nach oben

Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

01.06.2021 | KNEE

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

verfasst von: Lucas Beckers, Jacobus H. Müller, Jeremy Daxhelet, Salvatore Ratano, Mo Saffarini, Tarik Aït-Si-Selmi, Michel P. Bonnin

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 4/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this systematic review and meta-analysis was to investigate the variability in tibial geometric ratios among knees of different sexes and races to determine whether commercially-available tibial baseplates accommodate the morphologic diversity. The hypothesis was that anthropometric studies report considerable variability of tibial geometric ratios among sexes and races.

Methods

This systematic review and meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE^® and Embase^® on 28 January 2021 for clinical studies reporting on tibial geometric ratios. Tibial geometric ratios, as reported by the clinical studies, were represented by plotting their means and two standard deviations for comparison to two symmetric and two asymmetric commercially-available tibial baseplates.

Results

A total of 27 articles that reported on a combined total of 20,944 knees were eligible for data extraction. Variation in tibial aspect ratios was equal among sexes. The greatest variation in aspect ratio was observed among East Asians, followed by Caucasians, African-Americans, Indian and Middle Easterns. The variation in tibial asymmetry ratio was larger among men compared to women. The greatest variation in asymmetry ratio was observed among African-Americans, followed by Caucasians, East Asians, Indian and Middle Easterns. Bone-implant mismatch of > 3 mm overhang or > 4 mm under-coverage with four commercially-available tibial baseplates occurred in large proportions of knees due to variations in aspect ratio (in 17–100% of knees) and asymmetry ratio (in 7–100% of knees).

Conclusion

Anthropometric studies reported considerable inter-individual variability of tibial geometric ratios, which exceeded effects of sexual dimorphism and racial diversity. Bone–implant mismatch may be unavoidable in a large proportion of knees, when considering that a surgeon generally only uses one or a few TKA brands. These findings support the drive towards patient-specific implants to potentially achieve accurate bone–implant fit by implant customisation.

Level of evidence

IV.

Nur mit Berechtigung zugänglich

Asseln M, Hänisch C, Schick F, Radermacher K (2018) Gender differences in knee morphology and the prospects for implant design in total knee replacement. Knee 25(4):545–558PubMedCrossRef

Bansal V, Mishra A, Verma T, Maini D, Karkhur Y, Maini L (2018) Anthropometric assessment of tibial resection surface morphology in total knee arthroplasty for tibial component design in Indian population. JAJS 5(1):24–28

Beckers L, Müller JH, Daxhelet J, Saffarini M, Aït-Si-Selmi T, Bonnin MP (2021) Sexual dimorphism and racial diversity render bone-implant mismatch inevitable after off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06447-5CrossRefPubMed

Bellemans J, Carpentier K, Vandenneucker H, Vanlauwe J, Victor J (2010) The John Insall Award: both morphotype and gender influence the shape of the knee in patients undergoing TKA. Clin Orthop 468(1):29–36PubMedCrossRef

Bonnin MP, de Kok A, Verstraete M, Van Hoof T, Van Der Straten C, Saffarini M, Victor J (2017) Popliteus impingement after TKA may occur with well-sized prostheses. Knee Surg Sports Traumatol Arthrosc 25(6):1720–1730PubMedCrossRef

Bonnin MP, Saffarini M, Mercier PE, Laurent JR, Carrillon Y (2011) Is the anterior tibial tuberosity a reliable rotational landmark for the tibial component in total knee arthroplasty? J Arthroplasty 26(2):260–267PubMedCrossRef

Bonnin MP, Saffarini M, Shepherd D, Bossard N, Dantony E (2016) Oversizing the tibial component in TKAs: incidence, consequences and risk factors. Knee Surg Sports Traumatol Arthrosc 24(8):2532–2540PubMedCrossRef

Calek AK, Hochreiter B, Hess S, Amsler F, Leclerq V, Hirschmann MT, Behrend H (2021) High inter- and intraindividual differences in medial and lateral posterior tibial slope are not reproduced accurately by conventional TKA alignment techniques. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06477-zCrossRefPubMed

Chaichankul C, Tanavalee A, Itiravivong P (2011) Anthropometric measurements of knee joints in Thai population: correlation to the sizing of current knee prostheses. Knee 18(1):5–10PubMedCrossRef

10.

