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Yang B, Yuan FZ, Wang HJ, Gong X, Chang YH, Yu JK. Femoral anterior condyle height decreases as the distal anteroposterior size increases in total knee arthroplasty: A comparative study. PLoS One 2024; 19:e0297634. [PMID: 38408088 PMCID: PMC10896507 DOI: 10.1371/journal.pone.0297634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
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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Affiliation(s)
- Bo Yang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, The Third Affiliated hospital of Xi'an jiaotong University, Xi'an, China
| | - Fu-Zhen Yuan
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Hai-Jun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xi Gong
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Yan-Hai Chang
- Department of Orthopaedics, Shaanxi Provincial People's Hospital, The Third Affiliated hospital of Xi'an jiaotong University, Xi'an, China
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Changping District, Beijing, China
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Liu Z, Zhou A, Fauveau V, Lee J, Marcadis P, Fayad ZA, Chan JJ, Gladstone J, Mei X, Huang M. Deep Learning for Automated Measurement of Patellofemoral Anatomic Landmarks. Bioengineering (Basel) 2023; 10:815. [PMID: 37508842 PMCID: PMC10376187 DOI: 10.3390/bioengineering10070815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Patellofemoral anatomy has not been well characterized. Applying deep learning to automatically measure knee anatomy can provide a better understanding of anatomy, which can be a key factor in improving outcomes. METHODS 483 total patients with knee CT imaging (April 2017-May 2022) from 6 centers were selected from a cohort scheduled for knee arthroplasty and a cohort with healthy knee anatomy. A total of 7 patellofemoral landmarks were annotated on 14,652 images and approved by a senior musculoskeletal radiologist. A two-stage deep learning model was trained to predict landmark coordinates using a modified ResNet50 architecture initialized with self-supervised learning pretrained weights on RadImageNet. Landmark predictions were evaluated with mean absolute error, and derived patellofemoral measurements were analyzed with Bland-Altman plots. Statistical significance of measurements was assessed by paired t-tests. RESULTS Mean absolute error between predicted and ground truth landmark coordinates was 0.20/0.26 cm in the healthy/arthroplasty cohort. Four knee parameters were calculated, including transepicondylar axis length, transepicondylar-posterior femur axis angle, trochlear medial asymmetry, and sulcus angle. There were no statistically significant parameter differences (p > 0.05) between predicted and ground truth measurements in both cohorts, except for the healthy cohort sulcus angle. CONCLUSION Our model accurately identifies key trochlear landmarks with ~0.20-0.26 cm accuracy and produces human-comparable measurements on both healthy and pathological knees. This work represents the first deep learning regression model for automated patellofemoral annotation trained on both physiologic and pathologic CT imaging at this scale. This novel model can enhance our ability to analyze the anatomy of the patellofemoral compartment at scale.
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Affiliation(s)
- Zelong Liu
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexander Zhou
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Valentin Fauveau
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Justine Lee
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Philip Marcadis
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Zahi A. Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jimmy J. Chan
- Department of Orthopedics and Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - James Gladstone
- Department of Orthopedics and Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Xueyan Mei
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mingqian Huang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Li C, Ye Y, He S, Xu D, He P. High femoral anteversion in osteoarthritic knees, particularly for severe valgus deformity. J Orthop Traumatol 2022; 23:38. [PMID: 35972661 PMCID: PMC9381675 DOI: 10.1186/s10195-022-00653-8] [Citation(s) in RCA: 3] [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: 02/14/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Increased femoral anteversion (FA) has been correlated with less varus deformities in osteoarthritic (OA) knees, but the relationship between FA and the degree of valgus deformity in osteoarthritic (OA) knees is still largely unknown. We aimed to thoroughly analyze the distribution of FA in relation to varus or valgus deformities of the lower extremity in OA knees, and to further clarify the relationship between FA and trochlear morphology. Methods 235 lower extremities with OA knees were divided into five groups according to the mechanical tibiofemoral angle: excessive valgus (< − 10°), moderate valgus (− 10° to − 3°), neutral (− 3° to 3°), moderate varus (3° to 10°), and excessive varus (> 10°). FA (measured using the posterior condylar axis [pFA] and the transepicondylar axis [tFA]) was measured, and the relationships of FA to the mechanical tibiofemoral angle and femoral trochlear morphology were identified. Results Excessive FA (pFA ≥ 20°) was observed in 30.2% of all patients and in 58.8% of patients in the excessive valgus group. pFA showed a strong correlation with mechanical tibiofemoral angle (p = 0.018). Both the pFA and the tFA of patients in the excessive valgus group were greater than those in other four groups (all p ≤ 0.037). There were significant correlations between tFA and trochlear parameters, including the sulcus angle (SA), lateral trochlear slope (LTS), and medial trochlear slope (MTS) (all p ≤ 0.028). Conclusion High FA is prevalent, particularly in severe valgus knees, and FA is significantly related to the femoral trochlear morphology in OA knees. With the aim of improving the patellofemoral prognosis and complications, high FA should be considered during total knee arthroplasty.
