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. 2025 Nov 21;60(4):s00451812025.
doi: 10.1055/s-0045-1812025. eCollection 2025 Aug.

Anthropometric Analysis of Brazilian and Imported Total Knee Arthroplasty Implants in the Brazilian Population

Márcio de Castro Ferreira  1   2 , Carlos Eduardo da Siveira Franciozi  1   2 , Luiz Felipe Morlin Ambra  1 , Enzo Salviato Mameri  1 , Marcelo Seiji Kubota  1 , Marcus Vinícius Malheiros Luzo  1
Affiliations

Anthropometric Analysis of Brazilian and Imported Total Knee Arthroplasty Implants in the Brazilian Population

Márcio de Castro Ferreira et al. Rev Bras Ortop (Sao Paulo). .

Abstract
in English, Portuguese

Objective: To evaluate the anatomical conformity of 25 total knee arthroplasty (TKA) implants to the knee morphology of the Brazilian female and male population.

Methods: We analyzed 500 magnetic resonance imaging (MRI) scans of knees from 250 women and 250 men. We collected data on anteroposterior (AP) and mediolateral (ML) measurements of femurs, tibias, and implants to assess their morphological correspondence.

Results: The mean AP versus ML divergence between joint morphologies and the implants was as follows: 4.48 mm for female femurs; 4.89 mm for male femurs; 3.63 mm for female tibias; and 6.11 mm for male tibias. The implants with the best AP versus ML adaptation were: Medacta Sphere for female femurs; Stryker Triathlon for male femurs; Smith & Nephew Legion for female tibias; and Zimmer Persona for male tibias. When comparing the best femoral and tibial implant ratios for female subjects, the United Orthopedic U2 presented the best statistical score, followed by the Aesculap Columbus and Smith &Nephew Legion implants. For male patients, the implants with the highest scores were the Zimmer Persona, the Microport Advance, and the Smith & Nephew Legion. The worst ratios were found in the Peter Brehm BPK-S for female individuals and the Orthovasive Indus for male subjects.

Conclusion: The implants studied presented satisfactory results for bone coverage of the knees of Brazilian subjects of both genders undergoing TKA. However, we also found differences higher than 10 mm in most implants. This finding highlights that surgeons must carefully plan the TKA during implant selection. Imported implants proved to be more customizable than Brazilian ones in this population.

Objetivo: Avaliar a conformidade anatômica de 25 implantes de artroplastia total de joelho (ATJ) à morfologia de joelhos na população brasileira feminina e masculina.

Métodos: Foram analisados 500 exames de ressonância de joelhos de 250 mulheres e 250 homens. As medidas anteroposterior (AP) e mediolateral (ML) dos fêmures, tíbias, e implantes foram tomadas a fim de obter correspondência morfológica.

Resultados: As divergências médias das medidas AP e ML entre as morfologias articulares e os implantes analisados foram as seguintes: fêmures femininos 4,48 mm; fêmures masculinos 4,89 mm; tíbia feminina 3,63 mm; e tíbia masculina 6,11 mm. Os implantes com melhor adaptação AP versus ML foram: Medacta Sphere para o fêmur feminino; Stryker Triathlon para fêmur o masculino; Smith & Nephew Legion para tíbia feminina; e Zimmer Persona para a tíbia masculina. Na comparação da melhor relação de implantes femorais e tibiais para o sexo feminino, observou-se que o United Orthopedic U2 apresentou a melhor pontuação estatística, seguido dos implantes Aesculap Columbus e Smith & Nephew Legion. Para os homens, o melhor escore foi encontrado no Zimmer Persona, Microport Advance e Smith & Nephew Legion. A pior relação feminina foi com o Peter Brehm BPK-S, e a masculina, com o Orthovasive Indus.

Conclusão: Os implantes estudados foram satisfatórios para a cobertura óssea articular dos joelhos de brasileiros de ambos os sexos submetidos à ATJ. No entanto, também foram encontrados resultados com diferenças maiores do que 10 mm na maioria dos implantes. Isso ressalta a necessidade de atenção dos cirurgiões para realizar um bom planejamento para a escolha dos implantes. Demonstrou-se que os implantes importados eram mais customizáveis do que os nacionais na população brasileira.

Keywords: arthroplasty, replacement; joint disease; knee joint.

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Conflict of interest statement

Conflict of Interests The authors declare conflicts of interests regarding the orthopedic device manufacturers Smith & Nephew, Baumer, Johnson & Johnson, and Zimmer.

Figures

Fig. 1
Fig. 1
Anteroposterior (AP) measurement ( A ) per the most anterior and posterior articular prominence of the lateral femoral condyle and bicortical mediolateral (ML) distance ( B ) 9 mm from the femoral posterior articular surface at the level of the epicondylar axial cut. AP measurement ( C ) according to the most anterior and posterior articular prominence of the tibial plateau and ML distance ( D ) at the largest bicortical axis of the tibial articular surface at the level of the axial section of the posterior cruciate ligament (PCL) attachment. AP and ML measurements ( E ) from femoral and tibial arthroplasty implants.
Fig. 2
Fig. 2
Mediolateral (ML) versus anterolateral (AP) regression lines of femoral measurements in men and Baumer, NG, PAR, Ortosintese, MetaBio, and Rotaflex implants.
Fig. 3
Fig. 3
Mediolateral (ML) versus anterolateral (AP) regression lines of femoral measurements in women and the Baumer, NG, PAR, Ortosintese, MetaBio, and Rotaflex implants.
Fig. 4
Fig. 4
Fig. 4 Mediolateral (ML) versus anterolateral (AP) regression lines of femoral measurements in men and the Attune, Sphere, Legion, Triathlon, and Persona implants.
Fig. 5
Fig. 5
Mediolateral (ML) versus anterolateral (AP) regression lines of femoral measurements in women and the Attune, Sphere, Legion, Triathlon, and Persona implants.
Fig. 6
Fig. 6
Mediolateral (ML) versus anterolateral (AP) regression lines of tibial measurements in men and the Baumer, NG, PAR, Ortosintese, MetaBio, and Rotaflex implants.
Fig. 7
Fig. 7
Mediolateral (ML) versus anterolateral (AP) regression lines of tibial measurements in women and the Baumer, NG, PAR, Ortosintese, MetaBio, and Rotaflex implants.
Fig. 8
Fig. 8
Mediolateral (ML) versus anterolateral (AP) regression lines of tibial measurements in men and the Attune, Sphere, Legion, Triathlon, and Persona implants.
Fig. 9
Fig. 9
Mediolateral (ML) versus anterolateral (AP) regression lines of tibial measurements in women and the Attune, Sphere, Legion, Triathlon, and Persona implants.
See this image and copyright information in PMC

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