RESEARCH
Hip Knee J.
Vol.
No.
2, 2023, pp.
p-ISSN: 2723-7818 e-ISSN: 2723-7826 http://dx.
org/10.
46355/hipknee.
DISTAL FEMUR MORPHOLOGICAL DISCREPANCY COMPARED WITH TOTAL
KNEE ARTHROPLASTY IMPLANTS IN INDONESIA
Okkie Mharga Sentana1.
Pamudji Utomo2 Fellow Department of Orthopaedic and Traumatology.
Universitas Sebelas Maret.
Prof.
Dr.
Soeharso Orthopaedic Hospital.
Surakarta.
Indonesia
ABSTRACT
The prosthesis of knee joint in total knee arthroplasty (TKA) can give better fixation and stabilization if itAos chosen properly.
Most of prosthesis have been designed to be compatible with western population, not for Asian population.
Whether the implant size need to be adjusted with ethnics and gender still being a Aim to define whether the morphology of Distal Femur, among men and women in Indonesia have discrepancy and to assess compatibility of the prosthesis size in Indonesia.
The Methods this study was a descriptive cross-sectional study that conducted at Prof.
Dr.
R SoeharsoAos Orthopaedic Hospital Ae Surakarta.
Indonesia, using purposive quota sampling methods.
The inclusion criteria MRI knee joint of men and women .
ge Ou 18 years ol.
which have soft tissue injury of knee joint.
The morphological measurement of Distal Femur with the use of certain Software.
Then, the data were analyzed with SPSS ver.
17 using independent T-Test.
The results is Among 130 patients, we found that WomenAos fML were narrower than men.
While the ratio aspect of femur implants compared to gender, showed that it was not compatible for men, but more compatible for There is discrepancy of morphological size of Distal Femur among men and women in Indonesia.
causes incompatibility of using TKA implant in men patients in Indonesia, which more suitable for women size.
Keywords: Total Knee Arthroplasty.
Implants.
Femur.
Prosthesis.
Discrepancy This is an open access article under the CCAeBY-SA license.
Article History:
Corresponding Author:
Submission Revision Accepted : July 21th, 2023 : July 21th, 2023 : August 27th, 2023 Pamudji Utomo.
Prof.
Dr.
Soeharso Orthopaedic Hospital.
Jl.
Jenderal Ahmad Yani.
Pabelan.
Surakarta.
Indonesia.
pamudjiutomo@gmail.
TREATMENT OF CHRONIC PROSTHETIC JOINT INFECTION AFTER TOTAL KNEE ARTHROPLASTY WITH TWOSTAGE REVISION - A CASE SERIES
INTRODUCTION
Total Knee Arthroplasty (TKA) is a surgical procedure which has aim to eliminate pain sensation, improve and maintain knee joint So it is important to choose compatible prosthesis for Distal Femur and Proksimal Tibia size .
The prosthesis patientAos morphology can give better fixation and stabilization .
It becomes controversy, is there any discrepancy among men and womenAos knee joint, and whether it is necessary to adjust the specific prosthesis based on ethnics and gender .
The latest studies have showed that there was discrepancy of knee joint morphology based on gender and ethnics.
So many scientists suggest to adjust the implant size with gender size.
But in the other hand, some studies say that the genderAos differences were not significant.
Most of prosthesis have been designed to be compatible with western population, and for Asian population sometimes have to use bigger implant than patientAos needs.
So we conducted this study to define whether the morphology of Distal Femur.
Proximal Tibia, and Patella among men and women in Indonesia have discrepancy and to assess compatibility of the prosthesis size in Indonesia.
MATERIAL AND METHODS
This study was a descriptive crosectional study that conducted in SoeharsoAos Orthopaedic Hospital Ae Surakarta.
Indonesia using purposive quota sampling methods.
The inclusion criteria were MRI knee joint of men and women .
ge Copyright A 2023 the author.
| http://thehipkneejournal.
Ou 18 years ol.
which have soft tissue injury of knee joint.
Those who did not fulfill the inclusion criteria, had been excluded.
This research was approved by our institutional ethical review board.
The MRI data were taken from Radiology Department database of hospitals in Surakarta which have MRI facility.
While the patientAos data were taken from medical records and selected using inclusion and exclusion criteria.
The morphological measurement of Distal Femur with the Use of certain Software.
Then, the data were analyzed with SPSS ver .
independent T-Test.
Figure.
1 Morphological measurement of Distal Femur on MRI.
RESULTS
Distal femur the variable TEA in male patients was 81.
83 while female patients are 67.
The statistical test results obtained a value of p = <0.
<0.
which means that there was a significant difference in the results of the TREATMENT OF CHRONIC PROSTHETIC JOINT INFECTION AFTER TOTAL KNEE ARTHROPLASTY WITH TWOSTAGE REVISION - A CASE SERIES TEA examination between male and female ML variable in male patients with an average of 81.
44 while female patients with an average of 68.
The statistical test results obtained a value of p = <0.
<0.
which means that there was a significant difference in the results of the ML examination between male and female patients.
MAP variable in male patients with an average of 65.
while female patients with an average of The statistical test results obtained a value of p = <0.
<0.
which means that there was a significant difference in the results of the MAP examination between male and female patients.
LAP variable in male patients with an average of 67.
10 while female patients with an average The statistical test results obtained a value of p = <0.
<0.
which means that there was a significant difference in the results of the LAP examination between male and female AP variable in male patients with an average of 69.
