Gender differences in the anatomy of the distal femur

Gillespie, Robert J.; Levine, Ari; Fitzgerald, Steven J.; Kolaczko, Jensen G.; DeMaio, Marlene; Marcus, Randall E.; Cooperman, Daniel R.

doi:10.1302/0301-620x.93b3.24708

Cited by 52 publications

(61 citation statements)

References 14 publications

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“…We found differences in the ratio between AAF/CF and AAM/CM, with the mean ratio being larger in CMs compared to AAMs and CFs compared to AAFs. This finding conflicts with Gillespie et al [8] who reported a larger ML/AP ratio in African Americans than in Caucasians; however, their African American population was from the early 20th century, which could account for differing anatomic features from the current population. The radii of curvature analysis on both the medial and lateral condyles revealed AMs and AFs tend to have more curved condyles (ie, less radius of curvature) than Caucasians, implying a larger ROM.…”

Section: Discussioncontrasting

confidence: 78%

Three-dimensional Morphology of the Knee Reveals Ethnic Differences

Mahfouz

Fatah

Bowers

et al. 2012

Clinical Orthopaedics &Amp; Related Research

177

173

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BackgroundStudies have demonstrated sex differences in femoral shape and quadriceps angle raising a question of whether implant design should be sex-specific. Much of this research has addressed shape differences within the Caucasian population and little is known about differences among ethnic groups.Questions/purposesWe therefore asked: Do shape differences in the distal femur and proximal tibia exist among different ethnic groups and between the sexes in each ethnic population? And if ethnic differences exist, do they have a clinical impact on current TKA design?Subjects and MethodsWe analyzed 1000 normal adult knees (80 African American, 80 East Asian, and 860 Caucasian). Three-dimensional surface models were created for each bone and added to three-dimensional statistical bone atlases. Statistical shape analysis was conducted with a process combining principal components and multiple discriminate analyses. Eleven femoral and nine tibial measurements were calculated.ResultsWe found differences in mean measurements between the sexes and ethnicities. Males had larger knees, with a mean 5-mm-larger anteroposterior dimension than females in all ethnicities. African American females had a 7.4-mm-deeper patellar groove, 2.3-mm-smaller tibial mediolateral dimension, and 2.5-mm-larger tibial anteroposterior dimension than Caucasian females. African American males had a 4.3-mm-larger femoral anteroposterior dimension, 10.1-mm-larger tibial mediolateral dimension, and 6-mm-larger tibial anteroposterior dimension than Asian males.ConclusionsWe identified differences in three-dimensional knee morphology among Caucasian, African American, and East Asian populations. Clinical studies will be required to determine whether these differences are important for implant design.

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Section: Discussioncontrasting

confidence: 78%

Three-dimensional Morphology of the Knee Reveals Ethnic Differences

Mahfouz

Fatah

Bowers

et al. 2012

Clinical Orthopaedics &Amp; Related Research

177

173

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“…Although individual studies have been conducted measuring relevant morphologic endpoints among various distinct populations [1, 2, 4, 6, 8, 13, 14, 23, 24, 26, 27, 29–32, 34, 36, 39, 41–43, 45–47, 50–54, 56], to our knowledge to date there has not been a systematic analysis of their findings to clarify what specific differences exist among ethnicities. We hoped that performing this analysis would facilitate research in the clinical implications of these anatomic differences and determine whether design initiatives would be merited to address the potential for compromised implant fit.…”

Section: Discussionmentioning

confidence: 99%

What Differences in Morphologic Features of the Knee Exist Among Patients of Various Races? A Systematic Review

