“…Our results are amongst the best, with similar inter- and intra-observer reliability compared to other authors; for this, we have the following explanations: the reference points were specified in a precise manner and all three of the examiners followed the same protocol [ 6 , 8 , 22 , 23 , 26 , 27 , 29 – 31 , 34 , 35 , 39 , 42 , 44 , 48 ].…”
Section: Discussionsupporting
confidence: 78%
“…The repeatability and reliability of the classic Berger method and its modifications were examined by several authors. Most of them mention good and excellent intra- and inter-observer intra-class correlation coefficients (ICC) [ 8 , 23 , 26 , 27 , 29 – 31 , 35 , 42 , 44 , 48 ].…”
Purpose
The revision of any total knee replacement is carried out in a significant number of cases, due to the excessive internal rotation of the tibial component. The goal was to develop a personalized method, using only the geometric parameters of the tibia, without the femoral guidelines, to calculate the postoperative rotational position of tibial component malrotation within a tolerable error threshold in every case.
Methods
Preoperative CT scans of eighty-five osteoarthritic knees were examined by three independent medical doctors twice over 7 weeks.
The geometric centre of the tibia was produced by the ellipse annotation drawn 8 mm below the tibial plateau, the sagittal and frontal axes of the ellipse were transposed to the slice of the tibial tuberosity. With the usage of several guide lines, a right triangle was drawn within which the personalized Berger angle was calculated.
Results
A very good intra-observer (0.89-0.925) and inter-observer (0.874) intra-class correlation coefficient (ICC) was achieved. Even if the average of the personalized Berger values were similar to the original 18° (18.32° in our case), only 70.6% of the patients are between the clinically tolerable thresholds (12.2° and 23.8°).
Conclusion
The method, measured on the preoperative CT scans, is capable of calculating the required correction during the planning of revision arthroplasties which are necessary due to the tibial component malrotation. The personalized Berger angle isn’t altered during arthroplasty, this way it determines which one of the anterior reference points of the tibia (medial 1/3 or the tip of the tibial tuberosity, medial border or 1/6 or 1/3 or the centre of the patellar tendon) can be used during the positioning of the tibial component.
Level of evidence
Level II, Diagnostic Study (Methodological Study).
“…Our results are amongst the best, with similar inter- and intra-observer reliability compared to other authors; for this, we have the following explanations: the reference points were specified in a precise manner and all three of the examiners followed the same protocol [ 6 , 8 , 22 , 23 , 26 , 27 , 29 – 31 , 34 , 35 , 39 , 42 , 44 , 48 ].…”
Section: Discussionsupporting
confidence: 78%
“…The repeatability and reliability of the classic Berger method and its modifications were examined by several authors. Most of them mention good and excellent intra- and inter-observer intra-class correlation coefficients (ICC) [ 8 , 23 , 26 , 27 , 29 – 31 , 35 , 42 , 44 , 48 ].…”
Purpose
The revision of any total knee replacement is carried out in a significant number of cases, due to the excessive internal rotation of the tibial component. The goal was to develop a personalized method, using only the geometric parameters of the tibia, without the femoral guidelines, to calculate the postoperative rotational position of tibial component malrotation within a tolerable error threshold in every case.
Methods
Preoperative CT scans of eighty-five osteoarthritic knees were examined by three independent medical doctors twice over 7 weeks.
The geometric centre of the tibia was produced by the ellipse annotation drawn 8 mm below the tibial plateau, the sagittal and frontal axes of the ellipse were transposed to the slice of the tibial tuberosity. With the usage of several guide lines, a right triangle was drawn within which the personalized Berger angle was calculated.
Results
A very good intra-observer (0.89-0.925) and inter-observer (0.874) intra-class correlation coefficient (ICC) was achieved. Even if the average of the personalized Berger values were similar to the original 18° (18.32° in our case), only 70.6% of the patients are between the clinically tolerable thresholds (12.2° and 23.8°).
Conclusion
The method, measured on the preoperative CT scans, is capable of calculating the required correction during the planning of revision arthroplasties which are necessary due to the tibial component malrotation. The personalized Berger angle isn’t altered during arthroplasty, this way it determines which one of the anterior reference points of the tibia (medial 1/3 or the tip of the tibial tuberosity, medial border or 1/6 or 1/3 or the centre of the patellar tendon) can be used during the positioning of the tibial component.
