Abstract
Purpose
The objectives of this study were to measure the morphometric parameters of preoperative distal femurs to determine the differences by diagnosis and gender after accounting for skeletal size.
Methods
One-hundred and seventy-nine Japanese patients who underwent total knee arthroplasty (TKA) (25 males and 154 females) were assessed. The anteroposterior length (AP), mediolateral width (ML), aspect ratio (AR), surgical epicondylar axis (SEA) to posterior condylar axis (PCA) angle, and Whiteside to SEA angle were measured on preoperative computed tomography scans. The AP/ML, AR/ML, SEA/PCA, and Whiteside/PCA relationships were evaluated and compared by patient diagnosis and gender. The results were also compared with the sizes of 10 currently available TKA implants in Japan.
Results
The mean AP, ML, AR, SEA/PCA angle, and Whiteside/PCA angle were 58.8 mm, 64.7 mm, 0.91, external rotation (ER) 3.5°, and ER 1.6°, respectively. AP and AR each were significantly correlated with ML (p < 0.001). AP, ML, and AR were not significantly different between patients diagnosed with osteoarthritis and rheumatoid arthritis. AP/ML and AR/ML were significantly correlated within each diagnosis (p < 0.001), but the analysis of covariance showed no significant differences between the diagnoses. AP and ML were significantly longer (p < 0.001) in males (63.6, 72.7 mm) than in females (58.1, 63.4 mm), while AR was smaller in males (0.88 vs. 0.92), with significant correlations for AP/ML (male: p < 0.010, female: p < 0.001) and AR/ML (male: p = 0.002, female: p < 0.001) in each gender. However, the analysis of covariance showed no significant differences between gender in the AP/ML and AR/MR correlations. The AP/ML ratio of our data was similar to the size variations of the 10 TKA implants, but the AR/ML ratio was quite different from almost all the implants.
Conclusions
No differences in preoperative femur morphometry were found between patients with different diagnoses, but the gender difference in AR was related to the difference in skeletal size between males and females.
Level of evidence
Case series with no comparison groups, Level IV.
Similar content being viewed by others
References
Akagi M, Nakamura T, Matsusue Y, Ueo T, Nishijyo K, Ohnishi E (2000) The Bisurface total knee replacement: a unique design for flexion four-to nine year follow-up study. J Bone Joint Surg Am 82(11):1626–1633
Arima J, Whiteside LA, McCarthy DS, White SE (1995) Femoral rotational alignment, based on the anterorposterior axis, in total knee arthroplasty in a valgus knee. A technical note. J Bone Joint Surg Am 77(9):1331–1334
Bellemans J, Carpentier K, Vandenneucker H, Vanlauwe J, Victor J (2010) The John Insall Award: both morphotype and gender influence the shape of the knee in patients undergoing TKA. Clin Orthop Relat Res 468(1):29–36
Bonnin MP, Schmidt A, Basiglini L, Bossard N, Dantony E (2013) Mediolateral oversizing influences pain, function, and flexion after TKA. Knee Surg Sports Traumatol Arthrosc 21(10):2314–2324
Booth RE Jr (2006) The gender-specific (female) knee. Orthopedics 29(9):768–769
Booth RE Jr (2006) Sex and the total knee: gender-sensitive designs. Orthopedics 29(9):836–838
Chen FB, Ji XF, Lai Y, Feng JC, Zheng WX, Sun YF, Fu YW, Li YQ (2009) Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee 16(5):341–347
Chin KR, Dalury DF, Zurakowski D, Scott RD (2002) Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty. J Knee Surg 15(4):213–217
Clarke HD, Hentz JG (2008) Restoration of femoral anatomy in TKA with unisex and gender-specific components. Clin Orthop Relat Res 466(11):2711–2716
Conley S, Rosenberg A, Crowninshield R (2007) The female knee: anatomic variations. J Am Acad Orthop Surg 15(Suppl 1):S31–S36
Emerson RH Jr, Martinez J (2008) Men versus women: does size matter in total knee arthroplasty? Clin Orthop Relat Res 466(11):2706–2710
Gillespie RJ, Levine A, Fitzgerald SJ, Kolaczko J, DeMaio M, Marcus RE, Cooperman DR (2011) Gender differences in the anatomy of the distal femur. J Bone Joint Surg Br 93(3):357–363
Greene KA (2007) Gender-specific design in total knee arthroplasty. J Arthroplasty 22(7 Suppl 3):27–31
