Reliable and reproducible technique to mark center of ankle in total knee arthroplasty

Abstract

Centre of ankleExtramedullary guide TKA a b s t r a c t Aim: Bony and soft tissue landmarks have been used in the past to determine the center of the ankle to facilitate the tibial cut using an extramedullary guide in total knee arthroplasty. However literature reports are scanty in regards to the most ideal method available and its reproducibility in marking the center of the ankle intra-operatively. Methods:We describe a method of using an electrocardiogram (ECG) lead in determining the center of the ankle, thus facilitating the alignment of the extramedullary guide for the tibia. Results: Using this technique, in our study the mean lateral tibial component angle was 90.09(84.2 e94.3 ). The number of knees in the range of 88 e92.4 were 120 out of 122 knees (98.40%). Conclusion:The described method is reliable and cheap, with reproducibility in determining the tibial cut in total knee arthroplasty.

Tibial Cut Accuracy in Mechanically Aligned Total Knee Arthroplasty Using Extensor Hallucis Longus Tendon to Determine Extramedullary Tibial Guide Position

“…Furthermore, subsidence and failure of tibial component have been directly related to postoperative TC accuracy. 14 The technique we describe has similar postoperative alignment compared with those shown in the literature using fluoroscopy or other traditional methods 9,15 (►Table 1). It is also far superior to the pre-EHL technique we used (intermalleolar), but the lack of rigorous postoperative STLE radiographs decreased the number of patients we could include in 2 years previous to the EHL tendon technique.…”

“…6 These cuts can be guided by intramedullary or extramedullary guides; there is consensus using intramedullary femoral guides, but there is no evidence to support the use of one over the other to guide TCs, 5,7,8 other than patient-specific contraindications to intramedullary guides. 5 The use of extramedullary tibial guides (EMTGs) increases surgical time mainly due to the use of fluoroscopy to guide its distal position 9 and difficulties in finding anatomical landmarks in overweight patients.…”

Accuracy of tibial positioning in the frontal plane: a prospective study comparing conventional and innovative techniques in total knee arthroplasty

“…Several methods to facilitate orientation in assistance with anatomical landmarks have been reported. A high precision of 98% for alignment has been described after identifying the center of the talus [24]. Another study advised palpating the anterior tibial crest which is within 3° of the tibial mechanical axis [13].…”