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Borukhov I, Esposito CI, Ismailidis P, LiArno S, Lyon JP, McCarthy TF, McEwen P. The trochlear sulcus of the native knee is consistently orientated close to the sagittal plane despite variation in distal condylar anatomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:3618-3626. [PMID: 34291310 PMCID: PMC10435591 DOI: 10.1007/s00167-021-06667-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to describe the native trochlear orientation of non-arthritic knees in three planes and to quantify the relationship between trochlear and distal condylar anatomy across race and sex. METHODS Computed tomography scans of 1578 femora were included in this study. The mediolateral position of the trochlear sulcus, the distal trochlear sulcus angle (DTSA) the medial sulcus angle (MSA) and the lateral sulcus angle (LSA) as well as the mechanical lateral distal femoral angle (mLDFA) were measured relative to a standard reference coordinate system. Multiple linear regression analyses were performed to account for potential confounding variables. RESULTS The mediolateral position of the trochlear sulcus had minimal mean deviation of the sagittal femoral plane. The mean DTSA was 86.1° (SD 2.2°). Multilinear regression analysis found mLDFA, sex, and age all influence DTSA (p < 0.05), with mLDFA having by far the greatest influence (r2 = 0.55). The medial facet of the trochlear sulcus was found to be flat proximally and more prominent distally. The lateral facet was relatively uniform throughout the arc. CONCLUSION In non-arthritic knees, due to a strong positive correlation between the DTSA and the mLDFA, the trochlear sulcus is consistently orientated in the sagittal femoral plane regardless of distal condylar anatomy. Minor deviations from the sagittal plane occur in a lateral direction in the middle part and in a medial direction at the proximal and distal part of the trochlea. These findings have relevance regarding the biomimetic design of total knee implants.
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Affiliation(s)
| | | | - Petros Ismailidis
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico Townsville, QLD, Australia.
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | | | | | | | - Peter McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico Townsville, QLD, Australia
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Prithishkumar IJ, Abdulwahab T, Mohammad A, Albelooshi A. Estimating aspect ratio of the distal femur and proximal tibia in the Emirati population from MRI scans of the knee: a preliminary experience. Sci Rep 2023; 13:4489. [PMID: 36934199 PMCID: PMC10024718 DOI: 10.1038/s41598-023-31715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/16/2023] [Indexed: 03/20/2023] Open
Abstract
Size and shape of knee implants play an important role in the success of total knee arthroplasty. Several studies have identified anthropometric differences of the distal femur and proximal tibia between the genders and ethnicities. Ill-fitting prosthesis can cause overhang or under-fit resulting in persistence of pain, periprosthetic fracture and decreased range of motion. The purpose of this study was to estimate the aspect ratio of distal femur and proximal tibia in the Emirati population and determine whether gender differences exist within this group. Magnetic resonance imaging datasets of unilateral knees scans performed on adult Emirati patients at a tertiary care hospital were retrospectively examined. Knee parameters were obtained from 65 males and 46 females (n = 111). Females showed significantly smaller AP and ML dimensions of distal femur and lower aspect ratios compared to males (p < 0.001). Proximal tibial dimensions (AP and ML) of Emirati women are also significantly smaller compared to men. However, aspect ratio of proximal tibia did not show gender variation (p = 0.956) within the Emirati population. Emirati knees showed significant gender differences in bony dimensions and aspect ratio of the knee, and also have smaller aspect ratios when compared with most other population groups.
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Affiliation(s)
- Ivan James Prithishkumar
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.
