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Miyama K, Akiyama T, Bise R, Nakamura S, Nakashima Y, Uchida S. Development of an automatic surgical planning system for high tibial osteotomy using artificial intelligence. Knee 2024; 48:128-137. [PMID: 38599029 DOI: 10.1016/j.knee.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND This study proposed an automatic surgical planning system for high tibial osteotomy (HTO) using deep learning-based artificial intelligence and validated its accuracy. The system simulates osteotomy and measures lower-limb alignment parameters in pre- and post-osteotomy simulations. METHODS A total of 107 whole-leg standing radiographs were obtained from 107 patients who underwent HTO. First, the system detected anatomical landmarks on radiographs. Then, it simulated osteotomy and automatically measured five parameters in pre- and post-osteotomy simulation (hip knee angle [HKA], weight-bearing line ratio [WBL ratio], mechanical lateral distal femoral angle [mLDFA], mechanical medial proximal tibial angle [mMPTA], and mechanical lateral distal tibial angle [mLDTA]). The accuracy of the measured parameters was validated by comparing them with the ground truth (GT) values given by two orthopaedic surgeons. RESULTS All absolute errors of the system were within 1.5° or 1.5%. All inter-rater correlation confidence (ICC) values between the system and GT showed good reliability (>0.80). Excellent reliability was observed in the HKA (0.99) and WBL ratios (>0.99) for the pre-osteotomy simulation. The intra-rater difference of the system exhibited excellent reliability with an ICC value of 1.00 for all lower-limb alignment parameters in pre- and post-osteotomy simulations. In addition, the measurement time per radiograph (0.24 s) was considerably shorter than that of an orthopaedic surgeon (118 s). CONCLUSION The proposed system is practically applicable because it can measure lower-limb alignment parameters accurately and quickly in pre- and post-osteotomy simulations. The system has potential applications in surgical planning systems.
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Affiliation(s)
- Kazuki Miyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan; Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka 819-0395, Japan; Akiyama Clinic, 2-28-39, Noke, Sawaraku, Fukuoka City, Fukuoka 814-0171, Japan.
| | - Takenori Akiyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan; Akiyama Clinic, 2-28-39, Noke, Sawaraku, Fukuoka City, Fukuoka 814-0171, Japan
| | - Ryoma Bise
- Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka 819-0395, Japan
| | - Shunsuke Nakamura
- Akiyama Clinic, 2-28-39, Noke, Sawaraku, Fukuoka City, Fukuoka 814-0171, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
| | - Seiichi Uchida
- Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka 819-0395, Japan
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Wilhelm NJ, von Schacky CE, Lindner FJ, Feucht MJ, Ehmann Y, Pogorzelski J, Haddadin S, Neumann J, Hinterwimmer F, von Eisenhart-Rothe R, Jung M, Russe MF, Izadpanah K, Siebenlist S, Burgkart R, Rupp MC. Multicentric development and validation of a multi-scale and multi-task deep learning model for comprehensive lower extremity alignment analysis. Artif Intell Med 2024; 150:102843. [PMID: 38553152 DOI: 10.1016/j.artmed.2024.102843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
Osteoarthritis of the knee, a widespread cause of knee disability, is commonly treated in orthopedics due to its rising prevalence. Lower extremity misalignment, pivotal in knee injury etiology and management, necessitates comprehensive mechanical alignment evaluation via frequently-requested weight-bearing long leg radiographs (LLR). Despite LLR's routine use, current analysis techniques are error-prone and time-consuming. To address this, we conducted a multicentric study to develop and validate a deep learning (DL) model for fully automated leg alignment assessment on anterior-posterior LLR, targeting enhanced reliability and efficiency. The DL model, developed using 594 patients' LLR and a 60%/10%/30% data split for training, validation, and testing, executed alignment analyses via a multi-step process, employing a detection network and nine specialized networks. It was designed to assess all vital anatomical and mechanical parameters for standard clinical leg deformity analysis and preoperative planning. Accuracy, reliability, and assessment duration were compared with three specialized orthopedic surgeons across two distinct institutional datasets (136 and 143 radiographs). The algorithm exhibited equivalent performance to the surgeons in terms of alignment accuracy (DL: 0.21 ± 0.18°to 1.06 ± 1.3°vs. OS: 0.21 ± 0.16°to 1.72 ± 1.96°), interrater reliability (ICC DL: 0.90 ± 0.05 to 1.0 ± 0.0 vs. ICC OS: 0.90 ± 0.03 to 1.0 ± 0.0), and clinically acceptable accuracy (DL: 53.9%-100% vs OS 30.8%-100%). Further, automated analysis significantly reduced analysis time compared to manual annotation (DL: 22 ± 0.6 s vs. OS; 101.7 ± 7 s, p ≤ 0.01). By demonstrating that our algorithm not only matches the precision of expert surgeons but also significantly outpaces them in both speed and consistency of measurements, our research underscores a pivotal advancement in harnessing AI to enhance clinical efficiency and decision-making in orthopaedics.
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Affiliation(s)
- Nikolas J Wilhelm
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, Munich, Germany; Munich Institute of Robotics and Machine Intelligence, Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany.
| | - Claudio E von Schacky
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Felix J Lindner
- Department of Orthopedic Sports Medicine , Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Orthopedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany
| | - Yannick Ehmann
- Department of Orthopedic Sports Medicine , Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopedic Sports Medicine , Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Sami Haddadin
- Munich Institute of Robotics and Machine Intelligence, Department of Electrical and Computer Engineering, Technical University of Munich, Munich, Germany
| | - Jan Neumann
- Department of Radiology, Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Florian Hinterwimmer
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Matthias Jung
- Department of Radiology, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Maximilian F Russe
- Department of Radiology, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Kaywan Izadpanah
- Department of Radiology, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine , Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, School of Medicine, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine , Klinikum rechts der Isar, School of Medicine, Munich, Germany
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Shih HT, Chen KH, Lee CH, Tu KC, Wang SP. Factors predicting lower limb alignment after Oxford medial unicompartmental knee arthroplasty. Sci Rep 2024; 14:5597. [PMID: 38454143 PMCID: PMC10920632 DOI: 10.1038/s41598-024-56285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 03/05/2024] [Indexed: 03/09/2024] Open
Abstract
This study aimed to identify the factors affecting hip-knee-ankle (HKA) angle following Oxford medial unicompartmental knee arthroplasty (MUKA). A retrospective analysis of 200 patients who underwent Oxford MUKA from June 2018 to October 2020 was conducted. Univariate and multivariate analyses were performed to investigate the impact of surgical and radiographic characteristics on the postoperative HKA angle. The mean HKA angle was 9.5 ± 4.3° before surgery and 3.6 ± 3.7° after surgery (p < 0.001). The postoperative HKA angle significantly correlated with the preoperative HKA angle, bearing size, tibial component alignment angle, and BMI (r = 0.71, p < 0.001; r = - 0.24, p = 0.001; r = 0.21, p = 0.004; r = - 0.18, p = 0.011). Multiple linear regression analysis revealed that the preoperative HKA angle (β = 0.68, p < 0.001), bearing size (β = - 0.31, p < 0.001), tibial component alignment angle (β = 0.14, p = 0.003), and BMI (β = - 0.09, p = 0.047) significantly affected the postoperative HKA angle. In conclusion, larger preoperative varus deformity, smaller bearing size, greater varus alignment of the tibial component, and lower BMI lead to greater postoperative varus alignment of the lower limb in Oxford MUKA. With this concept, surgeons can more accurately predict postoperative lower limb alignment and avoid malalignment in Oxford MUKA.
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Affiliation(s)
- Han-Ting Shih
- Department of Orthopaedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Kun-Hui Chen
- Department of Orthopaedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopaedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food Science and Technology, HungKuang University, Taichung, Taiwan
| | - Kao-Chang Tu
- Department of Orthopaedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Shun-Ping Wang
- Department of Orthopaedics, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
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Perkins CA, Coene RP, Miller PE, Anderson CN, Nunally KD, Parikh SN, Busch MT, Chambers HG, Christino MA, Cordasco FA, Edmonds EW, Fabricant PD, Ganley TJ, Green DW, Heyworth BE, Lawrence JTR, Matava MJ, Micheli LJ, Milewski MD, Nepple J, Pennock AT, Saluan PM, Shea KG, Wall EJ, Willimon SC, Kocher MS. Intrarater and Interrater Reliability of Radiographic Characteristics in Skeletally Immature Patients With Anterior Cruciate Ligament Tears: A PLUTO Study Group Reliability Study. J Pediatr Orthop 2023; 43:e695-e700. [PMID: 37694605 DOI: 10.1097/bpo.0000000000002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Radiographic measurements of limb alignment in skeletally immature patients with anterior cruciate ligament (ACL) tears are frequently used for surgical decision-making, preoperative planning, and postoperative monitoring of skeletal growth. However, the interrater and intrarater reliability of these radiographic characteristics in this patient population is not well documented. HYPOTHESIS Excellent reliability across 4 raters will be demonstrated for all digital measures of length, coronal plane joint orientation angles, mechanical axis, and tibial slope in skeletally immature patients with ACL tears. STUDY DESIGN Cohort study (diagnosis). METHODS Three fellowship-trained orthopaedic surgeons and 1 medical student performed 2 rounds of radiographic measurements on digital imaging (lateral knee radiographs and long-leg radiographs) of skeletally immature patients with ACL tears. Intrarater and interrater reliability for continuous radiographic measurements was assessed with intraclass correlation coefficients (ICCs) across 4 raters with 95% CIs for affected and unaffected side measurements. Interrater reliability analysis used an ICC (2, 4) structure and intrarater reliability analysis used an ICC (2, 1) structure. A weighted kappa coefficient was calculated for ordinal variables along with 95% CIs for both interrater and intrarater reliability. Agreement statistic interpretations are based on scales described by Fleiss, and Cicchetti and Sparrow: <0.40, poor; 0.40 to 0.59, fair; 0.60 to 0.74, good; and >0.74, excellent. RESULTS Radiographs from a convenience sample of 43 patients were included. Intrarater reliability was excellent for nearly all measurements and raters. Interrater reliability was also excellent for nearly all reads for all measurements. CONCLUSION Radiographic reliability of long-leg radiographs and lateral knee x-rays in skeletally immature children with ACL tears is excellent across nearly all measures and raters and can be obtained and interpreted as reliable and reproducible means to measure limb length and alignment. LEVEL OF EVIDENCE Level III.
