title: Reduction in bone volume resection with a newer posterior stabilized total knee arthroplasty design.
abstract: BACKGROUND
  Posterior stabilized total knee arthroplasty requires an intercondylar notch to accommodate the cam housing that articulates with the tibial post to create femoral rollback required for deep flexion. The volume of bone resected for the intercondylar notch varies with implant design, and newer designs may accommodate high flexion with less bone resection.
  
  
  OBJECTIVE
  This study aims to analyze the bone volume and density resected from the intercondylar notch for three posterior stabilized implants from a single company: a Posterior Stabilized (PS) system, a Hi-Flex system (HF), and a rounded new box-reamer (RB) system and to further assess whether the newer RB with a cylindrical cutting tool would preserve more native bone.
  
  
  METHODS
  Using a computer model, the PS, HF, and RB femoral components were digitally implanted into CT scans of 19 cadaver femurs. Nine cadavers were fit with a size 4 implant, six with size 3, and four with a size 2. The volume of intercondylar bone resected digitally for femoral preparation was measured. Bone density was measured by CT scans in Hounsfield units (HU). A paired t test was used to compare the mean volume of bone resected for each implant.
  
  
  RESULTS
  For the size 4 femurs, the newer RB design removed 8% less intercondylar bone than the PS design (7,832 ± 501 vs. 8,547 ± 377 mm(3), p < 0.001) and 28% less bone than the HF design (7,832 ± 501 vs. 10,897 ± 444 mm(3), p < 0.001). The average HU for size 4 femurs for RB design was 427 ± 72 (PS = 399 ± 69, p < 0.001; HF = 379 ± 66, p < 0.001). For the size 3 femurs, the RB design removed 12% less intercondylar bone than the PS (6,664 ± 786 vs. 7,516 ± 648 mm(3), p < 0.001) and 27% less bone than the HF (6,664 ± 786 vs. 9,078 ± 713 mm(3), p < 0.001). HU for size 3 femurs for the RB design was 452 ± 70 (PS = 422 ± 53, p < 0.1; HF = 410 ± 59, p < 0.01). For the size 2 femurs, the RB design removed 5% less intercondylar bone than the PS (5,730 ± 552 vs. 6,009 ± 472 mm(3), p < 0.01) and 22% less bone than the HF (5,730 ± 552 vs. 7,380 ± 532 mm(3), p < 0.001). HU for size 2 femurs for the RB design was 430 ± 48 (PS = 408 ± 55, p < 0.01; HF = 385 ± 56, p < 0.01).
  
  
  CONCLUSIONS
  The newer RB design removes less bone from the intercondylar notch than the classic PS and HF designs in all sizes tested. The bone-conserving cuts incorporated into this newer implant design appear to preserve native bone without compromising design objectives.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Pugh
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Ruel
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipman
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wright
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Gessell
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Westrich
keywords: bone resection; posterior stabilized; total knee arthroplasty