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Laser method for intraoperative evaluation of lower extremity alignment: comparison of a novel technique to CT and a conventional method



Accurate restoration of mechanical alignment is an important factor in reconstructive surgery of the lower extremity. Conventional intraoperative methods, such as using an electrocautery cable, provide only a momentary evaluation of alignment. In this study, we evaluated a novel technique using a laser emitter, which projected the mechanical axis of the lower extremity, providing continuous intraoperative information on alignment.

Materials and methods

Alignment of 16 cadaver lower extremities was measured using the electrocautery cable method, the laser method, and CT scan as the standard measurement. The mechanical axis was defined by a line from the center of the femoral head to the center of the ankle. For simplifying measurements the intersection with the tibial plateau was divided into percentages from the medial border (0 %) to the lateral border (100 %). For using the laser method a laser emitting and laser catching device was developed, which is positioned and centered on the femoral head and the ankle using an image intensifier. By catching the laser on the knee region the actual mechanical axis is marked.


The data demonstrated good correlation of the laser method when compared to the cable method (P = 0.44). Comparison of the average mechanical axis between cable method and CT (P = 0.819) and laser method and CT (P = 0.647) did not show a statistically significant difference. Average radiation time in comparison between cable method and laser method showed a statistically significant difference (P = 0.013), with the laser method requiring more radiation time.


Determination of the mechanical axis during surgery remains a difficult clinical problem. Restoration of alignment is an important prognostic factor for surgical outcome. Based on these data, the laser method represents a simple, yet effective tool for continuous intraoperative evaluation of lower extremity alignment.

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Conflict of interest

Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical standard

The ethical committee of the Hannover Medical School approved the study (1952-2013).

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Corresponding author

Correspondence to Nael Hawi.

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Hawi, N., Yarboro, S., Suero, E.M. et al. Laser method for intraoperative evaluation of lower extremity alignment: comparison of a novel technique to CT and a conventional method. Arch Orthop Trauma Surg 134, 645–650 (2014).

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  • Mechanical axis
  • Lower limb alignment
  • Laser method
  • Cable method