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Appropriate sagittal femoral component alignment cannot be ensured by intramedullary alignment rods

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The intraoperative sagittal cutting block alignment when intramedullary alignment rods are used was investigated. Its absolute orthogonal orientation in relation to the mechanical femoral axis should be analysed. It was hypothesized that (1) alignment rods do not ensure a desired deviation within a range between 0° and 3° flexion as it has been shown to be favourable for clinical and functional outcome. Further, the degree of flexion cannot be (2) foreseen by the surgeon or (3) estimated by clinical or radiological parameters.

Methods

Forty knees allocated to total knee arthroplasty were included. The distal femoral cutting block was aligned using an intramedullary rod. By means of a navigation device, the sagittal alignment of the cutting block in degrees of flexion was measured.

Results

The mean measured flexion of the cutting block was 4.4° (3.6 SD). Twenty-five per cent (10/40) of the values were within a corridor between 0° and 3° of flexion. The mean difference between expected and measured flexion was −1.5° (−7.6 to 4.7 95 % limits of agreement). The dorsoventral diameter of the distal femur showed a significant influence on measured flexion (R 2 = 0.112, p = 0.035).

Conclusion

Intramedullary alignment rods used in the present study do not ensure a distal cutting block alignment between 0° and 3° of flexion in relation to the femoral mechanical axis. The extent of flexion could not be foreseen either by the surgeon. The dorsoventral diameter of the distal femur correlated with measured flexion. However, only limited data is available on influence of femoral component flexion on implant failure or clinical and functional outcome.

Level of evidence

Diagnostic study, Level II.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany

    Günther Maderbacher, Jens Schaumburger, Clemens Baier, Hans-Robert Springorum, Anne-Maria Birkenbach, Joachim Grifka & Armin Keshmiri

  2. Center of Clinical Studies, University of Regensburg, Regensburg, Germany

    Florian Zeman

Authors
  1. Günther Maderbacher
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  2. Jens Schaumburger
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  3. Clemens Baier
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  4. Florian Zeman
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  6. Anne-Maria Birkenbach
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  7. Joachim Grifka
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  8. Armin Keshmiri
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Correspondence to Günther Maderbacher.

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Maderbacher, G., Schaumburger, J., Baier, C. et al. Appropriate sagittal femoral component alignment cannot be ensured by intramedullary alignment rods. Knee Surg Sports Traumatol Arthrosc 24, 2453–2460 (2016). https://doi.org/10.1007/s00167-015-3541-8

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  • DOI: https://doi.org/10.1007/s00167-015-3541-8

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