the ultrasound group (n = 60). Groups were comparable in age, sex, body mass index (BMI), and operated side. The planned positioning of the femoral ALL graft was proximal and posterior to the lateral epicondyle. The effective positioning of the femoral ALL graft was evaluated on postoperative lateral radiographs. The primary outcome was location of the graft in a 10-mm quadrant posterior and proximal to the lateral epicondyle. Results were analyzed in 2 subgroups according to BMI. RESULTS All 60 anterolateral grafts (100%) in the ultrasound group were positioned in a 10-mm quadrant posterior and proximal to the lateral epicondyle, as opposed to 52 (87%) in the palpation group (P = .006). Errors in graft positioning with palpation occurred in overweight patients (BMI >25) as well as nonoverweight patients (P = .3). CONCLUSION Femoral positioning of the ALL graft posterior and proximal to the lateral epicondyle is more reproducible with ultrasound guidance when compared with palpation alone, regardless of BMI.
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Affiliation(s)
- Marie Castoldi
- Institut Universitaire Locomoteur et du Sport, Department of Orthopaedic Surgery, Centre Hospitalo-Universitaire de Nice, Nice, France
| | | | - Vincent Marot
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Nicolas Reina
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France.,I2R: Institut de Recherche Riquet, Toulouse, France
| | - Dany Mouarbes
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Emilie Berard
- Department of Epidemiology, Health Economics and Public Health, UMR 1027 INSERM-University of Toulouse III, Toulouse University Hospital, Toulouse, France
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France.,I2R: Institut de Recherche Riquet, Toulouse, France
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11
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Abdelnasser MK, Khalifa AA, Bassem M, Abdelhameed MA, Adam MF, Bakr HM, Khalifa YE. Anthropometric measurements of non-arthritic knees in an Egyptian population: an MRI-based study. J Orthop Surg Res 2021; 16:552. [PMID: 34496904 PMCID: PMC8425145 DOI: 10.1186/s13018-021-02708-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background Knee anthropometric characteristics were evaluated for different ethnicities; however, data from North African populations are deficient. The primary aim was to investigate the Egyptian knees’ anthropometric characteristics as a representative of North African populations. Secondary aims are as follows: (1) to study the anthropometric gender difference, (2) to compare results with other ethnic groups, and (3) to study the mismatch in comparison to geometric characteristics of modern TKA implant designs. Methods Two hundred normal knee MRI scans (100 females and 100 males, aging from 18 to 60) were obtained for analysis. Linear measurements (anteroposterior (AP), mediolateral (ML), and aspect ratio (AR)) of the planned cut surface of the distal femur (f) and the proximal tibia (t) were evaluated. Results A significant difference between both sexes was found, males had larger measurements in anteroposterior [fAP: 60.97 ± 3.1 vs 54.78 ± 3.3 (P < 0.001), tAP: 46.89 ± 3.0 vs 41.35 ± 2.9 (P < 0.001)] and mediolateral [fML: 74.89 ± 3.2 vs 67.29 ± 3.7 (P < 0.001), tML: 76.01 ± 3.0 vs 67.26 ± 3.2 (P < 0.001)], the mean femoral and tibial AP and ML measurements were different from other ethnic groups. None of the seven studied TKA systems matched the largest ML or the smallest AP dimensions of the distal femur in the current study population. Conclusion A significant difference was found between males’ and females’ knee anthropometric characteristics. Some of the commonly used TKA implants in our area could not provide a perfect fit and coverage. Trial registration ClinicalTrials.gov identifier: NCT03622034, registered on July 28, 2018.
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Affiliation(s)
| | - Ahmed A Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.
| | - Micheal Bassem
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | | | - Mahmoud Faisal Adam
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Hatem M Bakr
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Yaser E Khalifa
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
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12
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Kacmaz IE, Er A, Basa CD, Zhamilov V, Bozdag M, Ekizoglu O. Posterior Tibial Slope and a New Morphometric Method With Multiplanar Reconstruction Technique in a Turkish Sample. Cureus 2021; 13:e15472. [PMID: 34262810 PMCID: PMC8258461 DOI: 10.7759/cureus.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/21/2022] Open
Abstract
Aim: The posterior tibial slope (PTS) is important in planning many orthopedic procedures. The aim of the study is to outline a PTS measurement method using multiplanar reconstruction (MPR) in knee computed tomography (CT) images. Methods: MPR reconstruction was performed on pre-captured CT angio images of 124 patients. A standard tibial axis was created. Then, using reference points, the PTS was measured separately for the medial PTS (MPTS) and lateral PTS (LPTS). To identify an intra- and interobserver error, the technical error of measurement (TEM), relative TEM (rTEM), and coefficient of reliability (R) of the measurement were analyzed. Results: The study enrolled 124 patients (88 males, 36 females) from 18 to 92 years old. The average MPTS 8.63 ± 2.7° and LPTS 7.77 ± 3.1° were significantly different (p < 0.05). However, there was no difference between the sexes (p = 0.52 for MPTS; p = 0.9 for LPTS). The R for intraobserver reliability was 0.942 for the MPTS and 0.943 for the LPTS, and that for interobserver reliability was 0.815 and 0.806, respectively. Conclusions: PTS measurement from CT images appears advantageous as it eliminates measurement limitations due to tibial rotation and has high intra- and interobserver consistency.