| | | | | | - Ali Albelooshi
- Mediclinic City Hospital, Dubai Healthcare City, Dubai, UAE
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Dandridge O, Garner A, Amis AA, Cobb JP, van Arkel RJ. Variation in the patellar tendon moment arm identified with an improved measurement framework. J Orthop Res 2022; 40:799-807. [PMID: 34191354 DOI: 10.1002/jor.25124] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/08/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
The mechanical advantage of the knee extensor mechanism depends heavily on the patellar tendon moment arm (PTMA). Understanding which factors contribute to its variation may help improve functional outcomes following arthroplasty. This study optimized PTMA measurement, allowing us to quantify the contribution of different variables. The PTMA was calculated about the instantaneous helical axis of tibiofemoral rotation from optical tracked kinematics. A fabricated knee model facilitated calculation optimization, comparing four data smoothing techniques (raw, Butterworth filtering, generalized cross-validated cubic spline-interpolation and combined filtering/interpolation). The PTMA was then measured for 24 fresh-frozen cadaveric knees, under physiologically based loading and extension rates. Combined filtering/interpolation enabled sub-mm PTMA calculation accuracy throughout the range of motion (root-mean-squared error 0.2 mm, max error 0.4 mm), whereas large errors were measured for raw, filtered-only and interpolated-only techniques at terminal flexion/extension. Before scaling, the mean PTMA was 46 mm; PTMA magnitude was consistently larger in males (mean differences: 5 to 10 mm, p < .05) and was strongly related to knee size: larger knees have a larger PTMA. However, while scaling eliminated sex differences in PTMA magnitude, the peak PTMA occurred closer to terminal extension in females (female 15°, male 29°, p = .01). Knee size accounted for two-thirds of the variation in PTMA magnitude, but not the flexion angle where peak PTMA occurred. This substantial variation in angle of peak PTMA has implications for the design of musculoskeletal models and morphotype-specific arthroplasty. The developed calculation framework is applicable both in vivo and vitro for accurate PTMA measurement.
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Affiliation(s)
- Oliver Dandridge
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Amy Garner
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.,MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK.,Royal College of Surgeons of England and Dunhill Medical Trust Clinical Research Fellowship. Royal College of Surgeons of England, London, UK.,Health Education Kent, Surrey and Sussex, Stewart House, London, UK
| | - Andrew A Amis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Justin P Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
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Koh YG, Nam JH, Chung HS, Lee HY, Kim HJ, Kim HJ, Kang KT. Gender-related morphological differences in sulcus angle and condylar height for the femoral trochlea using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2019; 27:3560-3566. [PMID: 30879109 DOI: 10.1007/s00167-019-05423-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/15/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed to elucidate the primary differences in trochlear morphology between men and women utilizing three-dimensional magnetic resonance image reconstruction of the femoral trochlea. METHODS Differences in anthropometric femoral trochlea data of 975 patients (825 women, 150 men) were evaluated. The following morphological parameters were measured at three flexion angles (15°, 30°, and 45°) of the femoral trochlea: the sulcus angle, condylar height, and the trochlear groove orientation and mediolateral groove position. RESULTS The sulcus angle was significantly greater in women than in men at 15° and 45° flexions (P < 0.05). However, there was no gender difference found in the sulcus angle at 30° flexion. Medial and lateral condylar height values were greater in men than in women for the three flexion angles (P < 0.01). The trochlear groove orientation and mediolateral groove position showed no gender-related differences. CONCLUSIONS Magnetic resonance image reconstruction demonstrated that measurement of trochlear morphology varied significantly between men and women. This study provides guidelines for the design of a suitable femoral component for total knee arthroplasty, considering gender-specific differences in the Korean population. Biomechanical guidelines for total knee arthroplasty in Korean individuals can be optimized using our finding, so as the risk of patellar dislocation to be decreased. Surgeons should be aware of gender differences in femoral trochlear to optimize choice of implant. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, South Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hyun-Seok Chung
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, South Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South 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, South Korea
| | - Hyo-Jeoung Kim
- Department of Sport and Healthy Aging, Korea National Sport University, 1239 Yangjaedaero,Songpa-gu, Seoul, 05541, South Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Thienpont E, Bernardoni M, Goldberg T. Anthropometric measurements of the femur change with component positioning in total knee arthroplasty. Knee 2016; 23:796-800. [PMID: 27039135 DOI: 10.1016/j.knee.2015.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/27/2015] [Accepted: 11/26/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND To analyze aspect ratio (AP size/ (ML) size) of osteoarthritic knees at four different areas of the femur and to observe if proximalization of the femoral cut would change the ML size as well as confirm that external rotation increases the measurements for the AP dimensions of the femur. METHOD From the available MyKnee database (Medacta International, Castel San Pietro, Switzerland) 1030 patients were randomly selected within 20° of deformity consisting of 400 men with a mean (SD) age of 67.5 (9) years and 630 women with a mean (SD) age of 69 (10) years (p<0.0001). A specific software program was developed to measure AP and ML dimensions of the femur on CT-scans for (3D) planning in four areas. The AP femoral size was measured with neutral axial rotation following the epicondylar axis and without accepting anterolateral notching. RESULTS Proximalization of the femur resulted in no changes except for a larger ML3 area in men. Increased axial rotation increased the AP dimensions for the same femur by a mean (SD) 2.5 (1) mm for males and females. CONCLUSIONS The crucial area for overhang of the femoral component is the anterior region (ML1) with an aspect ratio of about ±, but with an important range. Proximalization of the femoral cut is not accompanied by narrowing of the anterior femur but ML widening of the more posterior femur in men. Increased external rotation leads to a measurement of bigger AP size leading to an AP versus ML mismatch and change in aspect ratio.
