Purpose The aim of this study was to evaluate the anthropometric diferences between knees of Indonesian Asians and Dutch Caucasians and the it of nine diferent knee implant systems. Methods A total of 268 anteroposterior (AP) and lateral knee preoperative radiographs from 134 consecutive patients scheduled for total knee arthroplasty at two diferent centres in Jakarta and Leiden were included. Both patient groups were matched according to age and sex and included 67 Asians and 67 Caucasians. We assessed the radiographic diferences between the Asian and Caucasian anthropometric data. The dimensions of the nine knee implant designs (Vanguard, Genesis II, Persona Standard, Persona Narrow, GK Sphere, Gemini, Attune Standard, Attune Narrow, and Sigma PFC) were compared with the patients' anthropometric (distal femur and proximal tibia) measurements. ResultsThe Dutch Caucasian patients had larger mediolateral (ML) and AP femoral and tibial dimensions than the Indonesian Asians. The aspect ratios of the distal femur and tibia were larger in Asians than in Caucasians. The AP and ML dimensions were mismatched between the tibial components of the nine knee systems and the Asian anthropometric data. Both groups had larger ML distal femoral dimensions than the knee systems. Conclusion Absolute and relative diferences in knee dimensions exist not only between Asian and Caucasian knees but also within both groups. Not all TKA systems had a good it with the Asian and Caucasian knee phenotypes. An increase in the range of available knee component sizes would be beneicial, although TKA remains an adequate compromise. Level of evidence III.
Background Shoulder injections for conditions such as adhesive capsulitis are commonly performed and can be administered through image-based or landmark-based injection approaches. Ultrasound-guided injections are widely used and accurate because ultrasound allows real-time visualization of the needle and injected contrast. Landmark-based injections would be advantageous, if they were accurate, because they would save the time and expense associated with ultrasound. However, few prospective studies have compared well-described landmark-based shoulder injection techniques without ultrasound. Question/purpose Using anatomic landmarks, and without using ultrasound, is the accuracy of glenohumeral injection for adhesive capsulitis greater via the posterior approach or via a new anterior approach? Methods Between 2018 and 2020, we treated 108 patients potentially eligible for adhesive capsulitis treatment. These patients had clinical symptoms of aggravating shoulder pain with a duration of less than 4 months and passively impaired, painful glenohumeral ROM. Due to the exclusion of patients with other shoulder conditions (full-thickness rotator cuff ruptures and posttraumatic stiffness), 95 patients received an injection in this sequential, prospective, comparative study. Between 2018 and 2019, 41 patients (17 males and 24 females; mean age 52 ± 5 years; mean BMI 24 ± 3 kg/m2) were injected through the posterior approach, with the acromion as the anatomical landmark, during the first part of the study period. After that, between 2019 and 2020, 54 patients (20 males and 34 females; mean age 54 ± 4 years; mean BMI 23 ± 3 kg/m2) received an injection through a new anterior approach, with the acromioclavicular joint as the anatomic landmark, during the second part of the study period. Injections via both approaches were administered by two experienced shoulder specialists (both with more than 10 years of experience). Both specialists had experience with the posterior approach before this study, and neither had previous training with the new anterior approach. Injections contained a corticosteroid, local anaesthetic, and contrast medium. Radiographs were taken within 20 minutes after the injection, and a radiologist blinded to the technique determined accuracy. Accurate injections were defined as having contrast fluid limited to the glenohumeral joint, while inaccurate injections displayed leakage of contrast fluid into the soft tissue or subacromial space. All of the enrolled patients were analyzed. Results In the group with the posterior approach, the accuracy was 78% (32 of 41) in contrast to 94% (51 of 54, odds ratio 0.21 [95% CI 0.05 to 0.83]; p = 0.03) in patients with the new anterior approach. Conclusion The new anterior approach without the use of ultrasound was more accurate than the posterior approach. In fact, it was nearly as accurate as previously published ultrasound-guided approaches. We recommend using the new anterior approach for intraarticular glenohumeral injections instead of ultrasound-guided injections because it will save time and costs associated with ultrasound. Still, the clinical effects (anxiety, pain, functional outcome, and adverse events) of the new anterior approach should be compared with ultrasound-guided injections in a randomized study. Level of Evidence Level II, therapeutic study.
Background: Positioning and fit of the knee prostheses in patients determines functional outcome. For that matter anthropometric differences between knee joints of patients, will affect function. Since most total knees implant systems are designed for caucasians, discrepancies in matching to Asian patients might exist, with consequently less optimal fit of the implant. The aim of this study was to evaluate differences in anthropometric dimensions between Caucasian and Asian knees of patients eligible for total knee arthroplasty. Materials and Methods: 134 patients were included for radiographic anthropometric measurements on distal femurs, proximal tibia and patellar dimension were measured of 67 Caucasian and 67 Asian patients. Patient groups were age and gender matched. All radiographs were obtained preoperatively prior to total knee arthroplasty at two different centers, Jakarta and Leiden. The radiographic measurements were widest anteroposterior (AP) and widest mediolateral (ML) dimensions, aspect ratio (ML/AP), patellar length and patellar tendon length, patellar tendon/patella ratio. Sizes of eight knee implant designs (Vanguard, Genesis II, Persona -standard and narrow-, GK Sphere, Gemini, Attune and Sigma PFC) were collected from manufactures brochures and compared to the anthropometric measurements. Chi-Square test, student t-test and Bayesian statistics were used to compare differences between the two populations. Results: The mean age of the Caucasian group was 68 ± 7.1 years and the Asian patients were 67 ± 7.8 years. Both groups included 14.9% males and 85.1% females. The Dutch patients had a height of 166cm (sd 8.1 cm) the Indonesian patients 156 cm (sd 8.0 cm), the Dutch being 6.4% taller. Preoperative deformities in the Asians was predominantly into varus, while the Dutch patients had a slight valgus alignment; 90% of the KL scores were grade 3 and 4, comparable in both groups. In AP and ML the Caucasian femur is larger than the Asian femur (male-AP 12%, female-AP 15%, male-ML 6%, female-ML 9%). The Caucasian tibia is larger in AP and ML dimensions compared to the Asian patient’s tibia. The ML/AP aspect ratios were significantly different (p<0.0001) between Asian and Caucasian patients, with the ML/AP aspect ratio of both the femur and the tibia being larger in Asian patients 1.4 (sd 0.10) compared to Caucasians 1.3 (sd 0.10) for the femur. As for the tibia the aspect ratio in Asian patients is 1.5 (sd 0.11); Caucasians 1.3 (0.11). The Asian patients have a relative patella baja compared to the Caucasians. Good matching to the tibial aspect ratios (ML/AP) of Dutch and Indonesian patients appeared to present to the eight knee systems but to only three knee systems matched well to the femoral aspect ratios (ML/AP). Conclusion: Absolute and relative differences of knee dimensions exist between Caucasian and Asian knees. Caucasian has larger AP and ML for both tibial and femoral but smaller in aspect ratio for both tibia and femur compared to Asian patients. With respect to the fit of the implant to the natural knee, total knee arthroplasty remains a compromise to nature
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