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A simple technique to perform total knee replacement without violating the femoral canal: early clinical results on a cohort of 303 patients

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

It is becoming increasingly common to find patients candidate for total knee replacement with inaccessible femoral canal due to long femoral hip stems, osteo-synthetic hardware or diaphyseal mal-unions. To treat those patients avoiding complex and expensive procedures, we developed an innovative surgical technique based on a novel device called extra-medullary alignment system. We initially employed this technique in 18 cases with inaccessible femoral canal. Early results were so encouraging that we adopted this technique also for our standard cases.

Materials and methods

We report here our findings with a first series of 303 consecutive patients performed employing this technique. All patients received a cemented cruciate-retaining mobile-bearing total knee. Patients were followed for a minimum of 2 years and evaluated employing the Knee Society Score and the Oxford questionnaire. We also recorded the surgical time and any complication occurred intra-operatively and postoperatively. Patients’ X-rays were as well evaluated.

Results

No patient was lost to follow-up. Patients group average Knee Society and Oxford scores improved, respectively, from 45 and 16 pre-op to 92 and 45 at 2-year follow-up. Those results were compared and found aligned to those reported by similar historic control groups. Prosthetic implant alignment and surgical time demonstrated to be similar the one obtained using endo-medullary-referenced instruments. In this series, we did not observe any meaningful complication.

Conclusions

The extra-medullary alignment system seems to be a simple and reliable technique enabling to perform total knee replacement in a truly minimal invasive manner avoiding femoral canal violation.

Level of evidence

IV.

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Abbreviations

EMAS:

Extra-medullary alignment system

IM:

Intramedullary

ROM:

Range of motion

KSS:

Knee Society Score

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Authors and Affiliations

  1. Department of Orthopaedic Surgery II, Suzzara Hospital, Via G. Cantore 14, 46029, Suzzara, Mantua, Italy

    Gianluca Castellarin & Vincenzo Cimino

Authors
  1. Gianluca Castellarin
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  2. Vincenzo Cimino
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Contributions

GC designed the follow-up program and performed all the surgeries.

VC reviewed patients data and X-rays.

Corresponding author

Correspondence to Gianluca Castellarin.

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Conflict of interest

The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Every patient gave his/her written informed consent to have his/her clinical records later used for this prospective study.

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Not applicable.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Castellarin, G., Cimino, V. A simple technique to perform total knee replacement without violating the femoral canal: early clinical results on a cohort of 303 patients. Eur J Orthop Surg Traumatol 30, 1377–1382 (2020). https://doi.org/10.1007/s00590-020-02711-5

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  • DOI: https://doi.org/10.1007/s00590-020-02711-5

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