title: The posterior condylar offset ratio and femoral anatomy in anterior versus posterior referencing total knee arthroplasty.
abstract: BACKGROUND
  The preservation of joint anatomy is one of the key issues in total knee arthroplasty. The effect of the prosthesis' referencing system, relative to femoral anatomy, remains unknown. It was sought to determine if femoral anatomy, following total knee arthroplasty is better maintained using either anterior referencing or posterior referencing prosthesis. The posterior condylar offset ratio (PCOR) was employed for preoperative and postoperative radiographic comparison of femoral condyles. It was hypothesized that posterior referencing prosthesis would better restore condylar morphology.
  
  
  METHODS
  Sixty-six patients undergoing a total knee arthroplasty with anterior referenced Zimmer(®) NexGen(®) LPS prosthesis and ninety-one with posterior referenced Tornier(®) HLS Noetos(®) were divided into two groups according to the prosthetic model used and retrospectively compared. PCOR was calculated as the quotient of the distance between the posterior condylar border and the tangent to the posterior cortex of the femoral diaphysis, and the distance between the posterior condylar border and the tangent to the anterior cortex of the femoral diaphysis. PCOR was determined preoperatively and postoperatively and compared within each group and between both groups.
  
  
  RESULTS
  An increase in the PCOR (P<0.0001) following surgery was observed in both anterior referencing and posterior referencing models. No difference was noted when the postoperative PCOR was compared between both groups (P=0.61).
  
  
  CONCLUSIONS
  Both anterior and posterior referencing prosthesis lead to a similar increase of the PCOR following total knee arthroplasty.
  
  
  METHODS
  Level IV.
authors.affiliation: Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal. Electronic address: mim08025@icbas.up.pt.
authors.forename: P H
authors.initials: PH
authors.lastname: Almeida
authors.affiliation: Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Vilaça
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods*; D018483:Diaphyses / Q000601:surgery; D005260:Female; D005269:Femur / Q000033:anatomy & histology* / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
keywords: Anterior referencing; Femoral anatomy; Posterior condylar offset ratio; Posterior referencing; Total knee arthroplasty