Restoration of Femoral Anatomy in TKA With Unisex and Gender-specific Components

Clarke, Henry D.; Hentz, Joseph G.

doi:10.1007/s11999-008-0454-6

Cited by 75 publications

(60 citation statements)

References 15 publications

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“…The implications of failing to reproduce the normal asymmetry in PCO are unknown. Clarke and Hentz [6] also found that after TKA, PCO increased by 2.8 mm in men and by 1.3 mm in women and that compromises in sizing were often required with unisex implants, particularly in female patients. Consequently, current prosthesis design and instrumentation do not allow for anatomic reproduction of the PCO of the knee.…”

Section: Discussionmentioning

confidence: 94%

Plain Radiographs Underestimate the Asymmetry of the Posterior Condylar Offset of the Knee Compared With MRI

Voleti

Stephenson

Lotke

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Restoration of posterior condylar offset (PCO) during total knee arthroplasty is essential to maximize range of motion, prevent impingement, and minimize flexion instability. Previously, PCO was determined with lateral radiographs, which could not distinguish the asymmetries between the femoral condyles. MRI can independently measure both medial and lateral PCO. Questions/purposes The purpose of this study is to determine the normal PCO of the knee, to establish the differences in medial and lateral PCO, and to compare PCO measurements obtained from radiographs versus those obtained from MRI. Methods We identified 32 patients without a history of prior knee pathology who had both plain radiographs and MRI scans of the same knee performed. The PCO was measured on lateral radiographs and compared with MRI measurements using a novel three-dimensional protocol.Results By MRI, the mean medial PCO was 29 (± 3) mm and the mean lateral PCO was 26 (± 3) mm; both values were greater (p \ 0.001 and p = 0.03, respectively) than the mean radiographic PCO of 25 (± 2) mm. The medial PCO, as measured by MRI, was significantly greater than the lateral PCO (p \ 0.001). Conclusions Plain radiographs underestimate PCO as well as the asymmetry of the medial and lateral PCO compared with MRI. This discrepancy is the result of both articular cartilage thickness and the anatomic differences between medial and lateral condyles. Designers of knee prostheses and instrumentation should take these differences into account.

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Section: Discussionmentioning

confidence: 94%

Plain Radiographs Underestimate the Asymmetry of the Posterior Condylar Offset of the Knee Compared With MRI

Voleti

Stephenson

Lotke

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…While there are a few studies assessing clinical outcomes of gender-specific TKA [10,31,32,45], albeit at short followup periods, there are even fewer reports on the results of gender-specific THA [33,46]. This is more of a failure of the surgeons and manufacturers who advocate the need for gender-specific knee designs to conduct large-scale prospective trials to compare these outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Of these 20 reports, there were 15 focusing on the knee and five focusing on the hip (Table 1). There were four reports specifically on clinical outcomes after genderspecific TKA [10,31,32,45] (two of which had a prospective, randomized design [31,32]), and one additional study assessing whether women received benefit from expanded prosthesis sizes [16]. Four studies reported on the effect of gender and modularity on clinical outcomes in THA [25,33,36,46].…”

Section: Methodsmentioning

confidence: 99%

Do We Need Gender-specific Total Joint Arthroplasty?

Johnson

Costa

Mont

2011

Clinical Orthopaedics &Amp; Related Research

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Background Gender-specific differences in knee and hip anatomy have been well documented. Although it has been accepted these differences exist, there is controversy regarding if and how these differences should be addressed with gender-specific implant designs. Questions/purposes (1) What are the anatomic and morphologic differences, if any, in the knee and hip between men and women? (2) Do gender-specific TKA designs provide better clinical functioning, survivorship, and improved fit in women? (3) How have anatomic differences in the hip been addressed, if at all, by THA? Methods We conducted a systematic review of the MEDLINE database to identify all articles reviewing basic science and clinical outcomes of gender-specific total knee and total hip implants. From these, we reviewed 253 studies.Results The anatomic studies elucidated multiple differences in the anatomy of knees and hips between men and women. All reviewed studies report similar clinical function and satisfaction scores between men and women for gender-specific TKA and no improvement in these scores when comparing gender-specific TKA to unisex TKA.

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“…It has been demonstrated that women, on average, have smaller distal femurs as well as clinically significant variation in distal femur morphology compared to their male counterparts. One morphological variation in particular is a much larger aspect ratio (anterior/posterior to medial/lateral measurement) which places this patient population at a higher risk for medial/lateral femoral component overhang [35,[37][38][39][40][41] . Different body morphologic types have a significant correlation with distal femoral morphology.…”

Section: Patellofemoral Overstuffingmentioning

confidence: 99%

“…Overhang of ≥ 3 mm in at least one of the predetermined zones of the femoral implant is associated with a 90% increase in the risk of patient-reported knee pain 2 years following TKA [42] . Gender specific femoral components have been demonstrated to minimize femoral overhang and thus post-surgical complications by providing a component that better matches the morphological differences of the female knee [37] . Therefore to minimize complications following TKA, surgeons must be aware of the various morphological differences in the native anatomy of the…”

Section: Patellofemoral Overstuffingmentioning

confidence: 99%

Anterior knee pain following primary total knee arthroplasty

Shervin¹,

Pratt²,

Healey³

et al. 2015

WJO

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Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/ flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications. MINIREVIEWSSubmit a

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Restoration of Femoral Anatomy in TKA With Unisex and Gender-specific Components

Cited by 75 publications

References 15 publications

Plain Radiographs Underestimate the Asymmetry of the Posterior Condylar Offset of the Knee Compared With MRI

Plain Radiographs Underestimate the Asymmetry of the Posterior Condylar Offset of the Knee Compared With MRI

Do We Need Gender-specific Total Joint Arthroplasty?

Anterior knee pain following primary total knee arthroplasty

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