Use of Shorter Intramedullary Guide for Ipsilateral Total Knee Arthroplasty following Prior Total Hip Arthroplasty

Abstract

Alignment after total knee arthroplasty (TKA) plays an important role with respect to patient satisfaction and implant survivorship. In patients undergoing ipsilateral TKA with prior total hip arthroplasty (THA), the femoral intramedullary (IM) guide cannot be fully inserted into the femoral canal because of the prior THA. The purpose of this study was to determine the effect of femoral component alignment using a shorter IM guide during TKA in patients with an ipsilateral THA. We identified 42 patients undergoing ipsilateral TKA with the use of a short IM guide in the setting of a prior THA. A matched cohort group was identified from our total joint registry that included 42 patients who underwent primary TKA. The surgical goal was to achieve 5 degrees of valgus on the femoral side and 0 degree on the tibial side with an overall postoperative tibial–femoral angle of 5 degrees of valgus. Patients were evaluated clinically using Knee Society pain scores (KSSs), function scores, and with radiography. Both the tibial–femoral limb alignment and the femoral component alignment were compared using Student's t-test. There were no significant differences between the two groups with respect to sex, age, body mass index (BMI), pre- and postoperative KSSs. There was a statistically significant difference between the two groups with respect to radiographic tibial–femoral limb alignment, 4.33 degrees of valgus in the short stem THA–TKA group versus 5.4 degrees of valgus in the TKA group (p < 0.04); however, this difference did not correlate to a difference in postoperative outcomes. An adequate tibial–femoral component alignment was achieved in patients undergoing ipsilateral TKA with prior THA using a shortened IM femoral guide.

Prior unilateral total hip arthroplasty does not influence the outcome of ipsilateral total knee arthroplasty

“…A study [24] suggested that the changes in the axial alignment of the limb after THA could result in greater difficulty for the alignment of the knee during TKA and the authors recommended the use of a short intramedullar guide for ipsilateral TKA following prior THA, although the differences with the conventional guide were small. In the present study there was no difference in knee alignment between patients with or without prior THA.…”

Mid-long term results of total knee arthroplasty followed by ipsilateral total hip arthroplasty versus total hip arthroplasty subsequent to ipsilateral total knee arthroplasty: A retrospective cohort study

“…In present study, a total of 6 knees in THA-TKA group underwent shorter intramedullary guides due to abutment of the distal end of the prior hip prosthesis. Bradley et al [9] reported that the alterations in the axial alignment of the extremity by a prior THA could result in greater di culty for the alignment of the knee during TKA and the postoperative tibial-femoral limb alignment of THA-TKA patients using shorter femoral intramedullary guide was signi cant different from the control group who were treated only TKA, although the differences could not alter the mechanical axis alignment between the center of third of the knee. Here, we summarized some key aspects concerning the surgical technique of TKA subsequent to ipsilateral THA.…”

“…Further, prior studies reported that biomechanics loads during gait on the ipsilateral or contralateral knee also was altered after unilateral THA [5,8]. Additionally, due to a prior femoral prosthesis, it is di cult to thorough insert the femoral intramedullary guide into the femoral canal in certain cases during ipsilateral TKA which has a chance of malalignment [9].…”

Mid-long-term results of total knee arthroplasty followed by ipsilateral total hip arthroplasty versus total hip arthroplasty subsequent to ipsilateral total knee arthroplasty: a case-control analysis

“…Other studies have suggested that there is no increase in biomechanical loading during gait and posture on ipsilateral or contralateral knee joints after unilateral THA [ 10 ]. Furthermore, in certain cases, it is difficult to thoroughly insert the femoral intramedullary guide into the femoral canal during ipsilateral TKA due to a prior femoral prosthesis, increasing the chance of malalignment [ 11 ]. To date, only one study has analyzed the influence of prior THA on the functional outcome of subsequent ipsilateral TKA, which demonstrated the influence is limited [ 12 ].…”