Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
College of Medicine, Pusan National University, 179 Gudeok-ro, Seo-gu, Busan, 602-739, Korea.
Arch Orthop Trauma Surg. 2024 Nov;144(11):4995-5004. doi: 10.1007/s00402-024-05593-y. Epub 2024 Sep 29.
We aimed to investigate the anatomical and clinical advantages of an Asian-specific femoral component design with a high femoral aspect ratio, compared with the conventional femoral component design.
A retrospective analysis of the operation and outpatient clinic records of 239 knees operated on using an anatomically modified femoral component design (MFCD, Group A) and 153 knees operated on using a conventional femoral component design (CFCD, Group B) in Korean patients was performed. Three subgroups were created based on the mediolateral size of the two different femoral component designs. The geometric accommodation of each femoral component was assessed using intraoperatively measured femoral posterior condylar resection and posterior condylar trimming amounts. Clinical outcomes were assessed using a range of motion (ROM) and patient-reported outcome measurements.
In the comparison between Groups A and B, the mean combined bilateral posterior condylar trimming (XPCT) was 2.91 [2SD: - 4.12-9.94] and 1.45 [2SD: - 5.89-8.80], and the median XPCT was 3 and 1.5. In the largest subgroup (subgroup 2), Groups A and B included 100 and 112 patients, all six posterior condylar resection and trimming parameters were significantly larger in Group A. Preoperative and postoperative ROM and Hospital for Special Surgery scores were similar between the two groups. Preoperative Western Ontario and McMaster Universities Arthritis Index (WOMAC) was higher in Group A. However, postoperative WOMAC was similar between the groups. Perioperative improvement in WOMAC index was significantly greater in Group B.
The Asian-specific femoral component design resulted in more resection and trimming of the femoral posterior condyle than the conventional design despite it was not associated with different clinical outcomes. Surgeons should be aware of unexpected excessive posterior condylar resection and formation of large flexion gap when using femoral component design with high femoral aspect ratio.
本研究旨在探讨亚洲人特有的高股骨面比解剖型股骨假体设计与传统股骨假体设计相比的解剖和临床优势。
回顾性分析韩国患者 239 例（A 组）和 153 例（B 组）接受解剖型股骨假体（MFCD）和传统股骨假体（CFCD）手术的病历和门诊记录。根据两种不同股骨假体设计的内外侧尺寸将患者分为 3 个亚组。术中测量股骨后髁切除和后髁修整量来评估每个股骨假体的几何适应性。通过测量活动范围（ROM）和患者报告的结果测量来评估临床结果。
A 组和 B 组的双侧后髁联合修整量（XPCT）平均值分别为 2.91 [2SD：-4.12-9.94] 和 1.45 [2SD：-5.89-8.80]，中位数分别为 3 和 1.5。在最大的亚组（亚组 2）中，A 组和 B 组分别有 100 例和 112 例患者，A 组所有 6 项后髁切除和修整参数均明显大于 B 组。两组患者术前和术后 ROM 及 HSS 评分相似。A 组术前 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）评分较高，但术后两组 WOMAC 评分相似。B 组 WOMAC 指数的术后改善程度明显大于 A 组。
尽管亚洲人特有的股骨假体设计与传统设计相比并未导致不同的临床结果，但它会导致股骨后髁更多的切除和修整。使用高股骨面比的股骨假体设计时，外科医生应注意避免出现意外的过度后髁切除和形成较大的屈曲间隙。
