Clinical Orthopaedics and Related Research

, Volume 466, Issue 12, pp 3059–3065 | Cite as

The Female Knee: Anatomic Variations and the Female-specific Total Knee Design

  • Alan C. Merchant
  • Elizabeth A. Arendt
  • Scott F. Dye
  • Michael Fredericson
  • Ronald P. Grelsamer
  • Wayne B. Leadbetter
  • William R. Post
  • Robert A. Teitge


The concept and need for a gender-specific or female-specific total knee prosthesis have generated interest and discussion in the orthopaedic community and the general public. This concept relies on the assumption of a need for such a design and the opinion that there are major anatomic differences between male and female knees. Most of the information regarding this subject has been disseminated through print and Internet advertisements, and through direct-to-patient television and magazine promotions. These sources and a recent article in a peer-reviewed journal, which support the need for a female-specific implant design, have proposed three gender-based anatomic differences: (1) an increased Q angle, (2) less prominence of the anterior medial and anterior lateral femoral condyles, and (3) reduced medial-lateral to anterior-posterior femoral condylar aspect ratio. We examined the peer-reviewed literature to determine whether women have had worse results than men after traditional TKAs. We found women have equal or better results than men. In addition, we reviewed the evidence presented to support these three anatomic differences. We conclude the first two proposed differences do not exist, and the third is so small that it likely has no clinical effect.

Level of Evidence: Level IV, systematic review. See the Guidelines for Authors for a complete description of levels of evidence.