Kim

Phillips²,

Bhandari

et al. 2017

Clinical Orthopaedics &Amp; Related Research

109

119

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BackgroundMost TKA prostheses are designed based on the anatomy of white patients. Individual studies have identified key anthropometric differences between the knees of the white population and other major ethnic groups, yet there is limited understanding of what these findings may indicate if analyzed collectively.Question/purposeWhat are the differences in morphologic features of the distal femur and proximal tibia among and within various ethnicities?MethodsA systematic review of the PubMed database and a hand-search of article bibliographies identified 235 potentially eligible English-language studies. Studies were excluded if they did not include morphology results or had insufficient data for analysis, were unrelated to the distal femur or proximal tibia, were conducted in pediatric patients or those undergoing unicondylar knee arthroplasty, or bone surface measurements were obtained for trauma products. This left 30 eligible studies (9050 knees). Study quality was assessed and reported as good, fair, or poor according to the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Morphometric data for the distal femur and proximal tibia were available for four ethnic groups: East Asian (23 studies; 5543 knees), white (11 studies; 3111 knees), Indian (three studies; 283 knees), and black (three studies; 113 knees). Although relatively underrepresented, the knees from the Indian and black studies were maintained for hypothesis-generating purposes and to highlight crucial gaps in the data. The two key dimensions for selecting a suitable implant based on a patient’s unique anatomy—AP length and mediolateral (ML) width—were assessed for the femur and tibia, in addition to aspect ratio, calculated by dividing the ML width by the AP length. Study measurement techniques were compared visually when possible to ensure that each pooled study conducted a similar measurement process. Any significant measurement outliers were reviewed for eligibility to determine if the measurement techniques and landmarks used were comparable to the other studies included.ResultsWhite patients had larger femoral AP measurements than East Asians (62 mm, [95% CI, 57–66 mm] vs 59 mm, [95% CI, 54–63 mm]; mean difference, 3 mm; p < 0.001), a smaller femoral aspect ratio than East Asians (1.20, [95% CI, 1.11–1.29] vs 1.25, [95% CI, 1.16–1.34]; mean difference, 0.05; p = 0.001), and a larger tibial aspect ratio than black patients (1.55, [95% CI, 1.40–1.71] vs 1.49, [95% CI, 1.33–1.64]; mean difference, 0.06; p = 0.005).ConclusionsThis analysis uncovered differences of size (AP height and ML width of the femur and tibia) and shape (tibial and femoral aspect ratios) among knees from white, East Asian, and black populations. Future research is needed to understand the clinical implications of these discrepancies and to provide additional data with underrepresented groups.

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“…A recent study showed that the shape of the knee is not only dependent on gender, but also on the morphotype of the patient (Bellemans et al 2010). Prosthesis design should take inter-individual variations in knee joint anatomy into account (Dargel et al 2011, Gillespie et al 2011). However, these anatomical differences may be so small that have no clinical effect, which would agree with the findings of the present study.…”

Section: Discussionmentioning

confidence: 99%

No clinical benefit of gender-specific total knee arthroplasty

et al. 2014

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Background and purposeThere is no consensus regarding the clinical relevance of gender-speciﬁc prostheses in total knee arthroplasty (TKA). We summarize the current best evidence in a comparison of clinical and radiographic outcomes between gender-speciﬁc prostheses and standard unisex prostheses in female patients.MethodsWe used the PubMed, Embase, Cochrane, Science Citation Index, and Scopus databases. We included randomized controlled trials published up to January 2013 that compared gender-speciﬁc prostheses with standard unisex prostheses in female patients who underwent primary TKAs.Results6 trials involving 423 patients with 846 knee joints met the inclusion criteria. No statistically significant differences were observed between the 2 designs regarding pain, range of motion (ROM), knee scores, satisfaction, preference, complications, and radiographic results. The gender-specific design (Gender Solutions; Zimmer Inc, Warsaw, Indiana) reduced the prevalence of overhang. However, it had less overall coverage of the femoral condyles compared to the unisex group. In fact, the femoral prosthesis in the standard unisex group matched better than that in the gender-speciﬁc group.InterpretationGender-speciﬁc prostheses do not appear to confer any beneﬁt in terms of clinician- and patient-reported outcomes for the female knee.

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Gender differences in the anatomy of the distal femur

Cited by 52 publications

References 14 publications

Three-dimensional Morphology of the Knee Reveals Ethnic Differences

Three-dimensional Morphology of the Knee Reveals Ethnic Differences

What Differences in Morphologic Features of the Knee Exist Among Patients of Various Races? A Systematic Review

No clinical benefit of gender-specific total knee arthroplasty

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