J Knee Surg 2022; 35(04): 355-361
DOI: 10.1055/s-0040-1715101
Original Article

Anthropometric Comparison between Indian and Arabian Knees with Respect to Total Knee Replacement

Vijayamohan Sreedharan Nair
1   Department of Aster Orthtopedics and Rheumatology, Aster Medcity, Kochi, Kerela, India
Niranj Ganeshan Radhamony
2   Department of Aster Orthopaedics, Astermedcity, Kochi, Kerela, India
Arjun Padmalayam
2   Department of Aster Orthopaedics, Astermedcity, Kochi, Kerela, India
Nijith O. Govindan
3   Division of Arthroplasty, Department of Aster Orthopaedics, Aster Medcity, Kochi, Kerela, India
› Author Affiliations


Implants used for total knee replacement (TKR) in most Asian countries are not designed originally for the Asian population, and studies have shown anthropometric differences with respect to TKR among various ethnic groups. For this reason, implants designed for a specific population may not provide an anatomic fit when used in other populations. To avoid the consequences associated with such a misfit, the concept of ethnic-specific implant design is being introduced. In this study, the knee anthropometry of the Indian and Arabian patients was compared. They were operated with implants which were not ethnic-specific designs. Since the consequences associated with implant misfit apply equally to both the Indian and Arabian population, it is essential to compare the knee anthropometry of these two populations. Anthropometric measurements of the distal femur and proximal tibia of the Indian and Arabian knees were obtained intraoperatively using a Vernier caliper. Their respective aspect ratios (ARs) were calculated and statistically compared. It was found that the ARs of both tibia and femur of Indian and Arabian population did not show any statistical difference. There was no statistical difference between Indian and Arabian males (p = 0.345) and between Indian and Arabian females (p = 0.8210). However, a statistical difference in tibial AR (p-value = 0.049) and femoral AR (p-value = 0.003) was found significant when a comparison was made between the knees of Indian males and Indian females in the study. The above results suggested that TKR implants designed anatomically to suit the Indian population can also suit the Arabian population and vice versa. The obtained data can help implant designers to come up with ethnic-specific TKR implants.

