Inter-observer variability and its correlation to experience in measurement of lower limb mechanical axis on long leg radiographs

Vaishya, Raju; Vijay, Vipul; Birla, Vikas; Agarwal, Amit Kumar

doi:10.1016/j.jcot.2016.05.010

Journal of Clinical Orthopaedics and Trauma

2016

DOI: 10.1016/j.jcot.2016.05.010

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Inter-observer variability and its correlation to experience in measurement of lower limb mechanical axis on long leg radiographs

Raju Vaishya

Vipul Vijay

Vikas Birla

et al.

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Cited by 23 publications

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“…The authors have mentioned improved interobserver and intraobserver agreement using CT scans but did not explain this in detail. We have noticed that an interobserver agreement increases with the seniority and experience of the observer, probably due to better understanding and identification of the anatomical landmarks [3]. We believe that in the present study the ease of identification of anatomical landmarks using CT scans also helped improve interobserver agreement.…”

supporting

confidence: 51%

“…It is absolutely important to reduce the radiation exposure whenever possible. Thus, we adopted an autoexposure control system to minimize nonessential radiation exposure [3]. We also agree that the method of using scout films to calculate the 3D mechanical axis is desirable.…”

mentioning

confidence: 64%

“…Wagner et al [4] concluded the rates of reoperation, implant revision or removal, and common complications after total hip arthroplasty was strongly associated with BMI. However, Khatod et al [3] demonstrated BMI had no significant impact on the risk of hip re-revision. In the previous study, Jenkins et al [2] demonstrated a rate of survivorship free of any re-revision of 100% at 5 years and 97% at 10 years with a median BMI of 28.3 kg/m 2 (range, 17 to 48 kg/m 2 ).…”

mentioning

confidence: 99%

“…Results of Jenkins et al [2]suggest that, by carefully performing the surgery, a predictable success rate with porous tantalum augments can be achieved. In addition, Khatod et al [3] also demonstrated surgical factors at the time of revision total hip arthroplasty had a significant impact on the risk of rerevision. Therefore, the surgical factors are rather important in this kind of revision.…”

mentioning

confidence: 99%

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Response to Letter to the Editor on “Interobserver and Intraobserver Reliability of Computed Tomography-Based Three-Dimensional Preoperative Planning for Primary Total Knee Arthroplasty”

Miura

Hagiwara

2018

The Journal of Arthroplasty

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prediction using a computed tomography (CT)ebased technique [1]. The authors need congratulating for their work, but we would like to raise some concerns about this study:1. The authors have derived an improper conclusion that "CT-based 3D preoperative planning for primary total knee arthroplasty has clinical implications for predicting appropriate size and alignment of the component in patients with osteoarthritis and rheumatoid arthritis." However, their inference is not in line with the topic discussed in this study, which focuses on the intraobserver and interobserver variability in component size prediction and has not performed any correlation between the predicted and the finally implanted sizes. Hence, drawing an inference that CT-based size prediction has implications in predicting "appropriate" size would be incorrect. 2. The exclusion criteria have not been elaborated, in this pilot study. We wondered if the authors have excluded the patients with severe extra-articular deformities and those who had a significant bone loss, as these patients usually require special reconstructive procedures for the filling up of the bone defect such as cement, cement-screw construct, bone graft, and wedges. 3. The methodology of doing the CT scan is scanty in this study, as it is not clear whether the CT scan was a complete scan or just scout films at the level of the hip, knee, and ankle. We have used the CT scan for preoperative templating and found that the scout films are good enough to calculate the mechanical axis. It significantly decreases the radiation exposure due to the CT scan [2]. If the authors had subjected the patients to complete scans, then the amount of radiation exposure to the patients included in the study may raise some ethical issues. 4. The authors have mentioned improved interobserver and intraobserver agreement using CT scans but did not explain this in detail. We have noticed that an interobserver agreement increases with the seniority and experience of the observer, probably due to better understanding and identification of the anatomical landmarks [3]. We believe that in the present study the ease of identification of anatomical landmarks using CT scans also helped improve interobserver agreement. 5. In the table enumerating parameters for ideal size prediction for the tibia, the authors have mentioned that the ideal size was one which prevented overhang and "notching." We did not understand the meaning of "notching" on the tibial side, as it is commonly documented on the femoral side only. It is known, that one of the leading concerns for the tibial side component is the correct coverage, and the presence of underhang on the tibial side may lead to tray subsidence as it sits solely on cancellous bone. The authors should have included this criterion in the prediction of an ideal tibial size [4].

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supporting

confidence: 51%

mentioning

confidence: 64%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Response to Letter to the Editor on “Interobserver and Intraobserver Reliability of Computed Tomography-Based Three-Dimensional Preoperative Planning for Primary Total Knee Arthroplasty”

Miura

Hagiwara

2018

The Journal of Arthroplasty

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“…Similarly, measurement of the mechanical axis on long leg radiographs is considered useful to assess the pre operative deformities of the knee and to check on the restoration of limb alignment after TKA. Vaishya et al 10 reported intra observer variability in these measurments and found that the accuracy depends on of the experience of the personnel.…”

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confidence: 99%

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Vaishya¹,

Lal²

2016

Journal of Clinical Orthopaedics and Trauma

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Artificial intelligence‐based assessment of leg axis parameters shows excellent agreement with human raters: A systematic review and meta‐analysis

Salzmann,

Hassan Tarek,

Prill

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to conduct a systematic review and meta‐analysis on the reliability and applicability of artificial intelligence (AI)‐based analysis of leg axis parameters. We hypothesized that AI‐based leg axis measurements would be less time‐consuming and as accurate as those performed by human raters.MethodsThe study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). PubMed, Epistemonikos, and Web of Science were searched up to 24 February 2024, using a BOOLEAN search strategy. Titles and abstracts of identified records were screened through a stepwise process. Data extraction and quality assessment of the included papers were followed by a frequentist meta‐analysis employing a common effect/random effects model with inverse variance and the Sidik–Jonkman heterogeneity estimator.ResultsA total of 13 studies encompassing 3192 patients were included in this meta‐analysis. All studies compared AI‐based leg axis measurements on long‐leg radiographs (LLR) with those performed by human raters. The parameters hip knee ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint‐line convergence angle (JLCA) showed excellent agreement between AI and human raters. The AI system was approximately 3 min faster in reading standing long‐leg anteroposterior radiographs (LLRs) compared with human raters.ConclusionAI‐based assessment of leg axis parameters is an efficient, accurate, and time‐saving procedure. The quality of AI‐based assessment of the investigated parameters does not appear to be affected by the presence of implants or pathological conditions.Level of EvidenceLevel I.

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Inter-observer variability and its correlation to experience in measurement of lower limb mechanical axis on long leg radiographs

Cited by 23 publications

References 22 publications

Response to Letter to the Editor on “Interobserver and Intraobserver Reliability of Computed Tomography-Based Three-Dimensional Preoperative Planning for Primary Total Knee Arthroplasty”

Response to Letter to the Editor on “Interobserver and Intraobserver Reliability of Computed Tomography-Based Three-Dimensional Preoperative Planning for Primary Total Knee Arthroplasty”

Learn through innovation, research and publication

Artificial intelligence‐based assessment of leg axis parameters shows excellent agreement with human raters: A systematic review and meta‐analysis

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