Correlation of Anthropometric Measurements of Proximal Tibia in Iranian Knees with Size of Current Tibial Implants

Document Type: RESEARCH PAPER

Authors

1 Department of Biology and Anatomical Sciences, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

of the Caucasian population. The purpose of this study was to investigate the morphometry of the proximal tibia in the
standard resected surface of total knee arthroplasty (TKA).
Methods: In this descriptive study, the anthropometric data of the proximal tibia were measured in 132 knees (80 males
and 52 females) using magnetic resonance imaging in 2015. The collected data included anteroposterior (AP) length,
mediolateral (ML) width, medial AP, lateral AP, and aspect ratio (ML/AP). The medial and lateral AP distance to bone
center was calculated for symmetry analysis. The morphometric data were also compared with the same dimensions
of four current tibial implants.
Results: The mean age of the subjects was 38.26±11.45 year (age range: 20-60 years). The mean AP length and
mean ML width in the resected surface of the bone, as well as the mean aspect ratio (ML/AP) of tibial bone in all the
subjects, were 46.53±4.05 mm, 73.36±6.86 mm, and 1.58±0.11, respectively. The mean values of medial and lateral
AP distance up to bone center were 13.40±6.17 and 17.09±6.83 mm, respectively, indicating asymmetric proximal tibia
in the study population.
Conclusion: The measurements of anatomic shapes and dimensions of the proximal tibia revealed that women have
smaller dimensions than their male counterparts. Prostheses with smaller AP size tended to be undersized and larger
AP size had a tendency towards overhang in the mediolateral dimension. The data and obtained results of this study
can be used as guidance on designing tibial implant components suitable for TKA in the Iranian population.
Level of evidence: IV

Keywords

Main Subjects


1. Laskin RS. Total condylar knee replacement in
rheumatoid arthritis. A review of one hundred
and seventeen knees. J Bone Joint Surg Am. 1981;
63(1):29-35.
2. Dorr LD, Boiardo RA. Technical considerations in total
knee arthroplasty. Clinical orthopaedics and related
research. 1986;205:5-11.
3. Wang S, Feng C, Lu H. A study of Chinese knee joint
geometry for prosthesis design. Chinese medical
journal. 1992;105(3):227-33.
4. Insall JN. Surgical techniques and instrumentation
in total knee arthroplasty. Surgery of the knee.
1993:739-804.
5. Incavo SJ, Ronchetti PJ, Howe JG, Tranowski JP. Tibial
plateau coverage in total knee arthroplasty. Clinical
orthopaedics and related research. 1994;299:81-5.
6. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the
Knee Society clinical rating system. Clin Orthop relat
res. 1989;248(248):13-4.
7. Ravi B, Croxford R, Reichmann WM, Losina E, Katz
JN, Hawker GA. The changing demographics of total
joint arthroplasty recipients in the United States and
Ontario from 2001 to 2007. Best practice & research
Clinical rheumatology. 2012;26(5):637-47.
8. Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total
knee arthroplasty volume, utilization, and outcomes
among Medicare beneficiaries, 1991-2010. Jama.
2012;308(12):1227-36.
9. De La Mata J. Platelet rich plasma. A new treatment
tool for the rheumatologist? Reumatologí􀆴a Clí􀆴nica
(English Edition). 2013;9(3):166-71.
10. Goldberg VM, Figgie 3rd H, Figgie M. Technical
considerations in total knee surgery. Management
of patella problems. The Orthopedic clinics of North
America. 1989;20(2):189-99.
11. RANAWAT CS. The patellofemoral joint in total
condylar knee arthroplasty: pros and cons based
on five-to ten-year follow-up observations. Clinical
orthopaedics and related research. 1986;205:93-9.
12. Fehring TK, Valadie AL. Knee instability after total
knee arthroplasty. Clinical orthopaedics and related
research. 1994;299:157-62.
13. Bindelglass DF, Cohen JL, Dorr LD. Current principles
of design for cemented and cementless knees.
Techniques in Orthopaedics. 1991;6(4):80-5.
14. Lemaire P, Pioletti DP, Meyer F-M, Meuli R, Dörfl J,
Leyvraz P-F. Tibial component positioning in total knee
arthroplasty: bone coverage and extensor apparatus
alignment. Knee Surgery, Sports Traumatology,
Arthroscopy. 1997;5(4):251-7.
15. Westrich GH, Haas SB, Insall JN, Frachie A. Resection
specimen analysis of proximal tibial anatomy based
on 100 total knee arthroplasty specimens. The Journal
of arthroplasty. 1995;10(1):47-51.
16. Westrich GH, Agulnick MA, Laskin RS, Haas SB, Sculco
TP. Current analysis of tibial coverage in total knee arthroplasty. The Knee. 1997;4(2):87-91.

