Download PDF
J Knee Surg 2018; 31(01): 092-098
DOI: 10.1055/s-0037-1602133
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparative Study for Alignment of Extramedullary Guides versus Portable, Accelerometer-Based Navigation in Total Knee Arthroplasty

Kazu Matsumoto
1   Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
,
Hiroyasu Ogawa
1   Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
,
Masashi Fukuta
2   Department of Orthopaedic Surgery, Matsunami General Hospital, Hashima-gun, Gifu, Japan
,
Nobuyuki Mori
3   Department of Orthopaedic Surgery, Gifu Munincipal Hospital, Gifu, Japan
,
Haruhiko Akiyama
1   Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
› Author Affiliations
Further Information

Publication History

30 July 2016

09 March 2017

Publication Date:
01 May 2017 (online)

    Permissions and Reprints

Abstract

The use of portable, accelerometer-based navigation (PN) devices for positioning of the components of total knee arthroplasty (TKA) is emerging as an alternative to standard extramedullary (EM) systems, which was needed to the image intensifier. The aim of our study was to compare the accuracy of component positioning in TKA using an EM and PN systems. Data from 100 consecutive primary TKAs, performed by multiple surgeons in 87 patients between October 2010 and June 2015, were analyzed. Coronal and sagittal plane alignments of the TKA components, relative to the mechanical axis of the limb, were evaluated by radiography. The mean postoperative coronal alignment angle of the femoral (α) and tibial (β) components was comparable between the groups (α: PN, 89.9 ± 2.2 degrees; EM, 89.9 ± 1.6 degrees and β: PN, 90.1 ± 1.4 degrees; EM, 89.6 ± 1.3 degrees). Groups were also comparable with regard to mean postoperative sagittal alignment angle of the femoral and tibial components (γ: PN, 2.3 ± 3.3 degrees; EM, 1.8 ± 1.7 degrees and σ: PN, 89.7 ± 2.5 degrees; EM, 90.1 ± 1.3 degrees). The incidence rate of a component malalignment > 3 degrees in the coronal and sagittal planes of the mechanical axis of the knee was comparable between the groups. In conclusion, the coronal and sagittal alignments for the femoral components was less accurate compared with tibial component alignment, especially in the PN group, and the sagittal alignment of the femoral component was less accurate than coronal alignment for both groups. Both the PN and EM systems provide satisfactory coronal and sagittal component alignments in TKA. Further technical improvement of the PN system could further improve its application for accurate component implantation in TKAs.

Keywords

total knee arthroplasty - extramedullary guides - portable navigation - coronal alignment - sagittal alignment
 

