Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty

Engh, Gerard A.; Petersen, T.

doi:10.1016/s0883-5403(06)80002-1

Cited by 115 publications

(57 citation statements)

References 9 publications

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“…Outliers for the tibial and femoral component in this study for both PSPG (10%, 22%) and MI (7%, 18%) were lower than those in a meta-analysis for MI (20%, 34%) but higher than those using CAN (5%, 10%) [54]. The mean postoperative FAA-FMA angles for both PSPG and MI fell within the 5°to 7°range typically assumed for TKA performed using intramedullary guides and without preoperative LLRs [22,25]. Further studies are necessary to examine the effect of compensatory or compounding effects of individual component malalignment on the overall lower limb alignment and on implant function.…”

Section: Discussionmentioning

confidence: 44%

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

DeClaire

Berend

et al. 2012

Clinical Orthopaedics &Amp; Related Research

285

243

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Background Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA. Questions/purposes We compared the effectiveness of patient-specific positioning guides to manual instrumentation with intramedullary femoral and extramedullary tibial guides in restoring the mechanical axis of the extremity and achieving neutral coronal alignment of the femoral and tibial components. Methods We retrospectively reviewed 569 TKAs performed with patient-specific positioning guides and 155 with manual instrumentation by two surgeons using postoperative long-leg radiographs. For all patients, we assessed the zone in which the overall mechanical axis passed through the knee, and for one surgeon's cases (105 patient-specific positioning guide, 55 manual instrumentation), we also measured the hip-knee-ankle angle and the individual component angles with respect to their mechanical axes. Results The overall mechanical axis passed through the central third of the knee more often with patient-specific positioning guides (88%) than with manual instrumentation (78%). The overall mean hip-knee-ankle angle for patient-specific positioning guides (180.6°) was similar to manual instrumentation (181.1°), but there were fewer ± 3°hip-knee-ankle angle outliers with patient-specific positioning guides (9%) than with manual instrumentation (22%). The overall mean tibial (89.9°versus 90.4°) and femoral (90.7°versus 91.3°) component angles were closer to neutral with patient-specific positioning guides than with manual instrumentation, but the

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Section: Discussionmentioning

confidence: 44%

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

DeClaire

Berend

et al. 2012

Clinical Orthopaedics &Amp; Related Research

285

243

View full text Add to dashboard Cite

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“…This may have been attributable to the limited surgical exposure. Although there are adequate data to corroborate the importance of accurate femoral component alignment in the coronal plane [9,31,32,38], we are not aware of equally strong evidence concerning sagittal orientation of the femoral component. We found prolonged tourniquet and operating times for MIS TKAs, which is in agreement with other publications [11,24,25,27,37].…”

Section: Discussionmentioning

confidence: 79%

Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?

Liebensteiner

Krismer

Koller³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Less invasive dissection of the extensor apparatus, one of the aspects of minimally invasive surgical (MIS) TKA, might result in less reduction of postoperative quadriceps strength. However, it is unclear whether MIS is associated with less strength reduction. Questions/purposes We asked whether knee strength (extensor or flexor torque) would be greater in patients having a MIS TKA compared with patients having a standard TKA and whether knee scores, alignment, ROM, tourniquet and operating times, and hospital length of stay were improved. Methods We prospectively recruited 52 patients awaiting MIS or standard TKA, matched for age, weight, height, BMI, sex, and surgically treated side, but not randomized. Isokinetic tests were performed preoperatively and postoperatively to obtain peak values of extensor and flexor torque. Postoperative-to-preoperative ratios and the extensor-flexor torque ratio also were calculated. Results Mean baseline extensor torques were 57 Nm and 53 Nm for MIS and standard TKAs, respectively. At 8 weeks postoperatively, absolute values of the mean postoperative knee extensor torque also were similar: 47 and 45 Nm for patients with MIS and standard TKAs, respectively. The postoperative-to-preoperative ratios were 0.8 for extensor and flexor torque in both groups. The extensor-flexor torque ratios were similar between groups. Conclusions Our data suggest a less invasive dissection of the extensor apparatus involved in MIS TKA does not enhance postoperative quadriceps strength. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…In the cases presented in this study, instrumentation of the medullary canal of the femur would have been extremely difficult, if not impossible, because of the presence of angular deformities, IM sclerosis, long-stemmed hip implants, or hardware within the femoral canal. The use of conventional methods for such patients would have required short intramedullary or extramedullary alignment guides on the femur, as well as one-step or staged corrective osteotomy [13], potentially leading to a less predictable clinical and radiographic outcome [6].…”

Section: Discussionmentioning

confidence: 99%

“…Despite a number of studies [6,7] which have suggested that there is an improved alignment when this technology is used, a great debate still exists. Some surgeons have not reported these advantages [8,9] whereas others have found difficulties in demonstrating improvement in clinical results when CAS is used [10].…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted surgery as indication of choice: total knee arthroplasty in case of retained hardware or extra-articular deformity

Tigani

Masetti²,

Sabbioni

et al. 2012

International Orthopaedics (SICOT)

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Purpose The use of traditional cutting guides during knee arthroplasty in some cases could be extremely difficult, if not impossible, because of angular deformities, IM sclerosis, long-stemmed hip implants, or hardware within the femoral canal that cannot be removed. In these difficult cases navigation-assisted knee arthroplasty should be considered as an effective and appealing option. Methods We present 14 cases in which ideal mechanical and prosthetic alignment was achieved with different image-free, computer-assisted navigation systems, because of an extra-articular deformity (group A, nine patients) or because of a retained implant or hardware (group B, five patients).Results After a mean follow-up of 28 months (range 12-53 months), the average knee score increased overall from a mean of 33 points (range 12-63) to 78 points (range 63-90). The average functional score improved from a mean of 32 points (range 10-65) to 72 points (range 40-90). The postoperative mechanical axis ranged between 3°of varus and 3°of valgus. There was an implant revision in one patient who had a traumatic rupture of medial collateral ligament, which occurred 27 months after the index procedure.Conclusions Based on our results we think that the navigationassisted technique provides an alternative approach to the traditional instrumentation for treating these difficult patients in an effective and less invasive manner.

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Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty

Cited by 115 publications

References 9 publications

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?

Computer-assisted surgery as indication of choice: total knee arthroplasty in case of retained hardware or extra-articular deformity

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