  1. 1.
    Aglietti P, Insall JN, Cerulli G. I. Measurements of incongruence. Clin Orthop Relat Res. 1983;176:217–224.PubMedGoogle Scholar
  2. 2.
    Anonymous. Gender-specific knee replacements: a technology overview. J Am Acad Orthop Surg. 2008;16:63–67.Google Scholar
  3. 3.
    Baker PN, Khaw FM, Kirk LM, Esler CN, Gregg PJ. Randomized controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis. J Bone Joint Surg Br. 2007;89:1608–1614.PubMedCrossRefGoogle Scholar
  4. 4.
    Barrett W. The need for gender-specific prostheses in TKA: does size make a difference? Orthopedics. 2006;29(suppl):S53–S55.PubMedGoogle Scholar
  5. 5.
    Bengs BC, Scott RD. The effect of patellar thickness on intraoperative knee flexion and patellar tracking in total knee arthroplasty. J Arthroplasty. 2006;21:650–655.PubMedCrossRefGoogle Scholar
  6. 6.
    Booth RE Jr. The gender-specific (female) knee. Orthopedics. 2006;29:768–769.PubMedGoogle Scholar
  7. 7.
    Bourne RB, McCalden RW, MacDonald SJ, Mokete L, Guerin J. Influence of patient factors on TKA outcomes at 5 to 11 years follow-up. Clin Orthop Relat Res. 2007;464:27–31.PubMedGoogle Scholar
  8. 8.
    Brattstrom H. Shape of the intercondylar groove normally and in recurrent dislocation of the patella; a clinical and x-ray anatomical investigation. Acta Orthop Scand Suppl. 1964;68:1–148.Google Scholar
  9. 9.
    Brooks J. Gender-specific knees. CMAJ. 2007;176:309–310.PubMedGoogle Scholar
  10. 10.
    Chin KR, Dalury DF, Zurakowski D, Scott RD. Intra-operative measurements of male and female distal femurs during primary total knee arthroplasty. J Knee Surg. 2002;15:213–217.PubMedGoogle Scholar
  11. 11.
    Conley S, Rosenberg A, Crowninshield R. The female knee: anatomic variations. J Am Acad Orthop Surg. 2007;15(suppl 1):S31–S36.PubMedGoogle Scholar
  12. 12.
    Fehring TK, Murphy JA, Hayes TD, Roberts DW, Pomeroy DL, Griffin WL. Factors influencing wear and osteolysis in press-fit condylar modular total knee replacements. Clin Orthop Relat Res. 2004;428:40–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Font-Rodriguez DE, Scuderi GR, Insall JN. Survivorship of cemented total knee arthroplasty. Clin Orthop Relat Res. 1997;345:79–86.PubMedCrossRefGoogle Scholar
  14. 14.
    Gill GS, Joshi AB. Long-term results of kinematic condylar knee replacement. J Bone Joint Surg Br. 2001;83:355–358.PubMedCrossRefGoogle Scholar
  15. 15.
    Greene KA. Gender-specific design in total knee arthroplasty. J Arthroplasty. 2007;22:27–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Grelsamer RP, Dubey A, Weinstein CH. Men and women have similar Q angles. J Bone Joint Surg Br. 2005;87:1498–1501.PubMedGoogle Scholar
  17. 17.
    Guerra JP, Arnold MJ, Gaidosik RL. Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther. 1994;19:200–204.PubMedGoogle Scholar
  18. 18.
    Harwin SF, Greene KA, Hitt K. Early experience with a new total knee implant: maximizing range of motion and function with gender-specific sizing. Surg Technol Int. 2007;16:199–205.PubMedGoogle Scholar
  19. 19.
    Himanen AK, Belt E, Nevalainen J, Hämäläinen M, Lehto MU. Survival of the AGC total knee arthroplasty is similar for arthrosis and rheumatoid arthritis: Finnish Arthroplasty Register report on 8,467 operations carried out between 1985 and 1999. Acta Orthop. 2005;76:85–88.PubMedCrossRefGoogle Scholar
  20. 20.
    Hitt K, Shurman JR II, Greene K, McCarthy J, Moskal J, Hoeman T, Mont MA. Anthropomorphic measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am. 2003;85(suppl 4):115–122.PubMedGoogle Scholar
  21. 21.
    Horton MG, Hall TL. Quadriceps femoris muscle angle: normal values and relationships with gender and selected skeletal measures. Phys Ther. 1989;69:897–901.PubMedGoogle Scholar
  22. 22.
    Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load bearing distribution at the knee. Clin Orthop Relat Res. 1990;255:215–227.PubMedGoogle Scholar
  23. 23.
    Kane RL, Saleh KJ, Wilt TJ, Bershadsky B. The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2005;87:1719–1724.PubMedCrossRefGoogle Scholar
  24. 24.
    Khaw FM, Kirk LM, Morris RW, Gregg PJ. A randomized, controlled trial of cemented versus cementless press-fit condylar total knee replacement: ten-year survival analysis. J Bone Joint Surg Br. 2002;84:658–666.PubMedCrossRefGoogle Scholar
  25. 25.
    Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty: prevalence of the complication and outcomes of revision. J Bone Joint Surg Am. 2004;86:1479–1484.PubMedCrossRefGoogle Scholar
  26. 26.
    Livingston LA. The quadriceps angle: a review of the literature. J Orthop Sports Phys Ther. 1998;28:105–109.PubMedGoogle Scholar
  27. 27.
    Pierson JL, Ritter MA, Keating EM, Faris PM, Meding JB, Berend ME, Davis KE. The effect of stuffing the patellofemoral compartment on the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2007;89:2195–2203.PubMedCrossRefGoogle Scholar
  28. 28.
    Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE. Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res. 1996;331:35–44.PubMedCrossRefGoogle Scholar
  29. 29.
    Rand JA, Ilstrup DM. Survivorship analysis of total knee arthroplasty: cumulative rates of survival of 9,200 total knee arthroplasties. J Bone Joint Surg Am. 1991;73:397–409.PubMedGoogle Scholar
  30. 30.
    Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003;85:259–265.PubMedGoogle Scholar
  31. 31.
    Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting range of motion after total knee arthroplasty: clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am. 2003;85:1278–1285.PubMedGoogle Scholar
  32. 32.
    Roberts VI, Esler CN, Harper WM. A 15-year follow-up study of 4,606 primary total knee replacements. J Bone Joint Surg Br. 2007;89:1452–1456.PubMedGoogle Scholar
  33. 33.
    Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.PubMedCrossRefGoogle Scholar
  34. 34.
    Robertsson O, Knutson K, Lewold S, Lidgren L. The Swedish Knee Arthroplasty Register 1975–1997: an update with special emphasis on 41,223 knees operated on in 1988–1997. Acta Orthop Scand. 2001;72:503–513.PubMedCrossRefGoogle Scholar
  35. 35.
    Scuderi GR, Insall JN, Windsor RE. Survivorship of cemented knee replacements. J Bone Joint Surg Br. 1989;71:798–803.PubMedGoogle Scholar
  36. 36.
    Vazquez-Vela Johnson G, Worland RL, Keenan J, Norambuena N. Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br. 2003;85:52–56.PubMedCrossRefGoogle Scholar
  37. 37.
    Whiteside LA. The effect of patient age, gender, and tibial component fixation on pain relief after total knee arthroplasty. Clin Orthop Relat Res. 1991;271:21–27.PubMedGoogle Scholar
  38. 38.
    Woodland LH, Francis RS. Parameters and comparisons of the quadriceps angle of college-aged men and women in the supine and standing positions. Am J Sports Med. 1992;20:208–211.PubMedCrossRefGoogle Scholar
  39. 39.
    Wright RJ, Sledge CB, Poss R, Ewald FC, Walsh ME, Lingard EA. Patient-reported outcome and survivorship after Kinemax total knee arthroplasty. J Bone Joint Surg Am. 2004;86:2464–2470.PubMedGoogle Scholar
  40. 40.
    Zimmer Gender Solutions Knee. Available at: Accessed July 25, 2007.

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Alan C. Merchant
    • 1
  • Elizabeth A. Arendt
    • 2
  • Scott F. Dye
    • 3
  • Michael Fredericson
    • 4
  • Ronald P. Grelsamer
    • 5
  • Wayne B. Leadbetter
    • 6
  • William R. Post
    • 7
  • Robert A. Teitge
    • 8
  1. 1.Department of Orthopaedic SurgeryStanford University School of MedicineLos AltosUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of MinnesotaMinneapolisUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Department of Orthopaedic SurgeryStanford University School of MedicineStanfordUSA
  5. 5.Department of Orthopaedic SurgeryMount Sinai Medical SchoolNew YorkUSA
  6. 6.Center for Joint Preservation and ReplacementRubin Institute for Advanced Orthopaedics, Sinai HospitalBaltimoreUSA
  7. 7.Mountaineer Orthopedic Specialists, LLCMorgantownUSA
  8. 8.Wayne State UniversityWarrenUSA

Personalised recommendations