Anthropometric Measures of the Posterior Condyles: Gender Differences and Correlation to Implant Sizing

Abstract

There is abundant data concerning morphological dimensions of the distal femur, particularly in women, which has led to redesign of the femoral component in total knee arthroplasty (TKA). Clinical experience reveals existing asymmetry of the femoral posterior condyles, yet current implant designs have a symmetrical femoral component. The objectives of this study were to analyze the dimensions of posterior condylar bone resection from a group of patients undergoing TKA and correlate the measurements to one prosthetic system. We retrospectively reviewed single surgeon morphological data from the posterior condyles of 105 knees during TKA. The study included 54 males and 51 females. Measurement of the posterior condylar bones was performed with a standard metric metal ruler by one investigator. Known dimensions of a single type of implant design were compared with the resection data. The average difference of posterior medial and lateral condylar width was 5.7 and 5.3 mm in males and females, respectively. The average host posterolateral condylar bone was 5.4 mm less than the trial implant across five sizes in both males and females. Results suggest that the dimension of the posterior lateral condyle is much smaller than the dimension of the implant in both groups of patients. Dimension of the posterior medial is close to dimension of the implant. Overhang of the component posterolaterally can create soft tissue irritation and result in postoperative pain and decreased range of motion. Our results increase awareness of the dimensions of the native posterolateral condyle and may influence future design of femoral implants used in total knee arthroplasty.

Keywords

anthropometric measurements - posterior condyle - gender - implant size

Publication History

Received: 15 March 2019

Accepted: 18 September 2019

Article published online:
23 October 2019

• References

• 1 Fehring TK, Valadie AL. Knee instability after total knee arthroplasty. Clin Orthop Relat Res 1994; (299) 157-162
• 2 Mahoney OM, Kinsey T. Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Joint Surg Am 2010; 92 (05) 1115-1121
• 3 Merchant AC, Arendt EA, Dye SF. et al. The female knee: anatomic variations and the female-specific total knee design. Clin Orthop Relat Res 2008; 466 (12) 3059-3065
• 4 Bellemans J, Carpentier K, Vandenneucker H, Vanlauwe J, Victor J. The John Insall Award: Both morphotype and gender influence the shape of the knee in patients undergoing TKA. Clin Orthop Relat Res 2010; 468 (01) 29-36
• 5 Chin KR, Dalury DF, Zurakowski D, Scott RD. Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty. J Knee Surg 2002; 15 (04) 213-217
• 6 Conley S, Rosenberg A, Crowninshield R. The female knee: anatomic variations. J Am Acad Orthop Surg 2007; 15 (Suppl. 01) S31-S36
• 7 Hitt K, Shurman II JR, Greene K. et al. Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 115-122
• 8 Diduch DR, Scuderi GR, Scott WN, Insall JN, Kelly MA. The efficacy of arthroscopy following total knee replacement. Arthroscopy 1997; 13 (02) 166-171
• 9 Lonner JH, Jasko JG, Thomas BS. Anthropomorphic differences between the distal femora of men and women. Clin Orthop Relat Res 2008; 466 (11) 2724-2729
• 10 Dargel J, Michael JW, Feiser J, Ivo R, Koebke J. Human knee joint anatomy revisited: morphometry in the light of sex-specific total knee arthroplasty. J Arthroplasty 2011; 26 (03) 346-353
• 11 Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 2010; 92 (09) 1253-1258
• 12 Baker P, Cowling P, Kurtz S, Jameson S, Gregg P, Deehan D. Reason for revision influences early patient outcomes after aseptic knee revision. Clin Orthop Relat Res 2012; 470 (08) 2244-2252
• 13 Kim J, Nelson CL, Lotke PA. Stiffness after total knee arthroplasty. Prevalence of the complication and outcomes of revision. J Bone Joint Surg Am 2004; 86 (07) 1479-1484
• 14 Talmo CT, Cooper AJ, Wuerz T, Lang JE, Bono JV. Tibial component alignment after total knee arthroplasty with intramedullary instrumentation: a prospective analysis. J Arthroplasty 2010; 25 (08) 1209-1215
• 15 Clarke HD, Hentz JG. Restoration of femoral anatomy in TKA with unisex and gender-specific components. Clin Orthop Relat Res 2008; 466 (11) 2711-2716
• 16 MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH. The John Insall Award: gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res 2008; 466 (11) 2612-2616
• 17 Kelly MA, Clarke HD. Long-term results of posterior cruciate-substituting total knee arthroplasty. Clin Orthop Relat Res 2002; (404) 51-57
• 18 Scuderi GR. The stiff total knee arthroplasty: causality and solution. J Arthroplasty 2005; 20 (04) (Suppl. 02) 23-26
• 19 Elson DW, Brenkel IJ. Predicting pain after total knee arthroplasty. J Arthroplasty 2006; 21 (07) 1047-1053
• 20 Worland RL, Johnson GV, Alemparte J, Jessup DE, Keenan J, Norambuena N. Ten to fourteen year survival and functional analysis of the AGC total knee replacement system. Knee 2002; 9 (02) 133-137
• 21 Cress D, Pelton J, Thayer SC, Bukrey C. Development of a center of excellence for joint replacement. Orthop Nurs 2010; 29 (03) 150-168