MORPHOMETRIC STUDY OF UPPER END OF TIBIA IN GUJARAT REGION AND ITS CLINICAL IMPLICATION IN KNEE ARTHROPLASTY

Address for Correspondence: Dr. Shailesh M Patel, Professor and Head, Department of Anatomy, Govt. Medical College, Bhavnagar-364002, Gujarat, India. Mob. No.: +919426709012 E-Mail: dr_smpatel@yahoo.com Introduction: Upper end of tibia is the component of knee joint. Accurate morphometric anatomical data of the upper end of tibia and morphometric differences according to gender are very important to make design of total knee joint replacement prosthesis. Knee prosthesis made based on morphometric data of components of knee (femur and tibia) and according to gender difference will give better results after surgery in early mobility of patients as well as fewer post-operative complications. Aim: Present study was done to find out sexual dimorphism in upper end of tibia as well as differences in morphometric data of upper end of tibia between other populations across the world and within India. Materials and Methods: For the present study the material consisted of 120 dry tibia of known gender were used. Out of them 60 were of male tibia (30 of right side and 30 of left side) and 60 were of female tibia (30 of right side and 30 of left side). We have selected five metrical parameters 1. Bicondylar width (BCW), 2. Medial condylar antero-posterior distance of superior articular surface (MCAPD), 3. Lateral condylar antero-posterior distance of superior articular surface (LCAPD), 4. Medial condylar transverse distance of superior articular surface (MCTD) and 5. Lateral condylar transverse distance of superior articular surface (LCTD) for the present study based on which the tibial component of prosthesis for knee joint replacement surgery is made. Results: All five parameters which are chosen are found significantly larger in male than females. The findings are smaller than Caucasian population and population of North India and found larger than population of South India. Conclusion: Present study provides data of measurement of upper end of tibia by direct observation which will be useful to select correct sized knee prosthesis according to measurements. We have also provided data genderwise and on right and left side which will improve the longitivity of knee prosthesis, increased mobility of patient and improve the lifestyle after knee replacement surgery.


INTRODUCTION
As there is high incidence of obesity and worldwide the population is rapidly increasing towards old age, the incidences of osteoarthritis are increasing as well as need of partial as well as total knee replacement (TKR).Total knee replacement is very complex and accurate method considered beneficial for removing pain and improve the lifestyle of patients in severe case of osteoarthritis [2].So accurate morphometric anatomical data of the upper end of tibia and gender morphometric differences are very important in making the design of total knee joint replacement prosthesis.Mismatch between morphometric data and selected prosthesis for surgery may cause severe complications like cruciate ligament rupture, soft tissue misbalancing, less movements of knee joint after surgery and even prosthesis loosening [3][4][5].So knee prosthesis made according to morphometric data of femur and tibia i.e. components of knee joint and according to the gender will give excellent results in early mobility of patients as well as lesser complications after surgery [6,7].
The studies which are done are based on different ethnic groups [2,[7][8].The morphometric studies are done mostly by measurement by CT scans or magnetic resonance imaging techniques.[3,[9][10][11].There are very few data available in which the study is done over dry tibia by direct observation [12,13].We have done morphometric study of upper end of dry tibia and in known gender.The results will give basic data and exact measurements of upper end of tibia gender wise and for population of India especially the eastern part before the knee replacement surgeries.
Damaged and bones with arthritic changes were not considered for the study.The collected bones were assessed with sliding caliper (Martin type, 0-200 mm).

