The preferred technique for femoral implant sizing in primary total knee arthroplasty (TKA) is debatable. Sizing is based on the anterior femoral cortex or posterior condylar reference. Anterior referencing has lower risk of femoral notch fracture but the disadvantages are; Excess condylar bone removal with potential for flexion gap laxity, too little bone removal with potential for patellofemoral gap tightness. Posterior referencing has lower risk of flexion gap errors but disadvantages are; Excess trochlear bone removal creating a relevant notch, Too little condylar bone removal with potential for flexion gap tightness.

Using a single knee system, the study by Sachin R. Tapasvi et al compared anterior referencing (AR) versus posterior referencing (PR) in patients undergoing simultaneous bilateral TKA, where one reference technique was randomized to each knee. The study has been published in ‘Indian Journal of Orthopaedics’.

This prospective study compared the two sizing references using one posterior stabilized knee system. The study included 81 subjects with osteoarthritis and similar varus deformity in both knees. All subjects underwent identical surgical procedures, aside from the selected femoral sizing reference. Subjects were followed for at least 2 years.

The key findings of the study were:

• The two sizing techniques did not significantly diff er in all measured radiographic, operative, and clinical parameters.

• The mean posterior condylar off set ratios were similar.

• Two-year mean knee flexion and Revised Oxford Knee Scores showed no difference.

• Eighty-four percent of patients stated no preference for either technique.

The authors concluded – “Knees sized with anterior referencing had similar functional outcomes to those sized with posterior referencing. Using a current knee system with multiple sizing options, there is no discernable difference in all measured study parameters. Either reference is acceptable.”

Level of Evidence 2 (Randomized cohort study).

For further details on the article refer to:

Comparing Anterior Versus Posterior Size Referencing in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty: One Technique Per Knee Sachin R. Tapasvi et al Indian Journal of Orthopaedics (2026) 60:696–703 https://doi.org/10.1007/s43465-026-01690-9

Tags:    
Article Source : Indian Journal of Orthopaedics

Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.

NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.

Dr Supreeth D R

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Comments Policy
Our comments section is governed by our Comments Policy . By posting comments at Medical Dialogues you automatically agree with our Comments Policy , Terms And Conditions and Privacy Policy .