An Alternative Method to Create Extramedullary References in Total Knee Arthroplasty

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2011 Sep 16

PMID 21918883

Citations 7

Authors

Jai-Gon Seo

Young-Wan Moon

Sang-Hoon Park

Jae-Woo Shim

Sang-Min Kim

Affiliations

Soon will be listed here.

Abstract

Purpose: Historically, extramedullary techniques have focused on finding the femoral head center and referred mainly to the anterosuperior iliac spine (the FHC method) in total knee arthroplasty (TKA). The purpose of this study was to evaluate a new extramedullary alignment system that uses neutral overall limb mechanical alignment as an extramedullary reference (the MA method).

Methods: A retrospective review of 1018 TKAs (508 FHC group, 510 MA group) was performed to compare the radiographic results obtained using these two methods. There were 75 male patients and 577 female patients with varus osteoarthritis of the knee. Limb and prosthesis alignments in the coronal plane were investigated at 2 months after surgery.

Results: The accuracies of postoperative alignments of implanted prostheses were better in the MA group than in the FHC group, as assessed by (1) overall limb alignment (MA group, varus 1.4° ± 2.7°; FHC group, varus 2.2° ± 2.9°), and (2) femoral component coronal alignment (MA group, 89.4° ± 2.3°; FHC group, 88.0° ± 2.7°). Overall limb alignment was within 0° ± 5° of the mechanical axis in 96.1% of the MA group and in 86.6% of the FHC group. Mean femoral component medial angle was within 0° ± 5° in 98.4% of the MA group and in 92.5% of the FHC group.

Conclusion: The accuracies of the postoperative radiographic alignments of implanted prostheses were found to be improved when the mechanical axis of the overall lower limb was used as an extramedullary reference. This new reference system would help to achieve correct limb and prostheses alignments during TKA.

Level Of Evidence: III.

Citing Articles

Extramedullary femoral alignment system in total knee arthroplasty: Accuracy in relation of severity and different types of varus.

Aquili A, Cane P, Fravisini M, Farinelli L, Procaccini R, Gigante A J Orthop. 2021; 24:86-90.

PMID: 33679033 PMC: 7910404. DOI: 10.1016/j.jor.2021.02.007.

The usefulness of planning using a preoperative lateral leg image to determine accurate posterior tibial slope in total knee arthroplasty.

Tomite T, Saito H, Kijima H, Saito K, Tazawa H, Ishikawa N J Orthop. 2019; 16(1):25-30.

PMID: 30765930 PMC: 6355658. DOI: 10.1016/j.jor.2018.11.005.

Extramedullary versus intramedullary femoral alignment technique in total knee arthroplasty: a meta-analysis of randomized controlled trials.

Tang Q, Shang P, Zheng G, Xu H, Liu H J Orthop Surg Res. 2017; 12(1):82.

PMID: 28583144 PMC: 5460512. DOI: 10.1186/s13018-017-0582-3.

Using fibula as a reference can be beneficial for the tibial component alignment after total knee arthroplasty, a retrospective study.

Erdem M, Gulabi D, Cecen G, Avci C, Asci M, Saglam F Knee Surg Sports Traumatol Arthrosc. 2014; 23(7):2068-73.

PMID: 24664186 DOI: 10.1007/s00167-014-2957-x.

Intra- and post-operative accuracy assessments of two different patient-specific instrumentation systems for total knee replacement.

Ensini A, Timoncini A, Cenni F, Belvedere C, Fusai F, Leardini A Knee Surg Sports Traumatol Arthrosc. 2013; 22(3):621-9.

PMID: 24061719 DOI: 10.1007/s00167-013-2667-9.

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