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Archives of Orthopaedic and Trauma Surgery

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17-08-2021 | Knee Arthroplasty

Preoperative radiographic parameters in the case of using a narrow-version femoral implant in total knee arthroplasty

Authors: Jaehyun Kim, Seongyun Park, Ji Hyun Ahn

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2022

Abstract

Background

Recently, total knee arthroplasty (TKA) designs that allow the use of narrow-version femoral implants have been introduced to avoid femoral overhang. The purpose of this study was to investigate the frequency of the use of narrow-version femoral implants and identify the difference in radiographic parameters between using a narrow-version femoral implant and a standard-version femoral implant in TKA.

Methods

A retrospective study was conducted on 504 primary TKAs using a TKA system (Anthem or Persona) that allowed narrow-version femoral implants. Anteroposterior (AP) dimension, mediolateral (ML) dimension, and modified aspect percentage ratio (ML/AP dimension) of the distal femur in preoperative radiographs were compared between a standard-version group (n = 275) and a narrow-version group (n = 229). A cut-off value of a modified aspect percentage ratio indicating the need for a narrow-version femoral implant was determined using the receiver operating characteristic (ROC) curve.

Results

Mean ML dimension was 80.9 ± 6.1 mm in the standard-version group and 77.3 ± 4.4 mm in the narrow-version group (p < 0.001). Mean modified aspect percentage ratio was 138.8 ± 8.1% in the standard-version group and 131.7 ± 6.3% in the narrow-version group (p < 0.001). The optimum cut-off point of the modified aspect percentage ratio for narrow-version femoral implants was 135.4% (sensitivity: 72.0%; specificity: 66.7%) for Anthem and 133.3% (sensitivity: 75.9%, specificity: 76.4%) for Persona.

Conclusion

In the narrow-version femoral implant group, the ML dimension and the mean modified aspect percentage ratio were smaller than in the standard-version femoral implant group. A smaller modified aspect percentage ratio of the distal femur in preoperative radiographs could predict the need for narrow-version femoral implants in TKA. It was suggested that the cut-off point could be suggested as 135.4% for Anthem TKA design and 133.3% for Persona TKA design. These radiographic parameters are cost-effective and easily applicable for planning a TKA.A smaller modified aspect percentage ratio of the distal femur in preoperative radiographs could predict the need for narrow-version femoral implants in TKA. The cut-off point was 135.4% for Anthem TKA design and 133.3% for Persona TKA design.

Chung BJ, Kang JY, Kang YG, Kim SJ, Kim TK (2015) Clinical implications of femoral anthropometrical features for total knee arthroplasty in Koreans. J Arthroplasty 30:1220–1227. https://doi.org/10.1016/j.arth.2015.02.014CrossRefPubMed

Mahoney OM, Kinsey T (2010) Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Joint Surg Am 92:1115–1121. https://doi.org/10.2106/JBJS.H.00434CrossRefPubMed

Bonnin MP, Schmidt A, Basiglini L, Bossard N, Dantony E (2013) Mediolateral oversizing influences pain, function, and flexion after TKA. Knee Surg Sports Traumatol Arthrosc 21:2314–2324. https://doi.org/10.1007/s00167-013-2443-xCrossRefPubMedPubMedCentral

Hitt K, Shurman JR 2nd, Greene K, McCarthy J, Moskal J, Hoeman T, Mont MA (2003) Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am 85:115–122CrossRef

Bonnin MP, Saffarini M, Bossard N, Dantony E, Victor J (2016) Morphometric analysis of the distal femur in total knee arthroplasty and native knees. Bone Joint J 98:49–57. https://doi.org/10.1302/0301-620X.98B1.35692CrossRefPubMed

Fong TS, Kim SC, Kim JE, Lee ES, Kim TW, Lee YS (2019) Morphometric assessment of resected femoral cut surface in Korean knees and its fitting with western-designed femoral components. J Arthroplasty 34:1929–1937. https://doi.org/10.1016/j.arth.2019.04.061CrossRefPubMed

Li K, Saffarini M, Valluy J, Desseroit MC, Morvan Y, Telmon N, Cavaignac E (2019) Sexual and ethnic polymorphism render prosthetic overhang and under-coverage inevitable using off-the shelf TKA implants. Knee Surg Sports Traumatol Arthrosc 27:2130–2139. https://doi.org/10.1007/s00167-019-05410-9CrossRefPubMed

Fan L, Xu T, Li X, Zan P, Li G (2017) Morphologic features of the distal femur and tibia plateau in Southeastern Chinese population: a cross-sectional study. Medicine (Baltimore) 96:e8524. https://doi.org/10.1097/MD.0000000000008524CrossRef

Mahfouz M, Abdel Fatah EE, Bowers LS, Scuderi G (2012) Three-dimensional morphology of the knee reveals ethnic differences. Clin Orthop Relat Res 470:172–185. https://doi.org/10.1007/s11999-011-2089-2CrossRefPubMed

10.

Asseln M, Hanisch C, Schick F, Radermacher K (2018) Gender differences in knee morphology and the prospects for implant design in total knee replacement. Knee 25:545–558. https://doi.org/10.1016/j.knee.2018.04.005CrossRefPubMed

11.

