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

Maderbacher, Günther; Schaumburger, Jens; Baier, Christel; Zeman, Florian; Springorum, Hans-Robert; Birkenbach, Anne-Maria; Grifka, Joachim; Keshmiri, Armin

doi:10.1007/s00167-015-3541-8

Cited by 25 publications

(33 citation statements)

References 30 publications

(53 reference statements)

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“…Computernavigated and robotics use technologies such as intraoperative navigation and second calibration to achieve more accurate intramedullary positioning and femoral osteotomy. However, many studies have proven that they are not superior to the conventional method in the femoral component position [16,[42][43][44]47]; PSI also does not provide better results in this field [14,45].…”

Section: Discussionmentioning

confidence: 99%

Clinical value of CT-based patient-specific 3D preoperative design combined with conventional instruments in primary total knee arthroplasty: a propensity score-matched analysis

et al. 2020

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Purpose To evaluate the operation and early clinical effect in primary total knee arthroplasty (TKA) about the novel combination of CT-based patient-specific three-dimensional (3D) preoperative design and conventional osteotomy instruments, compared with the conventional method. Methods After a 1:1 propensity score-matching (PSM), patients were matched to the novel technique group and the conventional group, 109 cases in each group. The conventional group adopted a preoperative design based on a full-length radiograph (FLX) and received TKA with conventional osteotomy instruments. The novel technique group used a CT-based patient-specific 3D preoperative design combined with conventional osteotomy instruments; during the surgery, the femoral entry point, femoral valgus osteotomy angle, the fix point of tibial plateau extramedullary guide pin, and the position of tibial extramedullary positioning rod were accurately selected according to the preoperative 3D design to ensure accurate intraoperative implementation. The lower limb alignment, component position, operation time, tourniquet time, hospital stay, blood loss volume, incidence of postoperative complications, visual analog scale (Vas) score, and New Knee Society Score System (NEW-KSS) at 1 day before operation and 1, 6, and 12 months after operation were recorded and compared. Results The novel technique group was significantly better than the conventional group in controlling lateral tibial component angle (LTC) (P < 0.001), and the novel technique group had lower percentages of hip-knee-ankle angle (HKA) outliers (P < 0.001) and overcorrection (P = 0.003). The operation time, tourniquet time, and hospital stay of the novel technique group was shorter (P < 0.05). In 1 month after the operation, the novel technique group achieved a significantly better VAS score (P < 0.05), but a similar NEW-KSS score (P > 0.05) when compared with the conventional group. But in 6 and 12 months after surgery, no statistical differences were seen in the above two scores (P > 0.05). Conclusion The novel technique of CT-based patient-specific 3D preoperative design combined with conventional instruments can improve the accuracy of osteotomy in primary total knee arthroplasty, with benefits of significantly reducing pain and rapid recovery during the early postoperative period, but having no obvious effect on outcome after a 1-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Clinical value of CT-based patient-specific 3D preoperative design combined with conventional instruments in primary total knee arthroplasty: a propensity score-matched analysis

et al. 2020

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“…Therefore it is required to restore sagittal alignment of both femoral and tibial components accurately and precisely, which was not easy to be accomplished via conventional techniques. The exion of femoral component was highly varied in conventionally aligned TKA [37], and a recommended femoral sagittal alignment of within 3° exion could be acquired in only 25% of the studied cases [38]. In addition, Iorio et.al found that traditional instrumentations failed to achieve ideal tibial component positioning, with a tendency towards decreased tibial slope [39].…”

Section: Discussionmentioning

confidence: 99%

The iAssist Navigation System Demonstrated Superior Radiological Outcomes in Restoring Mechanical Alignment and Component Sagittal Positioning in Total Knee Arthroplasty

Gao

Hou

et al. 2020

Preprint

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Background: This study aimed to determine whether the iAssist navigation system (NAV) could improve the accuracy of restoring mechanical axis (MA), component positioning, and clinical outcomes compared to conventional (CON) total knee arthroplasty (TKA). Methods: A total of 301 consecutive patients (NAV: 27, CON: 274) were included. A 1:4 propensity score matching (PSM) was performed between the two groups according to preoperative demographic and clinical parameters. The postoperative MA, femoral coronal angle (FCA), femoral sagittal angle (FSA), tibial coronal angle (TCA) and tibial sagittal angle (TSA) were compared. Absolute deviations of aforementioned angles were calculated as the absolute value of difference between the exact and ideal value and defined as appropriate if within 3°, otherwise regarded as outliers. Additional clinical parameters, including the Knee Society knee and function scores (KSKS and KSFS) and range of motion (ROM), were assessed at the final follow-up (mean follow-up time was 21.88 and 21.56 months respectively for NAV and CON group). Results: A total of 98 patients/102 knees were analyzed after the PSM (NAV: 21 patients/24 knees, CON: 77 patients/78 knees). In the NAV group, the mean MA, FCA and TSA were significantly improved (p = 0.019, 0.006, <0.001, respectively). Proportions of TKAs within a ±3°deviation were significantly improved in all the postoperative radiological variables except for TCA (p = 0.003, 0.021, 0,017, 0.013, respectively for MA, FCA, FSA, and TSA). The absolute deviations of FSA and TSA were also significantly lower in the NAV group (p = 0.016, 0.048, respectively). In particular, no significant differences were found in either mean value, absolute deviation or outlier ratio of TCA between two groups. For the clinical outcomes, there were no significant differences between two groups, although KSKS, KSFS and ROM (p<0.01, respectively) dramatically improved compared to baseline. Conclusions: We suggested that the iAssist system could improve the accuracy and precision of mechanical alignment and component positioning without significant improvement of clinical outcomes. Further long-term high-quality studies are necessary to validate the results.

