Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment

Abstract

We undertook a prospective, randomised study of 135 total knee arthroplasties to determine the most accurate and reliable technique for alignment of the tibial prosthesis. Tibial resection was guided by either intramedullary or extramedullary alignment jigs. Of the 135 knees, standardised postoperative radiographs suitable for assessment were available in 100. Correct tibial alignment was found in 85% of the intramedullary group compared with 65% of the extramedullary group (p = 0.019). We conclude that intramedullary guides are superior to extramedullary instruments for alignment of the tibial prosthesis.

Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty

“…Implants have their unique ideal slope angles depending on whether the posterior cruciate ligament should be substituted and on other specific mechanical properties. However, no consensus has been reached regarding the reference axis for the posterior tibial slope by researchers or manufacturers [24]. We considered that the sagittal mechanical axis of the limb might be an ideal reference.…”

“…Even though according to our results, TAA is the closest to the MA its use as a practical guideline is limited. This is because surgeons cannot identify the TAA during TKA and intramedullary guides cannot reproduce this axis exactly [24,30,31], and therefore, ATC or FSA should be substituted for MA. The present study demonstrates that tibial slope angles with respect to mechanical axis and other anatomical axes are significantly correlated, which is in accordance with a previous study [32].…”

Proximal tibial resection in varus-deformed tibiae during total knee arthroplasty: an in vitro study using sawbone model

“…However, accuracy of tibial component alignment was acceptable in varus-deformed knees when the lateral intercondylar eminence was used as a reference for tibial osteotomy. In addition, a lower incidence of outliers could be reached compared with other studies [12,14,28]. Our proposal that recommends lateral intercondylar eminence as a proximal reference for the tibial cut would provide valuable insight to obtain proper tibial component alignment in varus knee, although any prolonged clinical benefits will require long-term in vivo study.…”

“…It appeared that there were no significant differences between methods in achieving acceptable tibial bone cuts, although direct comparisons between previous reports should be made with caution [9][10][11][12][13][14]. Oswald et al [15] analysed radiographs of 44 postmortem tibial specimens from normal donors.…”

Computer-assisted alignment system for tibial component placement in total knee replacement: a radiological study

“…Nowadays intramedullary guides are identified as the gold standard for the positioning of the femoral components, but opinions are divided as to which alignment guide is really superior in positioning the tibial component [11,15]. One study was in favour of a totally intramedullary technique even though this could increase the risk of venous embolism [16].…”