Cheng FB, Ji XF, Lai Y, Feng JC, Zheng WX, Sun YF, Fu YW, Li YQ (2009) Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee 16(5):341–347PubMedCrossRef

11.

Cho BW, Kwon HM, Hong YJ, Park KK, Yang IH, Lee WS (2021) Anatomical tibial component is related to more medial tibial stress shielding after total knee arthroplasty in Korean patients. Knee Surg Sports Traumatol Arthrosc 29(3):710–717PubMedCrossRef

12.

Clary C, Aram L, Deffenbaugh D, Heldreth M (2014) Tibial base design and patient morphology affecting tibial coverage and rotational alignment after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(12):3012–3018PubMedPubMedCentralCrossRef

13.

Dai Y, Bischoff JE (2013) Comprehensive assessment of tibial plateau morphology in total knee arthroplasty: influence of shape and size on anthropometric variability. J Orthop Res 31(10):1643–1652PubMedCrossRef

14.

Dai Y, Cross MB, Angibaud LD, Hamad C, Jung A, Jenny JY (2018) Posterior tibial slope impacts intraoperatively measured mid-flexion anteroposterior kinematics during cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26(11):3325–3332PubMedCrossRef

15.

Dai Y, Scuderi GR, Bischoff JE, Bertin K, Tarabichi S, Rajgopal A (2014) Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs. Knee Surg Sports Traumatol Arthrosc 22(12):2911–2923PubMedPubMedCentralCrossRef

16.

Dargel J, Michael JW, Feiser J, Ivo R, Koebke J (2011) Human knee joint anatomy revisited: morphometry in the light of sex-specific total knee arthroplasty. J Arthroplasty 26(3):346–353PubMedCrossRef

17.

Erkocak OF, Kucukdurmaz F, Sayar S, Erdil ME, Ceylan HH, Tuncay I (2016) Anthropometric measurements of tibial plateau and correlation with the current tibial implants. Knee Surg Sports Traumatol Arthrosc 24(9):2990–2997PubMedCrossRef

18.

Fan L, Xu T, Li X, Zan P, Li G (2017) Morphologic features of the distal femur and tibia plateau in Southeastern Chinese population: a cross-sectional study. Medicine (Baltimore) 96(46):e8524PubMedCrossRef

19.

Galea VP, Botros MA, Madanat R, Nielsen CS, Bragdon C (2019) Promising early outcomes of a novel anatomic knee system. Knee Surg Sports Traumatol Arthrosc 27(4):1067–1074PubMedCrossRef

20.

Gustke KA, Golladay GJ, Roche MW, Elson LC, Anderson CR (2017) A targeted approach to ligament balancing using kinetic sensors. J Arthroplasty 32(7):2127–2132PubMedCrossRef

21.

Hafez MA, Sheikhedrees SM, Saweeres ES (2016) Anthropometry of Arabian arthritic knees: comparison to other ethnic groups and implant dimensions. J Arthroplasty 31(5):1109–1116PubMedCrossRef

22.

Hartel MJ, Loosli Y, Delfosse D, Diel P, Thali M, Ross S, Kohl S, Eggli S (2014) The influence of tibial morphology on the design of an anatomical tibial baseplate for TKA. Knee 21(2):415–419PubMedCrossRef

23.

Hartel MJ, Loosli Y, Gralla J, Kohl S, Hoppe S, Röder C, Eggli S (2009) The mean anatomical shape of the tibial plateau at the knee arthroplasty resection level: an investigation using MRI. Knee 16(6):452–457PubMedCrossRef

24.

Hitt K, Shurman JR 2nd, Greene K, McCarthy J, Moskal J, Hoeman T, Mont MA (2003) Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am 85A(Suppl 4):115–122CrossRef

25.

Huijs S, Huysmans T, De Jong A, Arnout N, Sijbers J, Bellemans J (2018) Principal component analysis as a tool for determining optimal tibial baseplate geometry in modern TKA design. Acta Orthop Belg 84(4):452–460PubMed

26.

