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Gender difference in bowing of the sagittal femoral morphology measurement using magnetic resonance imaging

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Abstract

The importance of femoral sagittal bowing on total knee arthroplasty (TKA) has not been actively discussed. Femoral sagittal bowing can lead to cortex damage, fractures, or femoral malalignment. Therefore, the purpose of this study was to evaluate femoral sagittal bowing at different segments of the femur in the Korean population, and to discuss the implications on total knee arthroplasty. Differences in the morphology of femoral sagittal bowing for 978 patients—829 women and 148 men—were evaluated using magnetic resonance imaging. The angle between the femoral mechanical axis and the anterior cortex line was measured for all the patients. In addition, the gender difference in femoral sagittal bowing was investigated. The angle of femoral sagittal bowing with the mechanical axis was 2.8˚ ± 2.2˚. The angles for femoral sagittal bowing were 2.9˚ ± 2.2˚ and 2.3˚ ± 2.6˚ for females and males, respectively. Thus, a gender difference was found in the femoral sagittal bowing (p < 0.05). Excessive sagittal bowing of the femur can affect the final sagittal position of the femoral component, and this has implications for implant design selection. We recommend that surgeons accurately perform pre-operative evaluation of femoral bowing to prevent potential malalignment, rotation, and abnormal stresses between the femur and implant.

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References

  1. Abdelaal AH, Yamamoto N, Hayashi K, Takeuchi A, Morsy AF, Miwa S, Kajino Y, Rubio DA, Tsuchiya H (2016) Radiological assessment of the femoral bowing in Japanese population. Sicot J 2:2

    Article  Google Scholar 

  2. Bolognesi M, Hofmann A (2005) Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res 440:162–169

    Article  Google Scholar 

  3. Bruns W, Bruce M, Prescott G, Maffulli N (2002) Temporal trends in femoral curvature and length in medieval and modern Scotland. Am J Phys Anthropol 119(3):224–230

    Article  Google Scholar 

  4. Camera A, Biggi S, Cattaneo G, Brusaferri G (2015) Ten-year results of primary and revision condylar-constrained total knee arthroplasty in patients with severe coronal plane instability. Open Orthop J 9:379–389

    Article  Google Scholar 

  5. Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20(5):618–626

    Article  Google Scholar 

  6. Cho MR, Lee YS, Choi WK (2018) Relationship between lateral femoral bowing and varus knee deformity based on two-dimensional assessment of side-to-side differences. Knee Surg Relat Res 30(1):58–63

    Article  Google Scholar 

  7. Chung BJ, Kang YG, Chang CB, Kim SJ, Kim TK (2009) Differences between sagittal femoral mechanical and distal reference axes should be considered in navigated TKA. Clin Orthop Relat Res 467(9):2403–2413

    Article  Google Scholar 

  8. Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC (2008) Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Jt Surg Am 90(1):2–9

  9. Egol KA, Chang EY, Cvitkovic J, Kummer FJ, Koval KJ (2004) Mismatch of current intramedullary nails with the anterior bow of the femur. J Orthop Trauma 18(7):410–415

    Article  Google Scholar 

  10. Engh GA, Petersen TL (1990) Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplasty 5(1):1–8

    Article  CAS  Google Scholar 

  11. Gausepohl T, Pennig D, Koebke J, Harnoss S (2002) Antegrade femoral nailing: an anatomical determination of the correct entry point. Injury 33(8):701–705

    Article  CAS  Google Scholar 

  12. Greene KA (2007) Gender-specific design in total knee arthroplasty. J Arthroplasty 22(7 Suppl 3):27–31

    Article  Google Scholar 

  13. Harma A, Germen B, Karakas HM, Elmali N, Inan M (2005) The comparison of femoral curves and curves of contemporary intramedullary nails. Surg Radiol Anat 27(6):502–506

    Article  Google Scholar 

  14. Harper MC, Carson WL (1987) Curvature of the femur and the proximal entry point for an intramedullary rod. Clin Orthop Relat Res 220:155–161

    Google Scholar 

  15. Hungerford DS, Krackow KA (1985) Total joint arthroplasty of the knee. Clin Orthop Relat Res 192:23–33

    Google Scholar 

  16. Johnson KD, Tencer A (1990) Mechanics of intramedullary nails for femoral fractures. Unfallchirurg 93(11):506–511

    CAS  PubMed  Google Scholar 

  17. Karakas HM, Harma A (2008) Femoral shaft bowing with age: a digital radiological study of anatolian Caucasian adults. Diagn Interv Radiol 14(1):29–32

