Three-dimensional morphometric differences of resected distal femurs and proximal tibias in osteoarthritic and normal knees

Morphological Measurement and Clinical Significance of Abnormal Development of Distal Femur with Hemophilia Knee Arthritis: A Consideration on the Renewal of Total Knee Prosthesis

OBJECTIVE

The knee joint of hemophiliacs may face the result of local morphological changes due to long-term irritation of synovitis. This study aims to elucidate the morphological characteristics of distal femur in hemophilic arthritis (HA) and compare the compatibility of three types of prostheses with the anteroposterior (AP) and mediolateral (ML) dimensions of the femoral osteotomy surface.

METHODS

This study retrospectively and randomly selected 50 patients with HA registered for treatment at our hospital from June 2016 to August 2022 as the study subjects, with an equal number of male osteoarthritis (OA) patients and healthy male individuals set as the control group. This study used medical digitalization software to simulate osteotomies on the distal femur during total knee arthroplasties (TKA) for 50 patients with HA, OA patients, and the healthy population, respectively, and measure the morphological parameters to compare with three commonly used femoral components of TKA in clinical practice. The differences between the femur resection of anteroposterior and mediolateral (FRAP, FRML) osteotomy surface and the prosthesis's BOX-AP/ML were compared in three prostheses. One-way ANOVA and multiple Kruskal-Wallis H test were used for the normal or non-normal distribution data, and pairwise comparisons between groups were conducted using the Bonferroni method, and the linear correlation analysis was utilized to assess the relationship between section femoral morphological data and prosthesis parameters.

RESULT

In HA patients, the morphological characteristics of the distal femur were shown as shorter than femur AP (FAP), medial and lateral condyle anterior-posterior dimension (FMCAP, FLCAP), notch width (NW), posterolateral condyle height (PLCH), posteromedial condyle width (PMCW), and posterior condylar axis length (PCAL) dimension. They had comparatively smaller femur section aspect ratios (p < 0.005). They showed longer posterolateral condyle width (PLCW), anterior condyle mediolateral dimension (FRACML), anterolateral condyle height (ALCH), and femur resection anterior condylar mediolateral (FRACML) dimension (p < 0.005). They showed larger distal femur aspect ratio and resection aspect ratio (FAR, FRAR, p < 0.005). All selected prostheses showed ML undercoverage under similar AP dimensions, and ML undersizing of Attune systems was more obvious in three femoral prostheses.

CONCLUSION

The distal femur morphological change of HA patient is shown as smaller AP dimension, narrow posterior condyle spacing, lower and shallower trochlear, thinner anterior condyle, wider and lower intercondylar notch and higher posterior-lateral condyle. The selected prostheses showed ML undercoverage under similar AP dimensions. This typical morphological tendency of the distal femur seems to warrant consideration in the process of knee joint prosthesis upgrading.

Male porcine stifle joint: Insights into osteology and meniscus anatomy for orthopaedic research

INTRODUCTION

Utilizing large animal model like male pig for biomechanical studies offers a cost-effective approach to understanding human joint and tissue mechanics. Our study explores the osteology and meniscus anatomy of the male porcine stifle joint and compares it to human knee joint parameters, aiming to provide a valuable reference for orthopaedic research and surgical training.

METHODS

We examined 60 male porcine stifle joints and analyzed their menisci and bones. Dissections were meticulously performed, with measurements taken using digital Vernier calipers and ImageJ software. These dimensions included bone morphology and meniscal width, height, and volume, followed by statistical analysis using unpaired Student's t-tests.

