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Five or more gender- and size-diverse customizations of distal femur prostheses are needed to improve fit for Chinese knees

  • KNEE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Mismatch between partial imported prostheses and Chinese anatomy affects the clinical outcome of the procedure. The purpose of this study was to measure the anatomical dimensions of Chinese distal femurs to provide guidance for the design of more compatible distal femoral prostheses.

Methods

A total of 406 healthy distal femurs were reconstructed and measured. Consistency of these measurements and differences in sides, gender, and populations were examined. Parameter correlations were analyzed, and pairs with strong correlations underwent linear regression analysis. The design of distal femoral prostheses was referenced from the results of K-means and hierarchical clustering analysis.

Results

Ten parameters were measured, including the trans-epicondylar axis, width of the distal femur (ML), anteroposterior diameter of the distal femur (AP), etc. The intra-class correlation coefficient ranged from 0.795 to 0.999 for intra-observer consistency, and from 0.796 to 0.998 for inter-observer consistency. Males exhibited significantly larger parameters than females, except for the posterior condylar angle (all P values < 0.05). Compared to other populations, substantial differences were observed for most parameters, such as ML, AP, width of lateral femoral condyle, etc. (all P values < 0.05). Clustering analysis suggested that distal femoral prostheses should include at least five sizes to adequately accommodate the sampled population. ML sizes for males were 68, 70, 83, 73, and 89 mm, and for females 64, 65, 71, 67, and 77 mm. AP sizes for males were 56, 60, 60, 64, and 64 mm, and for females 48, 52, 54, 57, and 58 mm.

Conclusions

Chinese distal femur morphology, as analyzed using 3D techniques, varies significantly between genders and when compared with international data. For improved patient fit, the creation of five or more distal femur prostheses, diversified by gender and size and informed by the associated morphological parameters, is recommended.

Level of evidence

IV.

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Data availability

The data that supports the findings of this study are available on reasonable request from the corresponding author.

Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

AP:

Anteroposterior diameter of the distal femur

CI:

Confidence interval

CT:

Computed tomography

ICC:

Intraclass correlation coefficient

LAP:

Anteroposterior diameter of the lateral femoral condyle

LCW:

Width of lateral femoral condyle

LPCH:

Height of the posterior part of the lateral femoral condyle

MAP:

Anteroposterior diameter of the medial femoral condyle

MCW:

Width of medial femoral condyle

ML:

Width of the distal femur

MPCH:

Height of the posterior part of the medial femoral condyle

PCA:

Posterior condylar angle

TEA:

Transepicondylar axis

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Acknowledgements

We are very grateful for the software and technical consultation provided by the E3D digital medical team of Central South University, led by Prof. Shenghui Liao. We thank each of the anonymous patients included in this study.

Funding

No funding was received for this work.

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Author notes

  1. Song Chen, Zhenxin Zheng, and Jinku Guo equally contributed to this work.

Authors and Affiliations

  1. Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, No.100, Minjiang Avenue, Quzhou, 324000, Zhejiang, China

    Song Chen, Zhenxin Zheng, Jinku Guo, Shengkun Hong, Weijun Zhou, Jun Xie & Wei Wang

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  1. Song Chen
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  7. Wei Wang
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Contributions

SC: Substantial contributions to the research design, model construction, data acquisition, statistical analysis, drafting the paper and revising it critically; ZZ: Model construction, data acquisition, approval of the submitted and final version; JG: Manuscript revision, approval of the submitted and final version; SH: Manuscript revision, approval of the submitted and final version; WZ: Manuscript revision, approval of the submitted and final version; JX: Supervising the proper application of research, manuscript revision, approval of the submitted and final version; WW: contributions to the research design, manuscript revision, approval of the submitted and final version.

Corresponding authors

Correspondence to Song Chen, Jun Xie or Wei Wang.

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Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

The study was reviewed and approved by the institutional review board of Quzhou Affiliated Hospital of Wenzhou Medical University.

Informed consent

Informed consent was waived due to the nature of the retrospective study and the fact that all data were de-identified.

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Chen, S., Zheng, Z., Guo, J. et al. Five or more gender- and size-diverse customizations of distal femur prostheses are needed to improve fit for Chinese knees. Knee Surg Sports Traumatol Arthrosc 31, 5388–5397 (2023). https://doi.org/10.1007/s00167-023-07580-z

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