Karimi E, Zandi R, Norouzian M, Birjandinejad A (2019) Correlation of anthropometric measurements of proximal tibia in iranian knees with size of current tibial implants. Arch Bone Jt Surg 7(4):339–345PubMedPubMedCentral

27.

Kim JK, Park JY, Lee HJ, Ro DH, Han HS, Lee MC (2020) Do the increment of femoral condyle curvature and the change of tibia shape improve clinical outcome in total knee arthroplasty? A propensity score matching analysis. Knee Surg Sports Traumatol Arthrosc 28(9):2980–2989PubMedCrossRef

28.

Kwak DS, Surendran S, Pengatteeri YH, Park SE, Choi KN, Gopinathan P, Han SH, Han CW (2007) Morphometry of the proximal tibia to design the tibial component of total knee arthroplasty for the Korean population. Knee 14(4):295–300PubMedCrossRef

29.

Li K, Saffarini M, Valluy J, Desseroit MC, Morvan Y, Telmon N, Cavaignac E (2019) Sexual and ethnic polymorphism render prosthetic overhang and under-coverage inevitable using off-the shelf TKA implants. Knee Surg Sports Traumatol Arthrosc 27(7):2130–2139PubMedCrossRef

30.

Li P, Tsai TY, Li JS, Zhang Y, Kwon YM, Rubash HE, Li G (2014) Morphological measurement of the knee: race and sex effects. Acta Orthop Belg 80(2):260–268PubMed

31.

Liu Z, Yuan G, Zhang W, Shen Y, Deng L (2013) Anthropometry of the proximal tibia of patients with knee arthritis in Shanghai. J Arthroplasty 28(5):778–783PubMedCrossRef

32.

Ma Q-L, Lipman JD, Cheng C-K, Wang X-N, Zhang Y-Y, You B (2017) A comparison between chinese and caucasian 3-dimensional bony morphometry in presimulated and postsimulated osteotomy for total knee arthroplasty. J Arthroplasty 32(9):2878–2886PubMedCrossRef

33.

Mahfouz M, Abdel Fatah EE, Bowers LS, Scuderi G (2012) Three-dimensional morphology of the knee reveals ethnic differences. Clin Orthop 470(1):172–185PubMedCrossRef

34.

Mathis DT, Hirschmann MT (2021) Why do knees after total knee arthroplasty fail in different parts of the world? J Orthop 23:52–59PubMedCrossRef

35.

McCalden RW, Hart GP, MacDonald SJ, Naudie DD, Howard JH, Bourne RB (2017) Clinical results and survivorship of the GENESIS II total knee arthroplasty at a minimum of 15 years. J Arthroplasty 32(7):2161–2166PubMedCrossRef

36.

Meier M, Zingde S, Best R, Schroeder L, Beckmann J, Steinert AF (2020) High variability of proximal tibial asymmetry and slope: a CT data analysis of 15,807 osteoarthritic knees before TKA. Knee Surg Sports Traumatol Arthrosc 28(4):1105–1112PubMedCrossRef

37.

Moghtadaei M, Moghimi J, Farahini H, Jahansouz A (2015) Morphology of proximal tibia in Iranian population and its correlation with available prostheses. Med J Islam Repub Iran 29:225PubMedPubMedCentral

38.

Nakamura S, Morita Y, Ito H, Kuriyama S, Furu M, Matsuda S (2015) Morphology of the proximal tibia at different levels of bone resection in Japanese knees. J Arthroplasty 30(12):2323–2327PubMedCrossRef

39.

Nielsen CS, Nebergall A, Huddleston J, Kallemose T, Malchau H, Troelsen A (2018) Medial overhang of the tibial component is associated with higher risk of inferior knee injury and osteoarthritis outcome score pain after knee replacement. J Arthroplasty 33(5):1394–1398PubMedCrossRef

40.

Okazaki Y, Pujol N (2020) The use of an asymmetrical tibial tray in TKA optimises tibial rotation when fitted to the posterior tibial plateau border. Knee Surg Sports Traumatol Arthrosc 28(12):3821–3826PubMedCrossRef

41.