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Affiliation(s)
- Changzhao Li
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Yongheng Ye
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Suiwen He
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Dongliang Xu
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
| | - Peiheng He
- Department of Joint Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China.
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Wang JH, Weinberg DS, Amakoutou K, Cooperman DR, Liu RW. The distal femur trochlear groove appears to compensate for tibial deformity but not femoral deformity in an investigation of five-hundred and seventy-nine cadaveric skeletons. Arch Orthop Trauma Surg 2022; 142:1221-1227. [PMID: 34143261 DOI: 10.1007/s00402-021-03998-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/12/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The etiology of patellofemoral disorders is multifactorial. Preoperative patellofemoral anatomy evaluation is of great importance in patients undergoing surgery for patellofemoral disorders. Although anatomical risk factors of patellofemoral disorders have been thoroughly investigated in clinical and radiological studies, there are sparse data regarding the association between trochlear dysplasia with other anatomical parameters. This study sought to explore those associations using a large osteological collection. METHODS Five-hundred and seventy-nine cadaveric skeletons were obtained from the Hamann-Todd osteological collection. Mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), femoral version, tibial torsion, lateral position of the tibial tubercle, and femoral length were modeled as predictors of medial and lateral flange height of the distal femur trochlea at various degrees of knee flexion. RESULTS The average age and standard deviation for the 1158 lower extremities analyzed was 55.9 ± 10.2 years. There were 500 males (86%) and 79 females. Increasing MPTA or tibial valgus predicted increasing lateral femoral flange height at 0, 30, and 50 degrees of knee flexion [(standardized beta 0.111, p = 0.01), (standardized beta 0.129, p < 0.001), and (standardized beta 0.186, p < 0.001), respectively]. Increasing internal tibial torsion predicted increased medial flange height at 30 and 50° [(standardized beta - 0.114, p = 0.006), (standardized beta - 0.108, p = 0.006), respectively]. Increased femoral retroversion predicted increasing lateral flange height at 0 and 30 degrees [(standardized beta - 0.105, p = 0.005), (standardized beta - 0.098, p = 0.004), respectively]. CONCLUSIONS To maintain the equilibrium necessary for effective patellar tracking, the depth of trochlear groove appears to effectively compensate for some of the anatomical parameters of the proximal tibia associated with patellofemoral disorders, and appears to be less influenced by femoral alignment. The clinical relevance of these findings warrants further investigation, and emphasizes the importance of carefully assessing the lower limb alignment in the management of patellofemoral disorders.
