Anthropometric assessment of tibial resection surface morphology in total knee arthroplasty for tibial component design in Indian population

Bansal, Vivek; Mishra, Abhishek; Verma, Tarun; Maini, Dhruv; Karkhur, Yugal; Maini, Lalit

doi:10.1016/j.jajs.2017.12.002

Cited by 6 publications

(9 citation statements)

References 13 publications

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“…Of the 50 studies eligible for full‐text screening, 27 did not report tibial geometric ratios; three were conference proceedings; one was a review; and two were not in written in English (See supplementary material for excluded references). Ten additional studies were identified from reference lists [1, 9, 13, 17, 18, 33, 43] and grey literature [16, 26, 30], resulting in a total of 27 articles eligible for data extraction [1, 2, 4, 6, 7, 9, 10, 12, 13, 16–18, 21, 25, 26, 28, 30–33, 37, 38, 41, 43, 50, 51, 53] (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…Although the geometric ratios of four commonly implanted tibial baseplates could accommodate a large proportion of the observed morphologic variability, it is important to note that a surgeon generally only uses one or a few TKA brands, which makes it diicult to avoid bone-implant mismatch in all knees. Tibial AP and ML dimensions are signiicantly diferent among men and women, and between races [1,2,9,10,18,26,30,33,37,41,43,50,53]. One study found a strong correlation between the ML width and AP length at the medial and lateral compartments, but observed minimal diferences in correlations on the basis of sex and race [13].…”

Section: Discussionmentioning

confidence: 99%

“…™ SIGMA ® , DePuySynthes & ATTUNE ® , DePuySynthes; Asymmetric baseplates: GENESIS ◊ II, Smith + Nephew & Persona ® , ZimmerBiomet) [12]. To estimate the effect of mismatch between implant design and tibial geometry on prosthetic overhang or bone under‐coverage, the tibial geometric ratios (assumed to be normally distributed) were multiplied by the average AP length of 48 mm along the resected tibial plateau [2, 13, 25, 26, 33, 53]. The proportion of knees that would have bone–implant mismatch using the four commercially‐available tibial baseplates was then estimated using thresholds of ≤ 3 mm overhang and ≤ 4 mm under‐coverage [54].…”

Section: Methodsmentioning

confidence: 99%

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Considerable inter-individual variability of tibial geometric ratios renders bone–implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis

Beckers

Müller

Daxhelet

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this systematic review and meta‐analysis was to investigate the variability in tibial geometric ratios among knees of different sexes and races to determine whether commercially‐available tibial baseplates accommodate the morphologic diversity. The hypothesis was that anthropometric studies report considerable variability of tibial geometric ratios among sexes and races. MethodsThis systematic review and meta‐analysis was performed according to the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 28 January 2021 for clinical studies reporting on tibial geometric ratios. Tibial geometric ratios, as reported by the clinical studies, were represented by plotting their means and two standard deviations for comparison to two symmetric and two asymmetric commercially‐available tibial baseplates. ResultsA total of 27 articles that reported on a combined total of 20,944 knees were eligible for data extraction. Variation in tibial aspect ratios was equal among sexes. The greatest variation in aspect ratio was observed among East Asians, followed by Caucasians, African‐Americans, Indian and Middle Easterns. The variation in tibial asymmetry ratio was larger among men compared to women. The greatest variation in asymmetry ratio was observed among African‐Americans, followed by Caucasians, East Asians, Indian and Middle Easterns. Bone‐implant mismatch of > 3 mm overhang or > 4 mm under‐coverage with four commercially‐available tibial baseplates occurred in large proportions of knees due to variations in aspect ratio (in 17–100% of knees) and asymmetry ratio (in 7–100% of knees). ConclusionAnthropometric studies reported considerable inter‐individual variability of tibial geometric ratios, which exceeded effects of sexual dimorphism and racial diversity. Bone–implant mismatch may be unavoidable in a large proportion of knees, when considering that a surgeon generally only uses one or a few TKA brands. These findings support the drive towards patient‐specific implants to potentially achieve accurate bone–implant fit by implant customisation. Level of evidenceIV.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Considerable inter-individual variability of tibial geometric ratios renders bone–implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis

Beckers

Müller

Daxhelet

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Based on the 3D measurements, it provided greater convenience and accuracy than alternative methods [ 11 ]. The proximal tibia morphometric parameters are utilized for various purposes, including sex determination, ethnic identification, and primary data to design the total knee prosthesis [ 1 , 6 , 8 , 15 , 37 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Morphometric measurement of the proximal tibia to design the tibial component of total knee arthroplasty for the Thai population