Reddy AVG, Sankineani SR, Agrawal R, Thayi C (2020) Comparative study of existing knee prosthesis with anthropometry of Indian patients and other races, a computer tomography 3D reconstruction-based study. J Clin Orthop Trauma 11(Suppl 2):S228-s233PubMedCrossRef

42.

Saffarini M, Nover L, Tandogan R, Becker R, Moser LB, Hirschmann MT, Indelli PF (2019) The original Akagi line is the most reliable: a systematic review of landmarks for rotational alignment of the tibial component in TKA. Knee Surg Sports Traumatol Arthrosc 27(4):1018–1027PubMedCrossRef

43.

Shah D, Ghyar R, Ravi B, Shetty V (2013) 3D morphological study of the Indian arthritic knee: comparison with other ethnic groups and conformity of current TKA implant. Open J Rheumatol Autoimmune Dis 3(4):263–269CrossRef

44.

Tanaka Y, Nakamura S, Kuriyama S, Nishitani K, Ito H, Lyman S, Matsuda S (2020) Intraoperative physiological lateral laxity in extension and flexion for varus knees did not affect short-term clinical outcomes and patient satisfaction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05862-4CrossRefPubMed

45.

Tandogan RN, Kort NP, Ercin E, van Rooij F, Nover L, Saffarini M, Hirschmann MT, Becker R, Dejour D (2021) Computer-assisted surgery and patient-specific instrumentation improve the accuracy of tibial baseplate rotation in total knee arthroplasty compared to conventional instrumentation: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06495-xCrossRefPubMedPubMedCentral

46.

Westrich GH, Haas SB, Insall JN, Frachie A (1995) Resection specimen analysis of proximal tibial anatomy based on 100 total knee arthroplasty specimens. J Arthroplasty 10(1):47–51PubMedCrossRef

47.

Wevers HW, Simurda M, Griffin M, Tarrel J (1994) Improved fit by asymmetric tibial prosthesis for total knee arthroplasty. Med Eng Phys 16(4):297–300PubMedCrossRef

48.

Yang B, Song CH, Yu JK, Yang YQ, Gong X, Chen LX, Wang YJ, Wang J (2014) Intraoperative anthropometric measurements of tibial morphology: comparisons with the dimensions of current tibial implants. Knee Surg Sports Traumatol Arthrosc 22(12):2924–2930PubMedCrossRef

49.

Yang B, Yu J, Gong X, Chen L, Wang Y, Wang J, Wang H, Zhang J (2014) Intraoperative study on anthropometry and gender differences of the proximal tibial plateau at the arthroplasty resection surface. Chin Med J (Engl) 127(1):92–95PubMedCrossRef

50.

Yang B, Yu JK, Zheng ZZ, Lu ZH, Zhang JY, Cheng JH (2013) Computed tomography morphometric study of gender differences in osteoarthritis proximal tibias. J Arthroplasty 28(7):1117–1120PubMedCrossRef

51.

Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G (2011) Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty 26(1):124–130PubMedCrossRef

52.

Yue W, Theobald M, Deckx J, Lawrenchuk M, Angibaud L (2016) Evaluation of a western originated total knee arthroplasty design on the fit of small sized femora. J Orthop Res 34:0942

53.

Zhang K, Han Q, Wang H, Yang K, Chen B, Zhang Y, Zhang S, Wang J, Chu H (2019) Measurement of proximal tibial morphology in northeast Chinese population based on three-dimensional reconstruction computer tomography. Medicine (Baltimore) 98(45):e17508PubMedCrossRef

54.

Zhang Y, Wang X, Wu Z, Xia Q, Shao Y (2017) Highly variable femoral morphology in osteoarthritic Chinese: are prostheses today sufficiently suitable? J Knee Surg 30(9):936–942PubMedCrossRef

Titel: 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
verfasst von: Lucas Beckers
Jacobus H. Müller
Jeremy Daxhelet
Salvatore Ratano
Mo Saffarini
Tarik Aït-Si-Selmi
Michel P. Bonnin
Publikationsdatum: 01.06.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 4/2023
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-021-06623-7

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

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