title: A lateralized anterior flange improves femoral component bone coverage in current total knee prostheses.
abstract: BACKGROUND
  Poor femoral implant fit to resected bone surfaces recently has been the motivation for several new total knee arthroplasty implant designs. Implant overhang risks adverse soft-tissue interaction while uncovered cut bone surfaces (underhang) risks increased postoperative bleeding or development of heterotopic bone.
  
  
  METHODS
  Femoral implant fit was studied systematically, and without the influence of surgical variation, by virtually implanting standard and narrow width femoral components (Bi-Surface 5) using preoperative computed tomography data for 150 varus osteoarthritic knees in Japanese patients. Overhang and underhang rates and bone widths were determined by gender.
  
  
  RESULTS
  Narrow femoral components helped avoid or minimize overhang in most female and some male knees. Although anterior width in the narrow components closely matched female bone width, the femoral component was necessarily displaced laterally to avoid overhang in the anteromedial portion. Consequently, there was significant medial underhang in the distal and posterior zones.
  
  
  CONCLUSIONS
  Ideally, the anterior femoral flange should be shifted 2 to 2.5mm laterally relative to the distal and posterior aspects to provide optimal femoral bone coverage in this prosthesis. The current study also confirmed that this modification can be generalized to the other two currently available "narrow type" prostheses. This geometric modification might allow surgeons to select a femoral component with slightly wider mediolateral dimensions in the distal and posterior aspects to minimize underhang, while eliminating anterior overhang.
  
  
  METHODS
  III.
authors: Department of Mechanical and Aerospace Engineering, University of Florida, 318 MAE-A, 116250, Gainesville, FL 32611, USA; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Electronic address: kawahara@ortho.med.kyushu-u.ac.jp.
authors: Shinya
authors: S
authors: Kawahara
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors: Ken
authors: K
authors: Okazaki
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors: Shigetoshi
authors: S
authors: Okamoto
authors: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors: Yukihide
authors: Y
authors: Iwamoto
authors: Department of Mechanical and Aerospace Engineering, University of Florida, 318 MAE-A, 116250, Gainesville, FL 32611, USA.
authors: Scott A
authors: SA
authors: Banks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D044466:Asian People; D005260:Female; D005269:Femur / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D020370:Osteoarthritis, Knee / Q000208:ethnology / Q000601:surgery*; D011474:Prosthesis Design
keywords: Femoral component; Gender; Overhang; Total knee arthroplasty (TKA); Underhang