Gender-Specific Design in Total Knee Arthroplasty

doi:10.1016/j.arth.2007.05.019

The Journal of Arthroplasty

Volume 22, Issue 7, Supplement, October 2007, Pages 27-31

https://doi.org/10.1016/j.arth.2007.05.019 Get rights and content

Abstract

Total knee arthroplasty (TKA) has now been performed for more than 3decades, with millions of implantations, and a tremendous volume of scientific data regarding its use. There is little, if anything, in the academic literature to suggest an inferior result when a TKA is performed in a female patient. Recently, implant manufacturers have introduced TKA designs with modified dimensions to accommodate the anatomical differences that occur between sexes. This article will attempt to clarify the known sex issues surrounding TKA, and outline the attempts by manufacturers to improve outcomes based on sex-specific or sex-friendly designs.

Section snippets

Sexual Differences in the Human Knee

Differences in knee anatomy, function, and pathologic conditions are often secondary to expression of the chromosomal differences between men and women. Tosi et al [1] have clearly outlined the influence of sex and gender on musculoskeletal health, stating that there are “…inherent differences in biology at the cellular and molecular level. There is a biologic basis for the differences…that cannot be explained simply by hormone levels.” Even at a young age, women are known to be more

TKA Outcomes

Historically, TKA has been successful in relieving patient's pain and restoring function both in the short term, and in long-term follow-up studies. Rand and Ilstrup [6] reviewed the survivorship of 9200 TKAs and found that the rate of implant survival in women was significantly greater than that of men, both at 5-year (93% vs 89%) and 10-year follow-up (83% vs 76%). Wright et al [17] reported no sex differences in survivorship of 523 TKAs followed up at a minimum of 10 years, and

Manufacturer's Response to Sex Issues

The observed narrower dimension of the female femur gains importance in the typical posterior referenced TKA surgical technique. Selecting the appropriate size is done first off the AP dimension of the distal femur. If the appropriate-sized femoral component then overhangs in the ML dimension, the surgeon must either accept this overhang, or downsize the femoral implant. Downsizing the implant may result in further loss of bone anteriorly and the potential for notching the anterior cortex.

Summary

Total knee arthroplasty has now been performed for more than 3 decades, with millions of implantations, and a tremendous volume of data regarding its use. In the author's opinion, there is little, if anything, in the academic literature to suggest an inferior result when a TKA is performed in a female patient. The amount of attention that implant manufacturers have focused on this issue is of interest, considering that there appears to be no issue at all. It may be that our current tools for

