Abstract
Background
Intramedullary (IM) or extramedullary (EM) mechanical guides are used as alignment tools during total knee arthroplasty (TKA) surgery. The EM guide is less invasive; however, the IM mechanical guide is the preferred option since it has shown superior outcomes in several studies. Picture archive and communication system (PACS) images, if available, are extensively used for preoperative planning and intraoperative guidance. This retrospective study compared TKA outcomes using the conventional IM guide and a new EM technique which uses PACS image for preoperative and intraoperative assessment bone resection. To the best of our knowledge, this is the first study with the new EM technique.
Materials and Methods
The study was performed on 205 knees (190 patients) for TKA from 2011 to 2013. The perioperative blood loss and the postoperative alignment angles were assessed for both mechanical guides. The angles were measured on the radiographs of the patient. The blood loss was assessed by the blood accumulated in the hemovac drain during the surgery and until 3 days after the surgery.
Results
The new EM guide provided similar postoperative alignment as that obtained with the IM guide.
Conclusion
The EM-guided method for femoral bone cutting using PACS films in TKA is as good as the IM method. The additional advantages of less injury to the bone and less fat emboli load to the cardiopulmonary system with the EM method makes it an attractive choice for routine, especially in the elderly and/or simultaneous bilateral, TKA in hospitals without modern computer-assisted navigation systems.
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References
Caillouette JT, Anzel SH. Fat embolism syndrome following the intramedullary alignment guide in total knee arthroplasty. Clin Orthop Relat Res 1990; 251:198–9.
Kandel L, Vasili C, Kirsh G. Extramedullary femoral alignment instrumentation reduces blood loss after uncemented total knee arthroplasty. J Knee Surg 2006;19:256–8.
Bonutti PM, Mont MA, McMahon M, Ragland PS, Kester M. Minimally invasive total knee arthroplasty. J Bone Joint Surg Am 2004;86-A Suppl 2:26–32.
Cates HE, Ritter MA, Keating EM, Faris PM. Intramedullary versus extramedullary femoral alignment systems in total knee replacement. Clin Orthop Relat Res 1993;286:32–9.
Mihalko WM, Boyle J, Clark LD, Krackow KA. The variability of intramedullary alignment of the femoral component during total knee arthroplasty. J Arthroplasty 2005;20:25–8.
Dutton AQ, Yeo SJ, Yang KY, Lo NN, Chia KU, Chong HC, et al. Computer-assisted minimally invasive total knee arthroplasty compared with standard total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am 2008;90:2–9.
Langdown AJ, Auld J, Bruce WJ. Computer-assisted knee arthroplasty versus a conventional jig-based technique. J Bone Joint Surg Br 2005;87:588–9.
Weng YJ, Hsu RW, Hsu WH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty 2009;24:668–73.
Yadav S, Sinha S, Luther E, Arora NC, Prasad M, Varma R, et al. Comparison of extramedullary and intramedullary devices for treatment of subtrochanteric femoral fractures at tertiary level center. Chin J Traumatol 2014;17:141–5.
Rottman SJ, Dvorkin M, Gold D. Extramedullary versus intramedullary tibial alignment guides for total knee arthroplasty. Orthopedics 2005;28:1445–8.
da Rocha Moreira Rezende B, Fuchs T, Nishi RN, Hatem MA, da Silva LM, Fuchs R, et al. Alignment of the tibial component in total knee arthroplasty procedures using an intramedullary or extramedullary guide: Double-blind randomized prospective study. Rev Bras Ortop 2015;50:168–73.
Meding JB, Berend ME, Ritter MA, Galley MR, Malinzak RA. Intramedullary v. extramedullary femoral alignment guides: A 15-year followup of survivorship. J Arthroplasty 2011;26:591–5.
Matsumoto K, Mori N, Ogawa H, Akiyama H. Accuracy of a novel extramedullary femoral alignment guide system in primary total knee arthroplasty. Arch Orthop Trauma Surg 2015;135:1743–8.
Shepherd DE, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis 1999;58:27–34.
Baldini A, Adravanti P. Less invasive TKA: Extramedullary femoral reference without navigation. Clin Orthop Relat Res 2008;466:2694–700.
Dennis DA, Channer M, Susman MH, Stringer EA. Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty. J Arthroplasty 1993;8:43–7.
Ishii Y, Ohmori G, Bechtold JE, Gustilo RB. Extramedullary versus intramedullary alignment guides in total knee arthroplasty. Clin Orthop Relat Res 1995;318:167–75.
Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994;95(2):153–6.
Maestro A, Harwin SF, Sandoval MG, Vaquero DH, Murcia A. Influence of intramedullary versus extramedullary alignment guides on final total knee arthroplasty component position: A radiographic analysis. J Arthroplasty 1998;13:552–8.
Lozano LM, Segur JM, Maculé F, Núñez M, Torner P, Castillo F, et al. Intramedullary versus extramedullary tibial cutting guide in severely obese patients undergoing total knee replacement: A randomized study of 70 patients with body mass index >35 kg/m2. Obes Surg 2008;18:1599–604.
Brys DA, Lombardi AV Jr., Mallory TH, Vaughn BK. A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty. Clin Orthop Relat Res 1991;263:175–9.
Engh GA, Petersen TL. Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplasty 1990;5:1–8.
Seo JG, Moon YW, Kim YS. A comparison of extramedullary and intramedullary femoral component alignment guide systems in TKA. J Korean Knee Soc 2006;18:47–54.
Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop Relat Res 1998;348:87–94.
Schipper IB, Marti RK, van der Werken C. Unstable trochanteric femoral fractures: Extramedullary or intramedullary fixation. Review of literature. Injury 2004;35:142–51.
Kuzyk PR, Bhandari M, McKee MD, Russell TA, Schemitsch EH. Intramedullary versus extramedullary fixation for subtrochanteric femur fractures. J Orthop Trauma 2009;23:465–70.
Jeon SH, Kim JH, Lee JM, Seo ES. Efficacy of extramedullary femoral component alignment guide system for blood saving after total knee arthroplasty. Knee Surg Relat Res 2012;24:99–103.
Singla A, Malhotra R, Kumar V, Lekha C, Karthikeyan G, Malik V, et al. A randomized controlled study to compare the total and hidden blood loss in computer-assisted surgery and conventional surgical technique of total knee replacement. Clin Orthop Surg 2015;7:211–6.
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Ku, MC., Chen, WJ., Lo, CS. et al. Femoral Component Alignment with a New Extramedullary Femoral Cutting Guide Technique. JOIO 53, 276–281 (2019). https://doi.org/10.4103/ortho.IJOrtho_119_17
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DOI: https://doi.org/10.4103/ortho.IJOrtho_119_17