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Affiliation(s)
- Emmanuel Thienpont
- Cliniques universitaires Saint Luc-UCL, Av. Hippocrate 10, 1200 Brussels, Belgium.
| | | | - Tyler Goldberg
- Texas Orthopedics, 4700 Seton Center Parkway Suite 200, Austin, 78759 TX, USA
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Thilak J, George MJ. Patient - implant dimension mismatch in total knee arthroplasty: Is it worth worrying? An Indian scenario. Indian J Orthop 2016; 50:512-517. [PMID: 27746494 PMCID: PMC5017173 DOI: 10.4103/0019-5413.189618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The correct sizing of the components in both anteroposterior and mediolateral (ML) dimensions is crucial for the success of a total knee arthroplasty (TKA). The size of the implants selected is based on the intraoperative measurements. The currently used TKA implants available to us are based on morphometric measurements obtained from a Western/Caucasian population. Hence, the risk of component ML mismatch is more common in Asian sub-population, as they are of a smaller built and stature. This study aims to look into the following aspects agnitude of the ML mismatch between the femoral component and the patient's anatomical dimension, evaluation of gender variations in distal femur dimensions, and gender-wise and implant-wise correlation of ML mismatch. MATERIALS AND METHODS Intraoperatively, the distal femoral dimensions were measured using sterile calipers after removing the osteophytes and compared with the ML dimension of the implant used. ML mismatch length thus obtained is correlated with the various parameters. RESULTS Males showed larger distal femoral dimensions when compared to females. Males had larger ML mismatch. None of the implants used perfectly matched the patient's anatomical dimensions. Patients with larger mismatch had lower scorings at 2 years postoperative followup. CONCLUSION Implant manufacturers need to design more options of femoral implants for a better fit in our subset of patients. The exact magnitude of mismatch which can cause functional implications need to be made out. The mismatch being one of the important factors for the success of the surgery, we should focus more on this aspect.