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Chai Y, Boudali AM, Walter WL. Correlations Analysis of Different Pelvic Tilt Definitions: A Preliminary Study. HSS J 2023; 19:187-192. [PMID: 37065107 PMCID: PMC10090844 DOI: 10.1177/15563316221136128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/23/2022] [Indexed: 11/27/2022]
Abstract
Background: Pelvic tilt (PT) is described as the pelvic orientation along the transverse axis, yet 4 PT definitions were established based on radiographic landmarks: anterior pelvic plane (PTa), the center of femoral heads to sacral plate (PTm), pelvic outlet (PTh), and sacral slope (SS). These landmarks quantify a similar concept, yet understanding of their relationships is lacking, and their differences are sometimes ignored. Purpose: This study aimed to examine the correlations and differences of PT definitions for education and research purposes. Methods: This study reviewed 105 sagittal pelvic radiographs of patients (68 men and 37 women) awaiting hip surgery at a single clinic. Hip hardware and spine pathologies were examined for subgroup analysis. Two observers annotated 4 PTs in a gender-dependent manner and repeated it after 6 months. The linear regression model and intraclass correlation coefficient (ICC) were applied with a 95% confidence interval. Results: The SS showed no correlation to the other 3 PT definitions, except for females in the hip hardware subgroup (n = 17). PTm demonstrated very strong linear correlation to PTh (r > 0.9) under the linear model PTm = 0.951 × PTh - 68.284. Conclusion: The PTm and PTh can be calculated from each other under a simple linear regression equation, which enables comparisons between them. SS presented poor correlations to the other PT parameters, except for the female subgroup with hip implant that required further analysis; PTa-related comparisons showed high anatomical variations between patients.
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Affiliation(s)
- Yuan Chai
- Sydney Musculoskeletal Health, Kolling
Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards,
NSW, Australia
| | - A. Mounir Boudali
- Sydney Musculoskeletal Health, Kolling
Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards,
NSW, Australia
| | - William L. Walter
- Sydney Musculoskeletal Health, Kolling
Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards,
NSW, Australia
- Department of Orthopaedic Surgery,
Royal North Shore Hospital, St Leonards, NSW, Australia
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Jagadeesh N, Kariya A, Pammi S, Shivalingappa VM, Ramakrishna C. Bone Ninja application is reliable alternative to PACS in measuring preoperative and postoperative alignment parameters of total knee arthroplasty. J Orthop 2022; 34:132-136. [PMID: 36090785 PMCID: PMC9449501 DOI: 10.1016/j.jor.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background A picture archiving and communication system (PACS) is a means wherein the images are acquired, displayed, transmitted, and stored digitally. Bone Ninja is an application on iPad (Apple Inc.) on the IOS platform, developed as a teaching tool for deformity corrections around the knee. The principal objective of this study is to determine the reliability and consistency of Bone Ninja application in measuring the preoperative and postoperative alignment in patients undergoing a total knee arthroplasty and compare it with the PACS. Methods This retrospective cross-sectional study was done using preoperative and postoperative leg-length radiographs of 50 consecutive patients (50 knees) who underwent unilateral total knee arthroplasty. Using Bone Ninja application and PACS, preoperative Lateral Distal Femoral Angle (LDFA), Tibiofemoral Angle (TFA), Medial Proximal Tibial Angle (MPTA) and postoperative Tibial alignment angle (TAA), Tibiofemoral angle (TFA), Femoral alignment angle (FAA) were measured independently by three doctors (two orthopedists and one radiologist). The measurements were repeated after an interval to determine intra and interobserver reliability. Results Both preoperative (TFA, LDFA, MPTA) and postoperative measurements (TFA, TAA, FAA) showed highly correlated intraobserver and interobserver correlation coefficients. Cohen kappa values for all the measurements were greater than 0.80 but the values were higher for PACS compared to Bone Ninja application. Conclusions PACS remains the gold standard, but bone ninja application is a reliable alternative for preoperative and postoperative alignment measures in total knee arthroplasty where PACS is not available.
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Affiliation(s)
- Nuthan Jagadeesh
- Department of Orthopedics, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India
| | - Ankur Kariya
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Srinath Pammi
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Chethana Ramakrishna
- Department of Medicine, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India
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Meng X, Wang Z, Ma X, Liu X, Ji H, Cheng JZ, Dong P. Fully automated measurement on coronal alignment of lower limbs using deep convolutional neural networks on radiographic images. BMC Musculoskelet Disord 2022; 23:869. [PMID: 36115981 PMCID: PMC9482267 DOI: 10.1186/s12891-022-05818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background A deep convolutional neural network (DCNN) system is proposed to measure the lower limb parameters of the mechanical lateral distal femur angle (mLDFA), medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), joint line convergence angle (JLCA), and mechanical axis of the lower limbs. Methods Standing X-rays of 1000 patients’ lower limbs were examined for the DCNN and assigned to training, validation, and test sets. A coarse-to-fine network was employed to locate 20 key landmarks on both limbs that first recognised the regions of hip, knee, and ankle, and subsequently outputted the key points in each sub-region from a full-length X-ray. Finally, information from these key landmark locations was used to calculate the above five parameters. Results The DCNN system showed high consistency (intraclass correlation coefficient > 0.91) for all five lower limb parameters. Additionally, the mean absolute error (MAE) and root mean squared error (RMSE) of all angle predictions were lower than 3° for both the left and right limbs. The MAE of the mechanical axis of the lower limbs was 1.124 mm and 1.416 mm and the RMSE was 1.032 mm and 1.321 mm, for the right and left limbs, respectively. The measurement time of the DCNN system was 1.8 ± 1.3 s, which was significantly shorter than that of experienced radiologists (616.8 ± 48.2 s, t = -180.4, P < 0.001). Conclusions The proposed DCNN system can automatically measure mLDFA, MPTA, LDTA, JLCA, and the mechanical axis of the lower limbs, thus helping physicians manage lower limb alignment accurately and efficiently. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05818-4.
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Fabricant PD, Heath MR, Mintz DN, Emery K, Veerkamp M, Gruber S, Green DW, Strickland SM, Wall EJ, Shubin Stein BE, Parikh SN, Chambers CC, Ellis HB, Farr J, Heyworth BE, Koh JL, Kramer DE, Magnussen RA, Redler LH, Sherman SL, Tompkins MA, Wilson PL. Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability. Arthroscopy 2022; 38:2702-2713. [PMID: 35398485 DOI: 10.1016/j.arthro.2022.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the interrater reliability of several common radiologic parameters used for patellofemoral instability and to attempt to improve reliability for measurements demonstrating unacceptable interrater reliability through consensus training. METHODS Fifty patients with patellar instability between the ages of 10 and 19 years were selected from a prospectively enrolled cohort. For measurements demonstrating unacceptable interrater reliability (intraclass correlation coefficient [ICC]: <0.6), raters discussed consensus methods to improve reliability and re-examined a subset of 20 images from the previous set of images. If reliability was still low after the second round of assessment, the measure was considered unreliable. RESULTS Of the 50 included subjects, 22 (44%) were male and the mean age at the time of imaging was 14 ± 2 years. With 1 or fewer consensus training sessions, the interrater reliability of the following radiograph indices were found to be reliable: trochlea crossing sign (ICC: 0.625), congruence angle (ICC: 0.768), Caton-Deshamps index (ICC: 0.644), lateral patellofemoral angle (ICC: 0.768), and mechanical axis deviation on hip-to-ankle alignment radiographs (ICC: 0.665-0.777). Reliable magnetic resonance imaging (MRI) indices were trochlear depth (ICC: 0.743), trochlear bump (ICC: 0.861), sulcus angle (ICC: 0.684), patellar tilt (ICC: 0.841), tibial tubercle to trochlear groove distance (ICC: 0.706), effusion (ICC: 0.866), and bone marrow edema (ICC: 0.961). CONCLUSIONS With 1 or fewer consensus training sessions, the interrater reliability of the following patellofemoral indices were found to be reliable for trochlear morphology: trochlea crossing sign and congruence angle on radiograph and trochlear depth, trochlear bump, and sulcus angle on MRI. Reliable patellar position measurements included: Caton-Deshamps index and lateral patellofemoral angle on radiograph and patellar tilt and tibial tubercle to trochlear groove distance on MRI. Additional global measurements (e.g., mechanical axis deviation on standing radiographs) and MRI assessments demonstrated acceptable reliability. LEVEL OF EVIDENCE II, prospective diagnostic study.
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Affiliation(s)
| | | | | | | | | | - Simone Gruber
- Hospital for Special Surgery, New York, New York, U.S.A
| | | | | | - Eric J Wall
- Cincinnati Children's Hospital, Cincinnati, Ohio, U.S.A
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Cazor A, Schmidt A, Shatrov J, Alqahtani T, Neyret P, Sappey-Marinier E, Batailler C, Lustig S, Servien E. Less risk of conversion to total knee arthroplasty without significant clinical and survivorship difference for opening-wedge high tibial osteotomies in varus knee deformities at 10-year minimum follow-up compared to closing-wedge high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc 2022; 31:1603-1613. [PMID: 36038667 DOI: 10.1007/s00167-022-07122-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes and survivorship at minimum 10-year follow-up of patients undergoing primary valgisation high tibial osteotomy (HTO) for medial osteoarthritis (OA), treated by Opening-Wedge HTO (OW-HTO) or Closing-Wedge HTO (CW-HTO). METHODS This was a retrospective cohort study of consecutive patients presenting to a single institution undergoing HTO for isolated medial compartment OA. Two hundred and twenty three HTOs for isolated medial tibio-femoral OA were performed between January 2002 and December 2010. Patients were eligible if they had minimum 10-year follow-up and received either a CW or OW-HTO. Fifteen (6.7%) patients died and twenty-five (11.2%) were lost to follow-up. One hundred and eighty three (82.1%) patients were included in the final analysis and divided into two groups: OW-HTO (96/183; 52.4%) and CW-HTO (87/183; 47.6%). Range of motion, KSS, KOOS scores, and conversion to TKA rate were analyzed between groups. Both groups were comparable regarding age, arthrosis stage, gender, ASA score and BMI at the time of HTO. Survival analysis was conducted with re-intervention for TKA as the end point. RESULTS At the time of HTO, mean age was 55 years ± 7.9 (27-73.9) with 72.7% of patients being male. The mean follow-up was 13.3 years ± 2.7 (10-19). Sixty-four (34.9%) patients underwent TKA at a mean delay of 9.3 years ± 3 (3-16). The conversion to TKA rate was significantly higher in the CW-HTO group versus the OW-HTO group: 42.5% (37/87) versus 28.1% (27/96) (p = 0.04). The survival at 15-year follow-up was 59.2% in the OW-HTO group versus 54.6% in the CW-HTO group (n.s.). At 13-year follow-up, KSS Function score was significantly better in the OW-HTO (90.9 versus 82.4; p = 0.007). No significant difference was observed between the two groups regarding the KOOS score, KSS Knee Score and complication rate. CONCLUSION At mean follow-up of 13 years, no significant clinical and survivorship difference was observed between the two groups. The conversion to TKA was significantly lower following OW-HTO. Minor correction was associated with risk of requiring subsequent TKA. LEVEL OF EVIDENCE Retrospective case series, IV.
