Three-dimensional assessment of lower limb alignment: Accuracy and reliability

Fürmetz, Julian; Sass, J.; Junior, Tancredo Alcântara Ferreira; Jalali, Jalil; Kovâcs, László; Mück, Fabian; Degen, Nikolaus; Thaller, Peter Helmut

doi:10.1016/j.knee.2018.10.011

Cited by 33 publications

(69 citation statements)

References 24 publications

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“…While the 3D model c can accurately represent the patients' anatomy, the 2D projections (scanogram a and radiograph b) do not adequately display the full information agreement, compared to the only substantial agreement for the 2D JLCA measurements, and therefore, indicates more reliable measurements using 3D JLCA. Likewise, Furmetz et al demonstrated low intra-and interobserver variability in 3D measurements of the lower extremity parameters [9], encouraging the application of 3D measurements in this area. If measured in NWB images, 3D HKA measurements in this study correlated very well with the conventional 2D method.…”

Section: Discussionmentioning

confidence: 90%

“…Deformity assessment in the state-of-the-art computerassisted planning is performed in 3D. Although 3D measurements show low intra-and interobserver variability [9], differences between two-dimensional (2D) and 3D measurements of the hip-knee-ankle angle (HKA) have been shown [19]. Thus, considerable measurement errors have to be expected in preoperative 3D planning as a result of the discrepancies between the WB and nonweight-bearing (NWB) conditions as well as due to the used measurement modality itself.…”

Section: Introductionmentioning

confidence: 99%

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The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters

Jud

Roth

Fürnstahl

et al. 2020

BMC Musculoskelet Disord

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Background: Deformity assessment and preoperative planning of realignment surgery are conventionally based on weight-bearing (WB) radiographs. However, newer technologies such as three-dimensional (3D) preoperative planning and surgical navigation with patient-specific instruments (PSI) rely on non-weight bearing (NWB) computed tomography (CT) data. Additionally, differences between conventional two-dimensional (2D) and 3D measurements are known. The goal of the present study was to systematically analyse the influence of WB and the measurement modality (2D versus 3D) on common WB-dependent measurements used for deformity assessment. Methods: 85 lower limbs could be included. Two readers measured the hip-knee-ankle angle (HKA) and the joint line convergence angle (JLCA) in 2D WB and 2D NWB radiographs, as well as in CT-reconstructed 3D models using an already established 3D measurement method for HKA, and a newly developed 3D measurement method for JLCA, respectively. Interrater and intermodality reliability was assessed. Results: Significant differences between WB and NWB measurements were found for HKA (p < 0.001) and JLCA (p < 0.001). No significant difference could be observed between 2D HKA NWB and 3D HKA (p = 0.09). The difference between 2D JLCA NWB and 3D JLCA was significant (p < 0.001). The intraclass correlation coefficient (ICC) for the interrater agreement was almost perfect for all HKA and 3D JLCA measurements and substantial for 2D JLCA WB and 2D JLCA NWB. ICC for the intermodality agreement was almost perfect between 2D HKA WB and 2D HKA NWB as well as between 2D HKA NWB and 3D HKA, whereas it was moderate between 2D JLCA WB and 2D JLCA NWB and between 2D JLCA NWB and 3D JLCA. Conclusion: Limb loading results in significant differences for both HKA and JLCA measurements. Furthermore, 2D projections were found to be insufficient to represent 3D joint anatomy in complex cases. With an increasing number of surgical approaches based on NWB CT-reconstructed models, research should focus on the development of 3D planning methods that consider the effects of WB on leg alignment.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters

Jud

Roth

Fürnstahl

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Total femur CT scans require high radiation dosages, which definitively limits the application in a clinical routine. Furthermore, recent publications regarding anatomy assessment in 3D state that true 3D angle measurement for AV is not useful [25,26]. This is due to fact that the 3D angle between the femoral neck axis and tangent to the femoral condyles is not only determined by the AV but also strongly influenced by the CCD angle.…”

Section: Technical Aspects Of Ct Scanmentioning

confidence: 99%

Anteversion Angle Measurement in Suspected Torsional Malalignment of the Femur in 3-Dimensional EOS vs Computed Tomography—A Validation Study

