Inter-observer and intra-observer reliability of mechanical axis alignment before and after total knee arthroplasty using long leg radiographs

Bowman, Anneka; Shunmugam, Meenalochani; Watts, AC; Bramwell, Donald; Wilson, Christopher J.; Krishnan, Jeganath

doi:10.1016/j.knee.2015.11.013

Cited by 39 publications

(32 citation statements)

References 24 publications

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“…are available. Of these, scanogram is considered the gold standard as it takes into consideration the competence of the ligaments in weight bearing orientation of the limb [1–4]. But the chief drawback of scanogram is that it does not take into consideration the third dimension of the limb and thus for accuracy, the scanogram should be taken in the plane of measurement.…”

Section: Introductionmentioning

confidence: 99%

Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

Bhimani

Bhimani²,

Singh

2019

Advances in Orthopedics

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Introduction. Malpositioning of the implant results in polyethylene wear and loosing of implant after total knee arthroplasty. Scanogram is often used for measurement of limb alignment. Computer navigation provides real time measurements and thus, the aim is to see any association pre- and postoperatively between coronal alignments measured on scanogram to computer navigation during total knee arthroplasty. Material and Methods. We prospectively gathered data of 200 patients with advanced degenerative symptomatic arthritis, who were consecutively selected for primary total knee arthroplasty with computer navigation. Every patient’s pre- and postoperative scanogram were compared to the intraoperative computer navigation findings. Results. The results show that the preoperative mean mechanical axis on navigation was 10.65° (SD ± 6.95) and on scanogram it was 10.38° (SD ± 6.89). On the other hand, the mean postoperative mechanical axis on navigation was 0.69° (SD ± 0.87) and on scanogram it was 2.73° (SD ± 2.10). Preoperatively, there was no significant difference (p value = 0.46) between the two. However, the postoperative outcomes suggest that there was a noteworthy difference, with no correlation between the mean Hip-Knee Ankle Axis (HKA) and intraoperative mechanical axis (p value <0.0001). Conclusion. Postoperative mechanical alignment values after total knee arthroplasty are lower on navigation than measured on standing full length hip to ankle scanogram.

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Section: Introductionmentioning

confidence: 99%

Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

Bhimani

Bhimani²,

Singh

2019

Advances in Orthopedics

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“…On the one hand, good intra-and interobserver correlations, with adequate repeatability coefficients in LLR measurements have been demonstrated in published papers. [18][19][20][21][22] On the other hand, in an own previous study, the over time-spaced measurements intraclass correlation coefficient of the senior observer was almost perfect (0.987; 95% confidence interval [CI]: 0.984-0.99) according to the criteria of Landis and Koch, 23 denoting low intraobserver variability. The postoperative measurement was blinded to the preoperative values and always performed with a minimum of 6 weeks of separation between both.…”

Section: Methodsmentioning

confidence: 94%

Computed Tomography-Based Patient-Specific Instrumentation Loses Accuracy with Significant Varus Preoperative Misalignment

et al. 2020

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Patient-specific instrumentation (PSI) has been introduced to simplify and make total knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed this study to determine whether the postoperative coronal alignment is related to preoperative deformity when computed tomography (CT)-based PSI is used for TKA surgery, and how the PSI approach compares with deformity correction obtained with conventional instrumentation. We analyzed pre-and post-operative full length standing hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention > 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI group, the mean (± SD) pre-operative HKA angle was 172.09 degrees varus (± 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was 179.43 degrees varus (± 2.32 degrees) with a maximum varus alignment of seven degrees and a maximum valgus alignment of six degrees. There has been a weak correlation among the values of the pre- and postoperative HKA angle. The adjusted odds ratio (aOR) of postoperative alignment outside the range of 180 ± 3 degrees was significantly higher with a preoperative varus misalignment of 15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p = 0.013). In the control group (conventional instrumentation), this loss of accuracy occurs with preoperative misalignment of 10 degrees. Preoperative misalignment below 15 degrees appears to present minimal influence on postoperative alignment when a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with preoperative varus misalignment over 15 degrees.

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“…In most cases however, long-leg AP radiographs can be relied upon to evaluate deformities with strong reliability across different levels of surgical experience. 48 The radiographs must be made in neutral rotation with the patellae facing forwards to avoid errors in assessing deformities with femoral bowing. 49 These films are also handy in estimating coronal laxity, planning of bone resection levels and orientation of implants in relation to the mechanical axes.…”

Section: Radiological Evaluationmentioning

confidence: 99%

Extra-articular deformities in arthritic knees-a grueling challenge for arthroplasty surgeons: An evidence-based update

et al. 2018

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Critical to the success of a total knee arthroplasty (TKA) is the anatomical alignment. This may appear as a challenge in an extra-articular deformity (EAD) that may be inherent in certain people or result from fracture malunion, congenital disorders, nutritional, metabolic and infective causes. This appraisal aimed at providing the reader with an up-todate overview of the research carried out on, and existent evidence of EAD correction while planning a TKA. We reviewed the current English literature on TKA in extra-articular knee deformities. Among the published data, a common initial approach of mandatory clinical and radiological assessment emerges as an obligatory step while handling cases with EAD. While several methods of managing the deformity and arthritis have been described, a broad division into intra-articular and extra-articular means can be deciphered. The relatively old-school, yet reliable thought process of extra-articular correction allows an all-inclusive restoration of alignment with the inherent complications related to the necessary osteotomy. A cohort of younger and more venturesome surgeons seem inclined towards performing navigated, intra-articular correction for mild to moderate and sometimes, severe deformities. The crux of the matter lies is obtaining a well-balanced knee without violating the all-important cruciates. Restoring the patient’s ambulatory status seems sooner with the intra-articular methods which are also more precise in determining the axes and while removing minimum bone. Greatest satisfaction is accomplished in those with less grotesque, rotationallyaligned knees while meticulously balancing soft-tissues and encouraging earlier weightbearing.

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Inter-observer and intra-observer reliability of mechanical axis alignment before and after total knee arthroplasty using long leg radiographs

Cited by 39 publications

References 24 publications

Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

Computed Tomography-Based Patient-Specific Instrumentation Loses Accuracy with Significant Varus Preoperative Misalignment

Extra-articular deformities in arthritic knees-a grueling challenge for arthroplasty surgeons: An evidence-based update

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