Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Special Considerations for TKA in Asian Patients 14 articles


What Are the Causes of Revision Total Knee Arthroplasty in Japan?

Yasuhiko Kasahara MD, PhD, Tokifumi Majima MD, PhD, Shoichi Kimura MD, PhD, Osamu Nishiike MD, Jun Uchida MD, PhD

There is limited information regarding the cause of revision TKA in Asia, especially Japan. Owing to differences in patient backgrounds and lifestyles, the modes of TKA failures in Asia may differ from those in Western countries.

Tibia Vara Affects the Aspect Ratio of Tibial Resected Surface in Female Japanese Patients Undergoing TKA

Shigeshi Mori MD, Masao Akagi MD, PhD, Shigeki Asada MD, Tetsunao Matsushita MD, Kazuhiko Hashimoto MD

Tibia vara seen in Japanese patients reportedly influences the tibial component alignment when performing TKA. However, it is unclear whether tibia vara affects the component position and size selection.

Comparative Demographics, ROM, and Function After TKA in Chinese, Malays, and Indians

Wei Ming Siow MBBS, MRCS, Pak Lin Chin MBBS, FRCS, Shi Lu Chia MBBS, FRCS, Ngai Nung Lo MBBS, MRCS, Seng Jin Yeo MBBS, FRCS

There is marked racial disparity in TKA use rates, demographics, and outcomes between white and Afro-Caribbean Americans. Comparative studies of ethnicity in patients undergoing TKAs have been mostly in American populations with an underrepresentation of Asian groups. It is unclear whether these disparities exist in Chinese, Malays, and Indians.

Surgical Technique: Computer-assisted Sliding Medial Condylar Osteotomy to Achieve Gap Balance in Varus Knees During TKA

Arun B. Mullaji FRCS Ed, MCh Orth, MS Orth, Gautam M. Shetty MS Orth

Extensive posteromedial release to correct severe varus deformity during TKA may result in mediolateral or flexion instability and may require a constrained implant. We describe a technique combining computer navigation and medial condylar osteotomy in severe varus deformity to achieve a primary goal of ligament balance during TKA.

The Incidence of Pulmonary Embolism and Deep Vein Thrombosis After Knee Arthroplasty in Asians Remains Low: A Meta-analysis

Woo-Suk Lee MD, PhD, Kang-Il Kim MD, PhD, Han-Jun Lee MD, PhD, Hee-Soo Kyung MD, PhD, Seung-Suk Seo MD, PhD

While Western literature has mostly reported the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after TKA with chemoprophylaxis, the Asian literature still has mostly reported the incidence without chemoprophylaxis. This may reflect a low incidence of DVT and PE in Asian patients, although some recent studies suggest the incidence after TKA in Asian patients is increasing. Moreover, it is unclear whether the incidence of DVT and PE after TKA is similarly low among different Asian countries.

Development and Validation of a New Evaluation System for Patients With a Floor-based Lifestyle: The Korean Knee Score

Jin Goo Kim MD, PhD, Jeong Ku Ha MD, Seung Beom Han MD, PhD, Tae Kyun Kim MD, PhD, Myung Chul Lee MD, PhD

Patients’ perspectives on functioning and health have been increasingly recognized as a crucial aspect of health care, leading to the use of patient-reported instruments for outcome assessment. However, available instruments for total knee arthroplasty do not reflect the floor-based lifestyle with high knee flexion of eastern Asia.

Distal Femur Rotation Relates to Joint Obliquity in ACL-deficient Chinese


The lower limb osteometry of Chinese differs from that of whites. The joint line of the knee in the coronal plane in Chinese is more medially inclined and the posterior condylar angle of the distal femur in the axial plane is larger. However, it is unclear whether there is any direct association between the coronal plane and axial plane osteometry.

High-flexion Prosthesis Improves Function of TKA in Asian Patients Without Decreasing Early Survivorship

Bum-Sik Lee MD, Jong-Won Chung MD, Jong-Min Kim MD, Kyung-Ah Kim PhD, Seong-Il Bin MD

Two previous studies recently raised the possibility of a high risk of early femoral components loosening with high-flexion (HF) prostheses in Asian populations and suggested that the high failure rate of HF TKAs was associated with HF ability. However, these findings are controversial given other studies reporting a low incidence of aseptic failures in HF prostheses.

Painful Patellar Clunk or Crepitation of Contemporary Knee Prostheses

Won Chul Choi MD, PhD, Keun-Jung Ryu MD, Sahnghoon Lee MD, PhD, Sang Cheol Seong MD, PhD, Myung Chul Lee MD, PhD

Painful patellar clunk or crepitation (PCC) is a resurgent complication of contemporary posterior-stabilized TKA. The incidence, time to presentation, causes, and treatment of PCC still remain controversial.

No Better Flexion or Function of High-flexion Designs in Asian Patients With TKA

Jong-Keun Seon MD, Ji-Hyeon Yim MD, Hyoung-Yeon Seo MD, Eun-Kyoo Song MD

Recently, high-flexion PCL-retaining (CR) and -substituting (PS) knee prostheses were designed to allow greater and safer flexion after TKA. However, the advantages of high-flexion TKA over standard design have been debated in terms of early maximal flexion. A recent study reported a high incidence of early loosening of the femoral component related to the deep flexion provided by high-flexion PS TKA.

Brief Followup Report: Does High-flexion Total Knee Arthroplasty Allow Deep Flexion Safely in Asian Patients?

Hyuk-Soo Han MD, PhD, Seung-Baik Kang MD, PhD

The long-term survivorship of TKA in Asian countries is comparable to that in Western countries. High-flexion TKA designs were introduced to improve flexion after TKA. However, several studies suggest high-flexion designs are at greater risk of femoral component loosening compared with conventional TKA designs. We previously reported a revision rate of 21% at 11 to 45 months; this report is intended as a followup to that study.

Trends in Use of Total Knee Arthroplasty in Korea From 2001 to 2010

In Jun Koh MD, Tae Kyun Kim MD, Chong Bum Chang MD, Hyung Joon Cho MD, Yong In MD

The use of total knee arthroplasty (TKA) has increased substantially in most Western countries. However, the trends in TKA use and changes in demographic characteristics of patients having TKA in Korea remain unclear.

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Marco Paolo G. Lasam MD, Kil Jae Lee MD, Chong Bum Chang MD, PhD, Yeon Gwi Kang MS, Tae Kyun Kim MD, PhD

Coronal alignment is considered key to the function and longevity of a TKA. However, most studies do not consider femoral and tibial anatomical features such as lateral femoral bowing and the effects of these features and subsequent alignment on function after TKA are unclear.