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Affiliation(s)
- A Cazor
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - A Schmidt
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.
| | - J Shatrov
- Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia Orthopaedic Research Institute, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - T Alqahtani
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - P Neyret
- Infirmerie Protestante, 3 rue Penthod, 69300, Lyon, France
| | - Elliot Sappey-Marinier
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - C Batailler
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France
| | - S Lustig
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.,IFSTTAR, LBMC UMR_T9406, Univ Lyon, Claude Bernard Lyon 1 University, 25 Avenue François Mitterand, Lyon, France
| | - E Servien
- FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la croix rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 29 Boulevard du 11 Novembre 1918, Lyon, France
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Measurement of Lower Extremity Alignment Using a Smartphone Application. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Identification of lower extremity misalignment requires radiation exposure and complex imaging. We developed and tested a smartphone application to facilitate quick identification of misalignment using photographs. Lower extremity alignment was measured by two independent researchers using a proprietary smartphone application and conventional radiographs. The results were compared between the methods and evaluators for interrater and intrarater reliability. Ninety datasets were obtained from 45 patients, with 90 lower extremity alignment angles measured via radiographs and the smartphone application. The intrarater reliability of the hip–knee–ankle angle (HKAA), measured twice by evaluator A using the radiographic imaging program, was 0.985, whereas that measured by evaluator B was 0.995. The intrarater reliability of the predicted lower extremity alignment angle (PLEAA) measured using the smartphone application was 0.970 and 0.968 for evaluators A and B, respectively. Thus, all results showed excellent reliability. In validity analysis, the correlation between PLEAA and HKAA measured twice by evaluators A and B was analyzed using Pearson’s correlation coefficient. HKAA (A) and PLEAA (A) had a positive correlation coefficient of 0.608 (p < 0.01), whereas HKAA (B) and PLEAA (B) had a positive correlation coefficient of 0.627 (p < 0.01). Thus, our smartphone application can facilitate for self-diagnosis of lower extremity misalignment.
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Kumar A, Hung CH, Hsieh SL, Kuo CC, Mao JT, Lin ET, Hsu HC. Makoplasty medial unicondylar knee replacement: Correction or postoperative angle matters? Int J Med Robot 2021; 18:e2356. [PMID: 34921488 DOI: 10.1002/rcs.2356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Various considerations prevail around optimal postoperative varus deformity, correction angle and physiological constitutional varus deformity. The goal of our present study was to understand correlation between these parameters and their influence over Western Ontario McMaster University Osteoarthritis Index scale (WOMAC). MATERIALS AND METHODS Consecutive robotic-arm-assisted medial onlay fixed bearing unicompartmental knee arthroplasty (UKA) in 143 knees studied. WOMAC score was recorded preoperatively and at specific intervals after surgery for consecutive 2 years. RESULTS Mean preoperative and postoperative varus deformities were 10.2° and 4.8°, respectively, and mean correction angle was 5.4°. The preoperative varus and correction angles were found well correlated (r = 0.815). The amount of improvement in the WOMAC total score was not influenced by the postoperative varus angle. CONCLUSION The correction angle has a stronger correlation with preoperative varus deformity, and postoperative varus deformity does not imply favourable clinical outcomes.
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Affiliation(s)
- Abhishek Kumar
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hung Hung
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Shang-Lin Hsieh
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Ting Mao
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Erh-Ti Lin
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
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Lateral unicompartmental knee arthroplasty is a safe procedure for post-traumatic osteoarthritis after lateral tibial plateau fracture: a case-control study at 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:3654-3663. [PMID: 33165637 DOI: 10.1007/s00167-020-06359-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Very few studies focus on lateral unicompartmental arthroplasty (LUKA) in the setting of post-traumatic osteoarthritis (PTOA). The hypothesis of our study is that LUKA is an effective procedure for isolated lateral PTOA with similar outcomes to non-traumatic LUKA. METHODS Between 1990 and 2016, eighteen LUKA performed for isolated lateral tibiofemoral osteoarthritis secondary to tibial plateau fracture were retrospectively reviewed (post-traumatic group) and matched with a control group of thirty-six LUKA performed for non-traumatic OA. Clinical (International Knee Score), radiological outcomes and revision rate were compared between the two groups with a minimum follow-up of three years. RESULTS With a mean follow-up of 10.1 years, postoperative IKS scores were similar between the two groups (IKS Knee: 89.1 (control) versus 85 (p = 0.03) and IKS Function: 85.9 (control) versus 77.9 (n.s.). Clinical improvement was greater for the post-traumatic group. No difference was observed with regard to revision rate (3/18 (16.7%) cases in the post-traumatic group and 7/36 (19.4%) in the control group, n.s.) or polyethylene wear per year between the two groups. The revision free-survival rate was 64.8% for the post-traumatic group and 58.8% for the control group at 22-year follow-up (n.s.). CONCLUSION LUKA is an effective procedure at long-term for patients suffering from isolated lateral PTOA with similar clinical and radiographic results compared to LUKA performed for non-traumatic OA and without increased risk of revision or prosthetic wear. LEVEL OF EVIDENCE IV.
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Preoperative Planning Using 3D Printing Technology in Orthopedic Surgery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7940242. [PMID: 34676264 PMCID: PMC8526200 DOI: 10.1155/2021/7940242] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
The applications of 3D printing technology in health care, particularly orthopedics, continue to broaden as the technology becomes more advanced, accessible, and affordable worldwide. 3D printed models of computed tomography (CT) and magnetic resonance image (MRI) scans can reproduce a replica of anatomical parts that enable surgeons to get a detailed understanding of the underlying anatomy that he/she experiences intraoperatively. The 3D printed anatomic models are particularly useful for preoperative planning, simulation of complex orthopedic procedures, development of patient-specific instruments, and implants that can be used intraoperatively. This paper reviews the role of 3D printing technology in orthopedic surgery, specifically focusing on the role it plays in assisting surgeons to have a better preoperative evaluation and surgical planning.
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Moorthy V, Lai MC, Liow MHL, Chen JY, Pang HN, Chia SL, Lo NN, Yeo SJ. Similar postoperative outcomes after total knee arthroplasty with measured resection and gap balancing techniques using a contemporary knee system: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2021; 29:3178-3185. [PMID: 32556437 DOI: 10.1007/s00167-020-06103-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The Attune® Knee System provides new instrumentation to achieve symmetric flexion/extension gaps in total knee arthroplasty (TKA). However, there is limited information on the optimal TKA technique using this system. The aim of this randomised controlled trial was to determine which surgical technique results in better postoperative clinical outcomes after TKA using the contemporary Attune® Knee System: the measured resection or gap balancing technique. METHODS A prospective randomized controlled trial was conducted with 100 patients undergoing TKA using measured resection (n = 50) or gap balancing (n = 50) technique. The measured femoral sizer was used in the measured resection group, while the balanced femoral sizer was used in the gap balancing group. Functional outcomes and quality of life were assessed preoperatively and at 6 months and 2 years post-surgery, using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 (SF-36). Using weight-bearing coronal radiographs, the hip-knee-ankle angle (HKA), coronal femoral component angle (CFA), coronal tibial component angle (CTA) and joint line height were also evaluated for each patient. RESULTS There were no significant differences in the functional scores or the proportion of patients from each group who were satisfied or had their expectations fulfilled at 6 months or 2 years post-surgery. There was also no significant difference in the number of patients who attained minimum clinically important difference (MCID) postoperatively between the groups. Postoperatively, there was no significant difference in the number of HKA outliers between the groups (p = 0.202). The postoperative CFA (p = 0.265) and CTA (p = 0.479) were similar between the groups. There was also no significant difference in the absolute change (p = 0.447) or proportion of outliers (p = 0.611) for joint line height between the groups. CONCLUSION Both measured resection and gap balancing techniques resulted in comparable functional and quality of life outcomes up to 2 years post-surgery. Both techniques appear to be equally effective in achieving excellent outcomes with the Attune® Knee System. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
| | - Mun Chun Lai
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Gao H, Liu Z, Wang G, Wang B. A New Accurate, Simple and Less Radiation Exposure Device for Distal Locking of Femoral Intramedullary Nails. Int J Gen Med 2021; 14:4145-4153. [PMID: 34377014 PMCID: PMC8349542 DOI: 10.2147/ijgm.s321005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Due to the metal elasticity of intramedullary nails (IMs) and irregularities of the long bone marrow cavity and other reasons, one of the greatest challenges for surgeons is to position the distal locking screw. Therefore, a novel laser guiding navigation device was designed for the distal locking of femoral IMs. The purpose of this study was to compare the effectiveness of the novel device and freehand technique for distal locking of IMs in the femoral model. Methods The laser guiding navigation device (laser group) and freehand technique (freehand group) were used in the distal locking of the IMs in the femoral model. All operations were performed by surgeons of the same level. The differences between the two groups were compared in terms of operative time, radiation exposure time, first success rate, deviation angle between ideal trajectory and actual trajectory, and learning curve. Results The distal locking of the IMs in the femoral model was performed 40 times in each group. The results showed that the laser group was better than the freehand group in terms of operative time (345±165 VS 212±105 seconds, t=4.27, P<0.001), radiation exposure time (164±57 VS 41±15 seconds, t=13.15, P<0.001) and first successrate (χ 2=21.36, P<0.001). Compared with the freehand group, the actual trajectory of the laser group was closer to the ideal trajectory in coronal and horizontal planes. Furthermore, the learning curve time of the laser group was shorter. Conclusion Compared with traditional freehand technique, the novel laser guiding navigation device can shorten the operative time and reduce radiation exposure invitro. In addition, it is easy to master with more accuracy and a higher first success rate in vitro.
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Affiliation(s)
- Hua Gao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zhenyu Liu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Gang Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Baojun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
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No difference in long-term outcomes between men and women undergoing medial fixed-bearing cemented unicompartmental knee arthroplasty: A retrospective cohort study with minimum 10-year follow up. Knee 2021; 30:26-34. [PMID: 33823334 DOI: 10.1016/j.knee.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some studies have suggested that women have poorer short-term outcomes after unicompartmental knee arthroplasty (UKA) due to a higher incidence of implant overhang. This study aimed to compare patient-reported outcome measures (PROMs) between men and women after UKA at a minimum follow-up of 10 years. METHODS Patients who underwent medial fixed-bearing UKA by two arthroplasty surgeons were identified from an institutional joint registry. Men and women were matched for age, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, range-of-motion and baseline PROMs using propensity scores. PROMs were compared at 2 and 10 years. Patients also completed a satisfaction questionnaire during these visits. Radiographic outliers were defined as > 2 mm of overhang. RESULTS A total of 128 patients were included. There was no difference in complications, length of stay or readmissions. Women had poorer Knee Society functional scores, Short-Form 36 physical and mental component scores (SF-36 MCS) at 2 years. No difference in PROMs was found at 10 years, except for poorer SF-36 MCS in women (P = 0.041). At 10 years, 96% of women and 92% of men were satisfied (P = 0.243). Fifteen-year survivorship free from any revision was 96% in each group. There were more medial-tibial outliers in women (9%) compared with men (5%) (P = 0.018). However, no association between outliers and outcomes or survivorship was found on multivariate analyses. CONCLUSION There was nodifference in clinical outcomes between men and women undergoing UKA at a minimum follow-up of 10 years. While women had a higher incidence of medial tibial overhang, this was not associated with long-term outcomes or survivorship.
