Factors influencing selection of relatively narrow femoral prosthesis in total knee arthroplasty

doi:10.3877/cma.j.issn.1674-134X.2024.02.006

Abstract

Abstract:

Objective

To study the morphological differences of knee joints by analyzing the use of two knee prosthesis systems and determine which factors are related to the use of prosthesis width.

Methods

From January 2019 to January 2021, 616 patients who underwent primary total knee arthroplasty in PLA General Hospital were retrospectively collected. Among them, 348 patients used Legion knee prosthesis system (Smith&Nephew Company, USA) and 268 patients used Unique knee prosthesis system (Zhengtian Company, Tianjin). Only patients with primary knee osteoarthritis were included, and patients with any history of surgery or knee joint trauma, a large number of bone defects requiring bone grafting and varus/valgus deformity greater than 15° were excluded. Statistics of gender, height, prosthesis type and other information were made. Pearson correlation analysis and binary logistic regression analysis were used to analyze the relationship between sex, height, femur size and prosthesis width selection.

Results

The two most frequently used femoral prostheses in the Unique group were both narrower in size than those in the Legion group (58/60 vs 58/62; 61/63 vs 61/66). Women in both groups had smaller and narrower femurs. The medial-lateral/anterior-posterior(ML/AP) ratio was (1.08±0.03) in men and (1.07±0.03) in women. There was statistically significant difference between male and female (t=-4.75, P<0.05). Binary logistic regression analysis was used to evaluate the influence of gender, height, and femur size on the use of narrow prosthesis, and it was found that gender was the most relevant factor. In Legion group, women were 4.41 times more likely to use narrow prosthesis than men [OR=4.41, 95%CI (1.97, 9.85), P<0.01]. In the Unique prosthesis, women were 7.11 times more than men [OR=7.11, 95%CI (2.71, 18.61), P<0.01]. The second is the size of the femur. The larger the size of the femur, the higher the utilization rate of narrow prosthesis.

Conclusions

There are differences in knee joint morphology between males and females, but there are quite a number of women and men who use narrow prosthesis. Ethnic differences should be taken into account to design components for Asian populations and the femoral component size options should be increased with lesser increments in between sizes.

Key words: Arthroplasty, replacement, knee, Prosthesis design, Sex factors

Hao Liu, Qingyuan Zheng, Long Cheng, Peng Xin, Bo Wu, Peng Ren, Guoqiang Zhang. Factors influencing selection of relatively narrow femoral prosthesis in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(02): 193-200.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2024.02.006

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2024/V18/I02/193

Figures/Tables 8

Table 1 General information of two groups of patients

Legion组	性别Gender	例数Number of cases	年龄(岁)Age	身高(cm)Height	BMI(kg/m²)
	女性Female	283	64.9±8.0	158.2±4.9	26.7±2.9
	男性Male	65	63.3±13.3	169.1±6.3	27.0±3.4
	t值		1.23	－15.16	0.51
	P值		P>0.05	P<0.001	P>0.05
Unique组	性别Gender	例数Number of cases	年龄(岁)Age	身高(cm)Height	BMI(kg/m²)
	女性Female	193	68.1±5.7	160.9±4.6	25.7±3.1
	男性Male	75	70.5±4.3	170.3±5.3	25.7±2.4
	t值		－2.85	－13.13	0.18
	P值		P>0.05	P<0.001	P>0.05

Figure 1 Femoral prosthesis size of Legion knee prosthesis system

Figure 2 Femoral prosthesis size of Unique knee prosthesis system

Figure 3 Distribution of femoral prosthesis sizes in Legionand Unique groups

Figure 4 Gender distribution of narrow version prostheses used in LegionandUnique groups

Figure 5 The share of narrow version prostheses used in two groups of different femoral sizes

Figure 6 Number of narrow version prostheses in two groups with different heights. A is the prostheses with different heights in Legion group; B is the prostheses with different heights in Unique group; C is the prostheses prostheses of different heights in male patients in Legion group; D is the prostheses of different heights in male patients in Unique group; E is the prostheses of different heights in female patients in Legion group; F is the prostheses with different heights in female patients in Unique group

Table 2 Two groups of binary logistic regression analysis data

项目Object	Legion组		Unique组
项目Object	OR(95%CI)	P值	OR(95%CI)	P值
性别Gender
男Male	1		1
女Female	4.41(1.97，9.85)	P<0.01	7.11(2.71，18.61)	P<0.01
身高(cm)Height
140～160	0.84(0.23，3.15)	P>0.05	5.78(1.62，20.48)	P<0.01
161～170	0.72(0.22，2.37)	P>0.05	3.45(1.17，10.16)	P<0.05
171～190	1		1
股骨尺寸^*Femursize
2#			1
3#	1		3.71(1.10，12.55)	P<0.05
4#	1.66(0.84，3.27)	P>0.05	5.89(1.72，20.19)	P<0.01
5#	3.61(1.61，8.10)	P<0.01	12.08(2.71，53.88)	P<0.01
6#	5.03(1.53，16.56)	P<0.01

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