| purpose:Total knee replacement(TKA)is the most effective treatment for advanced knee osteoarthritis.However,most of the prosthetic designs used in clinical practice are based on European and American racial anatomical data,and Chinese knee joint anatomical data are lacking.Therefore,this experiment will study the distal femur anatomical morphology through imaging methods,enrich the Chinese knee joint anatomical data,guide the selection of clinical TKA femur components,and further optimize the structure design of the prosthesis.Method:Collect MRI and DR of knee in healthy adults from November 2021 to January 2023.Inclusion criteria:(1)age 30-80 years old,male or female,(2)knee osteoarthritis grade0,grade 1(KL grade).Exclusion Criteria:(1)Rheumatoid arthritis or other inflammatory diseases causing severe knee deformity or accompanied by bone defect(2)Severe knee osteophyte(3)History of knee fracture(4)History of knee infection(5)History of knee surgery.For participants who met the criteria,X-rays were used to measure the inner and outer diameter of the femur(fML),anteroposterior diameter of the femur(fAP),the ratio of the inner and outer diameter of the femur to the anterior and posterior diameter(fML/fAP),the eccentricity of the posterior femoral condyle(PCO),and the posterior femoral condyle offset ratio(PCOR).MRI was used to measure the posterior femoral condyle angle(PCA)to analyze the sex differences in anatomical morphology,and statistically analyzed against the clinical use of prosthesis model parameters.Result:1.There were 213 participants in this trial,and according to the inclusion and exclusion criteria,7 subjects had severe rheumatoid arthritis and 6 subjects had a history of lower limb fracture.A total of 200 participants were enrolled,including 84 men and 116 women.2.The average diameter of the inner and outer femurs was 84.38±7.424 mm,the anteroposterior diameter of the femur was 64.44±6.489 mm,and the fML/fAP was1.31±0.094.The inner and outer diameter of the male femur was 91.30±5.191 mm,the anterior and anterior diameter was 68.90±6.179 mm,and the fML/fAP was 1.33±0.108,which was statistically significant compared with the inner and outer diameter of the female femur of 79.36±3.939mm(P=0.00),anterior and posterior diameter of61.20±4.490mm(P=0.00),and fML/fAP 1.30±0.080(P<0.05).3.The mean posterior femoral condyle eccentricity was 27.01±3.168 mm,and the posterior condyle offset ratio was 0.46±0.025.The eccentricity of the posterior femoral condyle was 28.93±3.161 mm in males and 0.46±0.022 in males and 25.63±2.352 mm,0.46 ± 0.027 in females.The posterior femoral condyle eccentricity in men and women were statistically significant(P=0.00),and there was no significant difference in the posterior femoral condyle offset ratio in men and females(P>0.05).With the increase of anteroposterior diameter of the femur,the eccentricity of the posterior femoral condyle will also increase,and the two are positively correlated(male R2=0.834,female R2=0.099);The posterior condyle offset ratio was not correlated with the anteroposterior diameter of the femur(male R2=0.012,female R2=0.014).4.The mean posterior condyle angle was 4.08±1.092°,4.68±1.194° for males and3.64±0.759° for females.The difference between male posterior condyle angle and female was statistically significant(P=0.00).5.The fML/fAP of prosthesis A is 1.09±0.010 and that of prosthesis B is 1.11±0.010,the former fML/fAP is smaller than the latter,that is,prosthesis B is more flattened.The increase of prosthesis model had no significant effect on the fML/fAP ratio.At the same time,the fML/fAP measurements were greater than the fML/fAP ratio of the two prostheses.Conclusion:1.The inner and outer diameter of the femur(fML),the ratio of the inner and outer diameter of the femur to the anteroposterior diameter(fML/fAP),and the anteroposterior diameter of the femur(fAP)were all greater than those of women,indicating that the distal femur anatomical morphology of men was flatter.The two prosthetic design parameters studied are not suitable for the anatomical morphology of men and women in this experiment,and a femoral prosthesis with a closer fML/fAP ratio should be selected.2.The posterior femoral condyle eccentricity(PCO)is larger in men than in women,and as the anteroposterior diameter of the femur increases,the posterior femoral condyle eccentricity also increases;There was no sex difference in the posterior femoral condyle shift ratio.3.The posterior femoral condyle angle in men is larger than the posterior femoral condyle angle in women(4.68±1.194° for males and 3.64±0.759° for females).When installing a femoral prosthesis,increase the angle of external rotation,especially for men,to better restore the line of force of femoral rotation.4.At present,the femoral component of knee artificial prosthesis still needs to be further optimized to fit the anatomical parameters,in order to develop diversified and individualized prostheses and improve the clinical efficacy after knee replacement. |
PDF Full Text Request