Intra-articular resection of bone with soft-tissue balancing and total knee replacement (TKR) has been described for the treatment of patients with severe osteoarthritis of the knee associated with an ipsilateral malunited femoral fracture. However, the extent to which deformity in the sagittal plane can be corrected has not been addressed. We treated 12 patients with severe arthritis of the knee and an extra-articular malunion of the femur by TKR with intra-articular resection of bone and soft-tissue balancing. The femora had a mean varus deformity of 16° (8° to 23°) in the coronal plane. There were seven recurvatum deformities with a mean angulation of 11° (6° to 15°) and five antecurvatum deformities with a mean angulation of 12° (6° to 15°). The mean follow-up was 93 months (30 to 155). The median Knee Society knee and function scores improved from 18.7 (0 to 49) and 24.5 (10 to 50) points pre-operatively to 93 (83 to 100) and 90 (70 to 100) points at the time of the last follow-up, respectively. The mean mechanical axis of the knee improved from 22.6° of varus (15° to 27° pre-operatively to 1.5° of varus (3° of varus to 2° of valgus) at the last follow-up. The recurvatum deformities improved from a mean of 11° (6° to 15°) pre-operatively to 3° (0° to 6°) at the last follow-up. The antecurvatum deformities in the sagittal plane improved from a mean of 12° (6° to 16°) pre-operatively to 4.4° (0° to 8°) at the last follow-up. Apart from varus deformities, TKR with intra-articular bone resection effectively corrected the extra-articular deformity of the femur in the presence of antecurvatum of up to 16° and recurvatum of up to 15°.

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PurposeThis study aimed to analyze the morphology of the anterior femoral condyle using a quantitative three‐dimensional reconstruction method. The morphological data were compared between genders. MethodsComputed tomography scans of femurs were taken from 90 healthy subjects and then reconstructed in 3D modeling software. Coaxial cutting planes were created at 10° increments to measure the lateral and medial anterior condylar heights (LACH and MACH, respectively), lateral and medial trochlear groove widths (LTW and MTW, respectively), and for trochlear groove tracking. The absolute values and normalized data were compared between male and female subjects. The sulcus angle and deepest point of the trochlear groove at each cross‐section were also analyzed to determine the differences in the depth of the trochlear groove. ResultsThe absolute dimensions of LACH, MACH, LTW, and MTW were significantly smaller in the female subjects, by 10.5%, 36.9%, 10.3%, and 11.0%, respectively, than in the males (p < 0.05). After normalization, no significant difference was found in the condylar height between the genders. However, the female subjects had a significantly larger value of approximately 7.9% for the normalized trochlear width. ConclusionMale subjects had greater condylar heights and widths than the female subjects. Although the trajectory of the trochlear groove varied greatly among the subjects, the trochlear groove appeared to be wider and shallower in the female subjects than in the male subjects. These results provide important information for the design of femoral trochlea to fit Asian female patients. Level of evidenceIII.

Cellular structures with tailored topologies can be fabricated using additive manufacturing (AM) processes to obtain the desired global and local mechanical properties, such as stiffness and energy absorption. Lattice structures usually fail from the sharp edges owing to the high stress concentration and residual stress. Therefore, it is crucial to analyze the failure mechanism of lattice structures to improve the mechanical properties. In this study, several lattice topologies with fillets were designed, and the effects of the fillets on the stiffness, energy absorption, energy return, and energy loss of an open-cell lattice structure were investigated at a constant relative density. A recently developed high-speed AM multi-jet fusion technology was employed to fabricate lattice samples with two different unit cell sizes. Nonlinear simulations using ANSYS software were performed to investigate the mechanical properties of the samples. Experimental compression and loading–unloading tests were conducted to validate the simulation results. The results showed that the stiffness and energy absorption of the lattice structures can be improved significantly by the addition of fillets and/or vertical struts, which also influence other properties such as the failure mechanism and compliance. By adding the fillets, the failure location can be shifted from the sharp edges or joints to other regions of the lattice structure, as observed by comparing the failure mechanisms of type B and C structures with that of the type A structure (without fillets). The results of this study suggest that AM software designers should consider filleted corners when developing algorithms for generating various types of lattice structures automatically. Additionally, it was found that the accumulation of unsintered powder in the sharp corners of lattice geometries can also be minimized by the addition of fillets to convert the sharp corners to curved edges.

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