Anthropometric Measurements of Distal Femur to Design the Femoral Component of Total Knee Arthroplasty for the Iranian Population

Document Type : RESEARCH PAPER


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

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

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


Background: Acquiring knowledge about anatomic and geometric quantities of bones is among the most vital
parameters in orthopedic surgery that has a significant effect on the treatment of various disorders and subsequent
outcomes. The aim of this study was to obtain anthropometric information for distal femur in order to compare with
similar dimensions of prosthesis used in total knee arthroplasty (TKA) surgery and to design more suitable and optimal
Methods: Morphological data of distal femur were measured in 132 knees (81 males and 51 females) using magnetic
resonance imaging (MRI). The data included anterior-posterior (AP) length, medial-lateral (ML) width, medial AP (MAP),
lateral AP (LAP), MAP to LAP distance in the anterior distal femur namely anterior medial lateral (AML) width, medial
and lateral condyle width, and intercondylar notch. The aspect ratio (ML/AP) was also calculated and the results were
compared with similar dimensions of currently used knee implants.
Results: Our data showed that men are significantly larger in all dimensions than women. In the distal femur with
similar AP lengths in both sexes, women had a smaller ML width than men (p <0.001). Comparison between the distal
femur and studied prostheses showed no high correlation and similarity between the femoral component and femoral
condyle prostheses in the resected surface of the bone.
Conclusion: The results of this study can provide the data needed to design prostheses suitable for the Iranian
Level of evidence: III


