+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty



Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty



Journal of Arthroplasty 8(1): 43-47



One hundred twenty consecutive total knee arthroplasties were performed to compare the accuracy of intramedullary versus extramedullary tibial resection guides. An intramedullary guide (group 1) was used in 60 cases and an extramedullary guide (group 2) was used in another 60 cases. In group 2, the distal portion of the extramedullary guide was shifted 3 mm medial to the midpoint of the ankle in order to position it over the center of the talus. Postoperative tibial component alignment angles were similar in both groups (group 1, 0.43 degrees varus; group 2, 0.36 degrees valgus). However, 88% of tibial components in group 2 were aligned within 2 degrees of the 90 degrees goal versus only 72% of tibial components in group 1. Satisfactory alignment can be obtained with either intramedullary or extramedullary resection guides, although a wider range of error was encountered with intramedullary guide use. Distal positioning of the extramedullary guide over the center of the talus rather than the midpoint of the ankle is important to avoid varus tibial resection. Extramedullary guides avoid the potential complications of intramedullary guide use, including fat embolization and hypoxia, intraoperative fracture, loss of polymethyl methacrylate pressurization, and inability of intramedullary rod passage due to deformity, retained hardware, or pathologic bone disease.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 046452806

Download citation: RISBibTeXText

PMID: 8436988

DOI: 10.1016/s0883-5403(06)80106-3


Related references

Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty. Clinical Orthopaedics and Related Research 1995(321): 106-110, 1995

Intramedullary versus extramedullary tibial alignment guides in total knee arthroplasty. Journal of the Formosan Medical Association 97(8): 564-568, 1998

Extramedullary Versus Intramedullary Tibial Alignment Guides for Total Knee Arthroplasty. Yearbook of Orthopedics 2006: 150-151, 2006

Extramedullary versus intramedullary tibial alignment guides for total knee arthroplasty. Orthopedics 28(12): 1445-1448, 2005

Leg alignment and tibial slope after minimal invasive total knee arthroplasty: a prospective, randomized radiological study of intramedullary versus extramedullary tibial instrumentation. Knee 19(4): 270-274, 2012

A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty. Clinical Orthopaedics and Related Research 1991(263): 175-179, 1991

Extramedullary versus intramedullary tibial alignment technique in total knee arthroplasty: A meta-analysis of randomized controlled trials. Clinics 70(10): 714-719, 2015

Differences between extramedullary, intramedullary, and computer-aided surgery tibial alignment techniques for total knee arthroplasty. Journal of Knee Surgery 19(1): 33-36, 2006

Extramedullary versus intramedullary alignment guides in total knee arthroplasty. Clinical Orthopaedics and Related Research 1995(318): 167-175, 1995

Comparison of extramedullary versus intramedullary referencing for tibial component alignment in total ankle arthroplasty. Foot and Ankle International 34(12): 1624-1628, 2013

A comparative study of extramedullary and intramedullary alignment systems in total knee arthroplasty. Clinical Orthopaedics and Related Research 1988(230): 176-181, 1988

Intramedullary versus extramedullary alignment guides on total knee arthroplasty: a meta-analysis. Journal of Comparative Effectiveness Research 7(12): 1181-1193, 2018

Alignment of the tibial component in total knee arthroplasty procedures using an intramedullary or extramedullary guide: double-blind randomized prospective study. Revista Brasileira de Ortopedia 50(2): 168-173, 2015

Comparison of Clinical Influence of Intramedullary versus Extramedullary Alignment Guides on Total Knee Arthroplasty. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae 37(4): 373-377, 2015

Intramedullary versus extramedullary femoral alignment systems in total knee replacement. Clinical Orthopaedics and Related Research 1993(286): 32-39, 1993