Efficacy of Extramedullary Femoral Component Alignment Guide System for Blood Saving after Total Knee Arthroplasty

Jeon, Soung Hoo; Kim, Ji Hun; Lee, Jung Myung; Seo, Eunseok

doi:10.5792/ksrr.2012.24.2.99

Cited by 19 publications

(17 citation statements)

References 24 publications

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“…An extramedullary femoral guide is used in total knee arthroplasty (TKA) systems. Many studies have compared the extramedullary femoral guide system with the conventional intramedullary guide system in TKA [20][21][22][23]. An extramedullary instrumentation system is also available in UKA.…”

Section: Introductionmentioning

confidence: 99%

A novel extramedullary technique to guide femoral bone preparation in mobile unicompartmental knee arthroplasty based on tibial cut and overall alignment

et al. 2020

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Background: The mobile Oxford unicompartmental knee arthroplasty (UKA) implant has been widely used with an intramedullary guide for femoral preparation. We modified the femoral guide technique based on the tibial cut first and spacer block technique. This study was performed to determine the radiographic accuracy and early clinical outcomes of the extramedullary method. Methods: We retrospectively evaluated 50 consecutive patients who underwent UKA using the extramedullary technique. An equal number of patients who underwent UKA with the conventional technique were matched as the control group. Clinical outcomes were evaluated in terms of the operating time, blood loss, range of motion, and Hospital for Special Surgery score. Radiographic accuracy was evaluated by the implant position and alignment in the coronal and sagittal planes. Results: The mean follow-up period was 39.76 ± 5.77 months. There were no differences in the postoperative Hospital for Special Surgery score, range of motion, or hip-knee-ankle angle between the two groups. The operating time in the extramedullary group was shorter than that in the conventional group (54.78 ± 7.95 vs. 59.14 ± 10.91 min, respectively; p = 0.025). The drop in hemoglobin after 3 days was only 12.34 ± 4.98 g/L in the extramedullary group which was less than that in the conventional group (p = 0.001). No significant differences were found in the postoperative coronal and sagittal angles between the two groups. Acceptable radiographic accuracy of the implant alignment and position was achieved in 92% of patients in the extramedullary group and 96% of patients in the conventional group. Conclusions: The radiographic and clinical results of the extramedullary technique were comparable with those of the conventional technique with the advantage of no intramedullary interruption, less blood loss, a shorter operating time, and more rapid recovery. As the technique depends on the accurate tibial cut and overall alignment, we do not recommend it to surgeons without high volume experiences. Trial registration: Retrospectively registered

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Section: Introductionmentioning

confidence: 99%

A novel extramedullary technique to guide femoral bone preparation in mobile unicompartmental knee arthroplasty based on tibial cut and overall alignment

et al. 2020

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“…Jung et al 24 recently developed an EM alignment technique that uses a newly designed mechanical axis marker system and is at least as accurate as the standard IM technique. Furthermore, EM guide systems have several advantages compared with the IM guide system, including reducing the volume of blood drained during surgery and, therefore, lowering the rate of allogeneic transfusions, 11 as well as being more adaptable to extra-articular deformities. 25 Recently, we reported on a newly developed femoral EM guide system, providing evidence of good results for the coronal and sagittal alignments of the femoral component.…”

Section: Discussionmentioning

confidence: 99%

“…However, as the EM guide system is less invasive than the IM system, there has been extensive research to advance EM systems over the past decade. 11 In our previous study, we developed a newly EM femoral alignment guide, providing the reliable component alignment and at least as accurate as the standard IM technique. 12 Recently, a portable, accelerometer-based navigation (PN) device for TKA was introduced, the KneeAlign 2 (OrthAlign Inc.).…”

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confidence: 99%

Comparative Study for Alignment of Extramedullary Guides versus Portable, Accelerometer-Based Navigation in Total Knee Arthroplasty

