Gender differences in knee morphology and the prospects for implant design in total knee replacement

Asseln, Malte; Hänisch, Christoph; Schick, Fabian; Radermacher, Klaus

doi:10.1016/j.knee.2018.04.005

Cited by 40 publications

(61 citation statements)

References 37 publications

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“…Based on these features, gender-speci c prostheses should be designed in consideration of gender characteristics. However, more and more studies focused on not only gender differences but individual differences [3,5]. Taking this issue into account, we exploratory analyzed the correlation coe cient between all parameters.…”

Section: Discussionmentioning

confidence: 99%

“…An extensive study from Mahfouz et al analyzed 1000 normal adult knees to identify differences in three-dimensional knee morphology among Caucasian, African American, and East Asian populations, which calculating 11 femoral and 9 tibial measurements [33]. Asseln et al comprehensively analyzed 412 pathological knees following TKA using 33 femoral and 21 tibial features to investigate gender differences and they indicated that large inter-individual variations should also be important for speci c implant design despite gender differences [3]. Yue et al investigated the morphologic measurements of femur and tibia in healthy Chinese and white subjects and described the differences in knee anthropometry between gender and ethnicity [51].…”

Section: Introductionmentioning

confidence: 99%

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The Three-Dimensional Morphology of the Patellofemoral Joint and the Normal Predicted Value of Tibial Tuberosity-Trochlear Groove Distance In Chinese Population

Li¹,

Liu²,

Tian³

et al. 2020

Preprint

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Our objective was to obtain normal patellofemoral measurements so as to provide a reference for prosthetic design. Besides, the absolute values and indices of TT-TG distances are still controversial in clinical application. A better method to enable precise clinical applications is still needed.Methods:78 knees of 78 subjects without knee pathologies were included in this cross-sectional study. A CT scan was obtained from all subjects and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analyzed 19 parameters including TT-TG distance and dimensions and shapes of patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances.Results:The dimensional indexes, TT-TG distance, and femoral aspect ratio of the males were significantly larger than those of females (all P values <0.05). However, after controlling the bias from age, height, and weight, there were no significant differences in TT-TG distances, PAL, and anterior-posterior dimensions between genders (all P values >0.05). The Pearson correlation coefficients between the AFO and other indexes were consistently below 0.3, indicating a none or weak relationship. Similar results were observed for the SA and the Wiberg index. Using LASSO regression, we obtained four parameters to predict TT-TG distance (R2=0.5612, P<0.01) to achieve the optimal accuracy and convenience. Conclusion:The anterior-posterior dimensions of the females were thicker than those of males for the same medial-lateral dimensions. More attention should be paid to not only gender differences but individual differences, especially the anterior condyle and trochlea. Besides, this study provided a new method of predicting TT-TG distance to enable precise clinical diagnoses and guide the medial transfer of the tibial tuberosity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Three-Dimensional Morphology of the Patellofemoral Joint and the Normal Predicted Value of Tibial Tuberosity-Trochlear Groove Distance In Chinese Population

Li¹,

Liu²,

Tian³

et al. 2020

Preprint

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“…Segmented femoral bone surface data of 90 cadavers of North American ethnicity, thereof 56 male, 32 female and 2 without gender information, without history of osteoarthritis and without visible osteophytes was available. The femora were aligned to a patient-specific bony coordinate system [10] and the individual J-Curves of the medial and lateral condyles were extracted, using a semi-automatic workflow which is described in a previous publication by our group [11]. Subsequently, the J-Curves were approximated by 300 equidistant points and a PCA was performed.…”

Section: Methodsmentioning

confidence: 99%

“…However, variations in the contour itself have not been investigated in detail yet. Consequently, the aim of this study was to analyze the main patterns of variation of the femoral J-Curve in the native knee by means of principal component analysis (PCA) and geometric parameter analysis [10] and to compare the results to standard implants' J-Curve variation.…”

Section: Introductionmentioning

confidence: 99%

Variation of the femoral J-Curve in the native knee

Grothues¹,

Asseln²,

Radermacher³

EPiC Series in Health Sciences

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The J-Curve in the native knee as well as the femoral component’s J-Curve after total knee arthroplasty are known to have a high influence on kinematics. Furthermore, the J-Curve’s shape affects ligament strain and tension and consequently already slight changes may strongly alter knee forces and stability. To optimize current implants’ J-Curve design with regard to the population’s morphology, information about the main sources of contour variation is necessary.In this study, a principal component analysis (PCA) was performed on the medial and lateral femoral J-Curves of 90 cadavers without history of osteoarthritis. The J-Curves’ mean shapes were further investigated by geometric parameter analysis and effect sizes were calculated for the first three principal components (PCs). In addition, a combined PCA for both sides was performed and evaluated qualitatively. The results were compared with the variation in standard implants’ J-Curve shape.The isolated PCA of medial and lateral J-Curves resulted in PCs involving changes in contour orientation, arc length, scaling and circularity. The combined PCA of both sides resulted in PCs comprising combinations of the individual variations together with changes in relative position. In contrast, the qualitative evaluation of J-Curves from 2 different standard implant systems revealed no visible changes in shape but only changes in size.Limitations of this study were the restriction to a 2-dimensional contour derivation and the sole consideration of the femoral contours. Nevertheless, the sagittal variability in the medial, lateral and combined femoral J-Curves should be considered in implant design.

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“…standard knee designs cover Korean female femora dimensions only poorly, with negative clinical outcome. Therefore, detailed knowledge about the characteristics of individual morphological features and its consideration is essential for improved endoprosthetic care [7].…”

Section: Literature Review 21 Implantmentioning

confidence: 99%

Simulation of knee implants made of Ti6Al4V material during walking

et al. 2018

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Bone is the connective tissue in the human body which consists of cells, fibers, and extracellular matrix. The bone matrix is the hardest part located in the outer layer of the bone, which is caused by the deposition of minerals in the matrix, so that the bone undergoes classification. The bone functions as a hard, rigid body frame, and provides a place or space for attachment of muscles and organs found in the human body. The simulation results using FEM showed that knee implants made with Ti6Al4V material had a total deformation of 0.15 mm, maximum principal stress of 17.012 MPa, and a maximum shear stress of 15.841 MPa. The analysis was performed using a variation of time 0 to 1.01 seconds.

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Gender differences in knee morphology and the prospects for implant design in total knee replacement

Cited by 40 publications

References 37 publications

The Three-Dimensional Morphology of the Patellofemoral Joint and the Normal Predicted Value of Tibial Tuberosity-Trochlear Groove Distance In Chinese Population

The Three-Dimensional Morphology of the Patellofemoral Joint and the Normal Predicted Value of Tibial Tuberosity-Trochlear Groove Distance In Chinese Population

Variation of the femoral J-Curve in the native knee

Simulation of knee implants made of Ti6Al4V material during walking

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