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Affiliation(s)
- Joanne H Wang
- Department of Orthopedic Surgery, Resident Physician, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Douglas S Weinberg
- Department of Orthopedic Surgery, Resident Physician, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Kouami Amakoutou
- Research Fellow in Pediatric Orthopaedic Surgery, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Daniel R Cooperman
- Department of Orthopedic Surgery, Professor of Pediatric Orthopedics, Yale-New Haven Children's Hospital, 1 Park Street, New Haven, CT, 06504, USA
| | - Raymond W Liu
- Department of Orthopedic Surgery, Victor M. Goldberg Professor in Orthopedic Surgery, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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A Study of Surgical Accuracy with X-Ray-Based Patient-Specific Instrument (X3DPSI ®) vs Conventional Instrument in Total Knee Arthroplasty Surgeries. Indian J Orthop 2022; 56:1240-1250. [PMID: 35813546 PMCID: PMC9232679 DOI: 10.1007/s43465-022-00623-6] [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: 10/15/2021] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Patient-specific instruments (PSI) have been shown to be a good solution in getting accurate bone cuts in total knee arthroplasty (TKA) in many studies. However, the need for an extra CT/MRI makes the existing PSI method costly and unsafe. X-ray-based PSI can solve these problems, if proven to be accurate. The purpose of this study was to introduce a novel method to measure the performance of X-ray to 3D-based PSI (X3DPSI ® ) in achieving planned bone cuts by comparing with conventional instruments (CI). MATERIALS AND METHODS This was a prospective study of a total of ten patients undergoing TKA surgery. Preoperative full length lower limb scanogram was done with specialized calibration strap-on marker to develop X3DPSI ® which was used intraoperatively for the placement of guiding pins for the cutting jig. Similarly, intraoperative guide pins were placed using CI also. Calibrated intraoperative X-ray images, in AP and LAT view, were taken while the cutting-block guiding pins were placed on the distal femur and proximal tibia. These X-ray images were used to calculate the cutting plane alignments for femur and tibia and to simulate the postoperative hip-knee-ankle (HKA) angle and MAD (mechanical axis deviation), in a virtual Tabplan3D environment for both the methods. RESULTS The results showed that there was a significant difference between the two methods in terms of femoral cutting plane angles and in terms of the HKA angles and MAD. There was no significant difference in the tibial cutting plane angles in the coronal plane. CONCLUSION The mechanical axis alignment achieved based on the virtual cuts made using the X3DPSI ® was significantly better than the alignment achieved based on the cuts made using the CI, in terms of both HKA and MAD. This novel method of X-ray-based PSI is a low-cost alternative to CT/MRI-based PSI if found to be accurate in future planned studies.
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O’Callaghan WB, Gouk C, Wilkinson MP, Haztratwala K. Computer-Aided Surgery-Navigated, Functional Alignment Total Knee Arthroplasty: A Surgical Technique. Arthroplast Today 2022; 14:121-127. [PMID: 35295192 PMCID: PMC8919216 DOI: 10.1016/j.artd.2022.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/22/2022] [Indexed: 11/30/2022] Open
Abstract
The decision on which technique to use to perform a total knee arthroplasty has become much more complicated over the last decade. The shortfalls of mechanical alignment and kinematic alignment has led to the development of a new alignment philosophy, functional alignment. Functional alignment uses preoperative radiographic measurements, computer-aided surgery, and intraoperative assessment of balance, to leave the patient with the most “normal” knee kinematics achievable with minimal soft-tissue release. The purpose of this surgical technique article is to describe in detail the particular technique needed to achieve these alignment objectives.
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Affiliation(s)
- William B. O’Callaghan
- The Orthopaedic Research institute of Queensland (ORIQL), Pimlico Townsville, Queensland, Australia
- Mater Health Services North Queensland Ltd, Pimlico Townsville, Queensland, Australia
- Townsville University Hospital, Douglas Townsville, Queensland, Australia
- Cairn Base Hospital, Cairns, Queensland, Australia
| | - Conor Gouk
- The Orthopaedic Research institute of Queensland (ORIQL), Pimlico Townsville, Queensland, Australia
- Townsville University Hospital, Douglas Townsville, Queensland, Australia
- Cairn Base Hospital, Cairns, Queensland, Australia
- James Cook University, Townsville, Queensland, Australia
- Corresponding author. Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner Street, Pimlico Townsville, Queensland, Australia 4812. Tel.: +61 07 47550564.
