ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2019
Sexual and ethnic polymorphism render prosthetic overhang and under-coverage inevitable using off-the shelf TKA implants.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 4 of them syntheses that pooled it.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Symmetric versus asymmetric tibial components: A systematic review of comparative studies.Journal of orthopaedic surgery and research · 2024Pooled it
- Considerable inter-individual variability of tibial geometric ratios renders bone-implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Pooled it
- No significant difference in early clinical outcomes of custom versus off-the-shelf total knee arthroplasty: a systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Pooled it
- Sexual dimorphism and racial diversity render bone-implant mismatch inevitable after off-the-shelf total knee arthroplasty: a systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Pooled it
- Inclusion and reporting by age, sex, and ethnicity in clinical studies of high-risk medical devices approved in the European Union.European heart journal. Quality of care & clinical outcomes · 2025Article
- Mid-to-long-term outcomes of posterior-stabilized type total knee arthroplasty in asian patients: A single-center retrospective cohort study.Journal of orthopaedics · 2025Article
- Cartilage thickness can be accurately measured intraoperatively in total knee arthroplasty: A step further in calipered kinematic alignment.Journal of experimental orthopaedics · 2025Article
- Satisfaction after total knee arthroplasty: a prospective matched-pair analysis of patients with customised individually made and off-the-shelf implants.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Deep Learning for Automated Measurement of Patellofemoral Anatomic Landmarks.Bioengineering (Basel, Switzerland) · 2023Article
- Clinical significance of distal femur morphology in a healthy Mongolian youth population.Scientific reports · 2023Article
- Sub-optimal femoral fit in total knee arthroplasty, a systematic review of human femoral data vs off-the-shelf contemporary femoral components.Journal of experimental orthopaedics · 2023Article
- Personalisation and customisation in total knee arthroplasty: the paradox of custom knee implants.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- A Morphometric Study of the Distal Femoral Resected Surface In Osteoarthritis Knees of the Patients in Southwest China and a Comparison with Femoral Components in Six Total Knee Arthroplasty Systems.Orthopaedic surgery · 2023Article
- Physiological Femoral Condylar Morphology in Adult Knees-A MRI Study of 517 Patients.Diagnostics (Basel, Switzerland) · 2023Article
- No difference in patient-reported satisfaction after 12 months between customised individually made and off-the-shelf total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2022Article
- Preoperative radiographic parameters in the case of using a narrow-version femoral implant in total knee arthroplasty.Archives of orthopaedic and trauma surgery · 2022Article
- Comparison of serum inflammatory indicators and radiographic results in MAKO robotic-assisted versus conventional total knee arthroplasty for knee osteoarthritis: a retrospective study of Chinese patients.BMC musculoskeletal disorders · 2022Article
- The Morphology of a Kinematically Aligned Distal Femoral Osteotomy Is Different from That Obtained with Mechanical Alignment and Could Have Implications for the Design of Total Knee Arthroplasty.Journal of personalized medicine · 2022Article
- A computational tool for automatic selection of total knee replacement implant size using X-ray images.Frontiers in bioengineering and biotechnology · 2022Article
- Lack of small tibial component size availability for females in a highly utilized total knee arthroplasty system.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
purposeUnexplained pain and stiffness after total knee arthroplasty (TKA) often result from mismatch between implant geometry and knee morphology, which depends on patient size, sex, and ethnicity. This study aimed to determine whether size, sex, or ethnicity are independently associated with distal femoral morphology in healthy Caucasian and Asian knees, and to compare anatomic ratios to those of commercially available TKA implants.
methodsTwo series of computed tomography (CT) angiograms from France (264 knees) and China (259 knees) were used to digitize osteometric landmarks at the level of the femoral epicondyles, to measure anteroposterior (AP) and mediolateral (ML) dimensions at the anterior, posterior, medial, and lateral zones. The aspect (ML/AP), trapezoidicity (MLp/MLa), and asymmetry (APl/APm) ratios, as well as the sulcus angle were calculated and compared to those of 9 TKA models. Multivariable analyses were performed to determine whether anatomic ratios were independently associated with sex, origin, or size.
resultsMultivariable analyses revealed that, independently from size, female knees were narrower (β = - 0.03; p < 0.001) and more asymmetric (β = 0.02; p < 0.001), while Chinese knees were more trapezoidal (β = 0.04; p = 0.002) and asymmetric (β = 0.02; p < 0.001) with shallower trochleae (β = 6.4°; p < 0.001). Compared to native knees, most implants were too wide, and many of the recent models too 'trapezoidal'. Most prosthetic trochleae were too shallow compared to French knees, but within the third quartile of Chinese knees.
conclusionsThe morphology of the distal femur depends on sex and ethnicity independently from size. The wide spectrum of morphotypes observed cannot be covered by 'off-the-shelf' TKA models, and until customized implants become more accessible, prosthetic overhang, and under-coverage remain inevitable. LEVEL OF EVIDENCE: III, Retrospective comparative study.
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