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Affiliation(s)
| | - Ali Er
- Radiology, Tepecik Training and Research Hospital, Izmir, TUR
| | - Can Doruk Basa
- Orthopaedics, Tepecik Training and Research Hospital, Izmir, TUR
| | - Vadym Zhamilov
- Orthopaedics, Tepecik Training and Research Hospital, Izmir, TUR
| | - Mustafa Bozdag
- Radiology, Tepecik Training and Research Hospital, Izmir, TUR
| | - Oguzhan Ekizoglu
- Forensic Medicine, Tepecik Training and Research Hospital, Izmir, TUR
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13
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Aljuhani WS, Qasim SS, Alrasheed A, Altwalah J, Alsalman MJ. The effect of gender, age, and body mass index on the medial and lateral posterior tibial slopes: a magnetic resonance imaging study. Knee Surg Relat Res 2021; 33:12. [PMID: 33832540 PMCID: PMC8034066 DOI: 10.1186/s43019-021-00095-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background The posterior tibial slope (PTS) is crucial in knee joint stability and in maintaining the natural movement of the knee. An increase in the PTS is associated with various knee pathologic conditions, such as anterior cruciate ligament (ACL) injury and anterior tibial translation (ATT). In the present study, we aimed to establish native medial and lateral PTS values for adult Saudis and to identify any association between PTS and gender, age, and body mass index (BMI). Materials and methods A total of 285 consecutive, normal, magnetic resonance imaging (MRI) studies of the knee were included in the study. The PTS was measured using the proximal anatomical axis of the tibia. The Kruskal-Wallis test was used to compare the medial and lateral PTS angles between age groups. The difference between the medial and lateral posterior tibial slopes was assessed using the Wilcoxon signed-rank test. The Mann-Whitney U test was performed to compare the medial and lateral PTS angles between men and women. Age, gender, and BMI were analyzed by multivariate linear regression to determine whether they positively predict the medial and lateral PTS angles. Results The mean physiological medial PTS was 5.86 ± 3.0° and 6.61 ± 3.32°, and the lateral PTS was 4.41 ± 3.35° and 4.63 ± 2.85° in men and women, respectively. This difference showed no statistically significant gender dimorphism (p > 0.05). The medial PTS was significantly larger than the lateral PTS (p < 0.0001). There was no statistically significant difference in the medial and lateral PTS angles between age groups (p > 0.05). Higher BMI was significantly associated with a steeper medial PTS (p = 0.001). Conclusions This study provided native values for medial and lateral PTS angles in Saudis, which can assist surgeons in maintaining normal knee PTS during surgery. The PTS was not influenced by age. The medial PTS was significantly larger than the lateral PTS in men and women. The PTS showed no significant gender dimorphism. BMI was significantly associated with the medial PTS.
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Affiliation(s)
- Wazzan S Aljuhani
- Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salman S Qasim
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Abdullah Alrasheed
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jumanah Altwalah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Radiology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed J Alsalman
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Radiology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
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14
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Maijanen H, Junno JA, Keisu A, Niinimäki J, Lehenkari P, Oura P. Sex estimation from knee breadth dimensions in a Finnish population. Leg Med (Tokyo) 2021; 51:101873. [PMID: 33823332 DOI: 10.1016/j.legalmed.2021.101873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Sex estimation is an important part of osteological analysis of skeletons and forensic identification process. Traditionally cranial and pelvic traits are utilized for accurate sex estimation. However, post-cranial measurements have also been proven to accurately estimate sex especially from robust bones such as the femur. In this study, we investigated the potential of knee breadth dimensions in sex estimation in a Finnish population. To conduct this study we utilized a study sample (n = 1654) belonging to the Northern Finland Birth Cohort 1966. All individuals were 46 years of age at the time of the examination. Three knee breadth dimensions were measured from subjects' knee posteroanterior radiographs: femoral biepicondylar breadth (FBEB), mediolateral breadth of the femoral condyles (FCML), and mediolateral breadth of the tibial plateau (TPML). Sex estimation was performed using logistic regression. The study clearly demonstrated that all three measurements were different between males and females. Sectioning points for individual knee breadth measurements were 82.9 mm for FBEB, 76.6 mm for FCML and 75.4 mm for TPML. The classification rates ranged from 90.9% to 93.6%. The less commonly used measurements of FCML and TPML showed higher accuracy than FBEB in sex estimation. Our study confirmed that knee breadths can be successfully utilized to improve sex estimation in cases where the skeleton is only partially preserved and other major components of sex estimation are absent. We can also provide new standards for sex estimation from the knee joint in a Finnish population.