2021

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Purpose This study evaluates the morphology of the Thai proximal tibia based on three-dimensional (3D) models to design the tibial component. Methods The 3D models of 480 tibias were created using reverse engineering techniques from computed tomography imaging data obtained from 240 volunteers (120 males, 120 females; range 20–50 years). Based on 3D measurements, a digital ruler was used to measure the distance between the triangular points of the models. The morphometric parameters consisted of mediolateral length (ML), anteroposterior width (AP), medial anteroposterior width (MAP), lateral anteroposterior width (LAP), central to a medial length (CM), central to a lateral length (CL), medial anterior radius (MAR), lateral anterior radius (LAR), and tibial aspect ratio (AR). An independent t-test was performed for gender differences, and K-means clustering was used to find the optimum sizes of the tibial component with a correlation between ML length and AP width in Thai people. Results The average morphometric parameters of Thai proximal tibia, namely ML, AP, MAP, LAP, CM, and CL, were as follows: 72.52 ± 5.94 mm, 46.36 ± 3.84 mm, 49.22 ± 3.62 mm, 43.59 ± 4.05 mm, 14.29 ± 2.72 mm, and 15.28 ± 2.99 mm, respectively. The average of MAR, LAR, and AR was 24.43 ± 2.11 mm, 21.52 ± 2.00 mm, and 1.57 ± 0.08, respectively. All morphometric parameters in males were significantly higher than those of females. There was a difference between the Thai proximal tibia and other nationalities and a mismatch between the size of the commercial tibial component and the Thai knee. Using K-means clustering analysis, the recommended number of ML and AP is seven sizes for the practical design of tibial components to cover the Thai anatomy. Conclusion The design of the tibial component should be recommended to cover the anatomy of the Thai population. These data provide essential information for the specific design of Thai knee prostheses.

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“…The advantage of this method is the investigation in a digital format that is non-destructive of the specimen, and the useful assessment identified anatomical landmarks and included the automatically calculated measurement [12]. Computed tomography data can be measured in both two-dimensional (2D) and three-dimensional (3D) formats [13][14][15][16]. Based on three-dimensional measurement, the femoral 3D models were created by a reverse engineering technique, which involves returning the physical product to virtual models that can be considered as two phases, including a digitization and reconstruction phase.…”

Section: Introductionmentioning

confidence: 99%

Morphometric Analysis and Three-Dimensional Computed Tomography Reconstruction of Thai Distal Femur

2021

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This study evaluates the distal femur morphology of the Thai population using a three-dimensional (3D) measurement method, measuring the distance between the triangular point of the femoral 3D model. The 3D model of 360 Thai femoral obtained from 180 volunteers (90 males, 90 females; range 20–50 years, average 32.8 years) was created using reverse engineering techniques from computed tomography imaging data. Using the 3D identified landmark method, the morphometric parameters evaluated included transepicondylar axis length (TEA), mediolateral length (ML), anteroposterior width (AP), medial anteroposterior width (MAP), lateral anteroposterior width (LAP), medial condyle width (MCW), lateral condyle width (LCW), intercondylar notch width (WIN), intercondylar notch depth (DIN), medial posterior condyle height (MPC), lateral posterior condyle height (LPC), femoral aspect ratio (ML/AP), lateral femoral aspect ratio (ML/LAP), and medial femoral aspect ratio (ML/MAP). The measured data were summarized for the analysis of an average value and standard deviation. Statistical analysis was performed using the independent samples t-test, unequal variances t-test, and linear regression. A p-value less than 0.05 (<0.05) was regarded as statistically significant and indicates strong evidence of the hypothesis. Additionally, the K-means clustering analysis of Thai distal femoral to the optimum size of the prosthesis with the correlation between ML length and AP width was performed. The results found that the morphometric parameters of the Thai male distal femur were significantly different and higher than those of Thai females, except for the ratio of ML/AP and ML/MAP. Comparatively, there was a significant difference between the specific size of Thai distal femur and that of the Korean population, which was also smaller than that for Caucasians. In addition, there was a mismatch between the distal femoral component sizing of knee prosthesis and what is available and commonly used in Thailand. At least six sizes of ML and/or AP should be recommended for the reasonable design of distal femoral prosthesis for covering the anatomy of Thais. These data are useful for predicting the morphometric parameters in forensic anthropology and provide basic data for the design of knee prostheses suitable for the Thai population.

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Anthropometric assessment of tibial resection surface morphology in total knee arthroplasty for tibial component design in Indian population

Cited by 6 publications

References 13 publications

Considerable inter-individual variability of tibial geometric ratios renders bone–implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis

Considerable inter-individual variability of tibial geometric ratios renders bone–implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis

Morphometric measurement of the proximal tibia to design the tibial component of total knee arthroplasty for the Thai population

Morphometric Analysis and Three-Dimensional Computed Tomography Reconstruction of Thai Distal Femur

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