| | - Matthew P.R. Wilkinson
- The Orthopaedic Research institute of Queensland (ORIQL), Pimlico Townsville, Queensland, Australia
- University of Tasmania, Hobart, Tasmania, Australia
| | - Kaushik Haztratwala
- The Orthopaedic Research institute of Queensland (ORIQL), Pimlico Townsville, Queensland, Australia
- Mater Health Services North Queensland Ltd, Pimlico Townsville, Queensland, Australia
- Townsville University Hospital, Douglas Townsville, Queensland, Australia
- James Cook University, Townsville, Queensland, Australia
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Beckers L, Müller JH, Daxhelet J, Saffarini M, Aït-Si-Selmi T, Bonnin MP. Sexual dimorphism and racial diversity render bone-implant mismatch inevitable after off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:809-821. [PMID: 33512544 DOI: 10.1007/s00167-021-06447-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/11/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to investigate the variability in femoral geometric ratios among knees of different sexes and races, and to appreciate whether the observed variability is accommodated by commonly implanted total knee arthroplasty (TKA) components. The hypothesis was that the anthropometric studies report considerable variability of femoral geometric ratios among sexes and races. METHODS This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 6 July 2020 for clinical studies reporting on femoral geometric ratios among sexes and races. Femoral geometric ratios were graphically represented as means and 2 standard deviations, and compared to those of 13 commonly implanted femoral components. RESULTS A total of 15 studies were identified that reported on a combined total of 2627 knees; all reported the aspect ratio, and 2 also reported the asymmetry ratio and trapezoidicity ratio. Men had wider knees than women, and compared to Caucasian knees, Arabian and Indian knees were wider, while East Asian were narrower. There were no differences in asymmetry ratio between men and women, nor among Caucasian and East Asian knees. Men had more trapezoidal knees than women, and East Asian knees were more trapezoidal than Caucasian knees. The commonly implanted femoral components accommodated less than a quarter of the geometric variability observed among sexes and races. CONCLUSION Anthropometric studies reported considerable sexual dimorphism and racial diversity of femoral geometric ratios. Since a surgeon generally only uses one or a few TKA brands, bone-implant mismatch remains unavoidable in a large proportion of knees. These findings support the drive towards personalized medicine, and accurate bone-implant fit may only be achievable through customisation of implants, though the clinical benefits of custom TKA remain to be confirmed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lucas Beckers
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | | | - Jeremy Daxhelet
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
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Yu Z, Cai H, Yang B, Yao J, Zhang K, Tian H, Liu Z. Relationship between patellofemoral finite helical axis and femoral trans-epicondylar axis using a static magnetic resonance-based methodology. J Orthop Surg Res 2021; 16:212. [PMID: 33761974 PMCID: PMC7988974 DOI: 10.1186/s13018-021-02328-2] [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: 12/21/2020] [Accepted: 03/01/2021] [Indexed: 01/14/2023] Open
Abstract
Background To manage patellofemoral joint disorders, a complete understanding of the in vivo patellofemoral kinematics is critical. However, as one of the parameters of joint kinematics, the location and orientation of the patellofemoral finite helical axis (FHA) remains unclear. The purpose of this study is to quantify the location and orientation of the patellar FHA, both in vivo and non-invasively at various flexion angles, and evaluate the relationship of the FHA and the trans-epicondylar axis (TEA). Methods The magnetic resonance (MR) images of 18 unilateral knees were collected at full extension, 30°, 60°, 90°, and maximum angle of knee flexion. Three-dimensional models of the knee joint at different flexion angles were created using the MR images, and then used to calculate the patellar tracking and FHA with a spline interpolation algorithm. By using a coordinate system based on the TEA, the FHA tracking was quantified. Six parameters concerning the location and orientation of the patellar FHA were analysed. Results The average patellar FHA drew an L-shaped tracking on the midsagittal plane moving from the posteroinferior to the anterosuperior side of the TEA with knee flexion. Before 90° flexion, the patellar rotational radius decreased slightly, with an average value of 5.65 ± 1.09 cm. During 20° to 90° knee flexion, the average angle between the patellar FHA and the TEA was approximately 10° and that between the FHA and the coronal plane was maintained at about 0°, while that between the FHA and the level plane fluctuated between − 10° and 10°. Conclusions This study quantitatively reported the continuous location and direction of the patellar FHA during knee flexion. The patellar FHA was close to but not coincident with the femoral TEA both in location and orientation, and the patellar rotational radius decreased slightly with knee flexion. These findings could provide a clear direction for further studies on the difference in patellofemoral FHA among various types of patellofemoral disorders, and provide a foundation for the application of FHA in surgical evaluation, preoperative planning and prosthesis design, thereby assisting in the diagnosis and treatment of patellofemoral disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02328-2.