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Affiliation(s)
- Heli Maijanen
- Faculty of Humanities, Department of Archaeology, University of Oulu, Oulu, Finland.
| | - Juho-Antti Junno
- Faculty of Humanities, Department of Archaeology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Faculty of Medicine, Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Asla Keisu
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Faculty of Medicine, Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Jaakko Niinimäki
- Faculty of Medicine, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Petri Lehenkari
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Faculty of Medicine, Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
| | - Petteri Oura
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Forensic Medicine, University of Helsinki, Helsinki, Finland; Forensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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15
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The posterior horn of the medial and lateral meniscus both reduce the effective posterior tibial slope: a radiographic MRI study. Surg Radiol Anat 2021; 43:1123-1130. [PMID: 33559716 DOI: 10.1007/s00276-021-02696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to quantify the posterior horn meniscal slope and determine its contribution to the reduction in posterior tibial slope. METHODS Patients aged between 16 and 60 years and had intact menisci with no evidence of previous injury or surgery were included. Patients with radiological evidence of osteoarthritis Grade II-IV, any acute or chronic meniscus injuries, fractures, and ligamentous injuries were excluded. The posterior bony slope (PTS) and the meniscus slope (MS) of the posterior horns were measured at 25, 50, and 75% from the medial and lateral borders of the tibial plateau. RESULTS 325 MR images (mean age 37.1 ± 10.9 years) were included. There were 194 males and 131 females, with 162 left and 163 right knees. The PTS in the medial compartment ranged from (-) 2.8° to 3.7° and from (-) 1.3° to 1.9° in the lateral compartment (p = 0.0001). The MS in the medial compartment ranged from 27.4° to 28.2°, and from 27.8° to 28.7° in the lateral compartment (p > 0.05). The differences between the medial and lateral knee compartment were statistically significant. At the 25% interval the p level was 0.037, at 50% p = 0.00001, and at 75% p = 0.0001. There were no significant between gender differences. CONCLUSIONS The results of this study demonstrated a significant reduction in posterior tibial bone slope by the posterior horns of both the medial and lateral meniscus, from a mean of (-) 1° to 2° to a more horizontal anterior slope. The posterior bone slope was larger in the medial compartment by 1°, resulting in a smaller slope reduction in the lateral compartment.
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16
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Nam JH, Koh YG, Kim PS, Park JH, Kang KT. Effect of the presence of the articular cartilage on the femoral component rotation in total knee arthroplasty in female and varus osteoarthritis knees. J Orthop Surg Res 2020; 15:499. [PMID: 33121532 PMCID: PMC7597046 DOI: 10.1186/s13018-020-02030-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Surgical techniques for total knee arthroplasty (TKA) require femoral rotational corrections that alter the position of the surface of the posterior femoral joint especially in kinematic alignment. However, preoperative planning of TKA based on computed tomography (CT), without knowing the femoral cartilage thickness, may cause post-surgery failures in femoral rotation. Therefore, this study aimed to evaluate the effects of posterior condyle cartilage thickness on rotational alignment in the femoral component. Methods Three-dimensional magnetic resonance imaging (MRI) scans were obtained for 139 male and 531 female osteoarthritis patients. The angles defined by the femoral posterior condylar axis (PCA) and the surgical transepicondylar axis (TEA) were evaluated with respect to the presence of cartilage. Additionally, these effects were evaluated with respect to patient gender and varus/valgus condition. Results In all patients, the angle between the TEA and PCA was significantly greater in the presence of cartilage than in the absence of cartilage. This result was also seen in female patients. However, there was no difference in the TEA/PCA angle in male patients based on the presence of cartilage. The TEA/PCA angle was significantly greater in the presence of cartilage than in the absence of cartilage in the female varus group. However, there were no differences in the TEA/PCA angle based on the presence of cartilage in the male varus/valgus and female valgus groups. Cartilage thickness in the posterior femoral condyle was significantly greater on the lateral side than on the medial side in all and male patients. However, there was no difference between the genders regarding cartilage thickness. Conclusion Surgical planning for TKA based on CT does not consider articular cartilage and could lead to external malrotation of the femoral implant. Therefore, the effect of the remaining posterior condylar cartilage should be considered by surgeons to prevent over-rotation of the femoral component, especially in female varus knees.