Mayr

Schmidt

Haasters

et al. 2021

The Journal of Arthroplasty

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Background: Computed tomography (CT) scan is the standard for assessment of femoral torsion. This observational study was conducted to evaluate the comparability of the EOS radiation dose scanning system (EOS imaging, Paris, France) and the CT scan in patients with suspected torsional malalignment of the femur. Methods: Patients with suspected torsional malalignment of the femur were included in a study for surgical planning. The primary endpoint was to compare the 3-dimensional radiological (EOS) imaging system with the CT scan to determine femoral anteversion (AV) angle. Three independent raters performed measurements. Comparability of CT scan and EOS values was assessed by Pearson correlation, t test, interobserver reliability, and intraobserver reliability (Cronbach alpha). Results: About 34 femora were examined. Interobserver reliability/intraobserver reliability was 0.911 of 0.955 for EOS and 0.934 of 0.934 for CT scan. EOS system revealed an AV angle of 12.2 ± 10.0 (À15.0 to 32.0 ). CT examinations showed an AV angle of 12.6 ± 9.2 (À3.2 to 35.6 ). About 11 hips featured physiological AV, 14 hips showed decreased AV (<10 ) or retroversion (<0 ), and 9 hips showed increased AV (>20 ). Overall, a strong Pearson correlation of t ¼ 0.855 and a highly significant correlation in the t test for both methods was seen. In patients with decreased AV, retroversion, or increased AV, Pearson correlation only resulted in a moderate/low correlation of t ¼ 0.495 and t ¼ 0.292. The t test showed no significant correlation at malrotation. Conclusion: In torsional malalignment, EOS does not have correlation with CT measurements. In contrast to CT scan, EOS allows femoral torsion measurement independent of legs' positioning.

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“…It is important to understand the native anatomical and biomechanical features of the bones and joints to achieve the successful results in Orthopedics and Trauma surgery [1][2][3][4]. Therefore, over time the different imaging methods have been developed for detailed investigation of the native anatomical and morphological changes.…”

Section: Introductionmentioning

confidence: 99%

Determination of the Gender-Related Differences on Native Femoral Anatomy Using Three-Dimensional Computerized Tomography Models in Caucasian Population

Tanoğlu¹

2021

Cureus

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IntroductionThree-dimensional (3D) modelling, which has an increasing interest in the literature, could help surgeons to better understand the lesions by visualizing the real anatomical features compared to plain radiographs and two-dimensional (2D) tomography images. We aimed to evaluate the native femoral anatomical features of Turkish females and males using 3D computed tomography models. MethodsWe evaluated the right femoral anatomical features of 60 females and 60 males between 31 and 65 years of age creating 3D computerized tomography models. The gender-specific differences of femoral neck inclination and anteversion, femoral mechanical-anatomical axis, anatomical and mechanical lateral distal femoral, medial and lateral proximal femoral angles were measured on 3D femoral anatomical models. ResultsThe mean age of our study groups was 50.6 ± 8.5. We determined a statistically significant difference between gender groups in terms of mean femoral neck anteversion angles (p = 0.009). We observed the retroversion of the femoral neck in 12 adults (10%). The mean values of femoral neck inclination, femoral mechanical -anatomical angle, anatomical and mechanical lateral distal femoral angles, medial and lateral proximal femoral angles did not differ any statistical significance between gender groups. ConclusionAlthough the anatomical angle measurements except femoral neck anteversion, did not differ significantly between gender groups of our study, there were differences between mean anatomical angles when compared to other studies in the literature, which investigate the different races or Caucasian population. Through 3D anatomical data, more compatible implants, prosthesis or biomaterials can be produced by determining gender and race-specific anatomical differences.

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Three-dimensional assessment of lower limb alignment: Accuracy and reliability

Cited by 33 publications

References 24 publications

The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters

The impact of limb loading and the measurement modality (2D versus 3D) on the measurement of the limb loading dependent lower extremity parameters

Anteversion Angle Measurement in Suspected Torsional Malalignment of the Femur in 3-Dimensional EOS vs Computed Tomography—A Validation Study

Determination of the Gender-Related Differences on Native Femoral Anatomy Using Three-Dimensional Computerized Tomography Models in Caucasian Population

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