Matsumoto

Ogawa

Fukuta³

et al. 2017

J Knee Surg

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The use of portable, accelerometer-based navigation (PN) devices for positioning of the components of total knee arthroplasty (TKA) is emerging as an alternative to standard extramedullary (EM) systems, which was needed to the image intensifier. The aim of our study was to compare the accuracy of component positioning in TKA using an EM and PN systems. Data from 100 consecutive primary TKAs, performed by multiple surgeons in 87 patients between October 2010 and June 2015, were analyzed. Coronal and sagittal plane alignments of the TKA components, relative to the mechanical axis of the limb, were evaluated by radiography. The mean postoperative coronal alignment angle of the femoral (α) and tibial (β) components was comparable between the groups (α: PN, 89.9 ± 2.2 degrees; EM, 89.9 ± 1.6 degrees and β: PN, 90.1 ± 1.4 degrees; EM, 89.6 ± 1.3 degrees). Groups were also comparable with regard to mean postoperative sagittal alignment angle of the femoral and tibial components (γ: PN, 2.3 ± 3.3 degrees; EM, 1.8 ± 1.7 degrees and σ: PN, 89.7 ± 2.5 degrees; EM, 90.1 ± 1.3 degrees). The incidence rate of a component malalignment > 3 degrees in the coronal and sagittal planes of the mechanical axis of the knee was comparable between the groups. In conclusion, the coronal and sagittal alignments for the femoral components was less accurate compared with tibial component alignment, especially in the PN group, and the sagittal alignment of the femoral component was less accurate than coronal alignment for both groups. Both the PN and EM systems provide satisfactory coronal and sagittal component alignments in TKA. Further technical improvement of the PN system could further improve its application for accurate component implantation in TKAs.

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“…Many authors recommend blood transfusion in case of hemoglobin level below 8–10 g/dL. 18 19) Tavares Cardozo et al 20) recommended blood transfusions in patients with hemoglobin less than 9 g/dL. Rosencher et al 21) reported that blood transfusion triggered after orthopedic surgery were hemoglobin levels of 8.93 ± 1.83 g/dL in Europe and 21% of these occurred when the hemoglobin level was greater than 10 g/dL.…”

Section: Discussionmentioning

confidence: 99%

Is Intraoperative Use of QuikClot Combat Gauze Effective for Hemostasis after Total Knee Arthroplasty?

et al. 2017

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BackgroundTo assess the hemostatic effect of QuikClot Combat Gauze (QCG) compared to that of standard gauze during cruciate-retaining total knee arthroplasty (TKA).MethodsSixty knees underwent TKA using a pneumatic tourniquet in this prospective randomized study. After implantation of the femoral and tibial components and hardening of the bone cement, the tourniquet was deflated and QCG (group 1) or standard gauze (group 2) was packed into the joint cavity for 5 minutes for hemostasis. Perioperative bleeding volume and blood transfusion volume were compared between two groups.ResultsThe mean intraoperative bleeding volume was 64.7 ± 12.7 mL in group 1 and 63.9 ± 9.2 mL in group 2 (p = 0.808). The mean postoperative blood drainage was 349.0 ± 170.6 mL in group 1 and 270.1 ± 136.3 mL in group 2 (p = 0.057). The average postoperative blood transfusion volume was 323.7 ± 325.9 mL in group 1 and 403.6 ± 274.8 mL in group 2 (p = 0.314).ConclusionsQCG was not significantly effective for reducing perioperative bleeding volume or the blood transfusion rate compared with standard gauze during TKA.

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Efficacy of Extramedullary Femoral Component Alignment Guide System for Blood Saving after Total Knee Arthroplasty

Cited by 19 publications

References 24 publications

A novel extramedullary technique to guide femoral bone preparation in mobile unicompartmental knee arthroplasty based on tibial cut and overall alignment

A novel extramedullary technique to guide femoral bone preparation in mobile unicompartmental knee arthroplasty based on tibial cut and overall alignment

Comparative Study for Alignment of Extramedullary Guides versus Portable, Accelerometer-Based Navigation in Total Knee Arthroplasty

Is Intraoperative Use of QuikClot Combat Gauze Effective for Hemostasis after Total Knee Arthroplasty?

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