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Affiliation(s)
- Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Paul Shinil Kim
- Department of Orthopaedic Surgery, The Bone Hospital, 67, Dongjak-daero, Dongjak-gu, Seoul, Republic of Korea
| | - Joon-Hee Park
- Department of Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, Republic of Korea.
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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17
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Hiranaka T, Tanaka T, Fujishiro T, Anjiki K, Nagata N, Kitazawa D, Kotoura K, Okamoto K. The tibial lateral axis is a novel extraarticular landmark for detection of the tibial anteroposterior axis. Surg Radiol Anat 2020; 42:1195-1202. [PMID: 32514589 DOI: 10.1007/s00276-020-02513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/02/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Although the tibial rotation axis is significant in knee arthroplasty, no reliable extraarticular landmark has been proposed. We hypothesized that the tibial lateral axis (TLA), a tangential line of the lateral tibial surface, is perpendicular to the surgical epicondylar axis (SEA) and compared it to other existing landmarks by 3D-CT. METHODS Fifty legs in 25 consecutive patients were studied. Using their preoperative CT, the TLAs were identified on slices at 10-50% of the total length of the tibia and the measured differences of angles against the line perpendicular to the SEA (the tibial AP axis) were calculated. The differences between the SEA and the femoral and tibial posterior condylar axis, Akagi's line and the line between the medial intercondylar spine and the medial border of the patellar tendon (sAP line)(intraarticular), the ankle axis, and the transmalleolar axis (extraarticular) were also calculated and compared. RESULTS The mean values of TLA at 10%, 20%, 30% were virtually parallel to the SEA (0.97° ± 4.84°, 0.02° ± 4.61°, 1.10° ± 4.97°, respectively). They were equivalent to existing intraarticular landmarks and superior to existing extraarticular landmarks, and these levels corresponded to the tip to the lower end of the tibial tubercle (at 10.8% and 17.0% of total tibial length). CONCLUSION The proximal TLAs can be an extraarticular bony landmark that indicates the line perpendicular to the SEA. A prospective study is needed to prove the validity and accuracy of the axes clinically.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan.
| | - Toshikazu Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Kensuke Anjiki
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Naosuke Nagata
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Daiya Kitazawa
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Ken Kotoura
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki City, Osaka, 561-1115, Japan
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Nam JH, Koh YG, Kim PS, Kang K, Kang KT. The femoral trochlear anterior line is a better alternative intra-operative reference compared to femoral anterior tangent line for femoral rotation in both genders in total knee arthroplasty. J Exp Orthop 2020; 7:43. [PMID: 32514814 PMCID: PMC7280378 DOI: 10.1186/s40634-020-00259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the most reliable reference axis for the femoral component rotation in TKA patients by comparing the trochlear anterior line (TAL) and the femoral anterior tangent line (FAT). To evaluate the variability of each anatomic parameter in a Korean population. Methods Magnetic resonance images (MRIs) were taken for 500 patients (400 females and 100 males) with knee joint osteoarthritis who had Kellgren and Lawrence grade 3 and 4 prior to TKA in our institution between February 2016 and September 2017. It was investigated that whether significant differences in variance and gender exist for TAL and FAT. Results TAL and the FAT were internally rotated by 5.1° ± 3.1° and 6.8° ± 6.1°, respectively, about the Transepicondylar axis (TEA). Although no gender-related differences were found for the TAL, they were found for the FAT. The variance of the TAL with respect to the TEA was significantly smaller compared with that for the FAT and thus exhibited a more consistent distribution. In addition, such a trend was found for both genders. Conclusions The results show that the TAL is a favorable index for appropriate rotational alignment of the femoral component in TKA.
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Affiliation(s)
- Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Paul Shinil Kim
- Department of Orthopaedic Surgery, The bone hospital, 67, Dongjak-daero, Dongjak-gu, Seoul, Republic of Korea
| | - Kiwon Kang
- Orthopaedic Clinic, Gaja Yonsei Hospital, A-304,7, Janggogae-ro 337 beon-gil, Seo-gu, Incheon, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Kacmaz IE, Topkaya Y, Basa CD, Zhamilov V, Er A, Reisoglu A, Ekizoglu O. Posterior tibial slope of the knee measured on X-rays in a Turkish population. Surg Radiol Anat 2020; 42:673-679. [PMID: 32052159 DOI: 10.1007/s00276-020-02430-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Posterior tibial inclination of the knee joint should be considered during anterior cruciate ligament reconstruction and total knee replacement surgery. This inclination is called the posterior tibial slope (PTS) angle. The PTS differs among populations and the aim of this study was to determine the mean PTS in a Turkish population. METHODS PTS was measured retrospectively on lateral knee X-rays (n = 1024). The angle between the line connecting the anterior and posterior points of the lateral tibial plateau and the tibial longitudinal axis was taken as the PTS angle. Intra- and inter-observer agreement regarding the measurements on 20 X-rays were checked. RESULTS The mean PTS angle for the entire cohort was 8.36 ± 3.3° (range: 2.1-18.7°); it was 8.57 ± 3.4° (range: 2.3-17.4°) in men and 8.16 ± 3.2° (range: 2.1-18.7°) in women. Although no significant correlation was detected between PTS and age, PTS was higher in men than in women. CONCLUSION The increasing number of total knee replacement surgeries has increased the need for studies on implant mismatch. In this study, reference PTS values were determined for a Turkish population. It may be beneficial to use patient-specific implants in some cases.