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Affiliation(s)
- Zhenguo Yu
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hong Cai
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Bin Yang
- Department of Orthopedics, Peking University International Hospital, Life Park 1, Zhongguancun Life Science Park, Changping District, Beijing, 102206, China.
| | - Jie Yao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, No.37 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Ke Zhang
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hua Tian
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China
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Gender differences in femoral trochlea morphology. Knee Surg Sports Traumatol Arthrosc 2021; 29:563-572. [PMID: 32232538 DOI: 10.1007/s00167-020-05944-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/17/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to analyze the morphology of the anterior femoral condyle using a quantitative three-dimensional reconstruction method. The morphological data were compared between genders. METHODS Computed tomography scans of femurs were taken from 90 healthy subjects and then reconstructed in 3D modeling software. Coaxial cutting planes were created at 10° increments to measure the lateral and medial anterior condylar heights (LACH and MACH, respectively), lateral and medial trochlear groove widths (LTW and MTW, respectively), and for trochlear groove tracking. The absolute values and normalized data were compared between male and female subjects. The sulcus angle and deepest point of the trochlear groove at each cross-section were also analyzed to determine the differences in the depth of the trochlear groove. RESULTS The absolute dimensions of LACH, MACH, LTW, and MTW were significantly smaller in the female subjects, by 10.5%, 36.9%, 10.3%, and 11.0%, respectively, than in the males (p < 0.05). After normalization, no significant difference was found in the condylar height between the genders. However, the female subjects had a significantly larger value of approximately 7.9% for the normalized trochlear width. CONCLUSION Male subjects had greater condylar heights and widths than the female subjects. Although the trajectory of the trochlear groove varied greatly among the subjects, the trochlear groove appeared to be wider and shallower in the female subjects than in the male subjects. These results provide important information for the design of femoral trochlea to fit Asian female patients. LEVEL OF EVIDENCE III.
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Müller JH, Li K, Reina N, Telmon N, Saffarini M, Cavaignac E. Sexual and ethnic polymorphism result in considerable mismatch between native trochlear geometry and off-the-shelf TKA prostheses. Knee Surg Sports Traumatol Arthrosc 2020; 28:3871-3878. [PMID: 32020254 DOI: 10.1007/s00167-020-05871-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/20/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine if trochlear morphology in healthy knees depends on sex and ethnicity, and to compare it to off-the-shelf TKA prostheses. METHODS Three retrospective series of CT angiograms from France (female, 124; male, 135), China (female, 122; male, 137) and South Africa (female, 21; male, 62) were used to digitize osseous landmarks at the level of the femoral epicondyles. Sulcus angle, trochlear rotation, lateral trochlear inclination, trochlear asymmetry ratio, and trochlear depth index were quantified for each knee and for 10 total knee arthroplasty (TKA) models. Univariable regression analyses were performed to determine associations of the five trochlear parameters with sex and ethnicity. Interquartile ranges (IQR) of native trochlear parameters were compared to the trochlear parameters of 10 off-the-shelf TKA prostheses. RESULTS Compared to French knees, Chinese knees had greater sulcus angle (β = 6.3°, p < 0.001), trochlear rotation (β = 0.8°, p = 0.004) and trochlear depth index (β = 1.60, p < 0.001). Conversely, South African knees had greater trochlear rotation (β = 1.9°, p < 0.001) and lateral trochlear inclination (β = 3.7°, p < 0.001). Female knees had smaller trochlear asymmetry ratios (β = - 0.03, p = 0.05) but greater trochlear rotation angles (β = 0.7, p = 0.005). Considerable mismatches in trochlear morphology were revealed between native knees and off-the-shelf TKA prostheses. CONCLUSIONS The findings suggest that thresholds used in the diagnosis of patellofemoral instability should be adapted to patient sex and ethnicity, and that standard off-the-shelf TKA may not restore native trochlear parameters in all patients. LEVEL OF EVIDENCE III, retrospective comparative.
