Asymmetric Implant Design for Posterolateral Overhang of the Femoral Component in Total Knee Arthroplasty: A Retrospective Computed Tomography-Based Study.

ABSTRACT

Introduction During total knee arthroplasty (TKA), also referred to as total knee replacement (TKR), patients may experience pain in the posterolateral knee. One possible cause is the impingement between the popliteus tendon and the femoral components. The purpose of this study was to analyze the posterolateral overhang of the femoral component using 3D template software. Methods Preoperative CT scan images of 50 knees (11 males and 39 females) with osteoarthritis of grade 2 or lower according to the Kellgren-Lawrence classification were analyzed. The mean age of the subjects was 73.8±7.6 years (range 52-84 years). The Athena (Soft Cube Co., Ltd., Osaka, Japan) knee 3D image-matching software was used for the analysis. The positions of the two femoral components (symmetrical and asymmetrical) were simulated. In the coronal plane, the component overhang was measured between the resected lateral part of the posterior femur and its corresponding component size, and the two designs were compared in three zones (proximal, central, and distal). Results In the simulated femoral component, the asymmetric design had a significantly lower component overhang than the symmetric design in the proximal zone of the lateral posterior condyle (0.2±1.9 mm vs. 3.5±1.6 mm, p<0.01). In the proximal zone, significant overhang (>3 mm) was observed in 30 knees (60.0%) with the symmetric design, but only three knees (6.0%) had asymmetric designs (p<0.01). Conclusions The posterolateral overhang of the lateral posterior condyle occurs when a symmetrical prosthesis is used. The use of an asymmetric implant with a small, rounded proximal portion of the lateral posterior condyle improves this overhang and is expected to decrease problems such as impingement of the popliteus tendon and improve patient satisfaction.