Abstract
Introduction
We aimed to assess the accuracy of a new extramedullary guide system for achieving appropriate femoral component alignment in total knee arthroplasty (TKA) and to determine whether it differed between patients operated on by different surgeons.
Materials and methods
We performed 100 consecutive primary TKAs in 100 patients using a newly developed extramedullary guide, the “S guide”; 50 were performed by author KM at A Hospital, and 50 by author NM at B Hospital. All patients received the Vanguard RP mobile-bearing prosthesis (Biomet Japan, Tokyo, Japan). We assessed the coronal and sagittal alignment of the femoral component with the mechanical axis using plane radiographs. Data were analyzed statistically using Prism 5.0 software, and a p value of <0.05 was regarded as indicating significance.
Results
The mean postoperative coronal alignment angle of the femoral component (α) was 0.1° ± 1.4°, with no significant differences between A Hospital and B Hospital (p = 0.67), and 98 % of patients had an α deviating by less than 3° from the mechanical axis. The mean postoperative sagittal alignment angle of the femoral component (γ) was 1.7° ± 1.7°, with no significant differences between the groups (p = 0.61), and 86 % of patients had a γ deviating by less than 3° from the mechanical axis.
Conclusions
This study shows that the S-guide is reliable for use in TKA.
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References
Laskin RS (2001) The Genesis total knee prosthesis: a 10-year followup study. Clin Orthop Relat Res 388:95–102
Rodriguez JA, Bhende H, Ranawat CS (2001) Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res 388:10–17
Scott WN, Rubinstein M, Scuderi G (1988) Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg Am 70:1163–1173
Volz RG (1986) Basic update #2. Biomechanics: lever arm, instant center of motion, moment force, joint reactive force. Orthop Rev 15:677–684
Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, Faris GW, Davis KE (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 428:26–34
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714
Brys DA, Lombardi AV Jr, Mallory TH, Vaughn BK (1991) A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty. Clin Orthop Relat Res 263:175–179
Dennis DA, Channer M, Susman MH, Stringer EA (1993) Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty. J Arthroplasty 8:43–47
Engh GA, Petersen TL (1990) Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplasty 5:1–8
Jeon SH, Kim JH, Lee JM, Seo ES (2012) Efficacy of extramedullary femoral component alignment guide system for blood saving after total knee arthroplasty. Knee Surg Relat Res 24:99–103
Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172
Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS (1993) Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 286:40–47
Collier MB, Engh CA Jr, McAuley JP, Engh GA (2007) Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am 89:1306–1314
Matsuda S, Miura H, Nagamine R (1999) Posterior tibial slope in the normal and varus knee. Am J Knee Surg 12:165–168
Mihalko WM, Krackow KA (1999) Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop Relat Res 360:243–250
Cates HE, Ritter MA, Keating EM, Faris PM (1993) Intramedullary versus extramedullary femoral alignment systems in total knee replacement. Clin Orthop Relat Res 286:32–39
Jung WH, Chun CW, Lee JH, Ha JH, Jeong JH (2013) The accuracy of the extramedullary and intramedullary femoral alignment system in total knee arthroplasty for varus osteoarthritic knee. Knee Surg Sports Traumatol Arthrosc 21:629–635
Kandel L, Vasili C, Kirsh G (2006) Extramedullary femoral alignment instrumentation reduces blood loss after uncemented total knee arthroplasty. J Knee Surg 19:256–258
Fahmy NR, Chandler HP, Danylchuk K, Matta EB, Sunder N, Siliski JM (1990) Blood-gas and circulatory changes during total knee replacement. Role of the intramedullary alignment rod. J Bone Joint Surg Am 72:19–26
Ishii Y, Ohmori G, Bechtold JE, Gustilo RB (1995) Extramedullary versus intramedullary alignment guides in total knee arthroplasty. Clin Orthop Relat Res 318:167–175
Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20(7 Suppl 3):132–138
Bardakos N, Cil A, Thompson B, Stocks G (2007) Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle: a radiographic study. J Arthroplasty 22(6 Suppl 2):85–89
Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22:1097–1106
Stulberg SD, Loan P, Sarin V (2002) Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 84-A(Suppl 2):90–98
Lustig S, Scholes CJ, Stegeman TJ, Oussedik S, Coolican MR, Parker DA (2012) Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up. Int Orthop 36:1835–1839
Dennis DA, Kim RH, Johnson DR, Springer BD, Fehring TK, Sharma A (2011) Control-matched evaluation of painful patellar crepitus after total knee arthroplasty. Clin Orthop Relat Res 469:10–17
Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A (2014) What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop 85:480–487
Krishnan SP, Dawood A, Richards R, Henckel J, Hart AJ (2012) A review of rapid prototyped surgical guides for patient-specific total knee replacement. J Bone Joint Surg Br 94:1457–1461
Thienpont E, Schwab PE, Fennema P (2014) A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement. Bone Joint J 96-B:1052–1061
Nam D, Cody EA, Nguyen JT, Figgie MP, Mayman DJ (2014) Extramedullary guides versus portable, accelerometer-based navigation for tibial alignment in total knee arthroplasty: a randomized, controlled trial. J Arthroplasty 29(2):288–294
Middleton FR, Palmer SH (2007) How accurate is Whiteside’s line as a reference axis in total knee arthroplasty? Knee 14(3):204–207
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Matsumoto, K., Mori, N., Ogawa, H. et al. Accuracy of a novel extramedullary femoral alignment guide system in primary total knee arthroplasty. Arch Orthop Trauma Surg 135, 1743–1748 (2015). https://doi.org/10.1007/s00402-015-2318-3
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DOI: https://doi.org/10.1007/s00402-015-2318-3