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Affiliation(s)
- Jai Thilak
- Division of Arthroplasty and Sports Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Melvin J George
- Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala, India,Address for correspondence: Dr. Melvin J George, F1, Rohini Apartments, Meenchira Road, Amrita Institute of Medical Sciences, Ponekkara P.O., Kochi - 682 041, Kerala, India. E-mail:
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Koninckx A, Deltour A, Thienpont E. Femoral sizing in total knee arthroplasty is rotation dependant. Knee Surg Sports Traumatol Arthrosc 2014; 22:2941-6. [PMID: 24105348 DOI: 10.1007/s00167-013-2707-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/27/2013] [Indexed: 01/29/2023]
Abstract
PURPOSE The mismatch between the medio-lateral (ML) and the antero-posterior (AP) size of femoral components in total knee arthroplasty (TKA) has been linked to gender, ethnicity, morphotype and height differences in patients. The hypothesis of this study was that the AP size measurement of a femoral component increases with more external rotation in posterior referencing TKA. METHODS During a 2-year period, 201 patients were included in this prospective study. The AP distance of the distal femur was measured with an AP sizer of the Vanguard (Biomet, Warsaw, US) knee system. This AP sizer allows to dial in external rotation by 1° increments and to determine the femoral size with an anterior boom. AP size was noted at 0°, 3° and 5° of external rotation and then compared for ML matching. RESULTS Antero-posterior and corresponding ML sizes match perfectly for the Vanguard at 0° of external rotation and a central boom position on the anterior femoral surface. Then, the anterior boom was positioned on the antero-lateral cortex and the AP size increased a mean (SD) 1 (0.5) mm. With 3° of external rotation, the AP size increased a mean (SD) 2.3 (0.4) mm and for 5° a mean (SD) 3.8 (0.3) mm (P < 0.05). This increase in AP size resulted in ML overhang of 2.2 (1.2) mm for 3° and 4.8 (2.6) mm for 5° (P < 0.05). CONCLUSIONS Antero-posterior size measurement of the distal femur is determined by the anatomy of the anterior surface with a higher antero-lateral cortex and the amount of external rotation that is dialled in during surgery. Since these parameters vary case per case, the availability of narrow components offers more surgical options to the surgeon and its importance extends beyond the gender aspect allowing different amounts of external rotation to be used without ML overhang. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Angelique Koninckx
- Department of Orthopedic Surgery, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Ishimaru M, Hino K, Onishi Y, Iseki Y, Mashima N, Miura H. A three-dimensional computed tomography study of distal femoral morphology in Japanese patients: gender differences and component fit. Knee 2014; 21:1221-4. [PMID: 25450008 DOI: 10.1016/j.knee.2014.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/22/2014] [Accepted: 09/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous anthropometric studies have reported gender differences in distal femoral morphology. However, to date, very few studies have investigated the knee morphology of Japanese adults and possible gender differences. The purpose of this study was to examine the distal femoral morphology of Japanese patients, to characterize anatomical differences between male and female, and to evaluate the need to create gender-specific knee prostheses. MATERIAL AND METHODS We evaluated 80 knees in 40 male and 40 female Japanese patients scheduled for total knee arthroplasty (TKA). The mediolateral (ML) and anteroposterior (AP) dimensions of the knees at different levels were measured preoperatively using three-dimensional computed tomography, and ML/AP aspect ratios were calculated. RESULTS On the distal femoral cut surface, the mean ML widths were 74.9 mm for male and 65.1mm for female, and the mean AP lengths were 63.4mm for male and 58.9 mm for female. Such values were generally smaller compared to data from European and North American studies. In this study, the mean ML/AP aspect ratios were 1.31 for male and 1.25 for female, higher than those from non-Asian regions. The ML/AP ratios of Japanese patients were negatively correlated with distal femoral AP length. CONCLUSIONS Japanese female had a relatively narrower femoral width for a given AP length than male. Our study suggests the utility of Japanese-specific implants and provides useful insights for manufacturers to design components of appropriate sizes and aspect ratios for Japanese TKA patients.
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Affiliation(s)
- Masami Ishimaru
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Japan
| | - Kazunori Hino
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Japan
| | - Yoshio Onishi
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Japan
| | - Yasutake Iseki
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Japan
| | - Naohiko Mashima
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Japan
| | - Hiromasa Miura
- Department of Bone and Joint Surgery, Graduate School of Medicine, Ehime University, Japan.
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Piriou P, Mabit C, Bonnevialle P, Peronne E, Versier G. Are gender-specific femoral implants for total knee arthroplasty necessary? J Arthroplasty 2014; 29:742-8. [PMID: 24140276 DOI: 10.1016/j.arth.2013.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/21/2013] [Accepted: 09/11/2013] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine the effect of gender on epiphyseal morphology and using this information to determine if an implant product line with a single width provides sufficient bone coverage for the entire population of knees being replaced. Morphology of the distal femoral epiphysis from 420 continuous knees was acquired with a surgical navigation system during primary TKA. A three-dimensional model of the distal femur was generated and used to determine the anterioposterior (AP) and mediolateral (ML) dimensions on 19 different virtual knee sections. Female knees had smaller AP and ML dimensions than male knees. The ML width of the distal femoral epiphysis was associated with femur length, not gender. Measurements derived from surgical navigation confirm that distal femoral epiphysis dimensions are related to femur length only independently of gender.