Hitt K, Shurman JR, Greene K, McCarthy J, Moskal J, Hoeman T, Mont MA (2003) Anthropometric measurements of the human knee: correlation to sizing of current knee arthroplasty systems. J Bone Joint Surg Am 85(Suppl 4):115–122
Ho WP, Cheng CK, Liau JJ (2006) Morphometrical measurements of resected surface of femurs in Chinese knees: correlation to the sizing of current femoral implants. Knee 13(1):12–14
Hosaka K, Saito S, Ishii T, Mori S, Sumino T, Tokuhashi Y (2011) Asian-specific total knee system: 5–14 year follow-up study. BMC Musculoskelet Disord 12:251
Iorio R, Kobayashi S, Healy WL, Cruz AI Jr, Ayers ME (2007) Primary posterior cruciate-retaining total knee arthroplasty: a comparison of American and Japanese cohorts. J Surg Orthop Adv 16(4):164–170
Kim D, Seong SC, Lee MC, Lee S (2012) Comparison of the tibiofemoral rotational alignment after mobile and fixed bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(2):337–345
Lonner JH, Jasko JG, Thomas BS (2008) Anthropomorphic differences between the distal femora of men and women. Clin Orthop Relat Res 466(11):2724–2729
Low FH, Khoo LP, Chua CK, Lo NN (2000) Determination of the major dimensions of femoral implants using morphometrical data and principal component analysis. Proc Inst Mech Eng H 214(3):301–309
MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH (2008) The John Insall Award: gender-specific total knee replacement: prospective collected clinical outcomes. Clin Orthop Relat Res 466(11):2612–2616
Mahfouz MR, Merkl BC, Fatah EE, Booth R Jr, Argenson JN (2007) Automatic methods for characterization of sexual dimorphism of adult femora: distal femur. Comput Methods Biomech Biomed Engin 10(6):447–456
Merchant AC, Arendt EA, Dye SF, Fredericson M, Grelsamer RP, Leadbetter WB, Post WR, Teitge RA (2008) The female knee: anatomic variations and the female-specific total knee design. Clin Orthop Relat Res 466(12):3059–3065
Miyazaki Y, Nakamura T, Kogame K, Saito M, Yamamoto K, Suguro T (2011) Analysis of the kinematics of total knee prostheses with a medial pivot design. J Arthroplasty 26(7):1038–1044
Nam D, Maher PA, Robles A, McLawhorn AS, Mayman DJ (2013) Variability in the relationship between the distal femoral mechanical and anatomical axes in patients undergoing primary total knee arthroplasty. J Arthroplasty 28(5):798–801
Smitowicz M, Jung L (2006) Total knee arthroplasty in patients with severe deformities due to rheumatoid arthritis. Ortop Traumatol Rehabil 8(2):219–225
Tanavalee A, Rojpornpradit T, Khumrak S, Ngarmukos S (2011) The early results of gender-specific total knee arthroplasty in Thai patients. Knee 18(6):483–487
Urabe K, Miura H, Kuwano T, Matsuda S, Nagamine R, Sakai S, Masuda K, Iwamoto Y (2003) Comparison between the shape of resected femoral sections and femoral prostheses used in total knee arthroplasty in Japanese patients: simulation using three-dimensional computed tomography. J Knee Surg 16(1):27–33
Vaidya SV, Ranawat CS, Aroojis A, Laud NS (2000) Anthropometric measurements to design total knee prostheses for the Indian population. J Arthroplasty 15(1):79–85
Wang SW, Feng CH, Lu HS (1992) A study of Chinese knee joint geometry for prosthesis design. Chin Med J 105(3):227–233
Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172
Yoshino N, Takai S, Ohtsuki Y, Hirasawa Y (2001) Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees. J Arthroplasty 16(4):493–497
Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G (2011) Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty 26(1):124–130
Acknowledgments
The authors would like to acknowledge Kenrin Shi MD, PhD (Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan), who provided carefully considered feedback and valuable comments.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nishikawa, M., Owaki, H., Kaneshiro, S. et al. Preoperative morphometric differences in the distal femur are based on skeletal size in Japanese patients undergoing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22, 2962–2968 (2014). https://doi.org/10.1007/s00167-014-3253-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3253-5