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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2020

01-09-2020 | Knee-TEP | KNEE

Modern total knee arthroplasty designs do not reliably replicate anterior femoral morphology

Authors: Alexander W. Kuo, Darren B. Chen, Jil Wood, Samuel J. MacDessi

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2020

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Abstract

Purpose

Biomechanical studies suggest that PF tracking is not reliably restored to physiological values in TKA despite surgical technique optimization. A clinical observation is that current TKA designs may not replicate anterior femoral offset. The aim was to examine the intraoperative resection thicknesses of the anterior femoral condyles during TKA and correlate these findings relative to modern prostheses.

Methods

This was a retrospective analysis of 199 patients who underwent 233 TKAs using a single implant design with measured anterior femoral condylar resection thicknesses. The aim was to restore posterior condylar offset whilst minimizing overstuffing of the anterior compartment of the knee by choosing the smallest prosthesis to allow for the maximal anterior resection as close to the cortex without inducing notching. Prosthetic measurements from 7 commonly used TKAs were collected by analysis of 3D models of median sized explants.

Results

An average of 7.9 mm (SD 2.5 mm, range 2–16.5 mm) and 11.5 mm (SD 2.5 mm, range 2–21 mm) was resected from the medial and lateral aspects of the anterior femur, respectively. The average anterior flange thickness for the prosthesis data set was 6.6 mm (SD 0.6 mm, range 6.1–7.9 mm) medially and 7.6 mm (SD 0.7 mm, range 6.8–9.0 mm) laterally. Comparison across patients who received the median prosthesis size of 5 (SD 1.3, range 2–8) was inadequately restored by 1.4 mm (p < 0.00001) medially and 3.4 mm (p < 0.00001) laterally.

Conclusion

Host anatomy is not routinely restored during TKA. The surgical teaching to aim for an anterior femoral osteotomy close to the anterior cortex will result in understuffing of the PFJ and based on current prosthesis designs, the risk of overstuffing is not as significant as once believed. Future prostheses and surgical techniques should aim to restore not only posterior femoral but also anterior femoral offset.

Level of evidence

IV, Case series.
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Metadata
Title
Modern total knee arthroplasty designs do not reliably replicate anterior femoral morphology
Authors
Alexander W. Kuo
Darren B. Chen
Jil Wood
Samuel J. MacDessi
Publication date
01-09-2020
Publisher
Springer Berlin Heidelberg
Keywords
Knee-TEP
Knee-TEP
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05610-3

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