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Affiliation(s)
| | - Christian Mabit
- Orthopedic and Trauma Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Paul Bonnevialle
- Musculoskeletal Institute at CHU Toulouse, Purpan Orthopedics and Trauma Unit, Place Baylac, Toulouse, France
| | - Etienne Peronne
- La Châtaigneraie Clinic, Rue de la Châtaigneraie, Beaumont, France
| | - Gilbert Versier
- Orthopedic Surgery Department, Bégin Military Hospital, Saint Mandé, France
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Yan M, Wang J, Wang Y, Zhang J, Yue B, Zeng Y. Gender-based differences in the dimensions of the femoral trochlea and condyles in the Chinese population: correlation to the risk of femoral component overhang. Knee 2014; 21:252-6. [PMID: 23245733 DOI: 10.1016/j.knee.2012.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 10/29/2012] [Accepted: 11/10/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral component overhang has been observed in total knee arthroplasty with different prostheses. The purpose of this study is to assess gender-based anatomical differences of the distal femur and femoral trochlea in the Chinese population and analyze the risk sites of femoral component overhang in relation to any significant anatomical differences. METHODS Measurements of distal condylar and femoral trochlea were made through three-dimensional computed tomographic modeling of 200 normal Chinese knees; the anatomical differences between genders and its relations to the femoral component overhang were analyzed. Four implants were also measured and compared. RESULTS The ML/AP ratios of the femoral condyles showed statistically significant gender-based variation (Men:Women=1.06:1.03, P<0.0001). Both the proximal and distal ML widths of the trochlea were generally larger in the men than those of the women. Regression analysis of the morphological data showed that as the measuring level moves distally along the femur, the coronal width deviation between genders progressively increases to peak at the distal condyles. Female subjects had a smaller aspect ratio than those of four implants and a smaller trochlear ML width than those of three implants. CONCLUSIONS The males show significantly greater coronal dimensions of the trochlea than women which are likely to contribute to the higher prevalence of prosthetic overhang in women with some standard implants. CLINICAL RELEVANCE The overhang is most likely to occur in the distal femoral condyle and the distal region of the femoral trochlea when a standard knee prosthetic system is used in the Chinese women.
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Affiliation(s)
- Mengning Yan
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Wang
- Shanghai Key Laboratory of Orthopaedic Implant, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - You Wang
- Shanghai Key Laboratory of Orthopaedic Implant, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jun Zhang
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Yue
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yiming Zeng
- Shanghai Key Laboratory of Orthopaedic Implant, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Outcome of Autologous Matrix Induced Chondrogenesis (AMIC) in cartilage knee surgery: data of the AMIC Registry. Arch Orthop Trauma Surg 2013; 133:87-93. [PMID: 23070222 PMCID: PMC3535369 DOI: 10.1007/s00402-012-1621-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Autologous Matrix-Induced Chondrogenesis (AMIC) is an innovative treatment for localized full-thickness cartilage defects combining the well-known microfracturing with collagen I/III scaffold. The purpose of this analysis was to evaluate the medium-term results of this enhanced microfracture technique for the treatment of chondral lesions of the knee. METHODS AND MATERIALS Patients treated with AMIC (Chondro-Gide, Geistlich Pharma, Switzerland) were followed using the AMIC Registry, an internet-based tool to longitudinally track changes in function and symptoms by the Lysholm score and VAS. RESULTS A series of 57 patients was enrolled. The average age of patients (19 females, 38 males) was 37.3 years (range 17-61 years). The mean defect size of the chondral lesions was 3.4 cm(2) (range 1.0-12.0 cm(2)). All defects were classified as grade III (n = 20) or IV (n = 37) according to the Outerbridge classification. Defects were localized at the medial (n = 32) or lateral (n = 6) condyle, at the trochlea (n = 4) and at the patella (n = 15). The follow-up period was 2 years. The majority of patients were satisfied with the postoperative outcome, reporting a significant decrease of pain (mean VAS preop = 7.0; 1 year postop = 2.7; 2 years postop = 2.0). Significant improvement of the mean Lysholm score was observed as early as 1 year after AMIC and further increased values were noted up to 2 years postoperatively (preop. 50.1, 1 year postop. 79.9, 2 year postop. 85.2). CONCLUSIONS AMIC is an effective and safe method of treating symptomatic chondral defects of the knee. However, further studies with long-term follow-up are needed to determine if the grafted area will maintain structural and functional integrity over time. LEVEL OF EVIDENCE Prognostic study, Level IV.
