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

Reed, M; Bliss, W.; Sher, J. L.; Emmerson, Kevin; Jones, Steven M.; Partington, Paul

doi:10.1302/0301-620x.84b6.0840858

Cited by 34 publications

(23 citation statements)

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“…Reed et al concluded that the use of intramedullary jigs is superior to extramedullary jigs. 11 Dennis et al emphasized that extramedullary guides should be distally positioned over the centre of the talus, 3 mm medial to the midpoint of the ankle rather than right at the midpoint to avoid varus tibial resection. With this technique, 88% of tibial components were aligned within 90 ± 2°.…”

Section: Discussionmentioning

confidence: 99%

Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

Dhanasekararaja

George

Hussain

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: Tibial bowing in valgus knees with arthritis can lead to component malplacement during total knee arthroplasty (TKA). Incidence of valgus knees with medial tibial bowing, its effect on tibial component placement during primary TKA and methods to improve accuracy of the component placement were studied. Methods: Full-length weight-bearing alignment radiograph was taken in 117 patients (149 knees) with valgus deformity undergoing TKA. In these cases, the proximal tibial reference for extramedullary jig placement was planned preoperatively with reference to the tibial spines and classified as four zones. Results: The mean preoperative hip–knee–ankle (HKA) angle was 192.9° (180.3–234.5°). Bowing >3° was considered significant ( p < 0.001) and at this level of bowing, the proximal tibial reference was shifted from centre to medial. Tibial bowing <3° was considered straight and >3° as tibia valga. Tibia was bowed in 70 knees (46.97%). Severity of valgus deformity had strong positive correlation with the tibia valga ( p < 0.001). The post-operative medial proximal tibial angle (MPTA) and HKA angle were 91.63° (87.9–95.7°) and 182.6° (178.1–189.7°), respectively. The mean MPTA and post-operative HKA angle in bowed and straight tibiae were 90.35° versus 89.78° ( p = 0.547) and 181.5° versus 180.7° ( p = 0.5716), respectively, and the difference was not statistically significant. Conclusion: Medial tibial bowing is very common in valgus knees. Tibia valga has a strong positive correlation with the severity of valgus deformity. Accurate tibial component placement can be achieved with a medialized reference point for extramedullary tibial cutting jig in knees with significant tibia valga. The study has been registered in clinical trials registry – India (CTRI/2018/03/012283).

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Section: Discussionmentioning

confidence: 99%

Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

Dhanasekararaja

George

Hussain

et al. 2019

J Orthop Surg (Hong Kong)

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“…The theoretical advantages and disadvantages of both intramedullary and extramedullary methods are well documented in the literature [5]. The intramedullary method cannot be accurately used in patients who have a history of skeletal trauma and subsequent deformity, neither can the intramedullary method be reliably used in those with retained metal work or used on those with significant natural bowing of the tibia.…”

Section: Discussionmentioning

confidence: 99%

Tibial Alignment in Total Knee Replacement Surgery, Intramedullary Alignment Versus Extramedullary Alignment a Blinded Single Surgeon Study

Nahas¹,

Nwachuku²,

Khan³

et al. 2010

TOBONEJ

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Background:The clinical success of total knee arthroplasty is positively correlated with good component orientation. Controversy remains as to what is the best tibial alignment technique, this study compares the intramedullary versus the extramedullary surgical alignment guidance methods. Material and Methods:A retrospective study was done on 100 patients during the time period 2007 to 2010. The knee replacements were performed by the same surgeon, 49 procedures were performed via the intramedullary technique and 51 procedures were via the extramedullary technique. The tibiofemoral angle was measured pre-operatively as well as post operatively, the tibial alignment angle was measured post operatively also, the results were then statistically analysed. Results and Conclusion:There was no significant difference between both groups regarding the tibial alignment angles. Both techniques proved accurate in producing an acceptable post operative tibial component alignment angle. We advocate the surgeon may use his/her discretion when deciding upon the method of tibial alignment.

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“…Among surgical techniques, both intra-(IM) and extramedullary (EM) tibial guides have been used to provide the desired lower extremity alignment. However, there are still controversies over the outcome of TKA using either technique to provide a neutral alignment (1,9). Some studies have preferred one for providing a more accurate tibial alignment (9)(10)(11), while the others found no signi cant difference between either technique (1,(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Intra- vs. Extramedullary Tibial Guides on the Alignment of Lower Extremity and Functional Outcomes following Total Knee Arthroplasty: A Randomized Clinical Trial

Razzaghof¹,

Mortazavi²,

Moharrami³

et al. 2021

Preprint

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Background: Total knee arthroplasty (TKA) has been known as a definitive treatment of advanced knee osteoarthritis. Both intra- (IM) and extramedullary (EM) tibial guides have been used to restore the desired extremity alignment. However, controversy exists regarding the superiority of either technique. We aimed to compare their functional outcomes and accuracy in providing neutral alignment after TKA. Methods: In a randomized, double-blinded clinical trial, we studied 98 patients undergoing primary TKA in two groups of IM and EM. We measured the medial proximal tibial angle (MPTA), varus angle (VA), and joint-line convergence angle with normal ranges of 90°±3°, 0-2°, and 0±3°, respectively, on a three-joint alignment view after three months. We also assessed functional outcomes at the last follow-up. Finally, we compared these outcomes between groups. Results: Eighty-four patients (IM=42, EM=42) were included in the final analysis (16 males, 68 females; mean age: 63.9±8.6 years; mean follow-up: 27±2.9 months). The mean postoperative alignment angles showed no significant difference, although MPTA outliers were significantly more frequent in the EM group (26.2% vs. 9.5% in IM, P=0.04). None of the functional outcomes showed a significant difference between groups. However, the mean ROM increase was significantly higher in VAs within ±3° of normal than those outside it (30.8 vs. 27.4, respectively; P=0.039). Conclusions: We conclude that both techniques were not different in terms of the mean alignment angles and functional outcomes. However, fewer MPTA outliers can be seen with IM. A postoperative mechanical axis within ±3° of neutral can result in a more ROM increase after one year. Trial registration: IRCT, IRCT20160809029286N5. Registered 21 April 2020, https://www.irct.ir/trial/46976

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

Cited by 34 publications

References 0 publications

Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?

Tibial Alignment in Total Knee Replacement Surgery, Intramedullary Alignment Versus Extramedullary Alignment a Blinded Single Surgeon Study

The Effect of Intra- vs. Extramedullary Tibial Guides on the Alignment of Lower Extremity and Functional Outcomes following Total Knee Arthroplasty: A Randomized Clinical Trial

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