Which is better? Anterior or posterior referencing for femoral component position in total knee arthroplasty

Abstract

When sizing the femoral component or determining its placement in total knee arthroplasty (TKA), if the anterior–posterior diameter of the femoral condyle is between component sizes, the selected size will differ depending on whether anterior referencing (AR) or posterior referencing (PR) is used. As a result, the amount of resected bone will also vary. In the present prospective study, we compared the two referencing methods to determine which is more suitable for individual patients. We recruited 58 patients (92 joints) who received TKA using the standard technique with intermediate-size components. AR was used in 26 joints, and PR in 23 joints. Seventeen of the patients underwent same-day bilateral TKA in which components of different sizes were used for the left and right joints. AR resulted in significantly smaller anterior and posterior offsets than PR. Preoperative clinical evaluation revealed no significant differences among cases in which intermediate-size components were indicated, or those in which components of different sizes were indicated. When an intermediate-sized component was indicated using the AR method, moving the sizer forward resulted in a larger posterior gap, but this technique was nevertheless considered acceptable. AR is likely to be more suitable than PR as it achieves more physiological anterior clearance.

Anterior Referencing versus Posterior Referencing in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

“…There were 584 patients in all, 294 of whom referencing TKA and 290 of whom did not undergo posterior r The mean age was 70.4 ± 6.9 years, the mean BMI was 27.6 follow-up was 40.7 ± 8.1 months. Different types of implant we posterior stabilized implants Stryker Triathlon (Stryker Orthop [24], Zimmer ® NexGen ® LPS (Zimmer Holdings Inc., Warsaw, I Noetos ® (Tornier Inc., Amsterdam, The Netherlands) [25], U2 T Taipei, Taiwan) [11], Legion CR and LPS TKA Systems (Smith USA) [10], LOSPA implant (Corentec, Seoul, South Korea) [2 (Zimmer Biomet, Warsaw, IN, USA) [26].…”

“…There were 5 referencing TKA and 290 of who The mean age was 70.4 ± 6.9 follow-up was 40.7 ± 8.1 months. posterior stabilized implants Stry [24], Zimmer ® NexGen ® LPS (Zim Noetos ® (Tornier Inc., Amsterdam Taipei, Taiwan) [11], Legion CR a USA) [10] The methodological quality of the included studies was assessed independently by three authors (M.M., F.N., F.F. ); cohort studies were assessed using the Modified New-castle-Ottawa Quality Assessment [20].…”

“…The mean age was 70.4 ± 6.9 years, the mea follow-up was 40.7 ± 8.1 months. Different types posterior stabilized implants Stryker Triathlon ( [24], Zimmer ® NexGen ® LPS (Zimmer Holdings Noetos ® (Tornier Inc., Amsterdam, The Netherl Taipei, Taiwan) [11], Legion CR and LPS TKA S USA) [10], LOSPA implant (Corentec, Seoul, S (Zimmer Biomet, Warsaw, IN, USA) [26].…”

“…However, the nuances become apparent when the femoral condyle's anteroposterior size falls between available component sizes. Opting for AR results in more posterior bone resection, widening the flexion gap with smaller component sizes, potentially leading to anterior notch formation with larger sizes [10]. Conversely, PR may increase the risk of anterior clearance tightness and potential patellofemoral overstuffing with larger component sizes [10].…”

“…Opting for AR results in more posterior bone resection, widening the flexion gap with smaller component sizes, potentially leading to anterior notch formation with larger sizes [10]. Conversely, PR may increase the risk of anterior clearance tightness and potential patellofemoral overstuffing with larger component sizes [10]. This intricate dance requires not only technical prowess but also a profound understanding of the patient's unique anatomical characteristics.…”