3D Morphological Study of the Indian Arthritic Knee: Comparison with Other Ethnic Groups and Conformity of Current TKA Implant*

Abstract

Background: Studies have shown that there are striking variations in knee morphology between Asian and Western population. However, most of the existing total knee arthroplasty (TKA) implants are designed to suit the anatomy of Western population. Our study investigated anthropometry of Indian arthritic knees and compared them to international ethnic groups. Methods: Computed tomography was used to create 3D knee models and obtain anthropometric data of distal femur and proximal tibia of Indian arthritic knees. Femoral measurements included mediolateral length, medial and lateral anteroposterior length, medial and lateral condylar width and aspect ratio. Tibial measurements included mediolateral length, medial, lateral and central anteroposterior length and aspect ratio. A preoperative virtual implantation using Western TKA implants was carried out to visualize anatomical conformity. Results: Statistical analysis results showed that Indian males had significantly larger femoral and tibial mediolateral and anteroposterior width than Indian females; however, femoral and tibial aspect ratio was similar for both. In case of females, significant difference was observed between medial and lateral condylar widths. When compared to knee anthropometry of other ethnic groups, femoral and tibial aspect ratio of Indian knees was found to be similar to the Asian population and different from the Western population. The virtual implantation showed overhang of the femoral component in both lateral and medial regions. Conclusion: Morphological mismatch between Western and Indian knees established the fact that Western implants have drawbacks when implanted in Indian patients. The study also provided a basis for designing gender-specific TKA implants for the Indian population.

Morphological Measurements of Knee Joints in Indian Population: Comparison to Current Knee Prostheses

“…According to various research studies, Asian knees are generally smaller than the Western population [3]- [5] [8] [12]. Moreover, a study has also demonstrated that Asian knees have a smaller aspect ratio than those of the Western population [8]. Since components of the knee implants are required to cover maximum resected surface in order to achieve a successful outcome [2] [3], it is important to know the exact morphology of the resected surface of the Indian knees in order to design or validate knee prostheses for the Indian population.…”

“…At present, owing to a shortage of data on the distal femur and proximal tibia in this population, implants designed for knees of the Western population are being used without modifications for the ethnic group [7]. Anthropometric studies have shown that there are striking variations in knee morphology between the Asian and Western population [8]. Research on implant mismatching carried out in various Asian countries has led to the conclusion that the Asian-Pacific population should have special designs of TKA implants [9].…”

Computer tomography 3D reconstruction based study of knee anthropometry of Indian population: Comparison with other ethnic groups and current TKA implants

“…Maximal implant coverage on the bone surface minimizes the stress applied to the bone-implant interface [4,5] . Most TKA prosthesis designs are based on the anthropometry of western population, which differs from Asian knee morphometry [3] .…”

“…Being shortage of data on the morphometry of distal femur and proximal tibia in the Indian population, implants designed for knees of the western population are being used without modifications for the ethnic group [2] . Anthropometric studies have shown that there are striking variations in knee morphology between the Asian and western population [3] . In TKA, maximal implant coverage on the bone surface minimizes the stress applied to the bone-implant interface [4,5] .…”

Intercondylar notch morphometrics in Indian population: An anthropometric study with magnetic resonance imaging analysis

“…2,3,6,7 A thorough understanding of the anatomic relationships of these parameters is of much clinical value. 4,9 Significant morphological variations are noted in literature between ethnic groups 16 , 17 . The studies in Asian population primarly focus on East Asian population with little literature referencing the South Asian community who are ethinically different.…”