Three-dimensional analysis of alignment error in using femoral intramedullary guides in unicompartmental knee arthroplasty

The Journal of Arthroplasty
Burton MaRandy E Ellis

Abstract

We used computerized simulations with 3-dimensional models of 20 cadaver femora, calculated from computed tomographic scans, and a model of a rod measuring 200 x 5 mm to study femoral alignment accuracy for unicompartmental knee arthroplasty via minimally invasive reconstruction. The anatomical axis and insertion site were identified on each femur. A simulation of all feasible flexion-extension and varus-valgus orientations was performed. The average rod orientation was 3.2 degrees flexion and 2.5 degrees valgus. The range of orientation was 3.2 degrees extension to 9.7 degrees flexion and 4.5 degrees varus to 8.9 degrees valgus. The study suggests that a short narrow intramedullary rod inserted according to the manufacturer's specifications does not accurately find the anatomical axis and may lead to poor alignment of the femoral prosthesis. Given our finding of consistent bias toward excessive flexion and valgus alignment, we recommend that the operating surgeon carefully plan the insertion point of the intramedullary rod during surgery to compensate for this bias.

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Citations

Feb 5, 2010·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Elcil Kaya BicerPhilippe Neyret
Feb 13, 2014·Archives of Orthopaedic and Trauma Surgery·Jianlin XiaoYanguo Qin
Nov 28, 2013·Clinics in Sports Medicine·Brett Levine, Aaron G Rosenberg
Feb 16, 2015·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Günther MaderbacherArmin Keshmiri
May 27, 2016·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Yihui TuMinwei Cai
Nov 28, 2013·Clinics in Sports Medicine·Albert S M DunnKevin D Plancher
Aug 21, 2008·Clinical Orthopaedics and Related Research·Andrea Baldini, Paolo Adravanti
Feb 20, 2018·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Günther MaderbacherHermann Maderbacher
Nov 30, 2018·Journal of Comparative Effectiveness Research·Ya-Fei QinHui Li
May 28, 2019·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Paola KoenenHolger Bäthis
Apr 26, 2017·Archives of Orthopaedic and Trauma Surgery·Tilman WalkerTobias Gotterbarm
Jan 1, 2021·BioMed Research International·Fei GuQingqiang Yao

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