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Affiliation(s)
- Ismail Eralp Kacmaz
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, 35180, Izmir, Turkey.
| | - Yuksel Topkaya
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, 35180, Izmir, Turkey
| | - Can Doruk Basa
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, 35180, Izmir, Turkey
| | - Vadym Zhamilov
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, 35180, Izmir, Turkey
| | - Ali Er
- Department of Radiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Reisoglu
- Department of Orthopaedics and Traumatology, Tepecik Training and Research Hospital, 35180, Izmir, Turkey
| | - Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Izmir, Turkey
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20
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Koh YG, Nam JH, Chung HS, Kang KT. Difference in coronal curvature of the medial and lateral femoral condyle morphology by gender in implant design for total knee arthroplasty. Surg Radiol Anat 2019; 42:649-655. [PMID: 31686131 DOI: 10.1007/s00276-019-02368-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate the morphometric data obtained from the three-dimensional magnetic resonance images of ethnic Korean knee osteoarthritis, and to evaluate the morphological differences between the coronal curvature of the female and male femoral condyles. METHODS The differences in coronal curvature of the femoral condyle morphology of 1990 patients (1689 females and 301 males) were evaluated in three dimensions. A close-fit diameter was, respectively, generated on the medial and lateral femoral condyle articular surfaces, and these diameters reflect the coronal diameter of the femoral condyle curvature. These measurements were compared with those of the femoral design of five different commonly used total knee arthroplasty (TKA) implant designs. RESULTS The average diameter of the curvature of the medial condyles was significantly larger than that of the lateral condyles (P < 0.05). This trend was found in the male and female groups. In addition, the average diameter of the curvature of the femoral condyles was found to significantly differ between males and females (P < 0.05). For four TKA implant designs, the average diameter of the coronal curvature of femoral condyle was smaller than that obtained via our measurements, whereas one TKA implant design yielded a smaller average diameter. Furthermore, the medial and lateral coronal curvatures of the femoral condyle were symmetric in all TKA implant designs. CONCLUSION The study provided a reliable and consistent evaluation of the coronal curvature of femoral condyles in the Korean population. These results showed that a gender-specific or asymmetric femoral component design is required to regenerate the coronal curvature of the femoral condyles for ethnically Korean males and females.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun-Seok Chung
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Kızılgöz V, Sivrioğlu AK, Aydın H, Ulusoy GR, Çetin T, Tuncer K. The Combined Effect of Body Mass Index and Tibial Slope Angles on Anterior Cruciate Ligament Injury Risk in Male Knees: A Case-Control Study. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119867922. [PMID: 31427857 PMCID: PMC6681250 DOI: 10.1177/1179544119867922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Tibial slope angles (TSAs) have been identified as potential risk factors of
anterior cruciate ligament (ACL) injury in the literature. A higher body
mass index (BMI) might increase the risk of ACL tear because of greater
axial compressive force. The aim of this study was to determine the
relationship of these factors and the combined effect of BMI and TSA in
determination of risk potential for ACL injury. Methods: The preoperative magnetic resonance (MR) images of 81 ACL-injured male knees
and of 68 male individuals with no ACL injuries were evaluated by 2
radiologists to measure the TSA. The Mann-Whitney U-test
was performed to indicate the significant difference in height, weight, and
BMI values. The independent samples t-test was used to
determine the differences between ACL-injured and non-injured groups
regarding TSA values. Odds ratios were calculated by logistic regression
tests, and receiver operating characteristics (ROC) curves revealed the area
under the receiver operating characteristics curve (AUC) values to compare
the relationships of these parameters with ACL injury. Results: Body mass index, lateral tibial slope (LTS), and medial tibial slope (MTS)
were predictive of ACL risk injury. Body mass index alone had the greatest
effect among these parameters, and there were no statistically significant
differences in coronal tibial slope values between the ACL-ruptured and
control groups. The greatest AUC was observed for the combination of BMI,
MTS, and LTS. Conclusions: Body mass index, LTS, and MTS angles were associated with ACL injury risk and
BMI + MTS + LTS together revealed the greatest effect on ACL injury.
