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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)
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 Orthopaedic 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: (7 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: To compare coronal alignment parameters and early inflammatory marker trends between IM and EM tibial alignment techniques in primary TKA.
Materials/Patients and 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 PACS using standardized mechanical-axis methods. Outcomes included hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), alignment outliers, and perioperative WBC, ESR, CRP, and IL-6. Between-group comparisons used 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 +/- 3.0 degrees in the EM group (P = 0.270). Alignment outliers occurred in 18.2% and 21.8%, respectively (P = 0.812). Inflammatory markers rose 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 evidence of a 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 cautiously because sampling was incomplete and exploratory.
Objectives: To compare coronal alignment parameters and early inflammatory marker trends between IM and EM tibial alignment techniques in primary TKA.
Materials/Patients and 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 PACS using standardized mechanical-axis methods. Outcomes included hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), alignment outliers, and perioperative WBC, ESR, CRP, and IL-6. Between-group comparisons used 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 +/- 3.0 degrees in the EM group (P = 0.270). Alignment outliers occurred in 18.2% and 21.8%, respectively (P = 0.812). Inflammatory markers rose 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 evidence of a 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 cautiously because sampling was incomplete and exploratory.
Keywords: Arthroplasty, Replacement, Knee, Tibial alignment, Intramedullary, Extramedullary, Inflammatory markers
Type of Study: Research Article |
Subject:
Knee surgery
Received: 2026/05/4 | Accepted: 2026/05/4 | Published: 2026/02/24
Received: 2026/05/4 | Accepted: 2026/05/4 | Published: 2026/02/24
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