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A ligament tensor-guided extramedullary alignment technique for distal femoral cut in total knee replacement: results at a minimum 3 years follow-up

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Femoral intramedullary canal referencing is used by most knee arthroplasty systems for distal femoral cut; to avoid the opening of the femoral canal different solutions have been presented such as navigation, patient-specific instruments (PSI) or the use of an extramedullary device. The FuZion® system is a tensor device, created to merge the two main techniques for performing a total knee arthroplasty: the ligament balancing and measured resection techniques. Our idea was to use the tensor as an extramedullary cutting guide for the distal femoral cut, based on a 90° tibial resection.

Methods

A total of 110 patients were operated on with this technique. Patients were evaluated with weight-bearing long-standing X-rays, knee a-p and lateral views, validated PROMs (Oxford Knee Score, EQ-5D and EQ-VAS), the Knee Society Scoring System (KSS) and the Forgotten Joint Score (FJS). Minimum follow up was 3 years (range 38–50 months).

Results

Complete results were available for 104 patients (5 were lost in follow up and 1 died). Significant improvements were registered for all the evaluated scores from pre-op to the final follow up. Pre-op long-standing X-rays showed 21 valgus knees (20%) with a mean HKA of 187.6° (± 3.2°), 70 varus knees (62%) with a mean 172.2° (± 3.7°) HKA and 19 neutrally aligned knees, with a mean HKA of 179.5° (0 ± 2°). The radiographic evaluation at 3 months post-op showed 20 valgus knees (mean HKA 183.7° ± 1.5°), 67 varus knees (mean HKA 176.1° ± 1.8°) and 23 neutrally aligned knees with a mean HKA of 179.3° (0 ± 2°). At final follow up the survival rate was 100% for revision of the implant as the endpoint. With any reoperation as the endpoint Kaplan–Meier survival estimate showed a survival rate of 95.1% at 3 years.

Conclusions

This technique for performing a ligament driven alignment in total knee arthroplasty showed encouraging clinical outcomes at mid-term follow up leaving a residual deformity on the coronal plane.

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Funding

No funding was received for the present study.

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Authors and Affiliations

  1. Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy

    Stefano Marco Paolo Rossi, Rudy Sangaletti, Loris Perticarini & Francesco Benazzo

  2. Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy

    Alessandro Ivone, Matteo Ghiara, Eugenio Jannelli, Rudy Sangaletti & Francesco Benazzo

  3. Università degli Studi di Pavia, 27100, Pavia, Italy

    Rudy Sangaletti & Francesco Benazzo

Authors
  1. Stefano Marco Paolo Rossi
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  2. Alessandro Ivone
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  3. Matteo Ghiara
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  4. Eugenio Jannelli
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  7. Francesco Benazzo
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Corresponding author

Correspondence to Stefano Marco Paolo Rossi.

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Conflict of interest

Prof Francesco Benazzo declares a teaching contract with the manufacturer (Zimmer Biomet); all other authors declare no conflict of interest related to the present study.

Ethical approval

The study was approved by the Ethical Committee of our institution (IRB approval No. 2015001968).

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All patients signed informed consent for the surgical procedure and for publication of the data

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Rossi, S.M.P., Ivone, A., Ghiara, M. et al. A ligament tensor-guided extramedullary alignment technique for distal femoral cut in total knee replacement: results at a minimum 3 years follow-up. Arch Orthop Trauma Surg 141, 2295–2302 (2021). https://doi.org/10.1007/s00402-021-04115-4

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