Femoral Condyle Anatomy And Anatomical Femoral Prosthesis Correlation Studies And Clinical Observations

ObjectiveCurrently, total knee arthroplasty (TKA) is one of the effective treatment of moderate to severe knee osteoarthritis, rheumatoid arthritis of the knee, painful knee varus deformity and other serious end-stage knee disorders. From the last century sixties and seventies abroad began prosthesis for total knee replacement surgery,People’s perception of the knee anatomy、structural from the easy to the difficult, now has come to study the fine structure of the cognitive and research; TKA clinical surgery level and artificial knee prosthesis design standards are constantly improved and enhanced; TKA surgery has become more common application of domestic and international clinical efficacy is satisfactory orthopedic surgery; However, some patients in clinical after prosthesis still appears knee pain、knee flexion limited mobility、joint instability、poor prosthesis matching problems, This is mainly reflected in the level of surgical techniques, femoral prosthesis and the matching of the femoral condyle femoral condyle anatomical landmarks on the impact of surgery. This study focuses on the anatomy of the femoral condyle and femoral knee prosthesis with correlation, to study the anatomical adaptation of the prosthesis, provide theoretical reference on the development of clinical knee.MethodsFirst to people cadavers knee femoral condyle、shared by formalin-fixed specimens of adult corpses knee femoral condyle42cases, Cadavers provided by the Department of Anatomy, Taishan Medical College, and a anatomical knee prosthesis (Gemnini Posterior Stabilized, Gemini PS)(Prosthesis Figure1-6to1-11)femoral prosthesis as research subjects, Gemini PS femoral prosthesis data provided by the Link.measuring anatomical parameters of the femur specimens and Gemini PS femoral component parameters for comparison, analysis of the suitability of the femoral prosthesis. The various anatomical femoral condyle:anteroposterior diameter of the femoral condyle, lateral femoral condyle anteroposterior diameter, transverse diameter femoral condyle, intercondylar fossa height, diameter of the intercondylar fossa were measured and recorded; use SPSS17.0software to do a single sample t-test analysis of Gemini PS adaptation of the prosthesis for Various anatomical parameters obtained femoral condyle and Gemini PS femoral prosthesis parameters.For February2011to March2012in PLA88Hospital, TKA patients were followed for3,6,12month postoperative selected34cases TKA patients which is application Gemini PS, including22males and12females.Observed the Gemini PS femoral prosthesis, analysis relevant affect factor on clinically effect. Function was assessed using the American Knee Society score, the recovery process for TKA patients operated side knee function composite score, use SPSS17.0software to do Analysis of variance of knee functional scores at different time of6, and12months in the postoperative, In order to understand the Gemini PS prosthesis postoperative clinical effect. To do correlation analysis to patient sex, lateralization of knee surgery, femoral prosthesis size selected during operation, in order to understand their effects on recovery of knee function.Result1. The result of femoral condyle of the knee anatomy parameter as follows: the data of transverse diameter femoral condyle is64.75±4.73mm. the data of anteroposterior diameter of the medial femoral condyle is62.25±5.18mm, The sagital length of the lateral femoral condyleis60.26±5.77mm, the data of the width of intercondylar notch is18.41±3.08mm, the data of the height of intercondylar notch is32.49±4.16mm.2. Gemini PS femoral prosthesis is divided into six models (1、2、2A、3、4、5),the femoral prosthesis parameters according to1,2,2A,3,4,5in the order note as follows:anteroposterior diameter of the medial femoral condyle were53、58、61、64、66、70mm; Anteroposterior diameter of the lateral femoral condyle were50、57、57、62、65、69mm; the height of intercondylar notch were 33、34、36、38、41、43mm; the Width of intercondylar notch were22、23、24、24.5、25、25.5mm,the transverse diameter of femoral condyle were55、63、69、69、71、76mm. The parameter and parameters of42cases of knee femoral condylar for statistical analysis, application SPSS17.0software to do pairwise comparison on prosthesis model and the mean of specimens measurement,we found that Gemini PS femoral prosthesis three models (2,2A,3) and the mean of specimens measurement data in the three indicators (The width of femoral condyle, The sagital length of the lateral femoral condyle, The sagital length of medial femoral condyle) relatively close, P>0.05no difference in statistically significant, indicating that2,2A,3three prosthetic knee joint models of parameters and anatomical data fit people better.3.34patients received13to19months of clinical follow-up, The mean follow-up time is15.3months. This group of34cases preoperative KSS score is36.26±11.49; the score after surgery3months is78.02±6.80;the score after surgery6months is81.70±6.16;the score after surgery12months is84.52±5.93. The pairwise comparisons of the mean score at different time is significant differences, there was statistically significant, P<0.05. Explanation that after operative3months,6months and12months the function significantly improved compared with the preoperative. there are differences of functions score at different times after surgery3months,6months,12months, operative side KSS knee function composite score within a certain range is proportional to the time.4. Form34cases using the Gemini PS prosthesis TKA patients,we found that2,2A,3sizes is higher frequency of prosthesis in femoral prosthesis models,to a certain described that these models in clinical practice is more commonly used.5.34cases using the Gemini PS prosthesis TKA patients for knee pain score (The smaller of the score represents more severe pain, whereas the larger represents the lighter pain). The pain score of preoperative is23.34±6.06, the pain score of3,6,12months after operation were40.28±4.86,44.43±5.37and45.72±5.73;The results shows that KSS score between each time point, there were significant differences (P<0.05) except12months after operation compared with6months after operation, KSS score was no significant difference (P>0.05). Resumption of knee function significantly improved compared with the preoperative, the function is basically stable after6months, the function is no significant change after12months.6. The mean preoperative knee surgery side flexion, extension activity of34cases using the Gemini PS prosthesis patients is110.21±12.95°, the activity at3months after surgery is109.36±11.13°; the activity at6months after surgery is128.84±16.32°; the activity at12months after surgery is129.57±10.65°; The pairwise comparisons of the Knee activity at different time is that the Knee activity at3months after surgery is no significant difference compared with the preoperative (P=0.056); the Knee activity at3months after surgery is significant difference compared with6、12months after surgery (P=0.000); the Knee activity at6months after surgery is no significant difference compared with12months after surgery (P=0.512). Shows that the activity of knee return to steady state at6months after surgery, the activity is no significant changes as time goes by in a certain range.ConclusionThrough the lab specimens knee femoral condyle anatomy body parameter measurements with the anatomical femoral condyle prosthesis alignment analysis anatomical parameters, and analysis34cases of application Gemini PS prosthesis KSS score after TKA data.we found that some models of Gemini PS femoral component parameters able to match Chinese anatomical parameters, can be matched parameters indicators,2,2A,3sizes is higher frequency of34cases Gemini PS prosthesis TKA patients is more commonly used in clinical.The knee pain of operative side is significantly reduce compared with the preoperative, the activity is significantly improved compared with preoperative, lateralization surgery, the patient gender, and prosthesis models for KSS score of knee function score at different time had no significant effect, the clinical effect of application Gemini PS prosthesis is well.