Intramedullary Tibial Alignment Research Articles

Impact of intra- and extramedullary alignment on blood loss in total knee arthroplasty: a retrospective study.

There is a scarcity of scientific data regarding the correlation between alignment techniques during total knee arthroplasty (TKA) and blood loss as well as transfusion rates. This study's hypothesis posited that intramedullary-aligned (IM) TKA exhibits higher blood loss and transfusion rates when contrasted with extramedullary-aligned (EM) TKA. We conducted a retrospective examination of 883 patients who underwent total knee arthroplasty (TKA) in 2021 at a solitary orthopedic center in Germany. These patients were divided into two groups based on their tibial alignment technique: extramedullary alignment and intramedullary tibial alignment. In the intramedullary tibial alignment (IM) group, we observed a blood loss of 0.91 L, while in the extramedullary tibial alignment (EM) group, the blood loss was 0.89 L. These values did not demonstrate a significant difference (p = 0.69). Transfusion rates were 0.99% in the IM group and 0.21% in the EM group, and there was no significant distinction between them (Chi-squared test: p > 0.05). We observed no statistically significant variance in blood loss between the IM and EM groups. Likewise, there was no substantial disparity in transfusion rates between these groups. It can be concluded that the selection of a knee arthroplasty system incorporating either intramedullary tibial alignment or extramedullary alignment does not significantly impact blood loss.

Intramedullary Versus Extramedullary Alignment Guide for the Accurate Sagital Tibial Prosthesis Alignment in Total Knee Replacement Arthroplasty

Background: long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment, several studies have correlated poor outcome with malalignment of the components. The debate on the optimal system for femoral alignment is now largely resolved, but there is still controversy about whether intramedullary or extramedullary systems are better for the tibial side.
 Objecives : is to determine whether intramedullary or extramedullary tibial alignment guide is better for accurate sagital tibial prosthesis alignment in total knee replacement arthroplasty.
 Patients and methods: Of 65 patients recruited, only 48 patients (55 knees) were met the inclusion criteria of this study (32 female and 16 male) with an average age of 62.2 years ranging from 57 to 70 years who had attended the outpatient clinic in medical city-orthopedic and trauma consultation unit and private work, during the period from October 2010 till March 2012. All patients were diagnosed to have severe osteoarthritis of their knees and we performed total knee replacement arthroplasty for them. Patients were divided into two groups, group A, were 22 patients (25 knees) in which we used intramedullary alignment guide for the preparation of proximal tibia, and group B, were 26 patients (30 knees) in which we used extramedullary alignment guide for the preparation of the proximal tibia. Three months postoperatively, a standing long leg proper lateral plain X-ray (digital software) was taken and the sagital tibial slope was measured for each case.
 Results: Accurate alignment of sagital posterior slope of tibial prosthesis was found in 80% (20 out of 25 knees) in group A, and in 43.3% (13 out of 30 knees) in group B.By using Student t test, the P value was less than 0.001 which was very significant.
 Conclusion: we concluded that the intramedullary tibial alignment guide is statistically more accurate than extramedullary tibial alignment guide, in the sagital positioning of the tibial component.

The accuracy of intramedullary tibial guide of sagittal alignment of PCL-substituting total knee arthroplasty

Experimental and clinical studies on the accuracy of the intramedullary alignment method have produced different results, and few have addressed accuracy in the sagittal plane. Reported deviations are not only attributable to the alignment method but also to radiological errors. The purpose of this study was to evaluate the accuracy of the intramedullary alignment method in the sagittal plane using computed tomography (CT) and 3-dimensional imaging software. Thirty-one TKAs were performed using an intramedullary alignment method involving the insertion of a long 8-mm diameter rod into the medullary canal to the distal metaphysis of the tibia. All alignment instruments were set to achieve an ideal varus/valgus angle of 0° in the coronal plane and a tibial slope of 0° in the sagittal plane. The accuracy of the intramedullary alignment system was assessed by measuring the coronal tibial component angle and sagittal tibial slope angles, i.e., angles between the tibial anatomical axis and the tangent to the medial and lateral tibial plateau or the cut-surface. The mean coronal tibial component angle was 88.5°±1.2° and the mean tibial component slope in the sagittal plane was 1.6°±1.2° without anterior slope. Our intramedullary tibial alignment method, which involves passing an 8-mm diameter long rod through the tibial shaft isthmus, showed good accuracy (less than 3 degrees of variation and no anterior slope) in the sagittal plane in neutral or varus knees.

Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment

Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment

Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment

The Journal of Bone and Joint Surgery. British volumeVol. 85-B, No. 6 CorrespondenceFree AccessExtramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignmentE. THIENPONTE. THIENPONTSearch for more papers by this authorPublished Online:21 Feb 2018https://doi.org/10.1302/0301-620X.85B6.0850932AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited ByRadiographic Analysis of a Hand-Held Surgical Navigation System for Tibial Resection in Total Knee ArthroplastyThe Journal of Arthroplasty, Vol. 26, No. 8Radiographic Results of an Accelerometer-based, Handheld Surgical Navigation System for the Tibial Resection in Total Knee ArthroplastyOrthopedics, Vol. 34, No. 10 Vol. 85-B, No. 6 Metrics Downloaded 33 times History Published online 21 February 2018 Published in print 1 August 2003 InformationCopyright © 2003, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment

We undertook a prospective, randomised study of 135 total knee arthroplasties to determine the most accurate and reliable technique for alignment of the tibial prosthesis. Tibial resection was guided by either intramedullary or extramedullary alignment jigs. Of the 135 knees, standardised postoperative radiographs suitable for assessment were available in 100. Correct tibial alignment was found in 85% of the intramedullary group compared with 65% of the extramedullary group (p = 0.019). We conclude that intramedullary guides are superior to extramedullary instruments for alignment of the tibial prosthesis.