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Zietz C, Bergschmidt P, Fritsche A, Kluess D, Mittelmeier W, Bader R. Comparison of cross-sections of different femoral components for revision total knee replacement. J Orthop Surg (Hong Kong) 2012; 20:32-6. [PMID: 22535808 DOI: 10.1177/230949901202000107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED PURPOSE. To compare the inner contour of the femoral component of 10 total knee replacement (TKR) designs for possible exchange in use. METHODS Inner contours of the femoral components of 10 cemented, cruciate-retaining TKR designs (e.motion, Genesis, Genia, Innex, LCS, Multigen Plus, NexGen, PFC, Scorpio, Vanguard) were scanned and reconstructed to 2-dimensional contours. Their cross-sections were compared by superimposition and aligning at the distal and anterior cuts. The patellar notch and outer contour were not analysed. RESULTS The maximum deviation was 5 mm in the posterior and posterior oblique cuts and 10 mm in the anterior oblique cut. Based on similarity of the inner contour, LCS and Innex was classified as group I, e.motion, Genesis, Scorpio, Vanguard, and Multigen Plus as group II, and Genia, NexGen, and PFC as group III. All 2 designs in group I were not compatible with the other 8 designs. Four of the 5 designs in group II showed good compatibility. All 3 designs in group III significantly differed in the posterior and oblique cuts. CONCLUSION A standardised inner contour of the femoral component can increase compatibility of different TKR systems in revision surgery and reduces the extent of bone resection.
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Affiliation(s)
- Carmen Zietz
- Department of Orthopaedics, University of Rostock, Rostock, Germany.
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Demey G, Hobbs H, Lustig S, Servien E, Trouillet F, Magnussen RA, Neyret P. Influence of gender on the outcome of total knee arthroplasty. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s12570-012-0094-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tanavalee A, Rojpornpradit T, Khumrak S, Ngarmukos S. The early results of gender-specific total knee arthroplasty in Thai patients. Knee 2011; 18:483-7. [PMID: 21041089 DOI: 10.1016/j.knee.2010.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 09/07/2010] [Accepted: 10/02/2010] [Indexed: 02/02/2023]
Abstract
We prospectively evaluated a consecutive series of 314 patients (265 females and 49 males) who underwent unilateral TKA and received an average of 2 years of follow-up. In all patients, a standard (STD) or a gender-specific (GS) femoral component was selected based on the presentation of intra-operative medio-lateral overhanging of the femoral cutting guide over the femoral condyle. There were no significant differences in the pre-operative parameters of both groups. At the last follow-up, both STD and GS groups had similarly improved KS clinical scores (92.9 vs. 92.1 points), function scores (89.5 vs. 89.7 points) and ROM (133.5° vs. 134.1°) with no difference in the rate of lateral retinacular release. The overall percentage of the GS component selection was 52.5% (165/314) and was significantly higher in female patients than male patients (60.8% vs. 8.2%, p<0.0001). In addition, selected GS prostheses increased significantly with increasing femoral size (25% for size C, 53% for size D, 86% for size E, and 100% for size F, respectively). There were no complications or early loosening related to the GS prosthesis. The mean post-operative limb alignment was 5.5° of the anatomical valgus with no difference between groups. We concluded that the GS femoral component did not provide better clinical outcomes than the standard femoral component; however, it provided surgical ease to minimize prosthesis overhanging in patients with narrow femoral condyles.