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Patellar Tracking in Revision Total Knee Arthroplasty: Does Retaining a Patella From a Different Implant System Matter? J Arthroplasty 2021; 36:2126-2130. [PMID: 33612328 DOI: 10.1016/j.arth.2021.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/24/2020] [Accepted: 01/29/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patellar maltracking is a potential surgical complication following total knee arthroplasty (TKA) and can result in anterior knee pain, recurrent patellar dislocation, and damage to the medial patellar soft tissue stabilizers. Data remain unclear as to whether the patellar button should be revised during a revision TKA (rTKA) if changing the component implant system. Our study examines whether retaining the original patellar button during an rTKA using a different implant system affects patellar tracking. METHODS A retrospective cohort study of rTKA patients between August 2011 and June 2019 was performed at an urban, tertiary referral center. Patients were divided into 2 cohorts depending on whether their retained patella from their primary TKA was of the same (SIM) or different implant manufacturer (DIM) as the revision system used. Radiographic measurements were performed on preoperative and postoperative knee radiographs and differences were compared between the 2 groups. Baseline demographic data were also collected. RESULTS Of the 293 consecutive, aseptic rTKA cases identified, 122 underwent revision in the SIM cohort and 171 in the DIM cohort. There were no demographic differences between the groups. No statistical significance was calculated for differences in preoperative and postoperative patellar tilt or Insall-Salvati ratio between the groups. The DIM group was found to have more lateral patellar translation (-0.01 ± 6.09 vs 2.68 ± 7.61 mm, P = .001). However, when calculating differences in the magnitude of the translation (thereby removing differences due to laterality), no difference was observed (0.06 ± 3.69 vs 0.52 ± 4.95 mm, P = .394). CONCLUSION No clinically significant differences in patellar tracking were observed when the original patellar component was retained and a different revision implant system was used. Given the inherent risks of bone loss and fracture with patellar component revision, surgeons performing rTKA may retain the primary patella if it is well fixed and can still expect appropriate patellar tracking regardless of the revision implant system used. LEVEL OF EVIDENCE III, Retrospective cohort study.
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18
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Kim SG, Choi GW, Kim HK, Kim JG. Hip-to-calcaneus alignment differs from hip-to-talus alignment in patients with genu varum deformity. Knee Surg Sports Traumatol Arthrosc 2021; 29:975-981. [PMID: 32458031 DOI: 10.1007/s00167-020-06060-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/10/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE To (1) compare the weight-bearing line (WBL) ratios of the knee joints measured using the conventional (hip-to-talus radiographs, HTRs) and novel (hip-to-calcaneus radiographs, HCRs) orthoradiograms, (2) compare the hip-knee-ankle (HKA) angle between cases with < 5% and > 5% differences in WBL ratios between two orthoradiograms, and (3) investigate the optimal cutoff value (COV) of the HKA angle causing inconsistency in the orthoradiograms. METHODS Sixty limbs of 31 patients with HTR and HCR records were retrospectively reviewed. After drawing the mechanical axis on each radiograph, the WBL ratios of the knees were calculated and compared between the conventional and novel orthoradiograms. In subgroup analysis, cases with < 5% and > 5% differences in WBL ratios between two orthoradiograms were classified as consistent and inconsistent groups, respectively. Receiver operating characteristic curve based on the HKA angles of the lower limbs was used to identify the COV causing the inconsistency between the orthoradiograms. RESULTS Inter- and intra-rater reliabilities of all radiologic measurements were > 0.75. The WBL ratios showed no significant difference between the two orthoradiograms. However, the HKA angle was significantly larger in the inconsistent group than in the consistent group (7.0° ± 1.8° vs. 4.4° ± 2.5°; P < 0.001). The COV of the HKA angle that caused inconsistency in the two orthoradiograms was 4.0° (area under the curve, 0.774). CONCLUSION The hip-to-calcaneus alignment differed significantly from the hip-to-talus alignment in patients with genu varum deformity. HCR measurement can be a complementary method for planning corrective osteotomy for patients with genu varum deformity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sang-Gyun Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do, Republic of Korea
| | - Gi Won Choi
- Department of Orthopedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do, Republic of Korea
| | - Hak Kyu Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do, Republic of Korea
| | - Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do, Republic of Korea.
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Goh JKM, Chen JY, Yeo NEM, Liow MHL, Chia SL, Yeo SJ. Ten year outcomes for the prospective randomised trial comparing unlinked, modular bicompartmental knee arthroplasty and total knee arthroplasty. Knee 2020; 27:1914-1922. [PMID: 33221689 DOI: 10.1016/j.knee.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A sizeable proportion of knee osteoarthritis is limited to the medial and patellofemoral compartments. Whilst short- and medium-term studies comparing bicompartmental knee arthroplasty (BCA) and total knee arthroplasty (TKA) have shown similar outcome scores, there are no studies comparing long-term outcomes. This study aims to determine which procedure resulted in superior long-term outcome scores. METHODS Forty-eight patients with medial and patellofemoral compartment knee osteoarthritis were randomised to receive treatment in two groups: unlinked, modular BCA and TKA. The main outcome measures compared were the range of motion, Knee Society Function Score, Knee Society Knee Score, Oxford Knee Score, Physical Component Score and Mental Component Score of SF-36 pre-operatively and post-operatively up to 10 years. Radiographs of the operated knees were taken pre-operatively, post-operatively and at 10-year follow-up. RESULTS Twenty-six underwent BCA and 22 underwent TKA. Overall improvement was seen in both groups compared to pre-operatively, however there were no significant differences detected between the groups at 10 years. The median Hip-Knee-Ankle (HKA) angle was 183.38 (175.17-187.94) in the BCA group and 180.73 (174.96-185.65) in the TKA group. One patient from the BCA group had a peri-prosthetic fracture necessitating revision surgery to a TKA. CONCLUSIONS Outcome scores for BCA results were comparable to TKA at long-term follow-up. BCA is an alternative arthroplasty option in selected patients.
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Affiliation(s)
- Jeremy Keng Meng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Nicholas Eng Meng Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road Academia Building Level 4, Singapore 119228, Singapore
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Wakama H, Okamoto Y, Otsuki S, Nakagawa K, Okuno N, Neo M. Preoperative factors associated with extension gap in cruciate-retaining total knee arthroplasty: A retrospective study on continuous determination of distraction force. J Orthop Sci 2020; 25:1035-1039. [PMID: 31902557 DOI: 10.1016/j.jos.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this retrospective study was to identify the preoperative patient-related factors affecting the soft tissue balancing in cruciate-retaining total knee arthroplasty. This is an important clinical issue, as the acquisition of adequate soft tissue balancing is essential for successful outcomes. METHODS The study group included 59 knees treated for medial compartment osteoarthritis. The extension gap was measured using the newly electric tensor that enables continuous quantification of a distraction force ranging from 0 to 40 lbf. We performed regression analyses to identify the relationship between preoperative factors and the extension gap. RESULTS Patient height, weight, and percent mechanical axis showed univariate correlation with the extension gap of either 30 lbf or 40 lbf. In the multivariate regression analysis without encountering multicollinearity, percent mechanical axis was inversely associated with the extension gap (t-value = -2.31, p = 0.02 for 30 lbf; and t-value = -2.39; p = 0.02 for 40lbf) as a significant independent factor. CONCLUSIONS We revealed the significant influence of several factors on the absolute value of the extension gap. Particularly, the severity of preoperative coronal alignment was a statistically independent explanatory variable, and the extension gap was overvalued in knees with severe varus deformity. This influence should be considered when comparing different individual cases longitudinally. Our feasible strategies could lead to a better understanding about the soft tissue balancing in total knee arthroplasty.
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Affiliation(s)
- Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan.
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 5698686, Japan
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Wu CC, Yeow KM, Yeow YJ. Imaging Approaches for Accurate Determination of the Quadriceps Angle. Orthop Surg 2020; 12:1270-1276. [PMID: 32548902 PMCID: PMC7454214 DOI: 10.1111/os.12708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/05/2020] [Accepted: 04/25/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives A retrospective study was conducted using magnetic resonance image (MRI) and a full‐length standing scanogram (FLSS) to measure the quadriceps angle (Q‐angle) while avoiding soft tissue interference. Methods Two steps were retrospectively carried out in two case series. The first step involved using MRI to define the standardized patellar center (PC) and the tibial tubercle (TT) on the frontal plane of the MRI in one group of 60 consecutive patients (from July 2016 to December 2016, 29 men and 31 women, average of 46 years). The next step was transferring the location of the standardized PC and the TT from the MRI to the FLSS in another group of 100 consecutive patients (from April 2009 to March 2014, 50 men and 50 women, average of 36 years). The pelvis and intact femur, knee, and tibia were used to determine the Q‐angle on the FLSS. Results The standardized PC was positioned 42% from the lateral end of femur trans‐epicondylar line. The TT was 2 cm distal to the tibial articular surface and 37% from the lateral end of tibial width. The average Q‐angle was 9.5° in 100 patients (8.8° in 50 men and 10.1° in 50 women, P = 0.02). The average femoral length was 42.9 cm in 100 patients (44.7 cm in 50 men and 41.1 cm in 50 women, P < 0.001). Women and men had similar pelvic width (27.9 vs 27.8 cm, P = 0.89). Conclusion Using the FLSS may help to accurately determine the Q‐angle. Men and women have similar pelvic width. A larger Q‐angle in women may be mainly due to the shorter femur.
