Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 12/2015

01-12-2015 | Knee Arthroplasty

Accuracy of a novel extramedullary femoral alignment guide system in primary total knee arthroplasty

Authors: Kazu Matsumoto, Nobuyuki Mori, Hiroyasu Ogawa, Haruhiko Akiyama

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2015

Login to get access

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.
Literature
1.
go back to reference Laskin RS (2001) The Genesis total knee prosthesis: a 10-year followup study. Clin Orthop Relat Res 388:95–102CrossRefPubMed Laskin RS (2001) The Genesis total knee prosthesis: a 10-year followup study. Clin Orthop Relat Res 388:95–102CrossRefPubMed
2.
go back to reference Rodriguez JA, Bhende H, Ranawat CS (2001) Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res 388:10–17CrossRefPubMed Rodriguez JA, Bhende H, Ranawat CS (2001) Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res 388:10–17CrossRefPubMed
3.
go back to reference Scott WN, Rubinstein M, Scuderi G (1988) Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg Am 70:1163–1173PubMed Scott WN, Rubinstein M, Scuderi G (1988) Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg Am 70:1163–1173PubMed
4.
go back to reference Volz RG (1986) Basic update #2. Biomechanics: lever arm, instant center of motion, moment force, joint reactive force. Orthop Rev 15:677–684PubMed Volz RG (1986) Basic update #2. Biomechanics: lever arm, instant center of motion, moment force, joint reactive force. Orthop Rev 15:677–684PubMed
5.
go back to reference 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 428:26–34CrossRefPubMed 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 428:26–34CrossRefPubMed
6.
go back to reference Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714PubMed Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714PubMed
7.
go back to reference 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 263:175–179PubMed 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 263:175–179PubMed
8.
go back to reference Dennis DA, Channer M, Susman MH, Stringer EA (1993) Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty. J Arthroplasty 8:43–47CrossRefPubMed Dennis DA, Channer M, Susman MH, Stringer EA (1993) Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty. J Arthroplasty 8:43–47CrossRefPubMed
9.
go back to reference Engh GA, Petersen TL (1990) Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplasty 5:1–8CrossRefPubMed Engh GA, Petersen TL (1990) Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplasty 5:1–8CrossRefPubMed
10.
go back to reference 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 24:99–103PubMedCentralCrossRefPubMed 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 24:99–103PubMedCentralCrossRefPubMed
11.
go back to reference Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172PubMed Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172PubMed
12.
go back to reference 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 286:40–47PubMed 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 286:40–47PubMed
13.
go back to reference 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 89:1306–1314CrossRefPubMed 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 89:1306–1314CrossRefPubMed
14.
go back to reference Matsuda S, Miura H, Nagamine R (1999) Posterior tibial slope in the normal and varus knee. Am J Knee Surg 12:165–168PubMed Matsuda S, Miura H, Nagamine R (1999) Posterior tibial slope in the normal and varus knee. Am J Knee Surg 12:165–168PubMed
15.
go back to reference Mihalko WM, Krackow KA (1999) Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop Relat Res 360:243–250CrossRefPubMed Mihalko WM, Krackow KA (1999) Posterior cruciate ligament effects on the flexion space in total knee arthroplasty. Clin Orthop Relat Res 360:243–250CrossRefPubMed
16.
go back to reference Cates HE, Ritter MA, Keating EM, Faris PM (1993) Intramedullary versus extramedullary femoral alignment systems in total knee replacement. Clin Orthop Relat Res 286:32–39PubMed Cates HE, Ritter MA, Keating EM, Faris PM (1993) Intramedullary versus extramedullary femoral alignment systems in total knee replacement. Clin Orthop Relat Res 286:32–39PubMed
17.
go back to reference 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 21:629–635CrossRefPubMed 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 21:629–635CrossRefPubMed
18.
go back to reference Kandel L, Vasili C, Kirsh G (2006) Extramedullary femoral alignment instrumentation reduces blood loss after uncemented total knee arthroplasty. J Knee Surg 19:256–258CrossRefPubMed Kandel L, Vasili C, Kirsh G (2006) Extramedullary femoral alignment instrumentation reduces blood loss after uncemented total knee arthroplasty. J Knee Surg 19:256–258CrossRefPubMed
19.
go back to reference 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 72:19–26PubMed 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 72:19–26PubMed
20.
go back to reference Ishii Y, Ohmori G, Bechtold JE, Gustilo RB (1995) Extramedullary versus intramedullary alignment guides in total knee arthroplasty. Clin Orthop Relat Res 318:167–175PubMed Ishii Y, Ohmori G, Bechtold JE, Gustilo RB (1995) Extramedullary versus intramedullary alignment guides in total knee arthroplasty. Clin Orthop Relat Res 318:167–175PubMed
21.
go back to reference Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20(7 Suppl 3):132–138CrossRefPubMed Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20(7 Suppl 3):132–138CrossRefPubMed
22.
go back to reference 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):85–89CrossRefPubMed 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):85–89CrossRefPubMed
23.
go back to reference 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 22:1097–1106CrossRefPubMed 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 22:1097–1106CrossRefPubMed
24.
go back to reference 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):90–98PubMed 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):90–98PubMed
25.
go back to reference 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 36:1835–1839PubMedCentralCrossRefPubMed 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 36:1835–1839PubMedCentralCrossRefPubMed
26.
go back to reference 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 469:10–17PubMedCentralCrossRefPubMed 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 469:10–17PubMedCentralCrossRefPubMed
27.
go back to reference 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 85:480–487PubMedCentralCrossRefPubMed 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 85:480–487PubMedCentralCrossRefPubMed
28.
go back to reference 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 94:1457–1461CrossRefPubMed 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 94:1457–1461CrossRefPubMed
29.
go back to reference 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:1052–1061CrossRefPubMed 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:1052–1061CrossRefPubMed
30.
go back to reference 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):288–294CrossRefPubMed 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):288–294CrossRefPubMed
31.
go back to reference Middleton FR, Palmer SH (2007) How accurate is Whiteside’s line as a reference axis in total knee arthroplasty? Knee 14(3):204–207CrossRefPubMed Middleton FR, Palmer SH (2007) How accurate is Whiteside’s line as a reference axis in total knee arthroplasty? Knee 14(3):204–207CrossRefPubMed
Metadata
Title
Accuracy of a novel extramedullary femoral alignment guide system in primary total knee arthroplasty
Authors
Kazu Matsumoto
Nobuyuki Mori
Hiroyasu Ogawa
Haruhiko Akiyama
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 12/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-015-2318-3

Other articles of this Issue 12/2015

Archives of Orthopaedic and Trauma Surgery 12/2015 Go to the issue