17. Nagamine R, Miura H, Bravo CV, Urabe K, Matsuda
S, Miyanishi K, et al. Anatomic variations should be
considered in total knee arthroplasty. Journal of
orthopaedic science. 2000;5(3):232-7.
18. Kwak DS, Surendran S, Pengatteeri YH, Park SE, Choi
KN, Gopinathan P, et al. Morphometry of the proximal
tibia to design the tibial component of total knee
arthroplasty for the Korean population. The Knee.
2007;14(4):295-300.
19. Dai Y, Bischoff JE. Comprehensive assessment of
tibial plateau morphology in total knee arthroplasty:
influence of shape and size on anthropometric
variability. Journal of Orthopaedic Research.
2013;31(10):1643-52.
20. Harvey WF, Niu J, Zhang Y, McCree PI, Felson DT, Nevitt
M, et al. Knee alignment differences between Chinese
and Caucasian subjects without osteoarthritis. Annals
of the rheumatic diseases. 2008;67(11):1524-8.
21. Cooke DT, Harrison L, Khan B, Scudamore A,
Chaudhary AM. Analysis of limb alignment in the
pathogenesis of osteoarthritis: a comparison of
Saudi Arabian and Canadian cases. Rheumatology
international. 2002;22(4):160-4.
22. Uehara K, Kadoya Y, Kobayashi A, Ohashi H, Yamano
Y. Anthropometry of the proximal tibia to design a
total knee prosthesis for the Japanese population. The
Journal of arthroplasty. 2002;17(8):1028-32.
23. Lim H-C, Bae J-H, Yoon J-Y, Kim S-J, Kim J-G, Lee J-M.
Gender differences of the morphology of the distal
femur and proximal tibia in a Korean population. The
Knee. 2013;20(1):26-30.
24. Chaichankul C, Tanavalee A, Itiravivong P.
Anthropometric measurements of knee joints in Thai
population: correlation to the sizing of current knee
prostheses. The Knee. 2011;18(1):5-10.
25. Cheng FB, Ji XF, Lai Y, Feng JC, Zheng WX, Sun YF, et
al. Three dimensional morphometry of the knee
to design the total knee arthroplasty for Chinese
population. The Knee. 2009;16(5):341-7.
26. Moghtadaei M, Moghimi J, Farahini H, Jahansouz A.
Morphology of proximal tibia in Iranian population
and its correlation with available prostheses. Medical
journal of the Islamic Republic of Iran. 2015;29:225.
27. Stulberg BN, Dornbrowski RM, Froimson M, Easley
K. Computed tomography analysis of proximal tibial
coverage. Clinical orthopaedics and related research.
1995;311:148-56.
28. Wevers H, Simurda M, Griffin M, Tarrel J. Improved
fit by asymmetric tibial prosthesis for total knee
arthroplasty. Medical engineering & physics. 1994;
16(4):297-300.
29. Bindelglass DF, Dorr LD. Current concepts review:
symmetry versus asymmetry in the design of total knee
femoral components—an unresolved controversy.
The Journal of arthroplasty. 1998;13(8):939-44.

30. Harwin SF. Patellofemoral complications in
symmetrical total knee arthroplasty. The Journal of
arthroplasty. 1998;13(7):753-62.
31. Hitt K, Shurman JR, Greene K, McCarthy J, Moskal J,
Hoeman T, et al. Anthropometric measurements of
the human knee: correlation to the sizing of current
knee arthroplasty systems. J Bone Joint Surg Am.
2003;85(suppl 4):115-22.
32. Hussain F, Abdul Kadir MR, Zulkifly AH, Sa’at A, Aziz
AA, Hossain MG, et al. Anthropometric measurements
of the human distal femur: a study of the adult Malay
population. BioMed research international. 2013 Nov
5; 2013.