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Affiliation(s)
- Chi-Chuan Wu
- Department of Orthopaedic Surgery, Linkou Branch, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Kee-Min Yeow
- Department of Imaging Diagnosis, Taipei Branch, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Yun-Jen Yeow
- Department of Orthopaedic Surgery, Linkou Branch, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
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Burger JA, Dooley MS, Kleeblad LJ, Zuiderbaan HA, Pearle AD. What is the impact of patellofemoral joint degeneration and malalignment on patient-reported outcomes after lateral unicompartmental knee arthroplasty? Bone Joint J 2020; 102-B:727-735. [DOI: 10.1302/0301-620x.102b6.bjj-2019-1429.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims It remains controversial whether patellofemoral joint pathology is a contraindication to lateral unicompartmental knee arthroplasty (UKA). This study aimed to evaluate the effect of preoperative radiological degenerative changes and alignment on patient-reported outcome scores (PROMs) after lateral UKA. Secondarily, the influence of lateral UKA on the alignment of the patellofemoral joint was studied. Methods A consecutive series of patients who underwent robotic arm-assisted fixed-bearing lateral UKA with at least two-year follow-up were retrospectively reviewed. Radiological evaluation was conducted to obtain a Kellgren Lawrence (KL) grade, an Altman score, and alignment measurements for each knee. Postoperative PROMs were assessed using the Kujala (Anterior Knee Pain Scale) score, Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), and satisfaction levels. Results A total of 140 knees (130 patients) were identified for analysis. At mean 4.1 years (2.0 to 8.5) follow-up, good to excellent Kujala scores were reported. The presence of mild to moderate preoperative patellofemoral joint osteoarthritis had no impact on these scores (KL grade 0 vs 1 to 3, p = 0.203; grade 0 to 1 vs 2 to 3, p = 0.674). Comparable scores were reported by patients with osteoarthritis (Altman score of ≥ 2) evident on either the medial or lateral patellofemoral joint facet (medial, p = 0.600 and lateral, p = 0.950). Patients with abnormal patellar congruence and tilt angles (≥ 17° and ≥ 14°, respectively) reported good to excellent Kujala scores. Furthermore, lateral UKA resulted in improvements to patellofemoral alignment. Conclusion This is the first study demonstrating that mild to moderate preoperative radiological degenerative changes and malalignment of the patellofemoral joint are not associated with poor patient-reported outcomes at mid-term follow-up after lateral fixed-bearing UKA. Our data suggest that this may be explained by realignment of the patella and thereby redistribution of loads across the patellofemoral joint. Cite this article: Bone Joint J 2020;102-B(6):727–735.
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Affiliation(s)
- Joost A. Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, New York, New York, USA
| | - Matthew S. Dooley
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, New York, New York, USA
| | - Laura J. Kleeblad
- Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
| | | | - Andrew D. Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, New York, New York, USA
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Moo IH, Chen JYQ, Chau DHH, Tan SW, Lau ACK, Teo YS. Similar radiological results with accelerometer-based navigation versus conventional technique in total knee arthroplasty. J Orthop Surg (Hong Kong) 2019; 26:2309499018772374. [PMID: 29747561 DOI: 10.1177/2309499018772374] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Zimmer iASSIST system is an accelerometer-based, portable navigation device for total knee arthroplasty (TKA) that does not require the use of a large console for alignment feedback as required in computer-assisted surgery. The purpose of this study was to determine the accuracy of the accelerometer-based system in component positioning and overall mechanical alignment. METHODS Two groups of 30 patients each with primary osteoarthritis underwent TKA using either conventional method or Zimmer iASSIST navigation in 2013 was retrospectively studied. Patients were matched according to body mass index (BMI), gender and age. A senior arthroplasty surgeon performed all the operation using the same surgical approach. Perioperative and post-operative regimens were the same. All patients had standardized radiographs performed post-operatively to determine the lower limb mechanical alignment and component placement. RESULTS There was no difference between the two groups for age, BMI, gender, side of operated knee and preoperative mechanical axis ( p > 0.05). There was no difference in the proportion of outliers for mechanical axis ( p = 0.38), coronal femoral angle ( p = 0.50), coronal tibia angle ( p = 0.11), sagittal femoral angle ( p = 0.28) and sagittal tibia angle ( p = 0.33). The duration of surgery, post-operative drop in haemoglobin level and transfusion incidence did not show statistically significant differences between the two groups ( p > 0.05). CONCLUSIONS Our article showed that iASSIST was safe and remains a useful tool to restore mechanical axis. However, our data demonstrated no difference in lower limb alignment and component placement between the TKA that used accelerometer-based system and those that underwent conventional method.
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Affiliation(s)
- Ing How Moo
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore, Singapore
| | | | | | - See Wei Tan
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore, Singapore
| | | | - Yee Sze Teo
- Department of Orthopaedics Surgery, Changi General Hospital, Singapore, Singapore
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Varied influence of the femoral or tibial component on quadriceps angles: Verified by imaging studies. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:287-291. [PMID: 31103418 PMCID: PMC6738274 DOI: 10.1016/j.aott.2019.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 03/09/2019] [Accepted: 04/28/2019] [Indexed: 11/22/2022]
Abstract
Objective The aim of this study was to evaluate the varied influence of femoral or tibial component on Quadriceps angles (Q-angle) measured with magnetic resonance image (MRI) and full-length standing scanogram (FLSS) techniques. Methods Two groups of patients were studied. The first group underwent MRI studies and the second group underwent FLSS studies. Two-step procedures were carried out. Knee MRI in 60 consecutive adult patients simply taken for meniscus or ligament injuries were utilized at the first step. The standardized patellar center (PC) and tibial tubercle (TT) on the frontal plane of MRI were positioned. At the second step, the FLSS in other 100 consecutive young adult patients taken for chronic unilateral lower extremity injuries were used for locating the two landmarks from MRI. The Q-angle was then determined on the anterior superior iliac spine, standardized PC, and TT on the FLSS. Results For 60 patients, the standardized PC was at the point 42% from the lateral end of the trans-epicondylar line of the femur. The TT was at the point 2 cm distal to the tibial articular surface and 37% from the lateral end of the tibial width. For 100 patients, the Q-angle was an average of 9.5° and 65.2% of the Q-angle was contributed by the upper arm (the femur). Women had a larger Q-angle (10.1° vs. 8.8°, p = 0.02) and a shorter femur (41.1 vs. 44.7 cm, p < 0.001). Conclusion The Q-angle is about 9.5° with 65.2% contributed by the femur. The Q-angle may mainly be influenced by the femoral component. Level of evidence Level IV, Diagnostic Study.
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A residual intra-articular varus after medial opening wedge high tibial osteotomy (HTO) for varus osteoarthritis of the knee. Arch Orthop Trauma Surg 2019; 139:743-750. [PMID: 30673869 DOI: 10.1007/s00402-018-03104-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Indexed: 02/09/2023]
Abstract
PURPOSE Varus deformity of knee osteoarthritis was formed by both intra-articular and extra-articular pathologies. Such intra-articular deformities could not be fully corrected by a medial open-wedge high tibial osteotomy (HTO), which was performed as an extra-articular procedure. Therefore, the purpose of this study was to investigate whether any residual varus was left inside the joint after HTO in the patients with knee osteoarthritis, and a correlation of the residual varus could be traced. METHODS This study involved 66 patients (66 knees) undergoing HTO for medial knee osteoarthritis. The percentage of mechanical axis (%MA), mechanical femorotibial angle (mFTA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and joint line convergence angle (JLCA) were measured on radiographs of the full-length legs preoperatively and 6 months postoperatively. The relationship between changes in the JLCA and alignment correction was assessed. The postoperative residual JLCA was categorized as the optimal (postoperative JLCA ≤ 2°), the acceptable (2° < postoperative JLCA ≤ 5°), and the unacceptable (postoperative JLCA > 5°) to analyze its correlation with pre- or intra-operative factors. RESULTS Average %MA and mFTA were improved from 5.5 to 60% and from 190.2° to 176.4°, respectively. There was no change in mLDFA, whereas mMPTA changed from 80.3° to 91.8°. JLCA changed from 4.2° to 2.7°. The analyses of multiple linear regression showed that the preoperative JLCA and postoperative changes in mechanical alignment (%MA, mFTA and mMPTA) were two important variables dependently associated with differences in JLCAs postoperatively. However, postoperative JLCAs showed a stronger correlation to preoperative JLCAs than to changes in mechanical alignment postoperatively. A Chi-square analysis showed a significantly higher percentage of patients achieved acceptable postoperative JLCAs in the preoperative JLCA ≤ 6° group (78.8%) compared to the preoperative JLCA > 6° group (6.1%). Therefore, 6° of JLCA was suggested to be a tipping point. CONCLUSIONS The capability of HTO to correct intra-articular varus deformities, which was represented by JLCAs, is limited. Postoperative residual JLCAs were correlated primarily to preoperative JLCA values and total alignment correction, while the former accounted for most. A preoperative JLCA of 6° was suggested to be a tipping point, and a larger value indicated more than 5° residual JLCA after the HTO.
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Zhang Q, Zhang Q, Guo W, Gao M, Ding R, Wang W. Risk factors of postoperative valgus malalignment in mobile-bearing medial unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 2019; 139:241-248. [PMID: 30417208 DOI: 10.1007/s00402-018-3070-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this observational study was to investigate the risk factors of postoperative valgus malalignment after mobile-bearing medial unicompartmental knee arthroplasty (UKA). METHODS We retrospectively evaluated radiographic and surgical characteristics in 122 consecutive Oxford phase 3 UKAs. According to postoperative hip-knee-ankle angle (HKAA), 24 knees were sorted into group valgus with HKAA > 180° and 98 knees were sorted into group non-valgus with HKAA ≤ 180°. Logistic regression was performed to analyze risk factors including age, gender, BMI, side, preoperative limb alignment HKAA, preoperative LDFA, MPTA, FTFA, thickness of polyethylene bearing insert, tibial prothesis size, femoral prothesis size, medial tibial cut thickness, thickness of distal femoral mill, prothesis angle of coronal, and sagittal plane. RESULTS The mean mechanical preoperative HKAA of 174.39°±4.23° was corrected to 178.18°±3.49° postoperatively (t = - 13.45, p = 0.000). The mean of postoperative HKAA in valgus group and non-valgus group was 183.45 ± 2.21° and 176.88 ± 2.35°, respectively (t = 12.44, p = 0.000). After statistical analysis with univariate analysis, eight risk factor variables among 16 independent variables were identified as potential predictors with p value ≤ 0.1. Multivariate logistic regression analysis for these eight potential predictors revealed that tibial cut (p = 0.046), LDFA (p = 0.003), MPTA (p = 0.011), and FTFA (p = 0.008) were significant risk factors predicting postoperative valgus malalignment after mobile-bearing UKA. CONCLUSIONS Preoperative smaller LDFA, FTFA, larger MPTA and less medial tibial cut thickness were significantly associated with postoperative valgus malalignment in mobile-bearing UKA.
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Affiliation(s)
- Qidong Zhang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Qian Zhang
- Beijing University of Chinese Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Man Gao
- Beijing University of Chinese Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Ran Ding
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, 100029, China.
