The need for a standardized whole leg radiograph guideline: The effects of knee flexion, leg rotation, and X-ray beam height

Nguyen, Huu Chien; Gielis, Willem Paul; Egmond, Nienke van; Weinans, Harrie; Slump, Cornelis H.; Sakkers, R. J. B.; Custers, Roel J.H.

doi:10.1016/j.jcjp.2021.100022

Cited by 10 publications

(10 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Knee flexion was also only indirectly controlled in our protocol by asking patients to stand in full knee extension. Previous studies have demonstrated that a substantial degree of leg rotation of 10° or more is needed to alter HKA measurements in a clinically relevant fashion 8,18,34,35 . But with added knee flexion of 10°, the error becomes at least 2°3 5,36 .…”

Section: Discussionmentioning

confidence: 99%

“…A potential clinically relevant problem when considering that up to one-third of knee OA patients presents a knee flexion contracture of 6° or greater 37 . This highlights the importance of controlling leg rotation during WLR acquisition, to minimize the effect of knee flexion on standing WLRs 35,36 . Of note, controlling leg rotation using fixed floor template is not suitable for every patient.…”

Section: Discussionmentioning

confidence: 99%

“…This could be valuable in order to study the effects of rotational deformities in the lower limb on the measured geometry. An implied limitation of employing single view, standardized AP radiographs is the lack of 3-dimensional information regarding the tibial and femoral rotation and knee flexion contracture 35,36 . Third, this study included no control group undergoing the WLR protocol as proposed by Paley 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Future studies should add a control group undergoing the Paley WLR protocol and consider measuring the test-retest mMPTA, mLDFA, and JLCA at and beyond one decimal place accuracy, understanding that further accuracy may be mathematically significant but of clinically decreasing relevance and utility. Finally, future studies should consider adding 3D analyses for the measurement of tibial and femoral rotation 35,36 .…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A new protocol for obtaining whole leg radiographs with excellent reproducibility

Nguyen

Egmond

Hevesi

et al. 2022

Journal of Cartilage & Joint Preservation

Self Cite

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A new protocol for obtaining whole leg radiographs with excellent reproducibility

Nguyen

Egmond

Hevesi

et al. 2022

Journal of Cartilage & Joint Preservation

Self Cite

View full text Add to dashboard Cite

show abstract

“…Included patients were all placed in the examination room following the WLR protocol used at our radiology department. 10 The conditions for obtaining the digital photograph were kept similar to the WLR, making the images from the 2 modalities consistent for assessments. The patient’s feet were placed 10° externally rotated and 10 cm apart on a template.…”

Section: Methodsmentioning

confidence: 99%

Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable

et al. 2022

Self Cite

View full text Add to dashboard Cite

Objective Visual inspection of the lower limb is often part of standard clinical practice during a physical examination at the outpatient clinic. This study aims to investigate how reliable visual inspections are in terms of detecting lower limb malalignments without additional tools and physical examinations. Design This study enrolled 50 patients. Each patient underwent a whole leg radiograph (WLR); in addition, a standardized digital photograph was taken of the lower limbs. Four persons (different experience levels) visually rated the digital photograph twice (unaware of the hip knee angle [HKA] on the WLR) and placed them in the category: severe valgus (>5°); moderate valgus (2°-5°); neutral, moderate varus (2°-5°); and severe varus (>5°). Visual ratings were compared with the measured HKA on WLRs for correlation using Spearman’s rho. Linear ordinal regression models with significance when P < 0.05 were used to test whether body mass index (BMI), age, gender, and HKA were possible risk factors for incorrect visual HKA assessment. Results Spearman’s rho between the visual assessment and measured HKA on the WLR was moderate with 0.478 ( P < 0.01). Women had an increased odds ratio of 3.7 ( P = 0.001) for incorrect visual assessment. Higher HKA also increased the odds ratio for erroneous visual assessment with 1.4 ( P = 0.003). BMI and age did not significantly increase the odds of erroneous visual leg axis assessments in this study. Conclusions Visual assessment of the lower limb alignment does not provide clinically relevant information. Lower limb malalignment diagnoses cannot be performed using only a visual inspection. Physical examination tests and radiographical assessments are advised. Level of evidence: Diagnostic level II

show abstract

High variability exists in 3D leg alignment analysis, but underlying principles that might lead to agreement on a universal framework could be identified: A systematic review

Veerman,

ten Heggeler,

Tuijthof

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeTo (1) investigate the hypothesis that there is high variability in the reported methods to derive axes and joint orientations from three‐dimensional (3D) bone models to (a) perform 3D knee‐related leg alignment analysis and (b) define coordinate systems for the femur, tibia and leg and (2) identify underlying principles that might lead to agreement on a universal 3D leg alignment analysis framework.MethodsA systematic review of the literature between January 2006 and June 2024 was performed. Articles explicitly reporting methods to derive axes and joint orientations from CT‐based 3D bone models for alignment parameters and/or coordinate systems of the femur, tibia and leg were included. Study characteristics and reported methods were extracted and presented as a qualitative synthesis.ResultsA total of 93 studies were included. There was high variability in the reported methods to derive axes and joint orientations from 3D bone models. Nevertheless, the reported methods could be categorized into four groups, and several underlying principles of the four groups could be identified. Furthermore, the definitions of femoral and tibial coordinate systems were most frequently based on the mechanical axis (femoral, 13/19 [68%]; tibial, 13/26 [50%]) and a central medial‐lateral axis (femoral, 16/19 [84%]; tibial, 12/26 [46%]); no leg coordinate system was reported. Interestingly, of the included studies that reported on leg alignment parameters (76/93, 82%), only a minority reported expressing these in a complete coordinate system (25/76, 33%).ConclusionThere is high variability in 3D knee‐related leg alignment analysis. Therefore, universal 3D reference values for alignment parameters cannot yet be defined, and comparison of alignment parameter values between different studies is impossible. However, several underlying principles to the reported methods were identified, which could serve to reach more agreement on a future universal 3D framework for leg alignment analysis.Level of EvidenceLevel I (1).

show abstract

The need for a standardized whole leg radiograph guideline: The effects of knee flexion, leg rotation, and X-ray beam height

Cited by 10 publications

References 31 publications

A new protocol for obtaining whole leg radiographs with excellent reproducibility

A new protocol for obtaining whole leg radiographs with excellent reproducibility

Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable

High variability exists in 3D leg alignment analysis, but underlying principles that might lead to agreement on a universal framework could be identified: A systematic review

Contact Info

Product

Resources

About