A new protocol for obtaining whole leg radiographs with excellent reproducibility

Nguyen, Huu Chien; Egmond, Nienke van; Hevesi, Mario; Weinans, Harrie; Gielis, Willem Paul; Custers, Roel J.H.

doi:10.1016/j.jcjp.2022.100042

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…Earlier reports, however, showed high reliabilities of HKA measurements on WLRs. 11,[24][25][26][27] The HKA measurements performed in this study resulted in high intra-observer reliability, with a low mean absolute error of 0.15° between the 2 measurement moments. This is comparable with most literature.…”

Section: Discussionmentioning

confidence: 99%

“…Physicians should perform physical tests and possibly subsequently request a WLR for reliable leg geometry measurements. 11 Additional tests during physical examination include using goniometers, calipers for intercondylar and intermalleolar distances, and inclinometers. 1 , 7 In addition to physical tests and WLRs, plain knee radiographs are an excellent option for the measurement of femoro-tibial angles which correlates to the HKA.…”

Section: Discussionmentioning

confidence: 99%

“…HKA measurements on the standardized WLR used in our center were proven excellent reliable between one and multiple observers with measurement errors below 0.9°. 11 …”

Section: Methodsmentioning

confidence: 99%

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Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable

et al. 2022

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Objective Visual inspection of the lower limb is often part of standard clinical practice during a physical examination at the outpatient clinic. This study aims to investigate how reliable visual inspections are in terms of detecting lower limb malalignments without additional tools and physical examinations. Design This study enrolled 50 patients. Each patient underwent a whole leg radiograph (WLR); in addition, a standardized digital photograph was taken of the lower limbs. Four persons (different experience levels) visually rated the digital photograph twice (unaware of the hip knee angle [HKA] on the WLR) and placed them in the category: severe valgus (>5°); moderate valgus (2°-5°); neutral, moderate varus (2°-5°); and severe varus (>5°). Visual ratings were compared with the measured HKA on WLRs for correlation using Spearman’s rho. Linear ordinal regression models with significance when P < 0.05 were used to test whether body mass index (BMI), age, gender, and HKA were possible risk factors for incorrect visual HKA assessment. Results Spearman’s rho between the visual assessment and measured HKA on the WLR was moderate with 0.478 ( P < 0.01). Women had an increased odds ratio of 3.7 ( P = 0.001) for incorrect visual assessment. Higher HKA also increased the odds ratio for erroneous visual assessment with 1.4 ( P = 0.003). BMI and age did not significantly increase the odds of erroneous visual leg axis assessments in this study. Conclusions Visual assessment of the lower limb alignment does not provide clinically relevant information. Lower limb malalignment diagnoses cannot be performed using only a visual inspection. Physical examination tests and radiographical assessments are advised. Level of evidence: Diagnostic level II

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable

et al. 2022

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Femorotibial angle scan–rescan reproducibility: A high‐precision calculation on a large cohort

Hall,

Jones,

van Arkel

2024

Knee surg. sports traumatol. arthrosc.

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PurposeFemorotibial angle (FTA) is a convenient measure of coronal knee alignment that can be extracted from a short knee radiograph, avoiding the additional radiation exposure and specialist equipment required for full‐leg radiographs. While intra‐ and inter‐reader reproducibility from the same image has been reported, the full scan–rescan reproducibility across images, as calculated in this study, has not.MethodsIn this study, 4589 FTA measurement pairs from 2586 subjects acquired a year apart were used to estimate FTA scan–rescan reproducibility using data from the Osteoarthritis Initiative. Subjects with radiographic progression of osteoarthritis or other conditions that may cause a change in coronal knee alignment were excluded. Measurement pairs were analysed using paired‐samples tests to detect differences and compared to symptomatic changes in Western Ontario and McMaster Universities Arthritis Index scores for joint pain, stiffness and physical function to detect correlations.ResultsThe 95% limit of agreement and the paired‐samples correlation were calculated with high precision to be [−1.76°, +1.78°] and 0.938, considerably worse than the corresponding figures for intra‐ and inter‐reader reproducibility, without relation to symptomatic or radiographic changes in knee condition. This error will weakly attenuate and values from their true values in correlative studies involving FTA. The realistic maximum value for is 87% and for Pearson's is 93%.ConclusionThe scan–rescan reproducibility in FTA is almost double the intra‐ and inter‐reader reliability from a single scan. At almost ±2° accuracy, FTA is inappropriate for surgical use, but it is sufficiently reproducible to produce good correlations in studies predicting disease incidence and progression.Level of EvidenceLevel II, retrospective study.

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