Inter-observer reliability of measurements performed on digital long-leg standing radiographs and assessment of validity compared to 3D CT-scan

Boonen, Bert; Kerens, B.; Schotanus, Martijn G.M.; Emans, Pieter J.; Jong, Bob; Kort, Nanne P.

doi:10.1016/j.knee.2015.08.008

Cited by 38 publications

(38 citation statements)

References 16 publications

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“…The ICC shows a good and very good correlation for the radiographic measurement between all examiners. These results are comparable to those, which are published for standard limb alignment on long leg x-rays (ICC = 0.7 to 0.8) [5].…”

Section: Discussionsupporting

confidence: 90%

3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty

et al. 2021

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Purpose This study aimed to validate a new joint line measurement technique in total knee arthroplasty for separated assessment of the medial and lateral femoral joint line alteration with 3D-surface scan technology. Separate assessment of the medial and lateral joint line alteration may improve TKA alignment assessment regarding to joint line restoration in kinematic alignment and use of robotic-assisted TKA surgery. Methods The medial and lateral joint line difference after TKA implantation on an artificial bone model was analyzed and compared with a 3D-scan and full femoral radiographs pre- and postoperatively. Radiographic analysis included the perpendicular distance between the most distal point of the medial and lateral condyle and the reproduced preoperative lateral distal femoral angle (LDFA). For evaluation of validity and reliability, radiographs were captured initially with true anteroposterior view and subsequently with combined flexion and rotation malpositioning. Reliability of the introduced measurement technique in between three observers was tested with intraclass correlation coefficient (ICC). Results Radiographic measurement showed a mean difference of 0.9 mm on the medial side and 0.6 mm on the lateral side when compared to the 3D-surface scan measurement. The reliability of measurement accuracy was ≤ 1 mm in x-rays with < 10° flexion error regardless to malrotation in these images. The ICC test showed very good reliability for the medial joint line evaluation and good reliability for lateral joint line evaluation (ICC 0.92, ICC 0.86 respectively). Conclusion The new introduced joint line measurement method showed a sufficient reliability, accuracy and precision. It provides separated information about medial and lateral joint line alteration in TKA surgery in absolute values. Level of evidence V - Experimental Study

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Section: Discussionsupporting

confidence: 90%

3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty

et al. 2021

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“…The quality of the radiograph is crucial for the success and accuracy of the measurements. However, long-leg radiographs show good validity compared with 3D CT scans [ 34 ]. The quality of the JL measurement is based on an intact bone stock on the femoral side.…”

Section: Discussionmentioning

confidence: 99%

Imageless robotic handpiece-assisted total knee arthroplasty: a learning curve analysis of surgical time and alignment accuracy

Savov

Tuecking

Ehmig

et al. 2021

Arch Orthop Trauma Surg

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Introduction Robotic-assisted surgery techniques are increasing in total knee arthroplasty (TKA). One crucial point is the prolonged time of surgery. The primary objective of this study was to determine the learning curve necessary to minimize the time of surgery. The secondary objective was to evaluate the accuracy of the implant alignment when using an imageless robotic system for TKA. Materials and methods In a case–control study, the first 70 consecutive robotic-assisted TKA procedures performed by a single senior surgeon were analyzed with regard to surgery time and implant alignment by comparing the intraoperative plan with the postoperative alignment. The evaluation of the learning curve with respect to surgery time was conducted using cumulative summation (CUSUM) analysis. The joint line height was measured with a new technique. Surgery time and joint line reconstruction were compared to 70 consecutive conventional TKA procedures. Results The learning curve for robotic TKA was completed after 11 cases. The learning curve did not influence the accuracy of joint line obliquity, joint line height, or limb alignment. The intraoperative plan designed for the robotic system was precisely implemented. The mean skin-to-skin time in the robotic group after the learning curve was completed did not differ from that in the manual group. A significant positive correlation was observed between the preoperative hip–knee–ankle angle and the postoperative distalization of the joint line in the robotic-assisted TKA group. Conclusion After completing the initial learning curve of 11 cases, the surgery time required to perform imageless robotic handpiece-assisted TKA was similar to that for the conventional technique. However, no learning curve was observed for the implant positioning when using the imageless robotic system. The implementation of the intraoperative plan was accurate up to < 2°. The precision of the system allows the implementation of different joint balancing approaches between valgus and varus morphotypes.

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“…However, recently, Boonen et al showed better reliability and validity of the measurement on long leg radiograph compared with three-dimensional analysis. 23 Therefore, it is believed that our results were not affected with the means of photography. Finally, clinical outcomes with postoperative alignment using the HCC and TCC angles were not assessed.…”

Section: Discussionmentioning

confidence: 67%

Radiographic Comparison of the Mechanical Axis Including Calcaneus to the Conventional Mechanical Axis in Medial Unicompartmental Knee Arthroplasty

et al. 2019

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Since a hindfoot alignment is not included in the conventional mechanical axis (hip–ankle [HA] line), a mechanical axis including the calcaneus (hip–calcaneus [HC] line) has recently attracted attention as an alternative weight-bearing line. However, there are few reports on unicompartmental knee arthroplasty (UKA) regarding the HC line. Therefore, this study aimed to compare postoperative alignments after UKA between the HA line and the HC line. Postoperatively, HC radiographs were taken in 88 consecutive patients who underwent medial UKA. The hip–knee–ankle (HKA) and hip–knee–calcaneus (HKC) angles were compared in the same patient. Regarding tibial inclination, the conventional tibial component–ankle (TCA) angle was compared with reference to the HC line (tibial component–calcaneus [TCC] angle). The mean postoperative HKA and HKC angles were 2.8 ± 2.7 and 2.0 ± 2.5 degree, respectively. The mean postoperative TCA and TCC angles were 87.7 ± 2.1 and 88.5 ± 2.1 degree, respectively. There were significant differences between the two groups in both lower limb alignment and tibial component angle. The present study indicated that the HKC and the TCC angles significantly decreased the varus alignment by approximately 1 degree compared with the HKA and TCA angles. Neutral in the HA line corresponds to valgus in reference to the HC line, which may result in overcorrection. Surgeons should consider evaluating the HC line in place of the HA line, which may affect preoperative planning and postoperative outcome during UKA. This is a Level II, diagnostic study.

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Inter-observer reliability of measurements performed on digital long-leg standing radiographs and assessment of validity compared to 3D CT-scan

Cited by 38 publications

References 16 publications

3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty

3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty

Imageless robotic handpiece-assisted total knee arthroplasty: a learning curve analysis of surgical time and alignment accuracy

Radiographic Comparison of the Mechanical Axis Including Calcaneus to the Conventional Mechanical Axis in Medial Unicompartmental Knee Arthroplasty

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