Highly Variable Femoral Morphology in Osteoarthritic Chinese: Are Prostheses Today Sufficiently Suitable?

Abstract

We aimed to retrospectively investigate the morphology of the resected surfaces of femurs in Chinese patients who underwent total knee arthroplasty (TKA) and to assess the suitability of contemporary femoral components. Measurements on three-dimensional reconstruction after virtual bone cutting were performed on 142 knees from Chinese TKA candidates. The anteroposterior (AP) and mediolateral (ML) dimensions, aspect ratio (ML/AP), and posterior condylar angle (PCA) were measured in the axial plane; the height and length of medial and lateral anterior condyles and the maximal width of the anterior condyles were measured in the frontal plane. Femurs were matched to the prosthesis with the closest AP size. The ML dimensions of femurs were compared with the ML dimensions of the prosthesis. The AP and ML dimensions were significantly larger in male knees ( < 0.01), whereas the difference of aspect ratios was not found to be significantly different between genders ( = 0.26). Both medial and lateral heights of the anterior condyles were significantly higher in men after normalization by AP ( < 0.01 and < 0.05, respectively). The mean PCA averaged 3.8 degrees for Chinese subjects. The overall prevalence of clinically significant overhang was 6.4% in males and 4.8% in females. The design of femoral prosthesis with alternative ML dimensions of the femoral component is a solution to sufficiently avoid overhang while retaining ideal coverage when dealing with a high variation. Chinese men had higher anterior condyles than women after normalization by AP dimension. The mean PCA was 3.8 degrees for all patients with high variability.

Blood management in fast-track orthopedic surgery: an evidence-based narrative review

“…A prospective cohort study evaluated the safety and feasibility of early removal of drainage tube in primary fast-track TKA.Wound drainage was removed within 6–12 h after surgery. The procedure could drain the haematocele and reduce the risk of infection, without increasing the sense of pain, inflammatory reaction, limb swelling, and total blood loss.Removal of drainage tube was therefore safe and feasible within 6–12 h after surgery [192]. According to clinical expertise, drains can be avoided in selected cases, when local conditions free of obvious bleeding following re-established pressure ensure the absence of the risk of hematoma.…”

A Morphometric Study of the Distal Femoral Resected Surface In Osteoarthritis Knees of the Patients in Southwest China and a Comparison with Femoral Components in Six Total Knee Arthroplasty Systems

“…To the best of our knowledge, this morphometric study has the largest sample size compared with other studies related to the distal femoral resected surfaces of OA knees in China. We believe that our data are more reliable 16–18,20,22,37 . Of course, this study has some limitations.…”

“…Zhang et al . found that a relatively higher underhang prevalence (51.4% of male and 38.3% of female patients) exists in males implanted with the Attune prosthesis 37 . While, Ho et al .…”

“…We believe that our data are more reliable. [16][17][18]20,22,37 Of course, this study has some limitations. First, all patients enrolled in this study mainly came from the southwest region of China, which may not be representative of the entire Chinese population.…”

“…Zhang et al found that a relatively higher underhang prevalence (51.4% of male and 38.3% of female patients) exists in males implanted with the Attune prosthesis. 37 While, Ho et al concluded in their study that the NexGen, Duracon, and UK knee systems tend to overhang in the ML dimension at a given implant AP length. 18 The fact that the study's male patient percentage was 18.5% and our study's male patient percentage was 23.6% may be the cause of the study's divergent results.…”