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Aims. The morphometry of the distal femur was largely studied to improve
bone-implant fit in total knee arthroplasty (TKA), but little is
known about the asymmetry of the posterior condyles. This study
aimed to investigate the dimensions of the posterior condyles and
the influence of externally rotating the femoral component on potential prosthetic
overhang or under-coverage. Patients and Methods. We analysed the shape of 110 arthritic knees at the time of primary
TKA using pre-operative CT scans. The height and width of each condyle
were measured at the posterior femoral cut in neutral position,
and in 3º and 5º of external rotation, using both central and medial
referencing systems. We compared the morphological characteristics
with those of 14 TKA models. Results. In the neutral position, the dimensions of the condyles were
nearly equal. Externally rotating the femoral cut by 3º and 5º with
‘central referencing’ induced width asymmetry >
3 mm in 23 (21%)
and 33 (30%) knees respectively, while with ‘medial referencing’
it induced width asymmetry >
3 mm in 43 (39%) and 75 (68%) knees
respectively. The asymmetries induced by rotations were not associated
with gender, aetiology or varus-valgus alignment. Conclusion. External rotation may amplify the asymmetry between the medial
and lateral condyles, and exacerbate prosthetic overhang, particularly
in the superolateral zone. ‘Central referencing’ guides result in
less potential prosthetic overhang than ‘medial referencing’ guides. Cite this article: Bone Joint J 2017;99-B:894–903