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Clinical Orthopaedics and Related Research®

, Volume 475, Issue 1, pp 170–182

First Online: 04 October 2016Received: 23 March 2016Accepted: 19 September 2016DOI: 10.1007-s11999-016-5097-4

Cite this article as: Kim, T.K., Phillips, M., Bhandari, M. et al. Clin Orthop Relat Res 2017 475: 170. doi:10.1007-s11999-016-5097-4

Abstract

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.

The institution of one or more of the authors MP has received, during the study period, funding from Smith and Nephew, Inc Baar, Switzerland.

One of the authors certifies that he MB or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Smith and Nephew Inc Baar, Switzerland; an amount of less than USD 10,000 from Sanofi Paris, France; an amount of less than USD 10,000 from Ferring Pharmaceuticals Inc Saint-Prex, Switzerland; and an amount of less than USD 10,000 from DJO, LLC Vista, CA, USA.

One of the authors certifies that he TKK or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Smith and Nephew Inc Baar, Switzerland, and an amount of less than USD 10,000 from B. Braun Tuttlingen, Germany.

One author JW is an employee of Smith and Nephew, Inc Baar, Switzerland.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This study was performed at Global Research Solutions Inc Burlington, Ontario, Canada.

An erratum to this article is available at http:-dx.doi.org-10.1007-s11999-017-5301-1.

A comment to this article is available at http:-dx.doi.org-10.1007-s11999-016-5135-2.

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Author: T. K. Kim - Mark Phillips - Mohit Bhandari - John Watson - Rajesh Malhotra

Source: https://link.springer.com/







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