Level of evidence
Level II, Diagnostic Study (Methodological Study).
“…2 and 3 ). To our knowledge, only one publication reporting the reliability of the rotational position of TKR has reported limits of agreement, and this is in a non-standard form [ 31 ]. Fig.…”
Objectives
Rotational malalignment of knee replacements as measured on CT is understood to be associated with poor outcomes. The aim of this study is to measure the inter-rater and intra-rater reliability of measures of femoral and tibial version in the native arthritic knee and postoperative TKR component position using CT.
Methods
Eighty patients underwent CT of the knee before and after total knee replacement. Preoperative femoral and tibial version and component rotation were independently measured by two musculoskeletal radiologists.
Results
Mean differences between and within raters were small (< 1.6°). Maximum 95% limits of agreement for inter-rater and intra-rater comparisons were 8.1° and 7.6° for preoperative femoral version, 9.0° and 7.9° for postoperative femoral rotation, 26.0° and 20.5° for preoperative tibial version, and 24.9° and 23.6° for postoperative tibial rotation respectively. Postoperative ICCs varied from 0.68 to 0.81 (lower 95% CI:0.55–0.72) for both intra- and inter-rater comparisons. Preoperative ICCs were lower: 0.55–0.75 (lower 95% CI:0.40–0.65).
Conclusion
The lower 95% confidence level for ICC of version and rotational measurements using the Berger protocol of TKRs on CT are all less than 0.73 and that the normal range of differences between observers is up to 9° for the femoral component and 26° for the tibial component. This suggests that CT measurements derived from the Berger protocol may not be consistent enough for clinical practice.
Key Points
• CT is commonly used to measure the rotational profile of knee replacements in symptomatic patients using the Berger protocol.
• The limits of agreement for both femoral and tibial component rotation are wide even for experienced observers.
• CT measurements of the rotation of knee arthroplasty are not reliable enough for routine clinical use.
“…Complications secondary to poor component alignment have been reported to lead to a higher rate of revision surgery [9,10]. Computerised tomography (CT) imaging is a valid and reproducible technique for accurately measuring TKR-component rotation [11,12]. However, despite CT being widely used to examine implant rotation, the correlation between rotational alignment, PROMs and kinematic function comparing pre-and post-operative measurement is unclear [13,14].…”
Background: Osteoarthritis of the knee is a common condition that is expected to rise in the next two decades leading to an associated increase in total knee replacement (TKR) surgery. Although there is little debate regarding the safety and efficacy of modern TKR, up to 20% of patients report poor functional outcomes following surgery. This study will investigate the functional outcome of two TKRs; the JOURNEY II Bi-Cruciate Stabilised knee arthroplasty, a newer knee prosthesis designed to provide guided motion and improve knee kinematics by more closely approximating a normal knee, and the GENESIS II, a proven existing design. Aim: To compare the change in Patient-reported Outcome Measures (PROMs) scores of the JOURNEY II BCS and the GENESIS II from pre-operation to 6 months post operation. Methods: CAPAbility is a pragmatic, blinded, two-arm parallel, randomised controlled trial recruiting patients with primary osteoarthritis due to have unilateral TKR surgery across two UK hospitals. Eligible participants (n = 80) will be randomly allocated to receive either the JOURNEY II or the GENESIS II BCS knee prosthesis. Baseline measures will be taken prior to surgery. Patients will be followed at 1 week, 6 to 8 weeks and 6 months post-operatively. The primary outcome is the Oxford Knee Score (OKS) at 6 months post-operatively. Secondary outcomes include: other PROMs, biomechanical, radiological (computerised tomography, (CT)), clinical efficacy and safety outcomes. An embedded qualitative study will also investigate patients' perspectives via interview pre and post surgery on variables known to affect the outcome of TKR surgery. A sub-sample (n = 30) will have additional in-depth interviews to explore the themes identified. The surgeons' perspectives on the operation will be investigated by a group interview after all participants have undergone surgery. Discussion: This trial will evaluate two generations of TKR using PROMS, kinematic and radiological analyses and qualitative outcomes from the patient perspective.
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