  • References

  • 1 Laskin RS. The Genesis total knee prosthesis: a 10-year followup study. Clin Orthop Relat Res 2001; (388) 95-102
    PubMedGoogle Scholar
  • 2 Rodriguez JA, Bhende H, Ranawat CS. Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res 2001; (388) 10-17
    PubMedGoogle Scholar
  • 3 Scott WN, Rubinstein M, Scuderi G. Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg Am 1988; 70 (08) 1163-1173
    CrossrefPubMedGoogle Scholar
  • 4 Volz RG. Biomechanics update #2. Basic biomechanics: lever arm, instant center of motion, moment force, joint reactive force. Orthop Rev 1986; 15 (10) 677-684
    PubMedGoogle Scholar
  • 5 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
    CrossrefPubMedGoogle Scholar
  • 6 Berend ME, Ritter MA, Meding JB. , et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004; (428) 26-34
    PubMedGoogle Scholar
  • 7 Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991; 73 (05) 709-714
    Google Scholar
  • 8 Brys DA, Lombardi Jr AV, Mallory TH, Vaughn BK. A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty. Clin Orthop Relat Res 1991; (263) 175-179
    PubMedGoogle Scholar
  • 9 Dennis DA, Channer M, Susman MH, Stringer EA. Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty. J Arthroplasty 1993; 8 (01) 43-47
    CrossrefPubMedGoogle Scholar
  • 10 Engh GA, Petersen TL. Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplasty 1990; 5 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 11 Jeon SH, Kim JH, Lee JM, Seo ES. Efficacy of extramedullary femoral component alignment guide system for blood saving after total knee arthroplasty. Knee Surg Relat Res 2012; 24 (02) 99-103
    CrossrefPubMedGoogle Scholar
  • 12 Matsumoto K, Mori N, Ogawa H, Akiyama H. Accuracy of a novel extramedullary femoral alignment guide system in primary total knee arthroplasty. Arch Orthop Trauma Surg 2015; 135 (12) 1743-1748
    CrossrefPubMedGoogle Scholar
  • 13 Nam D, Nawabi DH, Cross MB, Heyse TJ, Mayman DJ. Accelerometer-based computer navigation for performing the distal femoral resection in total knee arthroplasty. J Arthroplasty 2012; 27 (09) 1717-1722
    CrossrefPubMedGoogle Scholar
  • 14 Nam D, Cody EA, Nguyen JT, Figgie MP, Mayman DJ. Extramedullary guides versus portable, accelerometer-based navigation for tibial alignment in total knee arthroplasty: a randomized, controlled trial: winner of the 2013 HAP PAUL award. J Arthroplasty 2014; 29 (02) 288-294
    CrossrefPubMedGoogle Scholar
  • 15 Fukagawa S, Matsuda S, Mitsuyasu H. , et al. Anterior border of the tibia as a landmark for extramedullary alignment guide in total knee arthroplasty for varus knees. J Orthop Res 2011; 29 (06) 919-924
    Google Scholar
  • 16 Nishikawa K, Mizu-uchi H, Okazaki K, Matsuda S, Tashiro Y, Iwamoto Y. Accuracy of proximal tibial bone cut using anterior border of tibia as bony landmark in total knee arthroplasty. J Arthroplasty 2015; 30 (12) 2121-2124
    CrossrefPubMedGoogle Scholar
  • 17 Berger RA, Rubash HE, Seel MJ, Thompson WH, Crossett LS. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis. Clin Orthop Relat Res 1993; (286) 40-47
    PubMedGoogle Scholar
  • 18 Collier MB, Engh Jr CA, McAuley JP, Engh GA. Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am 2007; 89 (06) 1306-1314
    CrossrefPubMedGoogle Scholar
  • 19 Matsuda S, Miura H, Nagamine R. , et al. Posterior tibial slope in the normal and varus knee. Am J Knee Surg 1999; 12 (03) 165-168
    Google Scholar
  • 20 Nam D, Weeks KD, Reinhardt KR, Nawabi DH, Cross MB, Mayman DJ. Accelerometer-based, portable navigation vs imageless, large-console computer-assisted navigation in total knee arthroplasty: a comparison of radiographic results. J Arthroplasty 2013; 28 (02) 255-261
    CrossrefPubMedGoogle Scholar
  • 21 Iorio R, Mazza D, Drogo P. , et al. Clinical and radiographic outcomes of an accelerometer-based system for the tibial resection in total knee arthroplasty. Int Orthop 2015; 39 (03) 461-466
    CrossrefPubMedGoogle Scholar
  • 22 Fujimoto E, Sasashige Y, Nakata K, Yokota G, Omoto T, Ochi M. Technical considerations and accuracy improvement of accelerometer-based portable computer navigation for performing distal femoral resection in total knee arthroplasty. J Arthroplasty 2017; 32 (01) 53-60
    CrossrefPubMedGoogle Scholar
  • 23 Cates HE, Ritter MA, Keating EM, Faris PM. Intramedullary versus extramedullary femoral alignment systems in total knee replacement. Clin Orthop Relat Res 1993; (286) 32-39
    PubMedGoogle Scholar
  • 24 Jung WH, Chun CW, Lee JH, Ha JH, Jeong JH. The accuracy of the extramedullary and intramedullary femoral alignment system in total knee arthroplasty for varus osteoarthritic knee. Knee Surg Sports Traumatol Arthrosc 2013; 21 (03) 629-635
    CrossrefPubMedGoogle Scholar
  • 25 Ishii Y, Ohmori G, Bechtold JE, Gustilo RB. Extramedullary versus intramedullary alignment guides in total knee arthroplasty. Clin Orthop Relat Res 1995; (318) 167-175
    PubMedGoogle Scholar
  • 26 Lustig S, Scholes CJ, Stegeman TJ, Oussedik S, Coolican MR, Parker DA. Sagittal placement of the femoral component in total knee arthroplasty predicts knee flexion contracture at one-year follow-up. Int Orthop 2012; 36 (09) 1835-1839
    CrossrefPubMedGoogle Scholar
  • 27 Dennis DA, Kim RH, Johnson DR, Springer BD, Fehring TK, Sharma A. The John Insall Award: control-matched evaluation of painful patellar Crepitus after total knee arthroplasty. Clin Orthop Relat Res 2011; 469 (01) 10-17
    CrossrefPubMedGoogle Scholar
  • 28 Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A. What is the optimal alignment of the tibial and femoral components in knee arthroplasty?. Acta Orthop 2014; 85 (05) 480-487
    CrossrefPubMedGoogle Scholar
  • 29 Kim YH, Park JW, Kim JS, Park SD. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 2014; 38 (02) 379-385
    CrossrefPubMedGoogle Scholar
  • 30 Kansara D, Markel DC. The effect of posterior tibial slope on range of motion after total knee arthroplasty. J Arthroplasty 2006; 21 (06) 809-813
    CrossrefPubMedGoogle Scholar
  • 31 Howell SM, Kuznik K, Hull ML, Siston RA. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 2008; 31 (09) 857-863
    CrossrefPubMedGoogle Scholar