scholarly journals Intramedullary versus Extramedullary Tibial Cutting Guides in Total Knee Procedures: Our Experience at King Abdulaziz University Hospital in Saudi Arabia

2016 ◽  
Vol 23 (1) ◽  
pp. 23-28
Author(s):  
Lutf A. Abumunaser ◽  
Amre S. Hamdi ◽  
Faeq M.W. Sawaf
Keyword(s):  
Tibial Component ◽  
University Hospital ◽  
X Rays ◽  
Component Alignment ◽  
Total Knee Replacements ◽  
Tibial Component Alignment ◽  
Significant Difference ◽  
Key Factor ◽  
Cutting Guides ◽  
Total Knee

The tibial component alignment is believed to be a key factor for the survivorship of total knee arthroplasty. But there is still controversy whether intramedullary or extramedullary cutting guidance is more accurate for tibial component alignment. This retrospective study aims to compare the accuracy of intramedullary and extramedullary tibial cutting guides in Total knee replacement. 88 Total knee replacements were carried out in 60 patients between January 2013 and April 2015. Out of 88 procedures 38 were in the intramedullary group and 50 in the extramedullary group. The tibial component alignment was evaluated by measuring the laterally formed angle between the transverse axis of the tibial component and the mechanical axis of the tibia. The tibial component angle was measured on postoperative long film X-rays of lower limb. The mean tibial component angle ± SD was 91.22 ± 2.74 for the intramedullary group, and 91.95 ± 2.34 (p = 0.184) for the extramedullary group. The normal tibial component angle values (88-92) was found in 52.6% in the intramedullary group and in 48% of the extramedullary group (p = 0.188). No statistically significant difference was found between the intramedullary and extramedullary tibial cutting guides with regard to the accuracy of the normal tibial component alignment.

DOES NAVIGATION TOTAL KNEE REPLACEMENT REALLY MAKE A DIFFERENCE?

2013 ◽  
Vol 16 (02) ◽  
pp. 1350007
Author(s):  
P. Motwani ◽  
A. Jariwala ◽  
N. Valentine
Keyword(s):  
Total Knee Replacement ◽  
Tibial Component ◽  
Sagittal Plane ◽  
Computer Navigation ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Background: Computer Navigation in Total Knee Replacement (TKR) has completed more than a decade since its inception. From that time, numerous studies have been done to see its effect on the variables of surgery and its outcome. Some studies have shown that it is definitely beneficial while others have negated its superiority over conventional techniques. This is an early outcome study on the results of navigation TKR in terms of alignment and clinical outcome at three years post-operatively. Methods: In the present study, 128 patients who had undergone navigation TKR (128 TKR) between January 2006 and November 2009 were included. The navigation system used was orthoPilot®. Patients were assessed post-operatively at one and three year using knee society score (KSS) and knee function score (KFS). All patients completed one year follow-up and 55 patients completed three year follow-up. From 128 patients, 40 navigated TKR patients operated between November 2007 and 2009 and were compared with 40 patients operated by conventional TKR operated between July 2007 and December 2008. Results: The mean KSS at 1 year post-operatively was 85.60 and at 3 years was 85.87. The mean KFS at 1 year post-operatively was 69.30 and at 3 years was 68.00. There was no statistically significant difference between navigation TKR and conventional TKR in terms of anatomical femoro-tibial alignment, femoral component alignment in coronal and sagittal plane and tibial component alignment in coronal plane. However, there was statistically significant difference between tibial component alignment in sagittal plane (p = 0.000) between both the groups. Conclusion: Computer navigation TKR affords a possibility to place both the femoral and tibial component very precisely without the risk of any greater axis deviation from ideal value. It helps in reducing the outliers in alignment of the limb and that of component and that improves the overall implant survival for a long time post-operatively.

scholarly journals ACCELEROMETER-BASED NAVIGATION VERSUS CONVENTIONAL TECHNIQUE IN TOTAL KNEE REPLACEMENT. A PROSPECTIVE STUDY IN A TERTIARY CARE MEDIUM VOLUME SETUP IN INDIA.