Kim YH, Choi Y, Kim JS (2010) Comparison of a standard and a gender-specific posterior cruciate-substituting high-flexion knee prosthesis: a prospective, randomized, short-term outcome study. J Bone Joint Surg Am 92:1911–1920. https://doi.org/10.2106/JBJS.I.00910CrossRefPubMed

12.

Budhiparama NC, Lumban-Gaol I, Ifran NN, de Groot PCJ, Utomo DN, Nelissen R (2021) Mismatched knee implants in Indonesian and Dutch patients: a need for increasing the size. Knee Surg Sports Traumatol Arthrosc 29:358–369. https://doi.org/10.1007/s00167-020-05914-9CrossRefPubMed

13.

Sharma G, Liu D, Malhotra R, Zhou YX, Akagi M, Kim TK (2017) Availability of additional mediolateral implant option during total knee arthroplasty improves femoral component fit across ethnicities: results of a multicenter study. JB JS Open Access 2:e0014. https://doi.org/10.2106/JBJS.OA.16.00014CrossRefPubMedPubMedCentral

14.

Kim TK, Phillips M, Bhandari M, Watson J, Malhotra R (2017) What differences in morphologic features of the knee exist among patients of various races? A systematic review. Clin Orthop Relat Res 475:170–182. https://doi.org/10.1007/s11999-016-5097-4CrossRefPubMed

15.

Marmor S, Renault E, Valluy J, Saffarini M (2019) Over-voluming predicted by pre-operative planning in 24% of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27:1544–1551. https://doi.org/10.1007/s00167-018-4998-zCrossRefPubMed

16.

McNamara CA, Hanano AA, Villa JM, Huaman GM, Patel PD, Suarez JC (2018) Anthropometric measurements of knee joints in the Hispanic population. J Arthroplasty 33:2640–2646. https://doi.org/10.1016/j.arth.2018.03.052CrossRefPubMed

17.

Gao F, Guo W, Sun W, Li Z, Wang W, Wang B, Cheng L, Kush N (2014) Correlation between the coverage percentage of prosthesis and postoperative hidden blood loss in primary total knee arthroplasty. Chin Med J (Engl) 127:2265–2269

18.

Kawahara S, Okazaki K, Okamoto S, Iwamoto Y, Banks SA (2016) A lateralized anterior flange improves femoral component bone coverage in current total knee prostheses. Knee 23:719–724. https://doi.org/10.1016/j.knee.2015.11.014CrossRefPubMed

19.

Chen SC, Zeng YM, Yan MN, Yue B, Zhang J, Wang Y (2017) Effect of femoral component flexion implantation on the mediolateral bone-prosthetic fit in total knee arthroplasty. Orthop Surg 9:91–96. https://doi.org/10.1111/os.12319CrossRefPubMedPubMedCentral

20.

Hsu AR, Gross CE, Bhatia S, Levine BR (2012) Template-directed instrumentation in total knee arthroplasty: cost savings analysis. Orthopedics 35:e1596–1600. https://doi.org/10.3928/01477447-20121023-15CrossRefPubMed

21.

Vaishya R, Vijay V, Krishnan M, Agarwal AK (2018) Fallacies of CT based component size prediction in total knee arthroplasty—are patient specific instruments the answer? J Clin Orthop Trauma 9:34–39. https://doi.org/10.1016/j.jcot.2017.11.001CrossRefPubMed

22.

Ooka NHM, Campos ALS, da Fonseca VM, Rodrigues LEO, Filho EB, Franco JS, Aluquerque RSPE, Gameiro VS (2018) Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays. Int Orthop 42:1275–1282. https://doi.org/10.1007/s00264-018-3764-7CrossRefPubMed

23.

Sershon RA, Courtney PM, Rosenthal BD, Sporer SM, Levine BR (2017) Can demographic variables accurately predict component sizing in primary total knee arthroplasty? J Arthroplasty 32:3004–3008. https://doi.org/10.1016/j.arth.2017.05.007CrossRefPubMed

24.

Hernandez-Vaquero D, Noriega-Fernandez A, Roncero-Gonzalez S, Perez-Coto I, Sierra-Pereira AA, Sandoval-Garcia MA (2019) Agreement in component size between preoperative measurement, navigation and final implant in total knee replacement. J Orthop Translat 18:84–91. https://doi.org/10.1016/j.jot.2018.10.006CrossRefPubMed

25.

Bhowmik-Stoker M, Scholl L, Khlopas A, Sultan AA, Sodhi N, Moskal JT, Mont MA, Teeny SM (2018) Accurately predicting total knee component size without preoperative radiographs. Surg Technol Int 33:337–342PubMed

26.

Heal J, Blewitt N (2002) Kinemax total knee arthroplasty: trial by template. J Arthroplasty 17:90–94. https://doi.org/10.1054/arth.2002.27258CrossRefPubMed

Title: Preoperative radiographic parameters in the case of using a narrow-version femoral implant in total knee arthroplasty
Authors: Jaehyun Kim
Seongyun Park
Ji Hyun Ahn
Publication date: 17-08-2021
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-04111-8

2024 ASCO Annual Meeting

Springer Medicine

Preoperative radiographic parameters in the case of using a narrow-version femoral implant in total knee arthroplasty

Abstract

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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