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Kim HJ, Park J, Shin JY, Park IH, Park KH, Kyung HS. More accurate correction can be obtained using a three-dimensional printed model in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2018; 26:3452-3458. [PMID: 29602970 DOI: 10.1007/s00167-018-4927-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to compare the accuracy of the preoperative planning method using a three-dimensional (3D) printed model with that of a method using picture archiving and communication system (PACS) images in high tibial osteotomy (HTO). METHODS Patients who underwent HTO using a 3D printed model (20 patients) and a method based on PACS images (20 patients) from 2012 to 2016 were compared. After obtaining the correction angle, in the 3D printed method, the wedge-shaped 3D printed model was designed. The PACS method used preoperative radiographs. The accuracy of HTO for each method was compared using radiographs obtained at the first postoperative year. The preoperative and postoperative posterior tibial slope angles were also compared. RESULTS The weight-bearing line was corrected 21.2 ± 11.8% from preoperatively to 61.6 ± 3.3% postoperatively in the 3D group and from 19.4 ± 12.3% to 61.3 ± 8.1% in the PACS group. The mean absolute difference with the target point was lower in the 3D group (2.3 ± 2.5) than in the PACS group (6.2 ± 5.1; p = 0.005). The number of patients in an acceptable range was higher in the 3D group than in the PACS group. The posterior tibial slope angle was not significantly different in the 3D group (8.6°-8.9°), but was significantly different in the PACS group (9.9°-10.5°, p = 0.042). CONCLUSIONS In open-wedge HTO, a more accurate correction for successful results could be obtained using the 3D printed model. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hee-June Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jaeyeong Park
- School of Mechanical Engineering, Yeungjin College, Daegu, South Korea
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Il-Hyung Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Hee-Soo Kyung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
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Lee M, Chen JY, Chen H, Chong HC, Koo K, Singh IR. Effect of Mechanical Axis Correction on Outcomes of Hallux Valgus Surgery. J Foot Ankle Surg 2018; 57:111-115. [PMID: 29268896 DOI: 10.1053/j.jfas.2017.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Indexed: 02/03/2023]
Abstract
A new method of mechanical axis planning has recently been suggested to aid in corrective surgery for hallux valgus (HV) deformity, which aims to identify the ideal position for the first metatarsal after correction. We investigated the influence of the mechanical axis angle (MAA) correction on the outcomes of corrective HV surgery. We reviewed 50 radiographs to identify the "normal" MAA range within the population. We also reviewed the medical records of 100 patients who had undergone scarf osteotomy at our institution from January 2011 to December 2013. These patients were segregated into 2 groups according to their postoperative MAA: those within the normal range (normal group) and those outside this range (outlier group). We compared the pre- and postoperative functional scores between the 2 groups using statistical analysis. The normal MAA range within our population was 12.5° ± 0.8° (range 11.0° to 14.3°). We found that the physical component summary score of the short-form 36-item health survey was significantly poorer for the outlier group at 6 and 24 months postoperatively compared with the normal group, although the other postoperative scores were comparable. Surgical correction of the MAA to the normal range of the patient population can be recommended because it provides improved quality of life. However, further studies are required to investigate the influence of MAA planning on other standardized foot and ankle scores.
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Affiliation(s)
- Merrill Lee
- Surgeon, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Jerry Yongqian Chen
- Surgeon, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Haobin Chen
- Surgeon, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Hwei Chi Chong
- Physiotherapist, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kevin Koo
- Surgeon, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Inderjeet Rikhraj Singh
- Associate Professor, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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FTFA change under valgus stress force radiography is useful for evaluating the correctability of intra-articular varus deformity in UKA. Arch Orthop Trauma Surg 2018; 138:1003-1009. [PMID: 29728833 DOI: 10.1007/s00402-018-2945-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this observational study was to investigate the postoperative alignment change with Oxford unicompartmental knee arthroplasties (UKA), and clarify whether femoro-tibial facet angle (FTFA) is useful for evaluating alignment correctability with UKA. METHODS This study evaluated 79 knees consecutive minimally invasive Oxford phase 3 UKAs performed between 2013 and 2014. Full-length weight-bearing radiographs of the lower limbs were obtained pre- and postoperatively to assess varus angle. Preoperative valgus stress radiography in the supine position was also performed. FTFA was measured on weight-bearing anteroposterior radiography and valgus stress radiography. RESULTS The preoperative varus angle of 4.6° ± 3.1° reduced to 1.7° ± 2.6° postoperatively. Preoperative varus angle and postoperative varus angle change strongly correlated with the FTFA value and its change on the valgus stress radiographs, respectively (p < 0.01). Based on preoperative FTFA under valgus stress radiography, intra-articular varus corrected group (37 knees) with preoperative varus angle 2.9° ± 2.4° was corrected to - 0.3° ± 2.0° after UKA. However, intra-articular varus uncorrected group (42 knees) with preoperative varus angle 6.0° ± 3.0° was only corrected to 3.5° ± 1.7°. Thirteen knees (16.5%) were overcorrected to valgus after UKA, with a mean FTFA of - 1.2° ± 0.4° under valgus stress force, which related with a postoperative valgus angle 0.8° ± 1.2°. CONCLUSION FTFA change under valgus stress force was useful for evaluating the correctability of UKA. It could reflect intra-articular varus deformity. Intra-articular varus deformity not corrected under valgus stress would result in varus after UKA. However, intra-articular deformity which could be overcorrected under valgus stress would have a tendency to valgus after Oxford UKA.
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Kleeblad LJ, van der List JP, Pearle AD, Fragomen AT, Rozbruch SR. Predicting the Feasibility of Correcting Mechanical Axis in Large Varus Deformities With Unicompartmental Knee Arthroplasty. J Arthroplasty 2018; 33:372-378. [PMID: 29074321 DOI: 10.1016/j.arth.2017.09.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/06/2017] [Accepted: 09/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Due to disappointing historical outcomes of unicompartmental knee arthroplasty (UKA), Kozinn and Scott proposed strict selection criteria, including preoperative varus alignment of ≤15°, to improve the outcomes of UKA. No studies to date, however, have assessed the feasibility of correcting large preoperative varus deformities with UKA surgery. The study goals were therefore to (1) assess to what extent patients with large varus deformities could be corrected and (2) determine radiographic parameters to predict sufficient correction. METHODS In 200 consecutive robotic-arm assisted medial UKA patients with large preoperative varus deformities (≥7°), the mechanical axis angle (MAA) and joint line convergence angle (JLCA) were measured on hip-knee-ankle radiographs. It was assessed what number of patients were corrected to optimal (≤4°) and acceptable (5°-7°) alignment, and whether the feasibility of this correction could be predicted using an estimated MAA (eMAA, preoperative MAA-JLCA) using regression analyses. RESULTS Mean preoperative MAA was 10° of varus (range, 7°-18°), JLCA was 5° (1°-12°), postoperative MAA was 4° of varus (-3° to 8°), and correction was 6° (1°-14°). Postoperative optimal alignment was achieved in 62% and acceptable alignment in 36%. The eMAA was a significant predictor for optimal postoperative alignment, when corrected for age and gender (P < .001). CONCLUSION Patients with large preoperative varus deformities (7°-18°) could be considered candidates for medial UKA, as 98% was corrected to optimal or acceptable alignment, although cautious approach is needed in deformities >15°. Furthermore, it was noted that the feasibility of achieving optimal alignment could be predicted using the preoperative MAA, JLCA, and age.
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Affiliation(s)
- Laura J Kleeblad
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
| | - Austin T Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, New York
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, New York
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Blackburn J, Ansari A, Porteous A, Murray J. Reliability of two techniques and training level of the observer in measuring the correction angle when planning a high tibial osteotomy. Knee 2018; 25:130-134. [PMID: 29223707 DOI: 10.1016/j.knee.2017.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/05/2017] [Accepted: 11/17/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In high tibial osteotomy, planning is critical for achieving successful realignment. Any method selected needs to be reliable, with inter-observer and intra-observer correlation. A literature review demonstrated two distinct methods of planning for high tibial osteotomy. HYPOTHESIS Both methods are precise and show excellent inter and intra-observer correlation. METHOD Fifty consecutive weight-bearing long leg alignment antero-posterior (AP) radiographs were identified and planning undertaken on suitable radiographs using the methods of Puddu (method 1) and Miniaci (method 2). Two observers, one junior trainee and one Specialist Knee Fellow, recorded measurements to calculate inter and intra-observer correlation. RESULTS Thirty-two radiographs were included. Inter-observer and intra-observer correlation, and correlation between the two methods were all greater than 0.97 (p<0.0001). CONCLUSION Our results show excellent correlation between both methods and both observers. Both methods are reliable for planning and can be performed by both junior trainees and subspecialists. Further work should consider how planning can ensure adequate intraoperative correction.
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Affiliation(s)
- Julia Blackburn
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom.
| | - Aneel Ansari
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - Andrew Porteous
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - James Murray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
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Wilczek JL, LaPorta GA. The Evolution of Limb Deformity: What Has Changed over the Past Ten Years? Clin Podiatr Med Surg 2018; 35:123-132. [PMID: 29156162 DOI: 10.1016/j.cpm.2017.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Limb deformity correction has been widely discussed in orthopedic literature with an increasing interest in technologically based surgical strategies. However, principles described by Ilizarov and Paley still form the basis of these newly developing surgical systems. The recent advances and increased use of computers and mobile devices in the medical arena, along with the application of dynamic hexapod external fixation, have allowed for easier and more convenient strategies, leading to a greater outreach and more confidence in the newer surgeon when faced with addressing a patient with a limb deformity.
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Affiliation(s)
- Jessica L Wilczek
- Department of Graduate Medical Education and Podiatric Surgery, Our Lady of Lourdes Memorial Hospital, 169 Riverside Drive, Binghamton, NY 13905, USA.
| | - Guido A LaPorta
- Department of Graduate Medical Education and Podiatric Surgery, Our Lady of Lourdes Memorial Hospital, 169 Riverside Drive, Binghamton, NY 13905, USA
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Jones LD, Brown CP, Jackson W, Monk AP, Price AJ. Assessing accuracy requirements in high tibial osteotomy: a theoretical, computer-based model using AP radiographs. Knee Surg Sports Traumatol Arthrosc 2017; 25:2952-2956. [PMID: 27056695 DOI: 10.1007/s00167-016-4092-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE High tibial osteotomy (HTO) is a recognised treatment for medial compartment knee arthritis and in recent years has regained popularity. Preoperative planning of wedge opening is based on standing AP radiographs, aiming to deliver the WBL to a desired point. Clinical results can be unpredictable, and this may be due to an inability to deliver the preoperative plan. This study explores the theoretical wedge opening accuracy required to deliver preoperative plans, based on clinical AP radiographs. METHODS A theoretical 2-D model of osteotomy was developed to determine the degree of radiological wedge opening accuracy required to deliver the weight-bearing line to a preoperative target of 62-66 % of the width of the tibial plateau. RESULTS This model suggests that, to deliver the weight-bearing line to the preoperative target on plane radiographs, the theoretical medial wedge must be opened to an accuracy of ±0.9 mm. CONCLUSION Although this study only explores a model of wedge opening based on AP radiographs, with current surgical systems, it is unlikely that the surgeon can achieve this level of accuracy within a real-life surgical setting. Surgical accuracy in HTO is known to be important for both short- and long-term clinical outcomes. This study highlights the need for improved surgical accuracy aids and/or patient stratification to mitigate the effects of surgical errors. LEVEL OF EVIDENCE II.