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“…On the frontal plane, no patients operated on with EM guide were outside 3 degrees of alignment range, while 22% in the IM cohort had a final alignment outside 3 degrees of range. Although recent studies 13 14 questioned the role of overall TKA postoperative alignment in implant survival, most of the authors 1 2 10 15 still advocate placing the implant within 3 degrees of a neutral mechanical axis. Fang et al, 10 in their retrospective study, based on 6,070 TKA patients looking for implant survival in well-aligned knees compared with that of the outliers (more than 3 degrees of valgus or varus alignment) reported that well-aligned TKAs has a longer survival than ones placed in varus or valgus alignment.…”

Section: Discussionmentioning

confidence: 99%

“…Out of 3,048 knees investigated at 15.8 years, 3.3% of flexed required revision while no neutrally aligned femoral implants required revision. Maderbacher et al 2 found that IM alignment rods caused a mean sagittal alignment of the cutting block of 4.4 degrees of flexion in relation to the mechanical femoral axis. In only 25% of the observed cases, a flexion within a range of the desired value of 0 to 3 degrees was obtained.…”

Section: Discussionmentioning

confidence: 99%

“…The desired alignment of the femoral component is traditionally obtained with the use of an intramedullary (IM) guide, but recent reports showed that IM guides achieve correct femoral component alignment, within less than 2-degree error, in less than 66% of knees. 1 2 Moreover, the use of IM guides implies risks for the patients, such as perioperative blood loss and the requirement for blood transfusion after joint replacement. Kim et al 3 showed that the invasiveness of IM guide leads to thromboembolic complications in 4% of cases with subsequent perioperative morbidity and neurological dysfunctions.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Blood Loss and Implant Alignment after Total Knee Arthroplasty with Inertial Based Extramedullary Femoral Cutting Guide

Bonanzinga

Tanzi

Neri

et al. 2018

Joints

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Purpose The purpose of this study was to compare, in terms of blood loss and implant alignment, a new generation of smart extramedullary (EM) cutting guides with the conventional intramedullary (IM) guide for total knee arthroplasty (TKA). The hypothesis was that the EM system would result in less blood loss and fewer days of hospitalization, while ensuring equal or higher accuracy in the alignment of the femoral implant. Methods Thirty-six patients were enrolled for the present study: 18 patients underwent TKA using the EM guide and for the other 18 patients the IM guide was used. Preoperative and postoperative X-rays were acquired. The preoperative and postoperative hemoglobin values were compared. Lastly, length of hospital stay was recorded. Results The hemoglobin difference was significantly lower in the EM group. The alignment of the prosthetic femoral implant in the two groups was comparable but all patients in the EM cohort had a final alignment within 3 degrees of range on the frontal view, while 22% of the patients in the IM cohort had a final alignment exceeding 3 degrees of range. The mean hospitalization duration showed no significant difference between groups, though EM group showed 1.6 days less compared with IM group. Conclusions The inertial-based EM guide system could be useful for decreasing blood loss compared with conventional guide. This device tended to have better results even in terms of accuracy, but this difference was not significant. Level of Evidence This is a level II, prospective cohort study.

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

Abstract: Diagnostic study, Level II.

Cited by 25 publications

References 30 publications

Clinical value of CT-based patient-specific 3D preoperative design combined with conventional instruments in primary total knee arthroplasty: a propensity score-matched analysis

Clinical value of CT-based patient-specific 3D preoperative design combined with conventional instruments in primary total knee arthroplasty: a propensity score-matched analysis

The iAssist Navigation System Demonstrated Superior Radiological Outcomes in Restoring Mechanical Alignment and Component Sagittal Positioning in Total Knee Arthroplasty

Evaluation of Blood Loss and Implant Alignment after Total Knee Arthroplasty with Inertial Based Extramedullary Femoral Cutting Guide

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