Is the femoral intramedullary alignment already actual in total knee arthroplasty?
Abstract Clinical outcomes and overall alignment after total knee arthroplasty (TKA) depend on femoral component positioning in the sagittal and the coronal plane, making choice of the distal femoral cutting guide crucial. Currently, there is no consensus on the potential advantage of an extramedull...
| Príomhchruthaitheoirí: | , , , |
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| Formáid: | Alt |
| Teanga: | English |
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Wiley
2023-01-01
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| Sraith: | Journal of Experimental Orthopaedics |
| Ábhair: | |
| Rochtain ar líne: | https://doi.org/10.1186/s40634-022-00563-y |
| _version_ | 1827324248291540992 |
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| author | Andrea Tecame Andrea Gambineri Pierangelo Za Paolo Adravanti |
| author_facet | Andrea Tecame Andrea Gambineri Pierangelo Za Paolo Adravanti |
| author_sort | Andrea Tecame |
| collection | DOAJ |
| description | Abstract Clinical outcomes and overall alignment after total knee arthroplasty (TKA) depend on femoral component positioning in the sagittal and the coronal plane, making choice of the distal femoral cutting guide crucial. Currently, there is no consensus on the potential advantage of an extramedullary (EM) guide compared to an intramedullary (IM) guide in TKA. The IM guide is the most widely used system for making the distal femoral cut although evidence for its superiority over the EM guide is lacking. However, inaccuracies arising with the IM guide include location of the rod entry point in the coronal plane, femoral canal diameter, femoral bowing, and structural features of the rod. Furthermore, the invasive procedure is associated with increased risk of postoperative blood loss, thromboembolic complications, and intraoperative fractures. While the EM guide has no such difficulties, its accuracy depends on the instruments used. Studies have reported results not inferior to the IM guide and a lower number of postoperative complications. Patient‐specific instrumentation (PSI) and robotic and computer‐assisted TKA have achieved excellent clinical and radiographic results and can overcome the problems inherent to the IM and the EM guide. Authors performed a systematic review of the literature and proposed a narrative review to summarize the characteristics of the IM and the EM guide and compare the advantages and disadvantages of each, as well as their limitations in comparison with new technologies. Authors also expressed their expert opinion. |
| first_indexed | 2024-03-08T04:57:10Z |
| format | Article |
| id | doaj.art-1f4b51a08f5348dc98fdfa72ecd1be8f |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-04-25T02:09:11Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-1f4b51a08f5348dc98fdfa72ecd1be8f2024-03-07T12:46:41ZengWileyJournal of Experimental Orthopaedics2197-11532023-01-01101n/an/a10.1186/s40634-022-00563-yIs the femoral intramedullary alignment already actual in total knee arthroplasty?Andrea Tecame0Andrea Gambineri1Pierangelo Za2Paolo Adravanti3Department of Orthopaedic and Trauma SurgeryCittà di Parma ClinicPiazzale Athos Maestri 5ParmaItalyDepartment of Orthopaedic and Trauma SurgeryCittà di Parma ClinicPiazzale Athos Maestri 5ParmaItalyDepartment of Orthopaedic and Trauma SurgeryCampus Bio‐Medico University of RomeVia Alvaro del Portillo 200RomeItalyDepartment of Orthopaedic and Trauma SurgeryCittà di Parma ClinicPiazzale Athos Maestri 5ParmaItalyAbstract Clinical outcomes and overall alignment after total knee arthroplasty (TKA) depend on femoral component positioning in the sagittal and the coronal plane, making choice of the distal femoral cutting guide crucial. Currently, there is no consensus on the potential advantage of an extramedullary (EM) guide compared to an intramedullary (IM) guide in TKA. The IM guide is the most widely used system for making the distal femoral cut although evidence for its superiority over the EM guide is lacking. However, inaccuracies arising with the IM guide include location of the rod entry point in the coronal plane, femoral canal diameter, femoral bowing, and structural features of the rod. Furthermore, the invasive procedure is associated with increased risk of postoperative blood loss, thromboembolic complications, and intraoperative fractures. While the EM guide has no such difficulties, its accuracy depends on the instruments used. Studies have reported results not inferior to the IM guide and a lower number of postoperative complications. Patient‐specific instrumentation (PSI) and robotic and computer‐assisted TKA have achieved excellent clinical and radiographic results and can overcome the problems inherent to the IM and the EM guide. Authors performed a systematic review of the literature and proposed a narrative review to summarize the characteristics of the IM and the EM guide and compare the advantages and disadvantages of each, as well as their limitations in comparison with new technologies. Authors also expressed their expert opinion.https://doi.org/10.1186/s40634-022-00563-yIntramedullaryExtramedullaryFemoral cutAlignmentTKA |
| spellingShingle | Andrea Tecame Andrea Gambineri Pierangelo Za Paolo Adravanti Is the femoral intramedullary alignment already actual in total knee arthroplasty? Journal of Experimental Orthopaedics Intramedullary Extramedullary Femoral cut Alignment TKA |
| title | Is the femoral intramedullary alignment already actual in total knee arthroplasty? |
| title_full | Is the femoral intramedullary alignment already actual in total knee arthroplasty? |
| title_fullStr | Is the femoral intramedullary alignment already actual in total knee arthroplasty? |
| title_full_unstemmed | Is the femoral intramedullary alignment already actual in total knee arthroplasty? |
| title_short | Is the femoral intramedullary alignment already actual in total knee arthroplasty? |
| title_sort | is the femoral intramedullary alignment already actual in total knee arthroplasty |
| topic | Intramedullary Extramedullary Femoral cut Alignment TKA |
| url | https://doi.org/10.1186/s40634-022-00563-y |
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