No clinical benefit of gender-specific total knee arthroplasty

Cheng, Tao; Zhu, Chen; Wang, Jiaxing; Cheng, Mengqi; Peng, Xiaochun; Wang, Qi; Zhang, Xianlong

doi:10.3109/17453674.2014.931194

Cited by 28 publications

(20 citation statements)

References 45 publications

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“…This serves as a cautionary example that not all changes to implants driven by morphologic findings result in discernible improvements. We note, though, that the ML width of the distal femur is associated primarily with femur length, not gender [37], which could play a role in the inability of gender-specific implants to confer a clinical benefit [4]. The differences in aspect ratio and femoral shape identified between ethnicities in our analysis may prove to be a more relevant factor in the long-term success of TKA, and is worthy of additional analysis.…”

Section: Discussionmentioning

confidence: 93%

“…Although individual studies have been conducted measuring relevant morphologic endpoints among various distinct populations [1, 2, 4, 6, 8, 13, 14, 23, 24, 26, 27, 29–32, 34, 36, 39, 41–43, 45–47, 50–54, 56], to our knowledge to date there has not been a systematic analysis of their findings to clarify what specific differences exist among ethnicities. We hoped that performing this analysis would facilitate research in the clinical implications of these anatomic differences and determine whether design initiatives would be merited to address the potential for compromised implant fit.…”

Section: Discussionmentioning

confidence: 99%

“…In an attempt to better match the anatomic considerations of women, who undergo TKA at a higher rate than men [38], gender-specific prostheses were introduced in the mid-2000s. The majority of clinical studies conducted to date have not uncovered relevant clinical advantages for these prostheses over unisex models, despite accomplishing one of their intended goals in reducing overhang of the femoral component [4, 49]. This serves as a cautionary example that not all changes to implants driven by morphologic findings result in discernible improvements.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

What Differences in Morphologic Features of the Knee Exist Among Patients of Various Races? A Systematic Review

Kim

Phillips²,

Bhandari

et al. 2017

Clinical Orthopaedics &Amp; Related Research

118

119

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BackgroundMost TKA prostheses are designed based on the anatomy of white patients. Individual studies have identified key anthropometric differences between the knees of the white population and other major ethnic groups, yet there is limited understanding of what these findings may indicate if analyzed collectively.Question/purposeWhat are the differences in morphologic features of the distal femur and proximal tibia among and within various ethnicities?MethodsA systematic review of the PubMed database and a hand-search of article bibliographies identified 235 potentially eligible English-language studies. Studies were excluded if they did not include morphology results or had insufficient data for analysis, were unrelated to the distal femur or proximal tibia, were conducted in pediatric patients or those undergoing unicondylar knee arthroplasty, or bone surface measurements were obtained for trauma products. This left 30 eligible studies (9050 knees). Study quality was assessed and reported as good, fair, or poor according to the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Morphometric data for the distal femur and proximal tibia were available for four ethnic groups: East Asian (23 studies; 5543 knees), white (11 studies; 3111 knees), Indian (three studies; 283 knees), and black (three studies; 113 knees). Although relatively underrepresented, the knees from the Indian and black studies were maintained for hypothesis-generating purposes and to highlight crucial gaps in the data. The two key dimensions for selecting a suitable implant based on a patient’s unique anatomy—AP length and mediolateral (ML) width—were assessed for the femur and tibia, in addition to aspect ratio, calculated by dividing the ML width by the AP length. Study measurement techniques were compared visually when possible to ensure that each pooled study conducted a similar measurement process. Any significant measurement outliers were reviewed for eligibility to determine if the measurement techniques and landmarks used were comparable to the other studies included.ResultsWhite patients had larger femoral AP measurements than East Asians (62 mm, [95% CI, 57–66 mm] vs 59 mm, [95% CI, 54–63 mm]; mean difference, 3 mm; p < 0.001), a smaller femoral aspect ratio than East Asians (1.20, [95% CI, 1.11–1.29] vs 1.25, [95% CI, 1.16–1.34]; mean difference, 0.05; p = 0.001), and a larger tibial aspect ratio than black patients (1.55, [95% CI, 1.40–1.71] vs 1.49, [95% CI, 1.33–1.64]; mean difference, 0.06; p = 0.005).ConclusionsThis analysis uncovered differences of size (AP height and ML width of the femur and tibia) and shape (tibial and femoral aspect ratios) among knees from white, East Asian, and black populations. Future research is needed to understand the clinical implications of these discrepancies and to provide additional data with underrepresented groups.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

What Differences in Morphologic Features of the Knee Exist Among Patients of Various Races? A Systematic Review

Kim

Phillips²,

Bhandari

et al. 2017

Clinical Orthopaedics &Amp; Related Research

118

119

View full text Add to dashboard Cite

show abstract

“…In a study conducted in female patients by Zaki et al [31], early clinical outcomes for knees with a gender-specific prosthesis were found to be similar to knees with a standard prosthesis there by showing no advantage of gender-specific knee prosthesis over standard unisex knee prosthesis with regards to early clinical outcomes. Genderspecific prosthesis didn't appear to confer any advantage in terms of clinician as well as patient-reported outcomes in study by Cheng et al [32] for the female knee. In present study of 1,635 high flex knees, an aggregate of 8 (0.49%) amendments were done, including four (0.24%) for infection, three (0.18%) for aseptic loosening, and one (0.06%) for dislocation.…”

Section: Discussionmentioning

confidence: 99%

Gender comparison of clinical outcomes post high-flex total knee arthroplasty

Hui¹,

Lu²,

Bai³

et al. 2018

biomedicalresearch

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Background: Although it is normally perceived that knee morphometry contrasts exist amongst the female as well as male populations, the literature normally disproves the need for gender specific totalknee prosthesis clinically. It was noted that standard/unisex knee performs alike or better in female than male. As of late, high flex knees became accessible, that mechanically accommodate raised flexion but not many studies have contrasted these devices' results in male and female to find out if there is any gender based contrast.

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“…Sir –We thank Dr. Xie and his colleagues for their great interest in performing such an in-depth methodological assessment of our article ( Cheng et al 2014 ). We would like to answer their questions that were raised in their letter to the editor.…”

mentioning

confidence: 99%