Volume 13, Issue 1 (Winter 2026)
JROS 2026, 13(1): 13-24 |
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Moghtadaei M, Farahini H, Yegane A, Ameri M, Zarei B, Sour B. Intramedullary Versus Extramedullary Tibial Alignment Guides in Total Knee Arthroplasty: Coronal Alignment and Early Inflammatory Marker Trends. JROS 2026; 13 (1) :13-24
URL: http://jros.iums.ac.ir/article-1-2323-en.html
URL: http://jros.iums.ac.ir/article-1-2323-en.html
1- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2- Clinical Research Development Center, Rasoul Akram Hospital Complex, Iran University of Medical Sciences, Tehran, Iran.
3- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran.
2- Clinical Research Development Center, Rasoul Akram Hospital Complex, Iran University of Medical Sciences, Tehran, Iran.
3- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran.
Abstract: (634 Views)
Background: Accurate tibial alignment is important in total knee arthroplasty (TKA), and intramedullary (IM) and extramedullary (EM) tibial guides may differ in alignment performance and early perioperative physiological effects.
Objectives: This study aimed to compare the coronal alignment parameters and early inflammatory marker trends between IM and EM tibial alignment techniques in primary TKA.
Methods: In this prospective pragmatic observational cohort, 110 primary TKA cases were analyzed (55 IM, 55 EM). Standing long-leg radiographs obtained during routine care were reviewed. When radiology report values were unavailable, two trained reviewers independently measured angles in the picture archiving and communication system (PACS) using standardized mechanical-axis methods. Outcomes included hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle, joint line convergence angle (JLCA), alignment outliers, and perioperative white blood cell count (WBC), erythrocyte sedimentation rate, C-reactive protein (CRP), and interleukin-6. Between-group comparisons were performed using Welch’s t-test or Fisher’s exact test; P values were exploratory.
Results: Coronal alignment point estimates were similar between groups; HKA was 178.7±3.6 degrees in the IM group and 179.4±3 degrees in the EM group (P=0.270). Alignment outliers occurred in 18.2% and 21.8% of cases, respectively (P=0.812). Inflammatory markers increased postoperatively in both groups. WBC was modestly higher in the IM group on postoperative day 1 (P=0.034); other available inflammatory marker comparisons showed no clear difference.
Conclusion: IM and EM tibial alignment techniques showed similar coronal alignment in this routine-care cohort. Early inflammatory marker trends were broadly similar, but laboratory findings should be interpreted with caution because sampling was incomplete and exploratory.
Objectives: This study aimed to compare the coronal alignment parameters and early inflammatory marker trends between IM and EM tibial alignment techniques in primary TKA.
Methods: In this prospective pragmatic observational cohort, 110 primary TKA cases were analyzed (55 IM, 55 EM). Standing long-leg radiographs obtained during routine care were reviewed. When radiology report values were unavailable, two trained reviewers independently measured angles in the picture archiving and communication system (PACS) using standardized mechanical-axis methods. Outcomes included hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle, joint line convergence angle (JLCA), alignment outliers, and perioperative white blood cell count (WBC), erythrocyte sedimentation rate, C-reactive protein (CRP), and interleukin-6. Between-group comparisons were performed using Welch’s t-test or Fisher’s exact test; P values were exploratory.
Results: Coronal alignment point estimates were similar between groups; HKA was 178.7±3.6 degrees in the IM group and 179.4±3 degrees in the EM group (P=0.270). Alignment outliers occurred in 18.2% and 21.8% of cases, respectively (P=0.812). Inflammatory markers increased postoperatively in both groups. WBC was modestly higher in the IM group on postoperative day 1 (P=0.034); other available inflammatory marker comparisons showed no clear difference.
Conclusion: IM and EM tibial alignment techniques showed similar coronal alignment in this routine-care cohort. Early inflammatory marker trends were broadly similar, but laboratory findings should be interpreted with caution because sampling was incomplete and exploratory.
Keywords: Arthroplasty, Replacement, Knee, Tibial alignment, Intramedullary (IM), Extramedullary (EM), Inflammatory markers
Type of Study: Research Article |
Subject:
Knee surgery
Received: 2025/06/19 | Accepted: 2025/12/22 | Published: 2026/01/1
Received: 2025/06/19 | Accepted: 2025/12/22 | Published: 2026/01/1
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