Sagittal shapes of current fixed-bearing unicompartmental knee replacements differ from those of normal knees

The principle when performing unicompartmental knee replacements (UKR), is to restore the natural alignment as well as the ligament tension. The tension in the ligaments is determined by the position of the joint line and the geometry of the articulating surfaces of the joint. If the surface geometry of the femoral component in a UKR is different from that of the natural knee it might cause abnormal ligament tension. This study was undertaken to determine the surface geometry of the native knee and to compare that with the geometry of different commercially available UKR femoral components.

Thirty-six native femurs and seven different UKR femoral component designs were included in this study. The sagittal shapes of the native femoral condyles and the prostheses were quantitatively described with the radius ratio (RR) and transition position index (TPI), which were calculated from the radii and transition point of the extension and flexion facets.

The different prostheses showed a wider shape variability than the native medial condyles, having at least two times greater coefficient of variation for the RR and TPI. The sagittal shape of three prostheses corresponded to the native medial femoral condyles whereas five prostheses corresponded to the lateral condyles. One prosthesis had curves that fell far outside the native knee shape.

There was a wider sagittal shape difference between the femoral components compared to the native knees. Clinically, the sagittal position of the prostheses can compensate for these differences, but it might be technically challenging.