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Affiliation(s)
- Volkan Kızılgöz
- Department of Radiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Ali Kemal Sivrioğlu
- Department of Radiology, Faculty of Medicine, Kocaeli University, Izmit, Turkey
| | - Hasan Aydın
- Department of Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gökhan Ragıp Ulusoy
- Department of Orthopaedics, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Türkhun Çetin
- Department of Radiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Kutsi Tuncer
- Department of Orthopaedics, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Misir A, Yildiz KI, Kizkapan TB. Wider femoral and mediolaterally narrower tibial components are required for total knee arthroplasty in Turkish patients. Knee Surg Sports Traumatol Arthrosc 2019; 27:2155-2166. [PMID: 30824980 DOI: 10.1007/s00167-019-05448-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the knee morphologic parameters in the Turkish population, compare them with known data, and identify new morphologic parameters. METHODS Magnetic resonance (MR) images of 1000 healthy subjects aged 18-50 years were included. One orthopedic surgeon and one experienced musculoskeletal radiologist reviewed MR images and measured 22 morphologic parameters. Sex and side differences were evaluated. Correlations between age and measurement parameters were assessed. The measured parameters were compared with known data. Femoral and tibial condylar height differences were identified. RESULTS A strong correlation was found among regarding all measurement parameters (p = 0.000 and k > 0.985 for all measurements) by both observers. A significant difference between the female and male subjects regarding the measurement parameters (p = 0.000) was found, except for the tibial coronal slope, posterior condylar angle (PCA), medial and lateral tibial slopes (MTS and LTS), and medial plateau depth. No measurement parameter was significantly correlated with age (n.s.). The femur surface ratio in male and female subjects was 1.29 ± 1.04 and 1.28 ± 1.12, respectively (n.s.). The tibial plateau aspect ratio was 61.4 ± 1.09 in males and 59.8 ± 1.57 in females (p = 0.004). The mean medial and lateral femoral condylar cartilage and bone height differences were 3.3 ± 1.1 and 3.1 ± 0.9 mm, respectively. The mean medial and lateral tibial condylar cartilage and bone height differences were 2.3 ± 0.3 and 1.6 ± 0.1 mm, respectively. CONCLUSION Compared to current designs, wider femoral and mediolaterally narrower tibial components are needed to provide well-fitting prosthesis and improve functional outcomes, especially in women. The data on femoral and tibial condylar height differences will be useful for future research on component design. In the clinical practice, the components developed based on these findings will have a substantial effect on postoperative outcomes and patient satisfaction. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Abdulhamit Misir
- Şanlıurfa Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Bölümü, Akpıyar mah. 4061. Sk. Yaşamkent Park evleri no:29 B blok d:21, Karaköprü, Şanlıurfa, Turkey.
| | - Kadir Ilker Yildiz
- Metin Sabancı Baltalimanı Kemik Hastalıkları Eğitim ve Araştırma Hastanesi, Istanbul, Turkey
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Koh YG, Nam JH, Chung HS, Kim HJ, Chun HJ, Kang KT. Gender differences in morphology exist in posterior condylar offsets of the knee in Korean population. Knee Surg Sports Traumatol Arthrosc 2019; 27:1628-1634. [PMID: 30374575 DOI: 10.1007/s00167-018-5259-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This study aimed to analyze the morphometric data from magnetic resonance images of arthritic knees in Korean adults, and to identify the existence of morphological differences of femoral posterior condylar offset (PCO) between genders. METHODS The differences in anthropometric PCO data in 975 patients (825 female and 150 male) were evaluated. The distances from the anterior and posterior femoral shaft cortex line to the most posterior femoral condyle tangent line were defined as the anterior-posterior dimension (AP) and the PCO. The PCO ratio (PCOR) was calculated as PCO/AP. RESULTS The medial PCO was greater than the lateral PCO (26.3 ± 2.2 vs. 24.3 ± 2.3 mm, p < 0.01). This difference was observed in both female patients (medial: 26.2 ± 2.2 mm vs. lateral: 24.2 ± 2.2 mm, p < 0.01) and male patients (medial: 26.8 ± 2.3 mm vs. lateral: 24.8 ± 2.4 mm, p < 0.01). The medial and lateral PCO values were also greater in male patients than in female ones (p < 0.01). In contrast, PCOR was greater in female patients than in male ones, both in the medial and lateral femoral condyles (p < 0.01). CONCLUSIONS It was shown that medial and lateral PCO and PCOR were asymmetric, and that there was gender difference in Korean population in our study. In addition, our data showed that the PCOR of contemporary TKAs may be small for Asian patients that may not be sufficient to meet the needs of the Korean patient population. These results confirm that a gender-specific femoral component design is necessary to recreate the PCO for male and female Asian populations. LEVEL OF EVIDENCE Non-consecutive patients, Level III.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun-Seok Chung
