Modern total knee arthroplasty designs do not reliably replicate anterior femoral morphology
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KNEE
Modern total knee arthroplasty designs do not reliably replicate anterior femoral morphology Alexander W. Kuo1 · Darren B. Chen2 · Jil Wood2 · Samuel J. MacDessi2,3 Received: 14 March 2019 / Accepted: 26 June 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose Biomechanical studies suggest that PF tracking is not reliably restored to physiological values in TKA despite surgical technique optimization. A clinical observation is that current TKA designs may not replicate anterior femoral offset. The aim was to examine the intraoperative resection thicknesses of the anterior femoral condyles during TKA and correlate these findings relative to modern prostheses. Methods This was a retrospective analysis of 199 patients who underwent 233 TKAs using a single implant design with measured anterior femoral condylar resection thicknesses. The aim was to restore posterior condylar offset whilst minimizing overstuffing of the anterior compartment of the knee by choosing the smallest prosthesis to allow for the maximal anterior resection as close to the cortex without inducing notching. Prosthetic measurements from 7 commonly used TKAs were collected by analysis of 3D models of median sized explants. Results An average of 7.9 mm (SD 2.5 mm, range 2–16.5 mm) and 11.5 mm (SD 2.5 mm, range 2–21 mm) was resected from the medial and lateral aspects of the anterior femur, respectively. The average anterior flange thickness for the prosthesis data set was 6.6 mm (SD 0.6 mm, range 6.1–7.9 mm) medially and 7.6 mm (SD 0.7 mm, range 6.8–9.0 mm) laterally. Comparison across patients who received the median prosthesis size of 5 (SD 1.3, range 2–8) was inadequately restored by 1.4 mm (p
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