Important Differences Exist in Posterior Condylar Offsets in an Osteological Collection of 1,058 Femurs

Weinberg, Douglas S.; Streit, Jonathan J.; Gebhart, Jeremy J.; Williamson, Drew F. K.; Goldberg, Victor M.

doi:10.1016/j.arth.2015.02.027

Cited by 15 publications

(21 citation statements)

References 34 publications

(59 reference statements)

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“…Furthermore, it is considered to be a strength of the present study that not only the variability in PFO and DCO was shown, but also in AP and ML measurements. Weinberg et al [26], who measured the PCO of 1058 femurs, support our findings with a further statement that the PCO varies not only among individuals, but also within individuals. Surgeons should be aware of this fact when doing bilateral TKA.…”

Section: Discussionsupporting

confidence: 91%

What Is the Possible Impact of High Variability of Distal Femoral Geometry on TKA? A CT Data Analysis of 24,042 Knees

Meier

Zingde

Steinert

et al. 2019

Clin Orthop Relat Res

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Background Previous studies analyzing femoral components of TKAs have demonstrated the limited ability of these components to accommodate size variations seen in the patient population, particularly width and femoral offset. Questions/purposes The purpose of this study was to use a large data set of knee CT scans (1) to determine the variations in the distal and posterior femoral geometries and to determine whether there is a correlation between distal condylar offset and posterior femoral offset as a potential parameter for symmetry/asymmetry; and (2) to evaluate what proportion of knees would have a substantial mismatch between the implant's size or shape and the patient's anatomy if a femoral component of a modern standard TKA of symmetric (sTKA) or asymmetric (asTKA) designs were to be used. One of the authors (SZ) is an employee of Conformis Inc (Billerica, MA, USA). One of the authors certifies that he (AS) has received personal fees for consultant teaching, during the study period, in an amount of less than USD 10,000 from Conformis Inc, outside the submitted manuscript. One of the authors certifies that he (WK) has received or may receive research support and royalties, during the study period, in an amount of USD 10,000 to USD 100,000 from Conformis Inc, outside the submitted manuscript. One of the authors certifies that he (FK) has received personal fees and grants, during the study period, in an amount of less than USD 10,000 from Conformis Inc, outside the submitted manuscript. One of the authors certifies that he (JB) has received personal fees for consultant teaching, during the study period, in an amount of less than USD 10,000, from Smith & Nephew (Smith & Nephew GmbH, Hamburg, Germany) and personal fees for consultant teaching in an amount of less than USD 10,000 from Conformis Inc, all outside the submitted manuscript. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Section: Discussionsupporting

confidence: 91%

What Is the Possible Impact of High Variability of Distal Femoral Geometry on TKA? A CT Data Analysis of 24,042 Knees

Meier

Zingde

Steinert

et al. 2019

Clin Orthop Relat Res

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“…42 There were no gender differences present in the maximal trochlear depth, a result similar to the findings of Pinskerova et al, who found no sex differences existed in trochlear depth measurements standardized for femoral size. 43 While racial differences in distal femur geometry have been described for other parameters, 17 we are unaware of any literature comparing trochlear depth between races. Referenced from the vertical: a beam oriented directly vertically corresponds to a beam orientation of 0 degrees.…”

Section: Discussionmentioning

confidence: 99%

“…Using a previously described mathematical technique for modeling the distal femur, basic formulae were used to calculate the maximum trochlear depth using an average of medial and lateral flange depths based on a linearly weighted average for the position of the trochlear grove relative to each flange. 17 The MicroScribe 3D has a positional accuracy of 0.43 mm and a positional resolution of 0.13 mm, according to official documentation provided by the manufacturer. All digitizer measurements were performed by a single individual, with another individual performing interexperimenter reliability on five specimens (150 measurements in total).…”

