A Protocol to Systematic Radiographic Assessment of Primary Total Knee Arthroplasty

Abstract

Although total knee arthroplasty (TKA) is considered one of the most successful procedures, however, a subset of patients are unsatisfied with the results, even with the introduction of new technologies and implant designs. Radiological assessment of TKA is still considered the most prevalent imaging modality for evaluating the knee joint pre-and postoperatively. Assessment of various angles and indices which could be measured in different radiographic views of the knee provides valuable information about the alignment of the entire limb and the individual prosthetic components, more so in the light of recent nuanced concepts of technique, alignment, and balance. This review article aims to present a comprehensive yet systematic approach to the most useful radiographic parameters for assessing the knee preoperatively and post-TKA by explaining the tools and techniques used for measuring various angles, indices and ratios in the coronal, sagittal and axial planes for diagnosis, preoperative planning, postoperative assessment, and routine follow-up. The protocol we followed in this review entailed first reporting the possible applications and software which could help in measuring these variables, then we mentioned the required series of knee radiographs. For the desired variables, we divided the assessment according to each plane, and in each, we reported the optimum position of the desired radiographic view followed by determining the axis and lines which will later form the desired angles to be measured; finally, we collected all the measurements in a table with the native knee values and the most accepted values after TKA.

Knee-Spine Syndrome: Management Dilemma When Knee Osteoarthritis Coexists With Spine Degeneration

“…Review studies have focused on preoperative evaluation by knee radiographs before knee arthroplasty. Radiological techniques evaluate axial, sagittal, and coronal planes for angle, axis, and index measurement [ 31 ]. The three sites include the pelvis with both hips in anteroposterior view, lumbosacral spine in lateral view, and bilateral knee in anteroposterior view in standing posture or a hip-knee-ankle long film of the lower extremity, to identify any significant contributing degeneration of any other site [ 32 ].…”

Concordance in Radiological Parameters of Different Knee Views After Total Knee Arthroplasty

“…It is important to remember that the measurement of the angles on our patients' follow-up is a part of the systematic evaluation and is useful for a better global understanding. Khalifa et al [ 24 ], proposed a similar assessment after TKA but did not report concordance in the measurement, which is crucial to obtain reliable results.…”

Mechanically aligned total knee arthroplasty with the extension-first technique does not equally restore neutral knee alignment in all preoperative knee phenotypes

“…The benefits of this study are that all cases were operated on or under the direct supervision of one surgeon and that all measurements were taken twice by two observers with substantial inter- and intraclass agreement on X-rays, which are still considered the primary imaging technique [ 13 ].…”