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Ho-Joong Kim
- Spine Center, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Heoung-Jae Chun
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Anthropometric Measurements of Knee Joints in the Hispanic Population. J Arthroplasty 2018; 33:2640-2646. [PMID: 29691176 DOI: 10.1016/j.arth.2018.03.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) systems provide a set of incrementally sized tibial and femoral components intended to accommodate most knee parameters. However, the most commonly used systems in the United States were developed using data from Caucasian patients which might not lead to the best fit in non-Caucasians. Therefore, we wanted to evaluate whether these TKA systems proportionally match femoral and tibial measurements in Hispanics. METHODS All lower extremity magnetic resonance imaging performed at our institution between January 2007 and October 2015 were screened. A total of 500 nonarthritic knees from the same number of Hispanic patients were included in this retrospective descriptive radiographic study. Intraoperative osseous TKA resections were simulated on magnetic resonance imaging. Linear regression analyses were used to contrast the mediolateral (ML) width/anteroposterior (AP) length of simulated resected femoral condyle and tibia with the ML/AP dimensions of components offered by 4 current TKA systems. RESULTS Simulated resected male femurs tended to be wider than most TKA system components for a given AP size, probably leading to component ML underhang. Altogether, systems studied accommodated most AP and ML measurements of female condyles. However, we identified subsets of Hispanic female patients with certain AP lengths and/or ML widths that particular knee systems could not accommodate. Resected male and female tibias tended to be slightly narrower than all TKA systems for a given AP size. CONCLUSION The results of our study provide valuable data concerning the unique morphology of the Hispanic knee. These data can assist surgeons in the selection of the most suitable TKA systems for these patients.
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Li K, Cavaignac E, Xu W, Cheng Q, Telmon N, Huang W. Morphometric evaluation of the knee in Chinese population reveals sexual dimorphism and age-related differences. INTERNATIONAL ORTHOPAEDICS 2018; 42:2349-2356. [PMID: 29464370 DOI: 10.1007/s00264-018-3826-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/31/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE Morphologic data of the knee is very important in the design of total knee prostheses. Generally, the designs of the total knee prostheses are based on the knee anatomy of Caucasian population. Moreover, in forensic medicine, a person's age and sex might be estimated by the shape of their knees. The aim of this study is to utilize three-dimensional morphometric analysis of the knee in Chinese population to reveal sexual dimorphism and age-related differences. MATERIALS AND METHODS Sexually dimorphic differences and age-related differences of the distal femur were studied by using geometric morphometric analysis of ten osteometric landmarks on three-dimensional reconstructions of 259 knees in Chinese population. General Procrustes analysis, PCA, and other discriminant analysis such as Mahalanobis and Goodall's F test were conducted for the knee to identify sexually dimorphism and age-related differences of the knee. RESULTS The shape of distal femur between the male and female is significantly different. A difference between males and females in distal femur shape was identified by PCA; PC1 and PC2 accounted for 61.63% of the variance measured. The correct sex was assigned in 84.9% of cases by CVA, and the cross-validation revealed a 81.1% rate of correct sex estimation. The osteometric analysis also showed significant differences between the three age-related subgroups (< 40, 40-60, > 60 years, p < 0.005). CONCLUSION This study showed both sex-related difference and age-related difference in the distal femur in Chinese population by 3D geometric morphometric analysis. Our bone measurements and geometric morphometric analysis suggest that population characteristics should be taken into account and may provide references for design of total knee prostheses in a Chinese population. Moreover, this reliable, accurate method could be used to perform diachronic and interethnic comparisons.