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Affiliation(s)
- Aree Tanavalee
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Bangkok 10330, Thailand.
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Intraoperative morphometric study of gender differences in Asian femurs. J Arthroplasty 2011; 26:984-8. [PMID: 21316917 DOI: 10.1016/j.arth.2010.11.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 11/28/2010] [Indexed: 02/01/2023] Open
Abstract
Sixty-two male and 290 female knees from the Singapore population were measured intraoperatively for anteroposterior (AP) height of both medial and lateral femoral condyles, mediolateral (ML) width, and AP/ML ratio (aspect ratio). Median AP/ML ratio for the medial condyle was 1.00 (range, 0.91-1.18) in men and 1.09 (range, 0.92-1.39) in women. Median AP/ML ratio for the lateral condyle was 0.98 (range, 0.84-1.14) in men and 1.06 (range, 0.89-1.36) in women. Both aspect ratios showed significant differences according to sex (P < .001). We conclude that women generally have narrower femurs than men for any given AP height. The aspect ratios of Asians also appear narrower than that reported in white populations.
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Mid-term results of Autologous Matrix-Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 2010; 18:1456-64. [PMID: 20127072 DOI: 10.1007/s00167-010-1042-3] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 01/02/2010] [Indexed: 12/20/2022]
Abstract
Articular cartilage defects heal poorly. Autologous Matrix-Induced Chondrogenesis (AMIC) is an innovative treatment for localized full-thickness cartilage defects combining the well-known microfracturing with collagen scaffold and fibrin glue. The purpose of this prospective study was to evaluate the medium-term results of this enhanced microfracture technique for the treatment of chondral lesions of the knee. Thirty-two chondral lesions in 27 patients were treated with AMIC. Within the context of clinical follow-up, these patients were evaluated for up to 5 years after the intervention. Five different scores (Meyer score, Tegner score, Lysholm score, ICRS score, Cincinnati score) as well as radiographs were used for outcome analysis. Articular resurfacing was assessed by magnetic resonance imaging (MRI). The average age of patients (11 females, 16 males; mean body mass index 26, range 20-32) was 37 years (range 16-50 years). The mean defect size of the chondral lesions was 4.2 cm(2) (range 1.3-8.8 cm(2)). All defects were classified as grade IV according to the Outerbridge classification. The follow-up period was between 24 and 62 months with a mean of 37 months. Twenty out of 23 individuals (87%) questioned were subjectively highly satisfied with the results after surgery. Significant improvement (P < 0.05) of all scores was observed as early as 12 months after AMIC, and further increased values were notable up to 24 months postoperatively. MRI analysis showed moderate to complete filling with a normal to incidentally hyperintense signal in most cases. Results did not show a clinical impact of patient's age at the time of operation, body mass index and number of previous operations (n.s.). In contrast, males showed significant higher values in the ICRS score compared to their female counterparts. AMIC is an effective and safe method of treating symptomatic full-thickness chondral defects of the knee in appropriately selected cases. However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time.
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Davis JJ, Bono JV, Lindeque BGP. Surgical strategies to achieve a custom-fit TKA with standard implant technique. Orthopedics 2010; 33:569-76. [PMID: 20704154 DOI: 10.3928/01477447-20100625-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recent trends in implant design have been geared toward taking individual differences in knee anatomy into consideration and modifying implants to accommodate these distinctions. The unique anatomy of the female knee gave birth to sex-specific knee implants and began a new era in implant design. This opened the door for the next progression of patient-specific cutting guides and implants. The current trend in implant design addresses individual variation with 3-D modeling that necessitates preoperative magnetic resonance imaging or computed tomography scans. While these innovations may turn out to be worthwhile, their use is currently limited by their expense and debatable clinical significance. Surgeons should not forget the basic surgical strategies to tailor their surgery to customize the fit of the standard implant. The surgical pearls reviewed here will allow surgeons to better understand sizing and customize every total knee arthroplasty with a patient-specific surgery. [corrected]
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Affiliation(s)
- Jason J Davis
- Department of Orthopedic Surgery, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA. [corrected]
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