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2022, Fuss und Sprunggelenk
Die Sprunggelenkendoprothetik entwickelt sich kontinuierlich fort. Es gab eine Vielzahl verschiedener Prothesendesigns, von denen sich nur wenige längerfristig durchsetzen konnten. Die Entwicklung der Prothesenkomponenten geht weiter, ebenso auch die Diskussion über die optimale Platzierung der Sprunggelenksprothese. Mit der hier vorliegenden Arbeit soll ein aktueller Überblick zur Sprunggelenkendoprothetik gegeben werden.
Total ankle arthroplasty is still developing. There were many different designs of total ankle arthroplasties and most of them are not available any more. The development of total ankle arthroplasty components is ongoing as well as the discussion of its optimal implantation. The present manuscript aims to provide a current overview of total ankle arthroplasty.
Influence of Narrow Femoral Implants on Intraoperative Soft Tissue Balance in Posterior-Stabilized Total Knee Arthroplasty
2020, Journal of Arthroplasty
Narrow femoral implants were developed to improve fit and prevent overhang in primary total knee arthroplasty (TKA). We compared intraoperative soft tissue balance between standard and narrow implants in posterior-stabilized (PS) TKA.
We enrolled 30 consecutive patients with varus osteoarthritis undergoing PS TKA using an image-free navigation system. Standard and narrow femoral trial implants were inserted, and their soft tissue balance was measured. Subgroup analysis, based on the actual implanted femoral implant, was performed to assess the influence of narrow implants on soft tissue balance.
Narrow trial group had significantly larger joint component gaps than standard trial group at all measured flexion angles, except at 60° (P < .05). For the standard implant cohort, narrow trial group had significantly larger joint component gaps than standard trial group at 30°, 120°, and 135° flexion (P < .05). For the narrow implant cohort, narrow trial group had significantly larger joint component gaps than standard trial group at all measured flexion angles, except at 0° and 60° (P < .05). Narrow trial group had significantly larger varus ligament balance than standard trial group at 45° and 60° flexion (P < .05). The varus angles for standard implants were comparable between groups; however, narrow trial group had significantly larger varus angles for narrow implants than standard trial group at 45°, 60°, and 120° flexion (P < .05).
The medial-lateral dimension and volume of the femoral component may influence intraoperative soft tissue balance in PS TKA. The effects may be greater when narrow implants are selected to avoid component overhang.
Ankle morphometry based on computerized tomography
2019, Foot and Ankle Surgery
Thorough understanding of the morphometry of the ankle joint is crucial to optimize conservative and operative therapy of ankle joint disorders. Despite recent improvements, basic anatomic and biomechanical correlations of the ankle joint including the orientation of the ankle joint axis and joint morphology as its key biomechanical features are not sufficiently recorded to date. The aim of this study was the evaluation of the ankle morphometry to gain information about the ankle joint axis.
In this study 98 high-resolution CT-scans of complete Caucasian cadaver legs were analysed. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar articular areas. Additionally, the radii of the articular areas, the medial distal tibial angle and the height of the talar dome were determined.
The radius of the central trochlea tali was 44.6 ± 4.1 mm (mean ± SD). The central trochlea tali arc length was 40.8 ± 3.0 mm and its width was 27.4 ± 2.5 mm. Additionally we determined 47.0 ± 4.4 mm for the tibial sagittal radius, 27.6 ± 3.0 mm for the tibial arc length and 27.4 ± 2.5 mm for the central tibial width.
The present study describes the three-dimensional morphometry of Caucasian ankle joints in detail. This dimensional analysis of the ankle joint will inform the development and placements of implants and prostheses.
Impact of intraoperative adjustment method for increased flexion gap on knee kinematics after posterior cruciate ligament-sacrificing total knee arthroplasty
2019, Clinical Biomechanics
Citation Excerpt :
If there is an excessive flexion gap, a femoral component that is larger by the size of the flexion gap should be used. Some commercially available femoral components have many AP and ML size variations to prevent increased patellofemoral contact force and ML overhang (Clarke and Hentz, 2008; Greene, 2007; Kawahara et al., 2012). Using the measured resection technique in PS-TKA, the femoral component size can be decided based on the posterior reference technique.
In general, the flexion gap is larger than the extension gap with posterior cruciate ligament-sacrificing total knee arthroplasty. Several methods compensate for an excessive flexion gap, but their effects are unknown. The purpose of this study was to compare three methods to compensate for an increased flexion gap.
In this study, squatting in knees with excessive (4 mm) and moderate (2 mm) flexion gaps was simulated in a computer model. Differences in knee kinematics and kinetics with joint line elevation, setting the femoral component in flexion, and using a larger femoral component as compensatory methods were investigated.
The rotational kinematics during flexion with setting the femoral component in flexion were opposite to those in the other models. Using a larger femoral component resulted in the most physiological motion. The peak anterior translation was 10 mm in the joint line elevation model compared with approximately 6 mm in the other models. In the joint line elevation model, patellofemoral contact stress was excessively increased at 90° of knee flexion. In contrast, tibiofemoral contact stress was higher during knee extension with setting the femoral component in flexion due to anterior impingement. There were few differences in the effect of the three compensatory methods with a moderate flexion gap.
