Reliability of EOS compared to conventional radiographs for evaluation of lower extremity deformity in adult patients

Wise, Kelsey; Kelly, Brandon J.; Agel, Julie; Marette, Shelly; Macalena, Jeffrey A.

doi:10.1007/s00256-020-03425-9

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Also the age and sex distribution in the TS cohort was similar to that of the larger GMP cohort. Other measurements at the knee remain valid, as EOS and standard radiographs have been shown to be similar near the center of the images 26,28,29 . Furthermore, the demographics and time between imaging and surgery also showed high similarity between the TS and GMP groups, further validating the cohort.…”

Section: Validity Of the Matched Cohortmentioning

confidence: 85%

Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity

McGinley

Worrall

Althoff

et al. 2023

Journal of Bone and Joint Surgery

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Background: Hemiepiphysiodesis (guided-growth) procedures have become the primary method of treatment for coronal-plane knee deformities in skeletally immature patients. Two leading techniques involve the use of a transphyseal screw or a growth modulation plate. However, clinical references for the estimation of correction are lacking, and no consensus has been reached regarding the superiority of one technique over the other. Therefore, the purpose of this study was to compare the rates of correction for distal femoral transphyseal screws and growth modulation plates in age- and sex-matched cohorts with coronal deformities. Methods: Thirty-one knees were included in each cohort on the basis of propensity scoring by chronological age and sex, and radiographic images were retrospectively reviewed preoperatively and postoperatively. Each case was measured for limb length, mechanical axis deviation (MAD), mechanical lateral distal femoral angle (LDFA), and bone age. Results: Both the MAD and LDFA rate of correction significantly differed between the screw and plate cohorts. The MAD rate of correction was observed to be 0.42 ± 0.37 mm/week (1.69 mm/month) in the plate cohort and 0.66 ± 0.51 mm/week (2.64 mm/month) in the screw cohort. The LDFA rate of correction was observed to be 0.12° ± 0.13°/week (0.50°/month) in the plate cohort and 0.19° ± 0.19°/week (0.77°/month) in the screw cohort. Conclusions: The current study provides simple clinical references for the rate of correction of MAD and the LDFA for 2 methods of hemiepiphysiodesis. The results suggest that transphyseal screws may correct coronal knee deformities during the initial treatment stage more quickly than growth modulation plates in distal femoral guided growth. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Validity Of the Matched Cohortmentioning

confidence: 85%

Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity

McGinley

Worrall

Althoff

et al. 2023

Journal of Bone and Joint Surgery

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“…This is important as even in healthy subjects, lower extremity alignment can vary significantly [ 16 ]. When compared to CR, EOS has shown differences in varus/valgus angle, femoral length as well as total limb length [ 17 ]. This matches our results for functional leg length as well as anatomical tibial and femoral length with significant intermodal differences.…”

Section: Discussionmentioning

confidence: 99%

Distances and angles in standing long-leg radiographs: comparing conventional radiography, digital radiography, and EOS

Birkenmaier,

Levrard,

Melcher

et al. 2024

Skeletal Radiol

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Objective Distances and angles measured from long-leg radiographs (LLR) are important for surgical decision-making. However, projectional radiography suffers from distortion, potentially generating differences between measurement and true anatomical dimension. These phenomena are not uniform between conventional radiography (CR) digital radiography (DR) and fan-beam technology (EOS). We aimed to identify differences between these modalities in an experimental setup. Materials and methods A hemiskeleton was stabilized using an external fixator in neutral, valgus and varus knee alignment. Ten images were acquired for each alignment and each modality: one CR setup, two different DR systems, and an EOS. A total of 1680 measurements were acquired and analyzed. Results We observed great differences for dimensions and angles between the 4 modalities. Femoral head diameter measurements varied in the range of > 5 mm depending on the modality, with EOS being the closest to the true anatomical dimension. With functional leg length, a difference of 8.7% was observed between CR and EOS and with the EOS system being precise in the vertical dimension on physical-technical grounds, this demonstrates significant projectional magnification with CR-LLR. The horizontal distance between the medial malleoli varied by 20 mm between CR and DR, equating to 21% of the mean. Conclusions Projectional distortion resulting in variations approaching 21% of the mean indicate, that our confidence on measurements from standing LLR may not be justified. It appears likely that among the tested equipment, EOS-generated images are closest to the true anatomical situation most of the time.

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“…While many studies mentioned above reported that EOS is reliable and reproducible for assessing lower limb alignment compared to conventional scanograms, some authors focused on the difference of lower limb measurements between EOS and conventional scanograms. Wise et al 25) conducted a study that included 10 patients with posttraumatic deformity who presented for evaluation of osteotomies. They concluded that the differences between conventional X-ray and EOS measurements were statistically significant; however, the value was 0.26°, too small to drive a treatment decision.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Lower-Limb Alignment in Patients with Advanced Knee Osteoarthritis: EOS Biplanar Stereoradiography versus Conventional Scanography

et al. 2022

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Background Accurate measurement of the lower limb alignment is one of the most crucial factors in advanced knee osteoarthritis patients scheduled for surgery. Recently, EOS biplanar stereoradiography with three-dimensional reconstruction was developed. The purpose of this study was to compare radiographic parameters between conventional scanography and EOS in patients with advanced knee osteoarthritis who need surgical treatment. Methods A total of 52 consecutive patients (104 knees) with bilateral knee osteoarthritis of advanced stage (Kellgren-Lawrence [KL] grade 3 or 4) were retrospectively reviewed. We measured the hip-knee-ankle angle (HKA) on conventional scanograms. In EOS, we measured HKA, hip-knee-shaft angle, mechanical lateral distal femoral angle, and mechanical medial proximal tibial angle. To evaluate sagittal and axial plane alignment, knee flexion angle (KFA), and knee joint rotation (KJR) were also measured. Results Ninety knees were KL grade 4, and 14 knees were grade 3. The average HKA was 10.14° ± 6.16° on conventional scanograms and 11.26° ± 6.21° in EOS. HKA was greater in EOS than on conventional scanograms, and the difference (1.12°; range, −1.07° to 3.22°) was statistically significant ( p < 0.001). Significant correlations were observed on the difference in HKA and mechanical medial proximal tibial angle ( r = –0.198, p = 0.044), KFA ( r = 0.193, p = 0.049), and KJR ( r = 0.290, p = 0.003). In multivariable linear regression analysis, the difference in HKA had significant relationship with KFA (β = 0.286, p = 0.003) and KJR (β = 0.363, p < 0.001). Conclusions HKA measured on conventional scanograms and in EOS differed significantly and the difference had a significant correlations with KFA, KJR, and medial proximal tibial angle. Surgeons can consider these results before orthopedic surgery in patients who have advanced knee osteoarthritis.

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Reliability of EOS compared to conventional radiographs for evaluation of lower extremity deformity in adult patients

Cited by 7 publications

References 22 publications

Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity

Faster Rate of Correction with Distal Femoral Transphyseal Screws Versus Plates in Hemiepiphysiodesis for Coronal-Plane Knee Deformity

Distances and angles in standing long-leg radiographs: comparing conventional radiography, digital radiography, and EOS

Comparison of Lower-Limb Alignment in Patients with Advanced Knee Osteoarthritis: EOS Biplanar Stereoradiography versus Conventional Scanography

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