2020 ◽  
pp. 1-4
Author(s):  
Sanket Tanpure ◽  
Suyog Madje ◽  
Ajay Chavan ◽  
Rohit kumar Vaishya ◽  
Ashish Phadnis
Keyword(s):  
Prospective Study ◽  
Femoral Component ◽  
Tibial Component ◽  
Mechanical Axis ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
Alignment Angle ◽  
A Prospective Study

The iASSIST system is a portable, accelerometer base with electronic navigation used for total knee arthroplasty (TKA) which guides the surgeon to align and validate bone resection during the surgical procedure. The purpose of this study was to compare the radiological outcome between accelerometer base iASSIST system and the conventional system. Method: A prospective study between two group of 36 patients (50 TKA) of primary osteoarthritis of the knee who underwent TKA using iASSIST ™ or conventional method (25 TKA in each group) from January 2018 to December 2019. A single surgeon performs all operations with the same instrumentation and same surgical approach. Pre-operative and postoperative management protocol are same for both groups. All patients had standardized scanogram (full leg radiogram) performed post operatively to determine mechanical axis of lower limb, femoral and tibial component alignment. Result: There was no significant difference between the 2 groups for Age, Gender, Body mass index, Laterality and Preoperative mechanical axis(p>0.05).There was no difference in proportion of outliers for mechanical axis (p=0.91),Coronal femoral component alignment angle (p=0.08),Coronal tibial component alignment angle (p=1.0).The mean duration of surgery, postoperative drop in Hb, number of blood transfusion didn’t show significant difference between 2 groups (p>0.05). Conclusion: Our study concludes that despite being a useful guidance tool during TKA, iASSIST does not show any difference in limb alignment (mechanical axis), Tibial and femoral component alignment when compared with the conventional method.

Efficacy of Portable Accelerometer-Based Navigation Devices versus Conventional Guides in Total Knee Arthroplasty: A Meta-analysis

2019 ◽  
Vol 33 (07) ◽  
pp. 691-703 ◽  
Author(s):  
Han Sun ◽  
Shuxiang Li ◽  
Kun Wang ◽  
Guofeng Wu ◽  
Jian Zhou ◽  
...  
Keyword(s):  
Tibial Component ◽  
Operative Time ◽  
Short Form ◽  
Meta Analysis ◽  
Mechanical Alignment ◽  
Knee Score ◽  
Component Alignment ◽  
Posterior Slope ◽  
Tibial Component Alignment ◽  
Total Knee

AbstractVarious studies have provided different conclusions regarding which component's alignment can be actually improved by a novel portable accelerometer-based navigation device (PAD) compared with the conventional guide (CON); the operative times and clinical outcomes reported by these studies also exhibited incongruity. Thus, this meta-analysis was conducted to evaluate the efficacy of PADs in total knee arthroplasty (TKA). The Web of Science, EMBASE, PubMed, MEDLINE, and Cochrane Library databases were systematically searched. Studies published till July 2018 and comparing PAD with CON in treatment with TKA were identified. Sixteen studies in which 1,551 TKAs were reported were included. Results showed that PAD was significantly superior to CON in reducing tibial component alignment out of ±3 degrees, femoral coronal angle out of ±3 degrees, and overall mechanical alignment out of ±3 degrees. PAD can also help obtain a more accurate result of femoral coronal angle (degree); however, it requires a longer operative time than the CON group. The two groups were comparable in tibial component alignment out of ±2 degrees, tibial component posterior slope out of ±3 degrees, tibial component posterior slope out of ±2 degrees, femoral coronal angle out of ±2 degrees, femoral sagittal angle out of ±3 degrees, femoral sagittal angle out of ±2 degrees, tibial component alignment (degree), tibial component posterior slope (degree), femoral sagittal angle (degree), overall mechanical alignment (degree), blood loss, Knee Society knee score, Knee Society function score, Oxford Knee Score, Short Form-36 physical component score, Short Form-36 mental component score, and range of motion. In conclusion, compared with CON, PAD can help improve the femoral coronal angle as well as decrease the outliers out of ±3 degrees in femoral/tibial coronal angles and overall mechanical alignment. However, PAD did not show significant advantages in tibial and femoral component sagittal angles out of ±3 degrees, various outliers of ±2 degrees, most mean values of component alignments, operative time, and various functional or satisfactory scores.