A larger femoral component should be used to compensate for an excessive flexion gap because it has less negative impact on posterior cruciate ligament-sacrificing total knee arthroplasty, whereas any compensation method might be acceptable for a moderate flexion gap.
Proximal and distal alignment of normal canine femurs: A morphometric analysis
2018, Annals of Anatomy
Many researchers are interested in femoral conformation because most orthopaedic problems of the long bones occur in the femur and its joints. The neck-shaft (NSA) and the anteversion (AVA) angles are good predictors for understanding the orientation of the proximal end of the femur. The varus (aLDFA) and procurvatum (CDFA) angles have also been used to understand the orientation of the distal end of the femur. The purposes of this study were to investigate the relationship between the proximal and distal angles of the femur and to compare the distal femoral angles in male and female dogs in order to investigate the sexual dimorphism. The measurements of normal CDFAs, which have not been previously reported, may also provide a database of canine distal femoral morphology.
A total of 75 cleaned healthy femora from different breeds or mixed breed of dogs were used. The three-dimensional images were reconstructed from computed tomographic images. The AVA, NSA, aLDFA and CDFA were measured on the 3D images. The correlation coefficients were calculated among the measured angles. The distal femoral angles were also compared between male and female femora.
The 95% confidence intervals of the AVA and the NSA were calculated to be 24.22°–29.50° and 144.97°–147.50°, respectively. The 95% confidence intervals of the aLDFA and the CDFA for all studied dogs were 92.62°–94.08° and 89.09°–91.94°, respectively. The NSA showed no correlation with either the aLDFA or CDFA. There was a weak inverse correlation between the AVA and CDFA and a weak positive correlation between the AVA and aLDFA. The differences in the aLDFA and CDFA measurements between male and female dog were not significant.
In conclusion, femoral version, regardless of the plane, might have little influence on distal femoral morphology in normal dogs. Besides this, there is no evidence of a sexual dimorphism in the varus and procurvatum angles of the dog distal femur. The data from this study may be used in both orthopaedic studies and for clinical applications related to the distal femur of dogs.
Effects of measurement methods for tibial rotation axis on the morphometry in Korean populations by gender
2017, Knee
There have been arguments for methodology in tibial rotation axis measurement, which accordingly determines the morphometry of the proximal tibia in total knee arthroplasty. The morphometry of the proximal tibia for the Korean population is determined by gender, based on the anatomical tibial axis and reliable rotational orientation in knee replacements, to evaluate the size suitability of the currently available prostheses in Korea.
This study reconstructed the MRI images in three-dimensions for identification and measurement of the mediolateral (ML) and anteroposterior (AP) lengths of the proximal tibia and the tibial aspect ratio (ML/AP) using proximal tibial anthropometric data for 700 osteoarthritic knees (587 females and 113 males). The ML and AP lengths were measured using tibial rotation axis techniques based on the medial one-third tibial tubercle and Cobb's method.
Significant differences (P < 0.05) in ML, medial anteroposterior (MAP), lateral anteroposterior (LAP) lengths, and aspect ratio (ML/LAP) were observed for males and females with respect to different measurement techniques for the tibial rotation axis. However, the measured aspect ratio (ML/MAP) of tibiae for the Korean population did not show significance. The measured aspect ratio (ML/AP) ratio of tibiae for the Korean population was higher than that of currently available tibial components.
Results from this study can guide development of gender-specific tibial prosthesis designs with different ML and AP aspect ratios based on the tibial anatomical rotation axis for the Korean population.

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^☆: No benefits or funds were received in support of the study.

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Gender-Specific Design in Total Knee Arthroplasty☆

Abstract

Section snippets

Sexual Differences in the Human Knee

TKA Outcomes

Manufacturer's Response to Sex Issues

Summary

J Arthroplasty

J Knee Surg

J Arthroplasty

J Arthroplasty

J Arthroplasty

Does sex matter in musculoskeletal health? The influence of sex and gender on musculoskeletal health

J Bone Joint Surg Am

Gender differences in patellofemoral joint biomechanics

Clin Orthop

Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002

J Bone Joint Surg Am

Rotational landmarks and sizing of the distal femur in total knee arthroplasty

Clin Orthop

Predicting range of motion after total knee arthroplasty: clustering, log-linear regression, and regression tree analysis

J Bone Joint Surg Am

Survivorship analysis of total knee arthroplasty. Cumulative rates of survival of 9200 total knee arthroplasties

J Bone Joint Surg Am

Survivorship of cemented total knee arthroplasty

Clin Orthop

Differences between men and women in the rate of use of hip and knee arthroplasty

N Engl J Med

Gender differences in patient preferences may underlie differential utilization of elective surgery

Am J Med