Orthopedic Surgery Department, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
Orthopedic Surgery Department, Hospital Santa Teresa (HST), Petrópolis, RJ, Brazil.
PLoS One. 2020 May 29;15(5):e0233715. doi: 10.1371/journal.pone.0233715. eCollection 2020.
Total knee arthroplasty (TKA) is the treatment option for patients with severe osteoarthritis (OA) of the knee whose symptoms are refractory to conservative management. Unfortunately, the level of patient dissatisfaction is high, reaching up to 25%. The reasons for this dissatisfaction are multifactorial, but bone-implant mismatch significantly increases the chance of pain and functional limitation. Sex-specific prosthesis designs have been developed to overcome this issue, but their use is still controversial. The primary objective of this study was to evaluate possible sex differences in the shape of the distal femur in patients with osteoarthritis. Secondary objectives were to investigate interpersonal variability of the distal femur and to determine the number of femoral implant sizes required to meet shape variations.
A cross-sectional observational study prospectively compared 294 knees of 293 patients with osteoarthritis according to sex (201 female/93 male). Six intraoperative measurements were performed on the distal femur (height and width of both lateral and medial condyles, total medial-lateral width of the femur, and intercondylar distance). Sex differences and interpersonal variability were analyzed by multiple linear regressions. Measurements were also correlated with patient height. An optimization analysis was used to estimate the number of femoral implant sizes required. There were significant sex differences in the distal femur, where men had higher values than women in all measurements. Great interpersonal variability was found. The height of the lateral condyle was correlated with patient height, but the correlation was not strong. Twenty-five femoral implant sizes were required to meet the shape variations in our sample.
The shape of the distal femur in patients with osteoarthritis shows great interpersonal variability, with men showing significantly higher values than women. A total of 25 different implant sizes would be necessary to adequately meet the variations observed in our study population.
全膝关节置换术（TKA）是治疗膝关节严重骨关节炎（OA）患者的选择，这些患者的症状对保守治疗无反应。不幸的是，患者的不满意程度很高，高达 25%。不满意的原因是多方面的，但骨-植入物不匹配显著增加了疼痛和功能受限的机会。已经开发了针对特定性别的假体设计来克服这个问题，但它们的使用仍然存在争议。本研究的主要目的是评估骨关节炎患者股骨远端形状的可能性别差异。次要目标是研究股骨远端的人际可变性，并确定需要多少个股骨植入物尺寸来满足形状变化。
一项前瞻性的横断面观察性研究根据性别（201 名女性/93 名男性）比较了 293 名骨关节炎患者的 294 个膝关节。在股骨远端进行了 6 次术中测量（外侧和内侧髁的高度和宽度、股骨的总内外宽度以及髁间距离）。通过多元线性回归分析性别差异和人际可变性。还将测量值与患者身高进行了相关性分析。使用优化分析来估计所需的股骨植入物尺寸数量。股骨远端存在显著的性别差异，男性在所有测量值上均高于女性。发现了很大的人际可变性。外侧髁的高度与患者身高相关，但相关性不强。需要 25 个股骨植入物尺寸才能满足我们样本中的形状变化。
骨关节炎患者股骨远端的形状存在很大的人际可变性，男性的数值明显高于女性。总共需要 25 种不同的植入物尺寸才能充分满足我们研究人群中观察到的变化。