Publication History

Received: 21 November 2019

Accepted: 25 June 2020

Article published online:
24 August 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Cheng C-K, Lung C-Y, Lee Y-M, Huang C-H. A new approach of designing the tibial baseplate of total knee prostheses. Clin Biomech (Bristol, Avon) 1999; 14 (02) 112-117
  • 2 Mahoney OM, Kinsey T. Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Joint Surg Am 2010; 92 (05) 1115-1121
  • 3 Ranawat CS. The patellofemoral joint in total condylar knee arthroplasty. Pros and cons based on five- to ten-year follow-up observations. Clin Orthop Relat Res 1986; (205) 93-99
  • 4 Dennis DA. Evaluation of painful total knee arthroplasty. J Arthroplasty 2004; 19 (04, Suppl 1): 35-40
  • 5 Culp RW, Schmidt RG, Hanks G, Mak A, Esterhai Jr JL, Heppenstall RB. Supracondylar fracture of the femur following prosthetic knee arthroplasty. Clin Orthop Relat Res 1987; (222) 212-222
  • 6 Yue B, Varadarajan KM, Ai S, Tang T, Rubash HE, Li G. Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty 2011; 26 (01) 124-130
  • 7 Ha CW, Na SE. The correctness of fit of current total knee prostheses compared with intra-operative anthropometric measurements in Korean knees. J Bone Joint Surg Br 2012; 94 (05) 638-641
  • 8 Jain JP. Knee prosthesis sizes in Indian patients undergoing total knee replacement. Int Surg J 2016; 2 (03) 348-351
  • 9 Vaidya SV, Ranawat CS, Aroojis A, Laud NS. Anthropometric measurements to design total knee prostheses for the Indian population. J Arthroplasty 2000; 15 (01) 79-85
  • 10 Cheng FB, Ji XF, Lai Y. et al. Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee 2009; 16 (05) 341-347
  • 11 Ho W-P, Cheng C-K, Liau J-J. Morphometrical measurements of resected surface of femurs in Chinese knees: correlation to the sizing of current femoral implants. Knee 2006; 13 (01) 12-14
  • 12 Urabe K, Miura H, Kuwano T. et al. Comparison between the shape of resected femoral sections and femoral prostheses used in total knee arthroplasty in Japanese patients: simulation using three-dimensional computed tomography. J Knee Surg 2003; 16 (01) 27-33
  • 13 Yip DK, Zhu YH, Chiu KY, Ng TP. Distal rotational alignment of the Chinese femur and its relevance in total knee arthroplasty. J Arthroplasty 2004; 19 (05) 613-619
  • 14 Tria Jr AJ. Minimally invasive total knee arthroplasty: the importance of instrumentation. Orthop Clin North Am 2004; 35 (02) 227-234
  • 15 Kim H-A, Kim S, Seo YI. et al. The epidemiology of total knee replacement in South Korea: national registry data. Rheumatology (Oxford) 2008; 47 (01) 88-91
  • 16 Scuderi GR, Tenholder M, Capeci C. Surgical approaches in mini-incision total knee arthroplasty. Clin Orthop Relat Res 2004; (428) 61-67
  • 17 Hafez MA, Sheikhedrees SM, Saweeres ES. Anthropometry of Arabian arthritic knees: comparison to other ethnic groups and implant dimensions. J Arthroplasty 2016; 31 (05) 1109-1116
  • 18 Uehara K, Kadoya Y, Kobayashi A, Ohashi H, Yamano Y. Anthropometry of the proximal tibia to design a total knee prosthesis for the Japanese population. J Arthroplasty 2002; 17 (08) 1028-1032
  • 19 Bloebaum RD, Bachus KN, Mitchell W, Hoffman G, Hofmann AA. Analysis of the bone surface area in resected tibia. Implications in tibial component subsidence and fixation. Clin Orthop Relat Res 1994; (309) 2-10
  • 20 Howell SM, Kuznik K, Hull ML, Siston RA. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 2008; 31 (09) 857-863
  • 21 Thienpont E, Paternostre F, Pietsch M, Hafez M, Howell S. Total knee arthroplasty with patient-specific instruments improves function and restores limb alignment in patients with extra-articular deformity. Knee 2013; 20 (06) 407-411
  • 22 Surendran S, Kwak DS, Lee UY. et al. Anthropometry of the medial tibial condyle to design the tibial component for unicondylar knee arthroplasty for the Korean population. Knee Surg Sports Traumatol Arthrosc 2007; 15 (04) 436-442
  • 23 Elias T. East Syrian missions to Asia with special reference to Malabar coast from sixth century to sixteenth century AD and its influence on Indian religion, society and culture. Accessed March 18, 2004 at: https://shodhganga.inflibnet.ac.in/handle/10603/6356?mode=full
  • 24 Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE. Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res 1996; (331) 35-46
  • 25 Lonner JH, Jasko JG, Thomas BS. Anthropomorphic differences between the distal femora of men and women. Clin Orthop Relat Res 2008; 466 (11) 2724-2729
  • 26 Chin KR, Dalury DF, Zurakowski D, Scott RD. Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty. J Knee Surg 2002; 15 (04) 213-217
  • 27 UNICEF Egypt. Children in Egypt: a statistical digest. Accessed June, 2015 at: https://www.unicef.org/eg_UNICEF-2015-Children-in-Egypt-Statistical-Digest(3).pdf
  • 28 Lim H-C, Bae J-H, Yoon J-Y, Kim S-J, Kim J-G, Lee J-M. Gender differences of the morphology of the distal femur and proximal tibia in a Korean population. Knee 2013; 20 (01) 26-30
  • 29 Hovinga KR, Lerner AL. Anatomic variations between Japanese and Caucasian populations in the healthy young adult knee joint. J Orthop Res 2009; 27 (09) 1191-1196
  • 30 Hussain F, Abdul Kadir MR, Zulkifly AH. et al. Anthropometric measurements of the human distal femur: a study of the adult Malay population. BioMed Res Int 2013; 2013: 175056