Effect of Tibial Component Alignment and Posterior Slope on Tibial Coverage in a Chinese Population: A Three-dimensional Anthropometric Study

2018 ◽  
Vol 33 (01) ◽  
pp. 053-061 ◽  
Author(s):  
Long Shao ◽  
Ting Wang ◽  
Junyi Liao ◽  
Wei Xu ◽  
Xi Liang ◽  
...  
Keyword(s):  
Tibial Component ◽  
Three Dimensional ◽  
Prosthesis Design ◽  
Tibial Tubercle ◽  
Virtual Surgery ◽  
Component Alignment ◽  
Posterior Slope ◽  
Symmetrical Design ◽  
Tibial Component Alignment ◽  
Significant Difference

AbstractThe standard for rotational alignment and posterior slope of the tibial component in total knee arthroplasty remains controversial. This study aimed to evaluate the effect of tibial component alignment and posterior slope on tibial coverage. Computer tomographic scans of 101 tibial specimens were used to reconstruct three-dimensional tibia models. A virtual surgery was performed to generate a resection plane with different posterior slopes on the proximal tibia. Symmetrical and anatomical tibial components were placed aligning to the medial one-third of tibial tubercle (Insall) and the medial edge of patella tendon (Akagi), respectively. Differences in coverage and mismatch were evaluated and statistically compared across alignments, slope angles, and genders. The tibial coverage increased from 83.21 to 85.96% for Akagi's alignments and from 85.19 to 87.22% for Insall alignments along with the increasing of posterior slope from 0 to 7 degrees. Regardless of the prosthesis design, there was a significant difference between two rotational alignments as the Insall alignment was significantly higher in tibial coverage. With a slope of 7 degrees, more overhang along with less underhang anteromedially were found in males compared with females. The current anatomical tibial design has a tendency of overhang in the anteromedial zone which does not exist in the symmetrical design. The current tibial baseplate design has better tibial coverage when aligning to the medial third of tibial tuberosity with slopes of 5 and 7 degrees. Gender difference should be taken into account and given priority for prosthesis design.

Improving tibial component alignment in total knee arthroplasty

2014 ◽  
Vol 23 (12) ◽  
pp. 3563-3570 ◽  
Author(s):  
G. Cinotti ◽  
P. Sessa ◽  
A. D’Arino ◽  
F. R. Ripani ◽  
G. Giannicola
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Total Knee

scholarly journals Radiographic evaluation of tibial component alignment in total knee arthroplasty following extramedullary and intramedullary tibial referencing

2017 ◽  
Vol 3 (6) ◽  
pp. 1199
Author(s):  
B. Harikrishnan ◽  
Anjan Prabhakara ◽  
Gururaj R. Joshi
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Radiographic Evaluation ◽  
Component Alignment ◽  
Tibial Component Alignment ◽  
Knee Deformity ◽  
Total Knee ◽  
The Difference

<p class="abstract"><strong>Background:</strong> Long term survivorship of total knee arthroplasty (TKA) is significantly dependant on prostheses alignment. The debate on optimal referencing for femoral component is largely resolved with Intra-medullary jigs reproducing superior alignment. However there is still a contention about whether intramedullary or extramedullary jigs are better for tibial referencing. This study aims to compare the accuracy of tibial component alignment in TKA using intramedullary and extramedullary tibial referencing jigs.</p><p class="abstract"><strong>Methods:</strong> Between December 2012 and September 2014, 66 primary conventional cemented TKAs were performed using Nexgen-LPS Flex (Zimmer) implants in 55 patients, 50-80 y old (mean 65.54 y) with osteoarthritis/rheumatoid arthritis. Intramedullary and extramedullary tibial referencing was used in alternate patients undergoing TKA after excluding patients with BMI <span style="text-decoration: underline;">&gt;</span>35 kg/m<sup>2</sup>, knee deformity <span style="text-decoration: underline;">&gt;</span>15<sup>0</sup>,excessive tibial bowing, previous fractures/surgeries/retained metalwork around knee. Postoperatively, tibial component alignment (TCA) in coronal plane was assessed using AP radiograph of leg. A 3<sup>º</sup> cutoff from neutral mechanical axis (i.e., 90<sup>o</sup>±3<sup>o</sup>) was considered acceptable.<strong></strong></p><p class="abstract"><strong>Results:</strong> The intramedullary group (n=33) had 4 outliers (TCA &gt;93<sup>º</sup> or &lt;87<sup>º</sup>) whereas the extramedullary group (n=33) had 7 outliers (p=0.511). The difference in mean TCA between intramedullary and extramedullary groups was not statistically significant [90.70±2.43 and 90.55±2.17 (p=0.790)]. There were no significant per-operative/post-operative complications in either group.</p><p><strong>Conclusions:</strong> We conclude that both intramedullary and extramedullary tibial referencing guides can be used to achieve desired tibial component alignment (90±3<sup>º</sup>) in TKA. However the surgeon should appreciate the benefits and deficiencies of either types of tibial referencing and use whichever is suited in a particular case. </p>

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