    PubMed  Google Scholar 

  18. Ko JH, Han CD, Shin KH, Nguku L, Yang IH, Lee WS, Kim KI, Park KK (2016) Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24(8):2476–2482

    Article  Google Scholar 

  19. Koh YG, Nam JH, Chung HS, Lee HY, Kim HJ, Kim HJ, Kang KT (2019) Gender-related morphological differences in sulcus angle and condylar height for the femoral trochlea using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc

  20. Lu ZH, Yu JK, Chen LX, Gong X, Wang YJ, Leung KK (2012) Computed tomographic measurement of gender differences in bowing of the sagittal femoral shaft in persons older than 50 years. J Arthroplasty 27(6):1216–1220

    Article  Google Scholar 

  21. Maestro A, Harwin SF, Sandoval MG, Vaquero DH, Murcia A (1998) Influence of intramedullary versus extramedullary alignment guides on final total knee arthroplasty component position: a radiographic analysis. J Arthroplasty 13(5):552–558

    Article  CAS  Google Scholar 

  22. Marra MA, Strzelczak M, Heesterbeek PJC, van de Groes SAW, Janssen D, Koopman B, Verdonschot N, Wymenga AB (2018) Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26(11):3377–3385

    Article  Google Scholar 

  23. Mihalko WM, Boyle J, Clark LD, Krackow KA (2005) The variability of intramedullary alignment of the femoral component during total knee arthroplasty. J Arthroplasty 20(1):25–28

    Article  Google Scholar 

  24. Novotny J, Gonzalez MH, Amirouche FM, Li YC (2001) Geometric analysis of potential error in using femoral intramedullary guides in total knee arthroplasty. J Arthroplasty 16(5):641–647

    Article  CAS  Google Scholar 

  25. O'Rourke MR, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC (2002) Osteolysis associated with a cemented modular posterior-cruciate-substituting total knee design: five to eight-year follow-up. J Bone Jt Surg Am 84(8):1362–1371

    Article  Google Scholar 

  26. Ritter MA, Thong AE, Keating EM, Faris PM, Meding JB, Berend ME, Pierson JL, Davis KE (2005) The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome. J Bone Jt Surg Am 87(11):2411–2414

    Google Scholar 

  27. Tang WM, Chiu KY, Kwan MF, Ng TP, Yau WP (2005) Sagittal bowing of the distal femur in Chinese patients who require total knee arthroplasty. J Orthop Res 23(1):41–45

    Article  CAS  Google Scholar 

  28. Tsubosaka M, Takayama K, Oka S, Muratsu H, Kuroda R, Matsumoto T (2017) Posterior condylar offset influences the intraoperative soft tissue balance during posterior-stabilized total knee arthroplasty. J Orthop Sci 22(6):1071–1076

    Article  Google Scholar 

  29. Zingde SM, Leszko F, Sharma A, Mahfouz MR, Komistek RD, Dennis DA (2014) In vivo determination of cam-post engagement in fixed and mobile-bearing TKA. Clin Orthop Relat Res 472(1):254–262

    Article  Google Scholar 

  30. Zuber K, Schneider E, Eulenberger J, Perren SM (1988) Form and dimension of the bone marrow cavity of the human femur with reference to the fit of intramedullary implants. Unfallchirurg 91(7):314–319

    CAS  PubMed  Google Scholar 

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Author notes

  1. Ji-Hoon Nam and Yong-Gon Koh have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Ji-Hoon Nam & Kyoung-Tak Kang

  2. Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea

    Yong-Gon Koh

  3. Department of Orthopaedic Surgery, The Bone Hospital, 67, Dongjak-daero, Dongjak-gu, Seoul, Republic of Korea

    Paul Shinil Kim

  4. Orthopaedic Clinic, Gaja Yonsei Hospital, A-304, 7, Janggogae-ro 337 beon-gil, Seo-gu, Incheon, Republic of Korea

    Kiwon Kang

  5. Department of Anesthesiology & Pain Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, Republic of Korea

    Joon-Hee Park

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  1. Ji-Hoon Nam
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  4. Kiwon Kang
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Contributions

JHP and KKT designed the research. JHN and PSK analyzed and discussed the results. KWK and KYG perform the work.

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Correspondence to Kyoung-Tak Kang.

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Joon-Hee Park and Kyoung-Tak Kang are considered co-corresponding authors.

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Nam, JH., Koh, YG., Kim, P.S. et al. Gender difference in bowing of the sagittal femoral morphology measurement using magnetic resonance imaging. Surg Radiol Anat 42, 1231–1236 (2020). https://doi.org/10.1007/s00276-020-02488-6

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  • DOI: https://doi.org/10.1007/s00276-020-02488-6

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