RESULTS

The various measurements of bones and menisci indicated a high degree of anatomical similarity to human knees. The anterior width of the medial meniscus was 12.545 ± 1.763 mm, while the lateral meniscus was 14.99 ± 1.720 mm. The middle width of the medial meniscus was 12.065 ± 1.691 mm, compared to the lateral meniscus at 14.375 ± 1.732 mm. The posterior width was 15.25 ± 1.741 mm for the medial meniscus and 16.39 ± 1.662 mm for the lateral meniscus. The femoral intercondylar notch dimensions widened and became shallower with age, resembling the maturation patterns seen in human knee development. The average volume of the medial meniscus was 4.30 ± 0.13 ml, while the lateral meniscus was 5.9 ± 0.29 ml. The aspect ratio of the femoral condyles was 1.04 ± 0.04 (0.95-1.11), while the aspect ratio of the tibial condyles was 0.65 ± 0.02 (0.61-0.70), measured via digital Vernier calipers. These findings were statistically significant, showcasing the male porcine model's relevance in replicating human knee mechanics (p < 0.05).

CONCLUSION

Male porcine stifle joints present a valid and accessible model for knee anatomy research. Our study underscores the value of the male porcine model in understanding human knee joint biomechanics and supports its continued use in orthopaedic research and training. These findings have significant implications for advancing orthopaedic research methodologies and enhancing surgical training practices by providing a reliable and anatomically comparable model.

Phenotyping of the Turkish population according to Coronal Plane Alignment of the Knee classification: A retrospective cross-sectional study

OBJECTIVES

This study aimed to phenotype healthy individuals and patients with arthritic knees in the Turkish population according to the Coronal Plane Alignment of the Knee (CPAK) classification.

PATIENTS AND METHODS

The retrospective cross-sectional study included 207 healthy individuals (109 males, 98 females; mean age: 32.9±8.4 years; range, 20 to 45 years) with a total of 414 knees (Group 1) and 296 patients (155 females, 141 males; mean age: 54.5±7.9 years; range, 43 to 80 years) with a total of 408 arthritic knees (Group 2) who met the inclusion criteria and underwent evaluation using digital long-leg radiographs between January 2019 and July 2023. Mechanical lateral distal femoral angle and medial proximal tibial angle were measured. Subsequently, the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) were calculated. Based on the results obtained, participants in both groups were categorized according to the CPAK classification.

RESULTS

In Group 1, the mean aHKA was 0.3°±2.5°, and the mean JLO was 175.2°±3.5°. In Group 2, the mean aHKA was -1.4°±3.9°, and the mean JLO was 174.6°±3.7°. The most common CPAK type in healthy individuals (Group 1) was type 2 (41.5%), followed by type 3 (14.7%) and type 1 (14.5%). In arthritis patients (Group 2), the most common CPAK type was type 2 (31.6%), followed by type 1 (28.2%) and type 3 (13.5%).

CONCLUSION

The CPAK classification serves as an important guide for categorizing lower extremity alignment. In the Turkish population, healthy individuals most commonly exhibited CPAK type 2, 3, and 1 alignments, respectively, while osteoarthritic patients predominantly displayed CPAK type 2, 1, and 3 alignments.

Systematic review of computed tomography parameters used for the assessment of subchondral bone in osteoarthritis

OBJECTIVE

To systematically review the published parameters for the assessment of subchondral bone in human osteoarthritis (OA) using computed tomography (CT) and gain an overview of current practices and standards.

DESIGN

A literature search of Medline, Embase and Cochrane Library databases was performed with search strategies tailored to each database (search from 2010 to January 2023). The search results were screened independently by two reviewers against pre-determined inclusion and exclusion criteria. Studies were deemed eligible if conducted in vivo/ex vivo in human adults (>18 years) using any type of CT to assess subchondral bone in OA. Extracted data from eligible studies were compiled in a qualitative summary and formal narrative synthesis.

RESULTS

This analysis included 202 studies. Four groups of CT modalities were identified to have been used for subchondral bone assessment in OA across nine anatomical locations. Subchondral bone parameters measuring similar features of OA were combined in six categories: (i) microstructure, (ii) bone adaptation, (iii) gross morphology (iv) mineralisation, (v) joint space, and (vi) mechanical properties.

CONCLUSIONS

Clinically meaningful parameter categories were identified as well as categories with the potential to become relevant in the clinical field. Furthermore, we stress the importance of quantification of parameters to improve their sensitivity and reliability for the evaluation of OA disease progression and the need for standardised measurement methods to improve their clinical value.