Section: Measuring Trochlear Depth Osteologically With a Microscribe mentioning

confidence: 99%

A Cadaveric Analysis of the Optimal Radiographic Angle for Evaluating Trochlear Depth

et al. 2016

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Disorders of the patellofemoral joint are common. Diagnosis and management often involves the use tangential imaging of the patella and trochlear grove, with the sunrise projection being the most common. However, imaging protocols vary between institutions, and limited data exist to determine which radiographic projections provide optimal visualization of the trochlear groove at its deepest point. Plain radiographs of 48 cadaveric femora were taken at various beam-femur angles and the maximum trochlear depth was measured; a tilt-board apparatus was used to elevate the femur in 5-degree increments between 40 and 75 degrees. A corollary experiment was undertaken to investigate beam-femur angles osteologically: digital representations of each bone were created with a MicroScribe digitizer, and trochlear depth was measured on all specimens at beam-femur angles from 0 to 75 degrees. The results of the radiographic and digitizer experiments showed that the maximum trochlear grove depth occurred at a beam-femur angle of 50 degrees. These results suggest that the optimal beam-femur angle for visualizing maximum trochlear depth is 50 degrees. This is significantly lower than the beam-femur angle of 90 degrees typically used in the sunrise projection. Clinicians evaluating trochlear depth on sunrise projections may be underestimating maximal depth and evaluating a nonarticulating portion of the femur.

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“…Though UKA has undergone periods of criticism since its inception, namely, questioning its survival in comparison to TKA [ 4 , 5 ], it may offer faster recovery [ 6 , 7 , 8 ], reduced complication rates [ 7 , 8 , 9 , 10 ], improved patient-reported functional outcomes [ 11 , 12 , 13 ], and a more normal feeling knee [ 14 , 15 ] in appropriately selected patients. The importance of continuing to study UKA and its technological developments is highlighted by the significant and increasing healthcare burden that osteoarthritis (OA) poses across the world and the increasing number of patients with OA-related knee disorders who seek to maintain a high level of activity [ 16 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast to the traditional method of selecting implant size and geometry from an available set of options, these implants are manufactured on an individual basis from a three-dimensional rendering of pre-operative computed tomography (CT) imaging. Their development originated from the high variability seen in distal femoral and proximal tibial bone geometry [ 16 , 17 , 18 , 19 ], as well as the increasing focus on restoring the natural knee anatomy with arthroplasty in recent years [ 20 , 21 ]. In theory, a closer approximation of the natural anatomy would provide for improved kinematics, as shown in customized TKA (C-TKA) [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Patient Satisfaction, Functional Outcomes, and Implant Survivorship in Patients Undergoing Customized Unicompartmental Knee Arthroplasty

Pumilia

Schroeder

Sarpong

et al. 2021

JPM

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Customized unicompartmental knee arthroplasty (C-UKA) utilizes implants manufactured on an individual patient basis, derived from pre-operative computed tomography images in an effort to more closely approximate the natural anatomy of the knee. The outcomes from 349 medial and lateral fixed-bearing C-UKA were reviewed. Implant survivorship analysis was conducted via retrospective chart review, and follow-up analysis was conducted via a single postoperative phone call or email. The rate of follow-up was 69% (242 knees). The average age at surgery was 71.1 years and the average body mass index was 28.8 kg/m2. Seven revision arthroplasties (2.1%) had knowingly been performed at an average of 1.9 years postoperatively (range: 0.1–3.9 years), resulting in an implant survivorship of 97.9% at an average follow-up of 4.2 years (range: 0.1–8.7) and 97.9% at an average of 4.8 years (range: 2.0–8.7) when knees with less than two years of follow-up were excluded. The reasons for revision were implant loosening (one knee), infection (two knees), progression of osteoarthritis (two knees), and unknown reasons (two knees). The average KOOS, JR. interval score was 84 (SD: 14.4). Of those able to be contacted for follow-up analysis, 67% were “very satisfied,” 26% were “satisfied,” 4% were “neutral,” 2% were “dissatisfied,” and 1% were “very dissatisfied.” When asked if the knee felt “natural,” 60% responded with “always,” 35% responded with “sometimes,” and 5% responded with “never.” After analyzing a large cohort of C-UKA, we found favorable rates of survivorship, satisfaction, and patient-reported functional outcomes.

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Important Differences Exist in Posterior Condylar Offsets in an Osteological Collection of 1,058 Femurs

Cited by 15 publications

References 34 publications

What Is the Possible Impact of High Variability of Distal Femoral Geometry on TKA? A CT Data Analysis of 24,042 Knees

What Is the Possible Impact of High Variability of Distal Femoral Geometry on TKA? A CT Data Analysis of 24,042 Knees

A Cadaveric Analysis of the Optimal Radiographic Angle for Evaluating Trochlear Depth

Patient Satisfaction, Functional Outcomes, and Implant Survivorship in Patients Undergoing Customized Unicompartmental Knee Arthroplasty

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