Are Korean Patients Different from Other Ethnic Groups in Total Knee Arthroplasty?

Abstract

Most of the implants used for total knee arthroplasty (TKA) in Asian patients have been produced based on anthropometry of Western people. Since anatomic features and life styles are different between Western and Eastern people, there would be ethnic differences in terms of conformity of implants to the patient's anatomy or clinical results after TKA. Therefore, surgeons in Asia are particularly interested in related surgical techniques and implant designs used in TKA for improved clinical results and patient satisfaction. In this review, we investigated the anthropometric differences of Koreans from Westerners. Koreans are of shorter stature, less weight, and smaller skeletal structure and have a higher incidence of constitutional varus alignment of the lower extremity. Moreover, compared to Westerner TKA populations, the proportion of female patients was large and primary osteoarthritis was prevalent in preoperative diagnosis in Korean TKA patients. Culturally, Koreans have life styles that demand high flexion positions of the knee such as squatting, kneeling, and cross-legged sitting. Although there were no notable differences in the complication and revision rates following TKA between Westerners and Koreans, the incidence of postoperative deep vein thrombosis and pulmonary thromboembolism was lower in Koreans than Westerners. We hope that further research on implant designs and more interest in TKA will improve outcomes in Korean patients.

Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty

“…The MA technique aims to create a neutral lower limb axis by cutting the distal femur and proximal tibia perpendicular to the femoral and tibial mechanical axes and provides reliable long-term fixation and functional improvement. [ 3 ] In addition, navigation-assisted TKA has been shown to better replicate the neutral MA of the knee, leading to fewer alignment outliers. [ 4 , 5 ] However, the MA technique with or without navigation can lead to unfavorable results, including abnormal tightening or slackening of the collateral, posterior cruciate, and retinacular ligaments and abnormal contact kinematics caused by changing the angle and level of the natural joint line, leading to unsatisfactory outcomes in up to 25% of patients.…”

Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

“…The MA technique aims to create a neutral lower limb axis by cutting the distal femur and proximal tibia perpendicular to the femoral and tibial mechanical axes and provides reliable longterm fixation and functional improvement. [3] In addition, navigation-assisted TKA has been shown to better replicate the neutral MA of the knee, leading to fewer alignment outliers. [4,5] However, the MA technique with or without navigation can lead to unfavorable results, including abnormal tightening or slackening of the collateral, posterior cruciate, and retinacular ligaments and abnormal contact kinematics caused by changing the angle and level of the natural joint line, leading to unsatisfactory outcomes in up to 25% of patients.…”

Short knee radiographs can be inadequate for estimating TKA alignment in knees with bowing

“…Bowing that could not be accessed using short knee radiographs has been suggested previously as the cause of discordance between the aFTA and mHKA [19,21]. Notably, the incidence of bowing is especially high in Asian patients [24,26,27]. If the proportion of bowing is higher in a given patient cohort, there would be a greater risk of overestimating or underestimating the alignment.…”