Abstract
BackgroundThere is no consensus whether the use of the extramedullary femoral cutting guide takes advantage over the intramedullary one in total knee arthroplasty. The aim of this study was to compare the extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for lower limb alignment, blood loss, and operative time during total knee arthroplasty.MethodsThe Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Chinese Periodical, Google, and reference lists of all the included studies were searched for randomized controlled trials. The following parameters were compared between the extramedullary technique and the intramedullary technique: (1) lower limb coronal alignment, (2) coronal alignment of femoral component, (3) sagittal alignment of femoral component, (4) blood loss, (5) and operation time.ResultsFour randomized controlled trials consisting of 358 knees were included in our study. There was no significant difference between the extramedullary and intramedullary groups for the lower limb coronal alignment (RR = 1.20, 95%CI 0.28~5.21, n.s.), coronal alignment of femoral component (RR = 0.65, 95%CI 0.19~2.22, n.s.), and sagittal alignment of femoral component (RR = 0.73, 95%CI 0.38~1.41, n.s.). A reduced blood loss was associated with the use of the extramedullary guide (MD = −120.34, 95%CI −210.08~−30.59, P = 0.009). No significant difference in operation time was noted between the two groups (MD = 1.41, 95%CI −1.82~4.64, n.s.).ConclusionsNeither extramedullary nor intramedullary femoral alignment is more accurate than the other in facilitating the femoral cut in total knee arthroplasty. Use of the extramedullary guide results in less blood loss and exhibits a similar operation time as compared with the intramedullary guide.
Highlights
There is no consensus whether the use of the extramedullary femoral cutting guide takes advantage over the intramedullary one in total knee arthroplasty
In total knee arthroplasty (TKA), the prosthetic placement and overall limb alignment has been demonstrated to be most influential in determining implant survival [1,2,3,4]
The pooled results of meta-analysis The pooled results indicated that there was no significant difference between the two groups in terms of the lower limb coronal alignment
Summary
There is no consensus whether the use of the extramedullary femoral cutting guide takes advantage over the intramedullary one in total knee arthroplasty. The aim of this study was to compare the extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for lower limb alignment, blood loss, and operative time during total knee arthroplasty. The ideal position for the components recreates a neutral mechanical axis. Previous studies used only the anterosuperior iliac spine as an intraoperative landmark for the EM referencing instruments [5,6,7]. Extramedullary instruments using newly designed mechanical axis marker systems have provided as accuracy in reproducing a neutral distal femoral resection on the coronal and sagittal planes during TKA as standard IM instruments [8,9,10]
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