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Affiliation(s)
| | - Ke Li
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nicolas Reina
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, Toulouse, France.,Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Norbert Telmon
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, Toulouse, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland.
| | - Etienne Cavaignac
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, Toulouse, France.,Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
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Zhou F, Xue F, Zhang S. The application of 3D printing patient specific instrumentation model in total knee arthroplasty. Saudi J Biol Sci 2020; 27:1217-1221. [PMID: 32346327 PMCID: PMC7182983 DOI: 10.1016/j.sjbs.2020.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 02/05/2023] Open
Abstract
The application of 3D printing patient specific instrumentation model in total knee arthroplasty was explored to improve the operative accuracy and safety of artificial total knee arthroplasty. In this study, a total of 52 patients who need knee replacement were selected as the study objects, and 52 patients were divided into experimental group and control group. First, the femoral mechanical-anatomical angle (FMAA), lateral femoral angle (LFA), hip-knee-ankle angle (HKA), femorotibial angle (FTA) of research objects in both groups were measured. Then, the blood loss during the operations, drainage volume after operations, total blood loss, hidden blood loss, and hemoglobin decrease of the experiment group and the control group were measured and calculated. Finally, the postoperative outcomes of patients who underwent total knee arthroplasty were evaluated. The results showed that before the operations, in the PSI group, the femoral mechanical-anatomical angle (FMAA) was (6.9 ± 2.4)°, the lateral femoral angle (LFA) was (82.4 ± 1.6)°, the hip-knee-ankle angle (HKA) was (166.4 ± 1.4)°, and the femorotibial angle (FTA) was (179.5 ± 7.3)°. In the CON group, the FMAA was (5.8 ± 2.4)°, the LFA was (81.3 ± 2.1)°, the HKA was (169.5 ± 1.9)°, and the FTA was (185.4 ± 5.4)°. The differences in these data between the two groups were not statistically significant (P > 0.05). After the operations, in the PSI group, the total blood loss, the hidden blood loss, and the hemoglobin (Hb) decrease were respectively (420.2 ± 210.5), (240.5 ± 234.5), and (1.7 ± 0.9); in the CON group, the total blood loss, the hidden blood loss, and the Hb decrease were respectively (782.1 ± 340.4), (450.9 ± 352.6), and (2.9 ± 1.0). These data of both groups were statistically significant (P < 0.05). Therefore, it can be seen that the 3D printing patient specific instrumentation model can effectively simulate the lower limb coronal force line and was highly consistent of the preoperative software simulation plan. In addition, the random interviews of patients who underwent total knee arthroplasty showed that the knees of patients had recovered well. The application of 3D printing patient specific instrumentation model in artificial total knee arthroplasty can effectively improve the operative accuracy and safety, and the clinical therapeutic effects were significant.
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12
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Cerveri P, Belfatto A, Manzotti A. Representative 3D shape of the distal femur, modes of variation and relationship with abnormality of the trochlear region. J Biomech 2019; 94:67-74. [DOI: 10.1016/j.jbiomech.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/13/2019] [Accepted: 07/09/2019] [Indexed: 01/17/2023]
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