The accuracy of the extramedullary and intramedullary femoral alignment system in total knee arthroplasty for varus osteoarthritic knee

The intramedullary (IM) femoral alignment system does not alway guarantee accuracy of the component position in the total knee arthroplasty (TKA). In some cases, the extramedullary (EM) femoral alignment system in total knee arthroplasty (TKA) is a useful alternative surgical option to adjust femoral component alignment. In the EM technique, accuracy of the femoral head center location is mandatory. The purpose of this prospective randomized study was to compare the alignment after TKA using two different femoral alignment systems. From January 2009 to December 2009, 91 patients (106 knees) with osteoarthritis underwent TKA. The IM femoral alignment system was used in 50 TKAs, and the EM system was used in 56 TKAs. We measured the coronal, sagittal alignment of the femoral component, and overall alignment from full-length standing. Anteroposterior radiographs were taken 1 year after surgery. The overall limb alignment was 0.2A degrees A A +/- A 1.9A degrees A varus in the EM group and 1.1A degrees A A +/- A 1.9A degrees A valgus in the IM group (p = 0.001). The coronal alignment of the femoral component was 90.0A degrees A A +/- A 1.1A degrees in the EM group and 90.3A degrees A A +/- A 1.2A degrees in the IM group, not statistically different (n.s.). The sagittal alignment of the femoral component was 2.3A degrees A A +/- A 1.7A degrees in the EM group and 2.5A degrees A A +/- A 1.0A degrees in the IM group (n.s.). Clinically acceptable overall limb alignment was achieved in 91.1 % of EM group and 84.0 % of IM group (n.s.). The present study suggests that by applying our EM technique that uses a newly designed mechanical axis marker system, the alignment of the femoral component and overall limb alignment is reliable and at least as accurate as the standard IM technique. I.