1. Lowe CJ, Barker KL, Dewey M, Sackley CM.
Effectiveness of physiotherapy exercise after knee
arthroplasty for osteoarthritis: systematic review and
meta-analysis of randomised controlled trials. Bmj.
2007; 335(7624):812.
2. Poitras S, Avouac J, Rossignol M, Avouac B, Cedraschi
C, Nordin M, Rousseaux C, Rozenberg S, Savarieau B,
Thoumie P, Valat JP. A critical appraisal of guidelines
for the management of knee osteoarthritis using
Appraisal of Guidelines Research and Evaluation
criteria. Arthritis research & therapy. 2007;
3. Chuang SH, Huang MH, Chen TW, Weng MC, Liu
CW, Chen CH. Effect of knee sleeve on static and
dynamic balance in patients with knee osteoarthritis.
The Kaohsiung journal of medical sciences. 2007;
4. Divine JG, Hewett TE. Valgus bracing for degenerative
knee osteoarthritis: relieving pain, improving gait, and
increasing activity. The Physician and sportsmedicine.
2005; 33(2):40-6.
5. Mazzuca SA, Page MC, Meldrum RD, Brandt KD, Petty‐
Saphon S. Pilot study of the effects of a heat‐retaining
knee sleeve on joint pain, stiffness, and function in
patients with knee osteoarthritis. Arthritis Care &
Research: Official Journal of the American College of
Rheumatology. 2004; 51(5):716-21.
6. Haim A, Rozen N, Dekel S, Halperin N, Wolf A. Control
of knee coronal plane moment via modulation of
center of pressure: a prospective gait analysis study.
Journal of biomechanics. 2008; 41(14):3010-6.
7. Goldberg VM, Figgie 3rd HE, Figgie MP. Technical
considerations in total knee surgery. Management 
of patella problems. The Orthopedic clinics of North
America. 1989; 20(2):189-99.
8. Ranawat CS. The patellofemoral joint in total condylar
knee arthroplasty. Pros and cons based on five-to tenyear
follow-up observations. Clinical orthopaedics
and related research. 1986 (205):93-9.
9. Fehring TK, Valadie AL. Knee instability after total
knee arthroplasty. Clinical orthopaedics and related
research. 1994 (299):157-62.
10. Ho WP, Cheng CK, Liau JJ. Morphometrical
measurements of resected surface of femurs in
Chinese knees: correlation to the sizing of current
femoral implants. The Knee. 2006; 13(1):12-4.
11. Hitt K, Shurman JR, Greene K, McCarthy J, Moskal J,
Hoeman T, Mont MA. Anthropometric measurements
of the human knee: correlation to the sizing of
current knee arthroplasty systems. JBJS. 2003;
12. Conley S, Rosenberg A, Crowninshield R. The female
knee: anatomic variations. JAAOS-Journal of the
American Academy of Orthopaedic Surgeons. 2007;
13. Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE.
Rotational landmarks and sizing of the distal femur
in total knee arthroplasty. Clinical Orthopaedics and
Related Research®. 1996; 331:35-46.
14. Chin KR, Dalury DF, Scott RD. Comparative
measurement of male and female distal femurs
during primary total knee arthroplasty. J Knee Surg.
2002; 15:213-7.
15. Campbell WC, Canale ST, Beaty JH. Campbell’s
operative orthopaedics. Philadelphia, PA: Mosby.
16. Biau D, Mullins MM, Judet T, Piriou P. Is anyone too old 
for a total knee replacement?. Clinical Orthopaedics
and Related Research®. 2006; 448:180-4.
17. Noble PC, Gordon MJ, Weiss JM, Reddix RN, Conditt
MA, Mathis KB. Does total knee replacement restore
normal knee function? Clinical Orthopaedics and
Related Research®. 2005; 431:157-65.
18. Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE,
Li G. Differences of knee anthropometry between
Chinese and white men and women. The Journal of
arthroplasty. 2011; 26(1):124-30.
19. Vaidya SV, Ranawat CS, Aroojis A, Laud NS.
Anthropometric measurements to design total knee
prostheses for the Indian population. The Journal of
arthroplasty. 2000; 15(1):79-85.
20. 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.
21. Lim HC, Bae JH, Yoon JY, Kim SJ, Kim JG, Lee JM. Gender
differences of the morphology of the distal femur and
proximal tibia in a Korean population. The Knee.
2013; 20(1):26-30.
22. Mahfouz MR, Merkl BC, Abdel Fatah EE, Booth Jr R,
Argenson JN. Automatic methods for characterization
of sexual dimorphism of adult femora: distal femur.
Computer methods in biomechanics and biomedical
engineering. 2007; 10(6):447-56.
23. Dargel J, Michael JW, Feiser J, Ivo R, Koebke J. Human
knee joint anatomy revisited: morphometry in the
light of sex-specific total knee arthroplasty. The
Journal of arthroplasty. 2011; 26(3):346-53.
24. Yue B, Wang J, Wang Y, Yan M, Zhang J, Zeng Y. How
the gender or morphological specific TKA prosthesis
improves the component fit in the Chinese population?.
The Journal of arthroplasty. 2014; 29(1):71-4.
25. Hussain F, Kadir A, Rafiq M, Zulkifly AH, Sa’at A, Aziz
AA, Hossain M, Kamarul T, Syahrom A. Anthropometric
measurements of the human distal femur: a study
of the adult Malay population. BioMed research
international. 2013; 2013.
26. 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.
27. 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.
28. Merchant AC, Arendt EA, Dye SF, Fredericson M,
Grelsamer RP, Leadbetter WB, Post WR, Teitge RA.
The female knee: anatomic variations and the femalespecific
total knee design. Clinical orthopaedics and
related research. 2008; 466(12):3059-65.
29. Baker K, Goggins J, Xie H, Szumowski K, LaValley M,
Hunter DJ, Felson DT. A randomized crossover trial of
a wedged insole for treatment of knee osteoarthritis.
Arthritis & Rheumatism. 2007; 56(4):1198-203.
30. Fehring TK, Murphy JA, Hayes TD, Roberts DW,
Pomeroy DL, Griffin WL. The Coventry Award Paper:
Factors Influencing Wear and Osteolysis in Press-
Fit Condylar Modular Total Knee Replacements.
Clinical Orthopaedics and Related Research®. 2004;
31. Himanen AK, Belt E, Nevalainen J, Hämäläinen M,
Lehto MU. Survival of the AGC total knee arthroplasty
is similar for arthrosis and rheumatoid arthritis:
Finnish Arthroplasty Register report on 8 467
operations carried out between 1985 and 1999. Acta
orthopaedica. 2005; 76(1):85-8.
32. Rand JA, Ilstrup DM. Survivorship analysis of total
knee arthroplasty. Cumulative rates of survival of
9200 total knee arthroplasties. The Journal of bone
and joint surgery. American volume. 1991; 73(3):397-
33. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS.
Factors affecting the durability of primary total knee
prostheses. JBJS. 2003; 85(2):259-65.
34. Robertsson O, Knutson K, Lewold S, Lidgren L. The
Swedish Knee Arthroplasty Register 1975-1997:
an update with special emphasis on 41,223 knees
operated on in 1988-1997. Acta Orthopaedica
Scandinavica. 2001; 72(5):503-13.
35. Booth RE. The gender-specific (female) knee.
Orthopedics. 2006; 29(9):768-9.
36. Barrett WP. The need for gender-specific prostheses
in TKA: does size make a difference?. Orthopedics.
2006; 29(9):S53.
37. Dorr LD, Boiardo RA. Technical considerations in total
knee arthroplasty. Clinical orthopaedics and related
research. 1986 (205):5-11.