title: Patient - implant dimension mismatch in total knee arthroplasty: Is it worth worrying? An Indian scenario.
abstract: BACKGROUND
  The correct sizing of the components in both anteroposterior and mediolateral (ML) dimensions is crucial for the success of a total knee arthroplasty (TKA). The size of the implants selected is based on the intraoperative measurements. The currently used TKA implants available to us are based on morphometric measurements obtained from a Western/Caucasian population. Hence, the risk of component ML mismatch is more common in Asian sub-population, as they are of a smaller built and stature. This study aims to look into the following aspects agnitude of the ML mismatch between the femoral component and the patient's anatomical dimension, evaluation of gender variations in distal femur dimensions, and gender-wise and implant-wise correlation of ML mismatch.
  
  
  METHODS
  Intraoperatively, the distal femoral dimensions were measured using sterile calipers after removing the osteophytes and compared with the ML dimension of the implant used. ML mismatch length thus obtained is correlated with the various parameters.
  
  
  RESULTS
  Males showed larger distal femoral dimensions when compared to females. Males had larger ML mismatch. None of the implants used perfectly matched the patient's anatomical dimensions. Patients with larger mismatch had lower scorings at 2 years postoperative followup.
  
  
  CONCLUSIONS
  Implant manufacturers need to design more options of femoral implants for a better fit in our subset of patients. The exact magnitude of mismatch which can cause functional implications need to be made out. The mismatch being one of the important factors for the success of the surgery, we should focus more on this aspect.
authors.affiliation: Division of Arthroplasty and Sports Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Jai
authors.initials: J
authors.lastname: Thilak
authors.affiliation: Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Melvin J
authors.initials: MJ
authors.lastname: George
keywords: Distal femoral dimensions; Orthopaedic equipment; arthroplasty; femoral component; gender specific knee; knee; mediolateral mismatch; osteoarthritis; replacement; total knee arthroplasty