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Considerable inter-individual variability of tibial geometric ratios renders bone–implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this systematic review and meta-analysis was to investigate the variability in tibial geometric ratios among knees of different sexes and races to determine whether commercially-available tibial baseplates accommodate the morphologic diversity. The hypothesis was that anthropometric studies report considerable variability of tibial geometric ratios among sexes and races.

Methods

This systematic review and meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on 28 January 2021 for clinical studies reporting on tibial geometric ratios. Tibial geometric ratios, as reported by the clinical studies, were represented by plotting their means and two standard deviations for comparison to two symmetric and two asymmetric commercially-available tibial baseplates.

Results

A total of 27 articles that reported on a combined total of 20,944 knees were eligible for data extraction. Variation in tibial aspect ratios was equal among sexes. The greatest variation in aspect ratio was observed among East Asians, followed by Caucasians, African-Americans, Indian and Middle Easterns. The variation in tibial asymmetry ratio was larger among men compared to women. The greatest variation in asymmetry ratio was observed among African-Americans, followed by Caucasians, East Asians, Indian and Middle Easterns. Bone-implant mismatch of > 3 mm overhang or > 4 mm under-coverage with four commercially-available tibial baseplates occurred in large proportions of knees due to variations in aspect ratio (in 17–100% of knees) and asymmetry ratio (in 7–100% of knees).

Conclusion

Anthropometric studies reported considerable inter-individual variability of tibial geometric ratios, which exceeded effects of sexual dimorphism and racial diversity. Bone–implant mismatch may be unavoidable in a large proportion of knees, when considering that a surgeon generally only uses one or a few TKA brands. These findings support the drive towards patient-specific implants to potentially achieve accurate bone–implant fit by implant customisation.

Level of evidence

IV.

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Funding

The authors are grateful to "GCS Ramsay Santé pour l’Enseignement et la Recherche" for funding the statistical analysis and manuscript preparation for this study.

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Authors and Affiliations

  1. Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France

    Lucas Beckers, Jeremy Daxhelet, Salvatore Ratano, Tarik Aït-Si-Selmi & Michel P. Bonnin

  2. ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland

    Jacobus H. Müller & Mo Saffarini

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  1. Lucas Beckers
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  2. Jacobus H. Müller
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  3. Jeremy Daxhelet
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  4. Salvatore Ratano
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Correspondence to Mo Saffarini.

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This study is a systematic review and meta-analysis of previously published clinicl studies. As such, ethical approval is not required, considering that the authors did not collect or analyse patient data.

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Beckers, L., Müller, J.H., Daxhelet, J. et al. Considerable inter-individual variability of tibial geometric ratios renders bone–implant mismatch unavoidable using off-the-shelf total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 31, 1284–1298 (2023). https://doi.org/10.1007/s00167-021-06623-7

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  • DOI: https://doi.org/10.1007/s00167-021-06623-7

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