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Affiliation(s)
- L D Jones
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK.
| | - C P Brown
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - W Jackson
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - A P Monk
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
| | - A J Price
- Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, UK
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Zhu M, Chen JY, Chong HC, Yew AKS, Foo LSS, Chia SL, Lo NN, Yeo SJ. Outcomes following total knee arthroplasty with CT-based patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc 2017; 25:2567-2572. [PMID: 26410097 DOI: 10.1007/s00167-015-3803-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/16/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE A 24-month prospective follow-up study was carried out to compare perioperative clinical outcomes, radiographic limb alignment, component positioning, as well as functional outcomes following total knee arthroplasty (TKA) between patient-specific instrumentation (PSI) and conventional instrumentation (CI). METHODS Ninety consecutive patients, satisfying the inclusion and exclusion criteria, were scheduled to undergo TKA with either PSI or CI. A CT-based PSI was used in this study, and a senior surgeon performed all surgeries. Patients were clinically and functionally assessed preoperatively, 6 and 24 months post-operatively. Perioperative outcomes were also analysed, including operating time, haemoglobin loss, the need for blood transfusion, length of hospitalisation, and radiographic features. RESULTS At 24-month follow-up, clinical and functional outcomes were comparable between the two groups. PSI performed no better than CI in restoring lower limb mechanical alignment or improving component positioning. There were no differences in operating time, haemoglobin loss, transfusion rate, or length of hospitalisation between PSI and CI. CONCLUSION No significant clinical benefit could be demonstrated in using PSI over CI after 24 months, and routine use of PSI is not recommended in non-complicated TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Meng Zhu
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Hwei Chi Chong
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Leon Siang Shen Foo
- Island Orthopaedic Consultants, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, Singapore, 228510, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
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Waldstein W, Kasparek MF, Faschingbauer M, Windhager R, Boettner F. Lateral-compartment Osteophytes are not Associated With Lateral-compartment Cartilage Degeneration in Arthritic Varus Knees. Clin Orthop Relat Res 2017; 475:1386-1392. [PMID: 27830485 PMCID: PMC5384912 DOI: 10.1007/s11999-016-5155-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Progression of arthritis in the lateral compartment is one of the main failure modes of unicompartmental knee arthroplasty (UKA). The decision regarding whether to perform a medial UKA sometimes is made based on whether lateral-compartment osteophytes are visible on plain radiographs obtained before surgery, but it is not clear whether the presence of lateral-compartment osteophytes signifies that the cartilage in the lateral compartment is arthritic. QUESTIONS/PURPOSES (1) Is the presence of lateral compartment osteophytes associated with biomechanical properties of lateral-compartment cartilage, and (2) are osteophytes in the lateral compartment associated with particular histologic features of cartilage in the lateral compartment? METHODS Between May 2010 and January 2012, we performed 201 TKAs for varus osteoarthritis confirmed on standardized AP hip-to-ankle standing radiographs. All patients with a varus deformity were considered for this prospective study. During the enrollment period, 100 patients (101 knees) were not enrolled for this study because of declined consent or because they were unable to perform all required preoperative radiographic examinations. That left 84 patients (100 knees), of whom an additional 23 patients (27%) were excluded because either radiographic or biomechanical data were missing. For final analysis, 61 patients (71 knees) were available. There were 29 males (48%) and 32 females (52%) with a mean age of 65 years (range, 49-89 years). Their mean BMI was 26 kg/m2 (range, 17-47 kg/m2). Lateral-compartment osteophytes were graded by two observers on AP standing knee radiographs based on a template of the Osteoarthritis Research Society International (OARSI) radiographic atlas. During surgery, osteochondral plugs were harvested from the lateral tibial plateau and the distal lateral femur for biomechanical and histologic assessments. The intrinsic material coefficients aggregate modulus (Ha) and dynamic modulus (DM) were determined by applying a compressive load of 20 g for 1 hour. The histologic analysis was performed according to the qualitative osteoarthritis cartilage histopathology assessment system. The Mann-Whitney U test was performed to compare the distribution of variables. Power analysis was performed for the Mann-Whitney U test using an alpha of 0.05, a power of 80%, and a sample size of 71 resulting in a detectable effect size of 0.6. Owing to the limited sample size, only medium or large effects in changes of biomechanical properties can be excluded with adequate power. RESULTS Ha and DM were not different with the numbers available when comparing knees with osteophyte Grades 0, 1, and 2 on the lateral tibia. For Grade 3 tibial osteophytes (n = 3), the lateral tibia cartilage showed low Ha (0.39 MPa; SD, 0.17 MPa) and low DM (2.85 MPa; SD, 2.12 MPa). On the lateral femur, no differences of Ha and DM were observed with the numbers available between Grades 0 to 3 osteophytes. No differences with the numbers available in the OARSI histologic grades on the lateral tibia plateau and the distal lateral femur were observed between the different osteophyte grades. CONCLUSIONS Lateral-compartment osteophytes are not associated with biomechanically weaker cartilage or with more-advanced histologic signs of degeneration of lateral-compartment cartilage in knees with varus arthritis. Given the small sample size of 71, the study was underpowered to detect small-to-modest decreases in biomechanical properties. Future studies with larger sample sizes are needed to confirm the current findings. CLINICAL RELEVANCE Factors other than the presence or absence of lateral-compartment osteophytes should be considered when evaluating patients with medial-compartment arthritis for medial UKA. Future studies are required to define the limitations of plain radiographs to rule out cartilage degeneration in the lateral compartment of varus knees.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Knee/adverse effects
- Biomechanical Phenomena
- Cartilage, Articular/diagnostic imaging
- Cartilage, Articular/pathology
- Cartilage, Articular/physiopathology
- Cartilage, Articular/surgery
- Female
- Humans
- Knee Joint/diagnostic imaging
- Knee Joint/pathology
- Knee Joint/physiopathology
- Knee Joint/surgery
- Male
- Middle Aged
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/pathology
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Osteophyte/diagnostic imaging
- Osteophyte/pathology
- Patient Selection
- Predictive Value of Tests
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Treatment Outcome
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Affiliation(s)
- Wenzel Waldstein
- Department of Orthopedic Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Maximilian F Kasparek
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, Ulm University Hospital, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Reinhard Windhager
- Department of Orthopedic Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Friedrich Boettner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Eberbach H, Mehl J, Feucht MJ, Bode G, Südkamp NP, Niemeyer P. Geometry of the Valgus Knee: Contradicting the Dogma of a Femoral-Based Deformity. Am J Sports Med 2017; 45:909-914. [PMID: 28125900 DOI: 10.1177/0363546516676266] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Realignment osteotomies of valgus knee deformities are usually performed at the distal femur, as valgus alignment is considered to be a femoral-based deformity. This dogma, however, has not been proven in a large patient population. Valgus malalignment may also be caused by a tibial deformity or a combined tibial and femoral deformity. PURPOSE The purposes of this study were (1) to analyze the coronal geometry of patients with valgus malalignment and identify the location of the underlying deformity and (2) to investigate the proportion of cases that require realignment osteotomy at the tibia, the femur, or both locations to avoid an oblique joint line. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The analysis included 420 standing full-leg radiographs of patients with valgus malalignment (mechanical femorotibial angle [mFTA], ≥4°). A systematic analysis of the coronal leg geometry was performed including the mFTA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and joint-line convergence angle (JLCA). The localization of the deformity was determined according to the malalignment test described by Paley, and patients were assigned to 1 of 4 groups: femoral-based valgus deformity, tibial-based valgus deformity, femoral- and tibial-based valgus deformity, or intra-articular/ligamentary-based valgus deformity. Subsequently, the ideal osteotomy site was identified with the goal of a postoperative change of the joint line of two different maximum values, ±2° and ±4°, from its physiological varus position of 3°. RESULTS Measurements of the coronal alignment revealed a mean (±SD) mFTA of 7.4° ± 4.3° (range, 4°-28.2°). The mean mLDFA and mean mMPTA were 84.8° ± 2.4° and 90.9° ± 2.6°, respectively. The mean JLCA was 1.2° ± 3.1°. The majority (41.0%) of valgus deformities were tibial based, 23.6% were femoral based, 26.9% were femoral and tibial based, and 8.6% were intra-articular/ligamentary based. To achieve a straight-leg axis and an anatomic postoperative joint line with a tolerance of ±4°, the ideal site of a corrective osteotomy was tibial in 55.2% of cases and femoral in 19.5% of cases. A double-level osteotomy would be necessary in 25.2% of cases. With a tolerance of ±2°, the ideal osteotomy site was the proximal tibia in 41.0% of cases and the distal femur in 13.6% of cases; a double-level osteotomy would be necessary in 45.5% of cases. CONCLUSION In contrast to the widespread belief that valgus malalignment is usually caused by a femoral deformity, this study found that valgus malalignment was attributable to tibial deformity in the majority of patients. In addition, a combined femoral- and tibial-based deformity was more common than an isolated femoral-based deformity. As a clinical consequence, varus osteotomies to treat lateral compartment osteoarthritis must be performed at the tibial site or as a double-level osteotomy in a relevant number of patients to avoid an oblique joint line.
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Affiliation(s)
- Helge Eberbach
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany
| | - Julian Mehl
- Department for Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany
| | - Gerrit Bode
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Freiburg, Germany.,OCM-Clinic Munich, Munich, Germany
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Mullaji AB, Shah S, Shetty GM. Mobile-bearing medial unicompartmental knee arthroplasty restores limb alignment comparable to that of the unaffected contralateral limb. Acta Orthop 2017; 88:70-74. [PMID: 27794622 PMCID: PMC5251267 DOI: 10.1080/17453674.2016.1253327] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Medial unicompartmental knee arthroplasty (UKA) is undertaken in patients with a passively correctable varus deformity. We investigated whether restoration of natural soft tissue tension would result in a lower limb alignment similar to that of the contralateral unaffected lower limb after mobile-bearing medial UKA. Patients and methods - In this retrospective study, hip-knee-ankle (HKA) angle, position of the weight-bearing axis (WBA), and knee joint line obliquity (KJLO) after mobile-bearing medial UKA was compared with that of the unaffected (clinically and radiologically) contralateral lower limb in 123 patients. Results - Postoperatively, HKA angle was restored to within ±3° of the contralateral lower limb in 87% of the patients and the WBA passed within ±1 Kennedy and White's tibial zone of the unaffected contralateral lower limb in 95% of the patients. The mean KJLO in the operated limbs was not significantly different from that in the unaffected lower limbs (p = 0.07) and the KJLO in the operated limb was restored to within ±3° of that in the contralateral lower limb in 96% of the patients. Interpretation - Lower limb alignment and knee joint line obliquity after mobile-bearing medial UKA were comparable to that of the unaffected contralateral limb in most patients. Comparison with the contralateral unaffected lower limb is a reliable method for evaluation and validation of limb mechanical alignment after mobile-bearing medial UKA.