MATERIALS AND METHODS
For study the material consisted of 120 dry tibia of known gender were used.Out of them 60 were of male (30 of right side and 30 of left side) and 60 were of female (30 of right side and 30 of left side).Gender was assessed by the records available in Department of Anatomy, Government Medical College, Bhavnagar, Gujarat, India.All bones were on gross examination were fully ossified and had no evidence of fractures or congenital or pathological anomalies.ments are certainly beneficial over the indirect methods like CT scan and MRI and direct method will give the accurate morphometric data.
Because the direct method of measurement is accurate we can match these morphometric data to make knee prosthesis for knee joint replacement surgery with the resected surface of the knee that will improve long term success of prosthesis and lesser complications in and after total knee joint replacement.There are several studies done which are based on western population and also the prosthesis available in market is based on western Caucasian population [2,13] although the Indian population have smaller knees as compared to them.This study will provide data of upper end of tibia for Indian population and will influence in the clinical outcome to design improved knee prosthesis based on our Indian knee measurements.
There is significant difference in morphometric data of the upper end of tibia in various populations of countries across world as well as populations within India.(Table 2) The bicondylar width of tibia in male was 74.53±2.34mm and in female was 67.06±2.41mm which was significantly greater in male than females (p<0.05).The measurements are very high in Iranian, Caucasian, Chinese and Brazilian populations in male as well as females [2,[10][11][12].
The medial condylar anteroposterior distance of superior articular surface (MCAPD) in males was 44.43±2.06mm while in females it was 39.71±2.03mm which was significantly higher in male than female (p<0.001).The lateral condylar anteroposterior distance of superior articular surface (LCAPD) in males was 38.38±2.39mm while in females it was 35.50±2.37 mm which was significantly higher in male than female (p<0.001).These measurements were lower than Iranian [2], Chinese [4], Caucasian [4] , Brazilian [11] and North Indian [12] populations but higher than South Indian population [13].
The medial condylar transverse distance of superior articular surface (MCTD) in males was 28.32±3.88mm while in females it was 26.19±1.43mm which was significantly higher in male than female (p<0.01).The lateral condylar transverse distance of superior articular

DISCUSSION
In this study we have selected five morphometric parameters of upper end of dry tibia and data collected by using the sliding caliper by direct observation.Most of the morphometric studies are done with measurement by radiographs, CT scans or magnetic resonance imaging techniques which are indirect methods [2,[7][8][9][10][11].
There are certain studies which are done in past suggest that indirect method of measurement like CT scan and MRI are found inaccurate and not precise even though correction done by the projection methods as well as by the resolutions [14,15].So obviously direct method of measure-surface (LCTD) in males was 27.26±1.92mm while in females it was 28.87±1.37mm which was significantly higher in male than female (p<0.01).These measurements were again lower than Iranian [2], Chinese [4], Caucasian [4], Brazilian [11] and North Indian [12] populations but higher than South Indian population [13].

CONCLUSION
Present study provides morphometric data of upper end tibia by direct observation which will be useful to select correct prosthesis of suitable size according to measurements.We have also provided data gender-wise and on right and left sides which will improve the longitivity of prosthesis, will increase mobility of patients and improve lifestyle of patient after knee replacement surgery.Females will surely benefit from newly designed prosthesis which is gender specific.

International
Journal of Anatomy and Research, Int J Anat Res 2018, Vol 6(1.1):4871-75.ISSN 2321-4287 DOI: https://dx.doi.org/10.16965/ijar.2017.493Article Information Tibia is the second largest and longest bone in the body.The proximal end of the tibia is widely expanded, has two condyles -medial and lateral, and between condyles there is intercondy lar area.The condyles of tibia are articular and make joint superiorly with corresponding condyles of femur which is the femoro-tibial component of knee joint [1].Ankur Z Zalawadia, Shailesh M Patel.MORPHOMETRIC STUDY OF UPPER END OF TIBIA IN GUJARAT REGION AND ITS CLINICAL IMPLICATION IN KNEE ARTHROPLASTY.

Table 1 :
Measurements of upper end of the tibia in mm.
* The p-values are calculated for comparison across gendersTable 2: Comparison of studies of various authors on morphometric study of upper end of tibia (data in Mean±SD in mm).S. No. Author, year and method of study Country andRESULTSThe morphometric measurements of the lower end of the femur are summarized in Table1