Background: Studies have shown that there are striking variations in knee morphology between Asian and Western
population. However, most of the existing total knee arthroplasty (TKA) implants are designed to suit the anatomy of
Western population. Our study investigated anthropometry of Indian arthritic knees and compared them to international
ethnic groups. Methods: Computed tomography was used to create 3D knee models and obtain anthropometric data of
distal femur and proximal tibia of Indian arthritic knees. Femoral measurements included mediolateral length, medial
and lateral anteroposterior length, medial and lateral condylar width and aspect ratio. Tibial measurements included
mediolateral length, medial, lateral and central anteroposterior length and aspect ratio. A preoperative virtual implantation
using Western TKA implants was carried out to visualize anatomical conformity. Results: Statistical analysis results
showed that Indian males had significantly larger femoral and tibial mediolateral and anteroposterior width than
Indian females; however, femoral and tibial aspect ratio was similar for both. In case of females, significant difference
was observed between medial and lateral condylar widths. When compared to knee anthropometry of other ethnic
groups, femoral and tibial aspect ratio of Indian knees was found to be similar to the Asian population and different from
the Western population. The virtual implantation showed overhang of the femoral component in both lateral and medial
regions. Conclusion: Morphological mismatch between Western and Indian knees established the fact that Western implants
have drawbacks when implanted in Indian patients. The study also provided a basis for designing gender-specific
TKA implants for the Indian population.