58 while female patients with an average of 63.
The statistical test results obtained a value of p = <0.
<0.
which means that there was a significant difference in the AP examination results between male and female patients.
PML variable in male patients with an average of 51.
while female patients with an average of 41 (Table 1.
MLb.
MAPb.
m LAPb.
APb.
PMLb.
m AMLb.
m < ACAb.
< PCAb.
ML/APb.
76,08 7,30 63,47 4,10 64,84 4,08 67,22 4,14 80,69 5,37
31,50
3,16
9,10
0,88
2,48
0,86
1,13
0,06
81,07
4,44
65,75
3,21
67,23
3,10
69,27
3,58
51,96
2,58
32,49
3,55
9,04
0,85
2,38
0,79
1,17
0,03
68,11
1,72
59,81
2,36
61,01
2,01
63,95
2,56
41,93
1,41
29,91
1,33
9,20
0,93
2,64
0,94
1,07
0,02
<0,00
<0,00
<0,00
<0,00
<0,00
<0,00
0,268
0,086
<0,00
The statistical test results obtained a value of p = <0.
<0.
which means that there was a significant difference in the results of the PML examination between male and female patients (Figure 2.
AML
variable in male patients with an average of 55 while female patients with an average of 29.
The statistical test results obtained a p value = <0.
<0.
which means that there was a significant difference in the AML examination results between male and female patients (Figure It was found that fMAP and fLAP show differences between men and women, where fMAP and fLAP in women tend to have narrower fML than men.
In a measurements of TKR implants with gender, it shows that the aspect ratio of implants does not match the male gender but matches the female gender more (Figure 4.
Table 1.
Comparison between male and female patients of distal femur morphology Distal Femur TEAa .
Total .
75,90 7,26 Male .
= .
81,05 3,83 Female .
67,65 1,55 <0,00 Copyright A 2023 the author.
| http://thehipkneejournal.
TREATMENT OF CHRONIC PROSTHETIC JOINT INFECTION AFTER TOTAL KNEE ARTHROPLASTY WITH TWOSTAGE REVISION - A CASE SERIES
Figure 4.
Aspect ratio dimension .
ML/fAP %) and femoral anterior-posterior .
AP) compared with 3 femur implants in Indonesia .
MAP.
anteroposterior dimension, fLAP.
condyle anteroposterior dimension.
Figure 2.
Femoral Surface Ratio .
ML/fAP %) Comparing fMAP/fML ratio and fLAP/fML ratio based on fAP Between Male and Female .
MAP.
femoral medial condyle anteroposterior dimension, fLAP.
lateral condyle anteroposterior dimension, male.
Figure 3.
The femoral medialolateral .
ML) and anteroposterior .
AP) dimensions were compared with the three femoral implants used in Indonesia.
MAP.
medial condyle anteroposterior dimension, fLAP.
condyle anteroposterior dimension.
Copyright A 2023 the author.
| http://thehipkneejournal.
DISCUSSION
We analyzed 130 patient data and presented the results become some According to figure 1, there was discrepancy of fMAP and fLAP among male and female.
FemaleAos fML were narrower than male patients.
While the ratio aspect of implant femur compared to gender, showed that it was not compatible for men, but more compatible for women.
Besides, the measurement of implants aspect ratio was also not compatible for male, but more compatible for female.
The study was to study by Budhiparama et al that found that the Dutch Caucasian patients had larger mediolateral (ML) and AP femoral dimensions than the Indonesian Asians.
The aspect ratios of the distal femur were larger in Asians than in Caucasians.
Both groups had larger ML distal femoral dimensions than the knee systems .
Hitt et al found that a wide variation in the aspect ratio for the femoral component was seen among the six different prosthetic systems was found.
For women, there was a significant association between the component size and the amount of mediallateral overhang, with larger sizes having more overhang .
< 0.
Although the femoral aspect ratio for the morphologic data showed higher ratios for smaller knees and proportionally lower ratios for larger
TREATMENT OF CHRONIC PROSTHETIC JOINT INFECTION AFTER TOTAL KNEE ARTHROPLASTY WITH TWOSTAGE REVISION - A CASE SERIES
knees, the designs showed little change in the aspect ratio .
Another study by Kim et al found that white patients had larger femoral AP measurements than East Asians .
mm, .
% CI, 57-66 m.
vs 59 mm, .
% CI, 54-63 m.
mean difference, 3 mm.
p < 0.
, a smaller femoral aspect ratio than East Asians .
20, .
% CI, 1.
25, .
% CI, 1.
difference, 0.
p = 0.
, and a larger tibial aspect ratio than black patients .
% CI, 1.
49, .
% CI, 1.
mean difference, 0.
p = 0.
Therefore, the analysis showed uncovered differences of size (AP height and ML width of the femur and tibi.
and shape .
ibial and femoral aspect ratio.
among knees from white.
East Asian, and black populations .
There were some limitations to this study.
WeAove only collected sample from one hospital, and it may be less representative to all Indonesian people.
There was also limitation of MRI data sources, so we could not obtain other MRI data from other And because 3D reconstruction MRI havenAot done yet, we couldnAot measure other indicators such as femoral curvature angle and tibia caster angle.
So, we suggest that multicenter studies with bigger samples and complete MRI facility may be the implant size functional result.
Copyright A 2023 the author.
| http://thehipkneejournal.
REFERENCES