Extramedullary Versus Intramedullary Tibial Cutting Guides in Megaprosthetic Total Knee Replacement

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2012 Oct 4

PMID 23031403

Citations 9

Authors

Vikas Karade

B Ravi

Manish Agarwal

Affiliations

Soon will be listed here.

Abstract

Background: In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements.

Methods: A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software.

Results: There was more varus placement in coronal plane with extramedullary cutting guide (-1.18 +/- 2.4 degrees) than the intramedullary guide (-0.34 +/- 2.31 degrees) but this did not reach statistical significance. The goal of 90 +/- 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/- 2.4 degrees) than intramedullary guide (0.50 +/- 3.80 degrees) for tibial component alignment, though 78% of patients were aligned within the goal of 0-5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups.

Conclusions: Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.

Citing Articles

A Study of Surgical Accuracy with X-Ray-Based Patient-Specific Instrument (X3DPSI) vs Conventional Instrument in Total Knee Arthroplasty Surgeries.

Shetty V, Shekhar S, Karade V, Maurya A, Sankar M, Wagh Y Indian J Orthop. 2022; 56(7):1240-1250.

PMID: 35813546 PMC: 9232679. DOI: 10.1007/s43465-022-00623-6.

Rethinking the Coronal Anatomic Axis of the Distal Tibia for Intramedullary Nail Placement: A Cadaveric Study.

Aneja A, Marquez-Lara A, Luo T, Teasdall R, Isla A, Albano A HSS J. 2022; 18(2):284-289.

PMID: 35645644 PMC: 9097000. DOI: 10.1177/15563316211008176.

Tibial alignment technique and its influence on clinical and functional outcomes following total knee arthroplasty.

Bansal M, Back D, Earnshaw P, Sandiford N J Clin Orthop Trauma. 2020; 11(Suppl 4):S534-S538.

PMID: 32774025 PMC: 7394794. DOI: 10.1016/j.jcot.2020.04.023.

World-Class Tumor Knee Prosthesis: Made in India.

Panda N, Krishnamurty B, Agarwal M, Ravi B Indian J Orthop. 2020; 54(2):130-140.

PMID: 32257029 PMC: 7096344. DOI: 10.1007/s43465-019-00033-1.

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.

References

Jeffcote B, Shakespeare D . Varus/valgus alignment of the tibial component in total knee arthroplasty. Knee. 2003; 10(3):243-7. DOI: 10.1016/s0968-0160(02)00101-1. View

Maestro A, Harwin S, Sandoval M, Vaquero D, Murcia A . Influence of intramedullary versus extramedullary alignment guides on final total knee arthroplasty component position: a radiographic analysis. J Arthroplasty. 1998; 13(5):552-8. DOI: 10.1016/s0883-5403(98)90055-9. View

Hewitt B, Shakespeare D . A straightforward method of assessing the accuracy of implantation of knee prostheses. Knee. 2001; 8(2):139-44. DOI: 10.1016/s0968-0160(00)00078-8. View

Reed M, Bliss W, Sher J, Emmerson K, Jones S, Partington P . Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment. J Bone Joint Surg Br. 2002; 84(6):858-60. DOI: 10.1302/0301-620x.84b6.12702. View

Cashman J, Carty F, Synnott K, Kenny P . Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee. J Orthop Surg Res. 2011; 6:44. PMC: 3179736. DOI: 10.1186/1749-799X-6-44. View

Chiu K, Yau W, Ng T, Tang W . The accuracy of extramedullary guides for tibial component placement in total knee arthroplasty. Int Orthop. 2007; 32(4):467-71. PMC: 2532261. DOI: 10.1007/s00264-007-0354-5. View

Lozano L, Segur J, Macule F, Nunez M, Torner P, Castillo F . Intramedullary versus extramedullary tibial cutting guide in severely obese patients undergoing total knee replacement: a randomized study of 70 patients with body mass index >35 kg/m2. Obes Surg. 2008; 18(12):1599-604. DOI: 10.1007/s11695-008-9564-1. View

Holme T, Henckel J, Cobb J, Hart A . Quantification of the difference between 3D CT and plain radiograph for measurement of the position of medial unicompartmental knee replacements. Knee. 2010; 18(5):300-5. DOI: 10.1016/j.knee.2010.07.010. View

Macdonald W, Styf J, Carlsson L, Jacobsson C . Improved tibial cutting accuracy in knee arthroplasty. Med Eng Phys. 2004; 26(9):807-12. DOI: 10.1016/j.medengphy.2004.06.006. View

10.

Rajadhyaksha A, Mehta H, Zelicof S . Use of tibialis anterior tendon as distal landmark for extramedullary tibial alignment in total knee arthroplasty: an anatomical study. Am J Orthop (Belle Mead NJ). 2009; 38(3):E68-70. View

11.

Yau W, Chiu K . Cutting errors in total knee replacement: assessment by computer assisted surgery. Knee Surg Sports Traumatol Arthrosc. 2008; 16(7):670-3. DOI: 10.1007/s00167-008-0550-x. View

12.

Yoo J, Chang C, Shin K, Seong S, Kim T . Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes. J Arthroplasty. 2008; 23(4):586-92. DOI: 10.1016/j.arth.2007.05.006. View

13.

Shakespeare D . Conventional instruments in total knee replacement: what should we do with them?. Knee. 2005; 13(1):1-6. DOI: 10.1016/j.knee.2005.06.002. View

14.

Schneider M, Heisel C, Aldinger P, Breusch S . Use of palpable tendons for extramedullary tibial alignment in total knee arthroplasty. J Arthroplasty. 2007; 22(2):219-26. DOI: 10.1016/j.arth.2006.04.023. View