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Affiliation(s)
- Ke Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Etienne Cavaignac
- Institut de l'appareil locomoteur, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse, France.,Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, 37 allée Jules Guesdes, 31000, Toulouse, France
| | - Wei Xu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Cheng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nobert Telmon
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, 37 allée Jules Guesdes, 31000, Toulouse, France
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Cavaignac E, Savall F, Chantalat E, Faruch M, Reina N, Chiron P, Telmon N. Geometric morphometric analysis reveals age-related differences in the distal femur of Europeans. J Exp Orthop 2017; 4:21. [PMID: 28608283 PMCID: PMC5468359 DOI: 10.1186/s40634-017-0095-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background Few studies have looked into age-related variations in femur shape. We hypothesized that three-dimensional (3D) geometric morphometric analysis of the distal femur would reveal age-related differences. The purpose of this study was to show that differences in distal femur shape related to age could be identified, visualized, and quantified using three-dimensional (3D) geometric morphometric analysis. Methods Geometric morphometric analysis was carried out on CT scans of the distal femur of 256 subjects living in the south of France. Ten landmarks were defined on 3D reconstructions of the distal femur. Both traditional metric and geometric morphometric analyses were carried out on these bone reconstructions. These analyses were used to identify trends in bone shape in various age-based subgroups (<40, 40–60, >60). Results Only the average bone shape of the < 40-year subgroup was statistically different from that of the other two groups. When the population was divided into two subgroups using 40 years of age as a threshold, the subject's age was correctly assigned 80% of the time. Discussion Age-related differences are present in this bone segment. This reliable, accurate method could be used for virtual autopsy and to perform diachronic and interethnic comparisons. Moreover, this study provides updated morphometric data for a modern population in the south of France. Conclusion Manufacturers of knee replacement implants will have to adapt their prosthesis models as the population evolves over time.
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Affiliation(s)
- Etienne Cavaignac
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, 37 allée Jules Guesde, 31000, Toulouse, France. .,Institut de l'appareil locomoteur, Hôpital Pierre-Paul Riquet, CHU Toulouse, France.
| | - Frederic Savall
- Institut de l'appareil locomoteur, Hôpital Pierre-Paul Riquet, CHU Toulouse, France
| | - Elodie Chantalat
- Laboratoire d'anatomie, Université Paul Sabatier, Toulouse, France
| | - Marie Faruch
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, 37 allée Jules Guesde, 31000, Toulouse, France.,Institut de l'appareil locomoteur, Hôpital Pierre-Paul Riquet, CHU Toulouse, France
| | - Nicolas Reina
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, 37 allée Jules Guesde, 31000, Toulouse, France.,Institut de l'appareil locomoteur, Hôpital Pierre-Paul Riquet, CHU Toulouse, France
| | - Philippe Chiron
- Institut de l'appareil locomoteur, Hôpital Pierre-Paul Riquet, CHU Toulouse, France
| | - Norbert Telmon
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, 37 allée Jules Guesde, 31000, Toulouse, France
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Loures FB, Carrara RJ, Góes RFDA, Albuquerque RSPE, Barretto JM, Kinder A, Gameiro VS, Marchiori E. Anthropometric study of the knee in patients with osteoarthritis: intraoperative measurement versus magnetic resonance imaging. Radiol Bras 2017; 50:170-175. [PMID: 28670028 PMCID: PMC5487231 DOI: 10.1590/0100-3984.2016.0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective: To compare intraoperative measurements of the knee with those obtained by
magnetic resonance imaging, in order to validate the latter method for use
in anthropometric studies. Materials and Methods: We studied 20 knees in 20 patients with osteoarthritis, all of whom underwent
total arthroplasty between August and December of 2013. We took six
measurements in the distal femur and two in the proximal tibia. Using the
information system of the institution, we made the measurements on magnetic
resonance imaging scans that had been obtained in the axial plane.
Intraoperative measurements were obtained using a caliper, after the initial
cuts made during the arthroplasty. The anatomical parameters determined by
magnetic resonance imaging were the same as those determined by
intraoperative measurement. The intraclass correlation coefficient was used
in order to assess the level of agreement in anthropometric measurements of
the knee performed by magnetic resonance imaging and by intraoperative
measurement. Results: Statistical analysis revealed a highly significant correlation between the
knee anthropometric parameters of the knee determined by intraoperative
measurement and those determined by magnetic resonance imaging. Conclusion: The dimensions of osteoarthritic knees measured by magnetic resonance imaging
were similar to those measured intraoperatively. Therefore, magnetic
resonance imaging can be considered a reliable method for use in large-scale
anthropometric studies that will allow the available implants to be adapted
and improved.
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Affiliation(s)
| | - Renato Janetti Carrara
- Member of the Brazilian Society of Orthopedics and Traumatology; MD, Intern in Knee Surgery at Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Rogério Franco de Araújo Góes
- Member of the Brazilian Society of Knee Surgery; Head of the Professor Donato D'Ângelo Department of Orthopedics and Traumatology, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | | | - João Maurício Barretto
- PhD, Member of the Center for Knee Surgery at the Instituto Nacional de Traumatología e Ortopedia, Rio de Janeiro, RJ, Brazil
| | - André Kinder
- MSc, MD, Radiologist at the Clínica Multimagem, Petrópolis, RJ, Brazil
| | | | - Edson Marchiori
- PhD, Full Professor at the Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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