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Affiliation(s)
- Arun B Mullaji
- Department of Orthopedic Surgery, Breach Candy Hospital,Mullaji Knee Clinic, Mumbai, India
| | | | - Gautam M Shetty
- Department of Orthopedic Surgery, Breach Candy Hospital,Mullaji Knee Clinic, Mumbai, India,Correspondence:
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Kim HJ, Lee HJ, Shin JY, Park KH, Min SG, Kyung HS. Preoperative planning using the picture archiving and communication system technique in high tibial osteotomy. J Orthop Surg (Hong Kong) 2017; 25:2309499016684701. [PMID: 28142346 DOI: 10.1177/2309499016684701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study aimed to evaluate the accuracy of the picture archiving and communication system (PACS) method in order to select the correction angle and gap in open-wedge high tibial osteotomy (HTO) and clinical results of the patients. MATERIAL AND METHODS This retrospective study analyzed 27 consecutive patients (30 knees) underwent open-wedge HTO using the PACS method between April 2013 and March 2015. Full-length lower limb radiographs obtained preoperatively and at the final follow-up were used to the percentages of crossing points of the weight-bearing line and tibial plateau with respect to the medial border and mechanical femur-tibia angle. Preoperatively predicted and postoperatively measured wedge angles and gaps were compared. The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee score and the Knee Society score. RESULTS At the 20.5 months (12-26.5) follow-up, the weight-bearing line on the tibial plateau was corrected from 17.3% to 61.3%, and the mechanical femur-tibia angle was corrected from 7.3° varus to 3.1° valgus. No significant difference in preoperative and postoperative measured values was observed ( p = 0.440 and p = 0.505). The mean HSS score increased from 66.7 to 88.8 ( p < 0.001). The knee score and function score of Knee Society increased from 62.0 to 88.7 ( p < 0.001) and from 60.2 to 91.7 ( p < 0.001), respectively. CONCLUSION In open-wedge HTO, correction of angular deformity based on the PACS method could be an accurate correction method and the good clinical results could be obtained.
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Affiliation(s)
- Hee-June Kim
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun-Joo Lee
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Ji-Yeon Shin
- 2 Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Kyeong-Hyeon Park
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Gi Min
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-Soo Kyung
- 1 Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Kwun JD, Kim HJ, Park J, Park IH, Kyung HS. Open wedge high tibial osteotomy using three-dimensional printed models: Experimental analysis using porcine bone. Knee 2017; 24:16-22. [PMID: 27876267 DOI: 10.1016/j.knee.2016.09.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the usefulness of three-dimensional (3D) printed models for open wedge high tibial osteotomy (HTO) in porcine bone. METHODS Computed tomography (CT) images were obtained from 10 porcine knees and 3D imaging was planned using the 3D-Slicer program. The osteotomy line was drawn from the three centimeters below the medial tibial plateau to the proximal end of the fibular head. Then the osteotomy gap was opened until the mechanical axis line was 62.5% from the medial border along the width of the tibial plateau, maintaining the posterior tibial slope angle. The wedge-shaped 3D-printed model was designed with the measured angle and osteotomy section and was produced by the 3D printer. The open wedge HTO surgery was reproduced in porcine bone using the 3D-printed model and the osteotomy site was fixed with a plate. Accuracy of osteotomy and posterior tibial slope was evaluated after the osteotomy. RESULTS The mean mechanical axis line on the tibial plateau was 61.8±1.5% from the medial tibia. There was no statistically significant difference (P=0.160). The planned and post-osteotomy correction wedge angles were 11.5±3.2° and 11.4±3.3°, and the posterior tibial slope angle was 11.2±2.2° pre-osteotomy and 11.4±2.5° post-osteotomy. There were no significant differences (P=0.854 and P=0.429, respectively). CONCLUSION This study showed that good results could be obtained in high tibial osteotomy by using 3D printed models of porcine legs.
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Affiliation(s)
- Jun-Dae Kwun
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-June Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaeyoung Park
- Division of Biomedical Science, Kyunpook National University, Daegu, Republic of Korea
| | - Il-Hyung Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Soo Kyung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Yoon SD, Zhang G, Kim HJ, Lee BJ, Kyung HS. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy. Knee Surg Relat Res 2016; 28:283-288. [PMID: 27894175 PMCID: PMC5134794 DOI: 10.5792/ksrr.16.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO). Materials and Methods This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border. Results The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group. Conclusions In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.
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Affiliation(s)
- Seong-Dae Yoon
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - GuoFeng Zhang
- Department of Orthopedic Surgery, Yantaishan Hospital, Yantai, China
| | - Hee-June Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Byoung-Joo Lee
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hee-Soo Kyung
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Affiliation(s)
- Hee-Soo Kyung
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Wu PH, Zhang ZQ, Fang SY, Yang ZB, Kang Y, Fu M, Liao WM. Preoperative Measurement of Tibial Resection in Total Knee Arthroplasty Improves Accuracy of Postoperative Limb Alignment Restoration. Chin Med J (Engl) 2016; 129:2524-2529. [PMID: 27779156 PMCID: PMC5125328 DOI: 10.4103/0366-6999.192789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Accuracy of implant placement in total knee arthroplasty (TKA) is crucial. Traditional extramedullary alignment instruments are fairly effective for achieving the desired mean tibial component coronal alignment. We modified the traditional tibial plateau resection technique and evaluated its effect on alignment restoration. Methods: Two hundred and eighty-two primary TKAs in our hospital between January 2013 and December 2014 were enrolled in this retrospective study. Group A consisted of 128 primary TKAs performed by one senior surgeon. Preoperative measurement of the tibial resection was conducted on radiographs, and the measured thicknesses of the lateral and medial plateau resection were used to place the tibial alignment guide. Group B consisted of 154 primary TKAs performed by the other senior surgeon, using a traditional tibial plateau resection technique. In all patients, an extramedullary guide was used for tibial resection, and preoperative and postoperative full-leg standing radiographs were used to assess the hip-knee-ankle angle (HKA), femoral component alignment angle (FA), and tibial component alignment angle (TA). A deviation ≥3° was considered unsatisfactory. Data were analyzed by unpaired Student's t-test. Results: The mean postoperative HKA and TA angles were significantly different between Groups A and B (178.2 ± 3.2° vs. 177.0 ± 3.0°, t = 2.54, P = 0.01; 89.3 ± 1.8° vs. 88.3 ± 2.0°, t = 3.75, P = 0.00, respectively). The mean postoperative FA was 88.9 ± 2.5° in Group A and 88.9 ± 2.6° in Group B, and no significant difference was detected (t = 0.10, P = 0.92). There were 90 (70.3%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 38 (29.7%) outliers (>3° deviation) in Group A, whereas there were 89 (57.8%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 65 (42.2%) outliers (>3° deviation) in Group B. The severity of the preoperative alignment deformity was a strong predictor for postoperative alignment. Conclusions: Using conventional surgical instruments, preoperative measurement of resection thickness of the tibial plateau on radiographs could improve the accuracy of conventional surgical techniques.
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Affiliation(s)
- Pei-Hui Wu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Zhi-Qi Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Shu-Ying Fang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Zi-Bo Yang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yan Kang
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Ming Fu
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Wei-Ming Liao
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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Seon JK, Park HW, Yoo SH, Song EK. Assessing the accuracy of patient-specific guides for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:3678-3683. [PMID: 25399345 DOI: 10.1007/s00167-014-3429-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 10/31/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Patient-specific guides have been introduced recently as a means of making accurate bone cuts through custom cutting blocks constructed based on pre-operative three-dimensional imaging. However, the controversy concerning the improved results of patient-specific guides have not been resolved yet; in addition, there have been no studies to investigate the causes of variable with inconsistent results and solutions for the causes. METHODS Thirty eight patients (38 knees) underwent total knee arthroplasty with patient-specific guides. The mean age of the patients was 68 years (SD ± 6.3), and all patients had a minimum 2-year follow-up. An intra-operative alignment using navigation and the causes of outliers were evaluated. RESULTS An average coronal alignment of PSI jigs was 0.5° (SD ± 0.9°) in femur and 0.1° (SD ± 0.8°) in tibia, and the number of outliers was two and three cases, respectively. An average sagittal alignment was 0.6° (SD ± 0.9°) in femur and 5.5° (SD ± 1.1°) in tibia, and the number of outliers was three and five cases, respectively. All outliers resulted from large osteophytes near the contact point of patient-specific guides which disturb sitting of the guide. CONCLUSION It was suggested that patient-specific guides were an effective and safe method to achieve accurate alignments, with no additional intra-operative complication. It is important to note that surgeons need to be precautious using the patient-specific instrumentation in patients with severe varus deformity. In addition, existing osteophytes which disturb sitting of the guides should be carefully evaluated pre-operatively and intra-operatively. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jong-Keun Seon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, South Korea
| | - Hyeong-Won Park
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, South Korea.
| | - Seung-Hyun Yoo
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, South Korea
| | - Eun-Kyoo Song
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, South Korea
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Vaishya R, Vijay V, Birla VP, Agarwal AK. Inter-observer variability and its correlation to experience in measurement of lower limb mechanical axis on long leg radiographs. J Clin Orthop Trauma 2016; 7:260-264. [PMID: 27857500 PMCID: PMC5106474 DOI: 10.1016/j.jcot.2016.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/23/2016] [Accepted: 05/28/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Restoration of mechanical axis (MA) is one of the most important aims of treatment of knee arthritis. The measurement of MA is often done on hip knee ankle (HKA) radiographs (LLR), but its measurement is often difficult and variable. We studied to check if inter-observer variability in the measurement of MA is dependent on the experience of the observer. MATERIALS AND METHODS 48 patients (70 knees) underwent measurement of MA on HKA radiographs. The measurement was done by five observers of different experience. All the results were tested for inter-observer variability. RESULTS The overall intra-class correlation was 0.70. The two full time consultants had good agreeability among them (p < 0.456). All the surgeons who had less than five years of experience among them also had good agreeability amongst them (all p values >0.005). All the other groups (except senior consultant and senior registrar) had statistically significant difference amongst them (all p values <0.005). CONCLUSION There is an inter-observer variability in the measurement of MA on the HKA radiographs. The agreeability between the observers increases as the experience of the personnel increases. Although long leg radiographs can be used for assessment for HKA, this variability should be kept in mind while using this as a tool for planning management of the arthritic knee.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Joint Replacement & Arthroscopy, Indraprastha Apollo Hospital, New Delhi 110076, India
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Whitaker AT, Gesheff MG, Jauregui JJ, Herzenberg JE. Comparison of PACS and Bone Ninja mobile application for assessment of lower extremity limb length discrepancy and alignment. J Child Orthop 2016; 10:439-43. [PMID: 27447466 PMCID: PMC5033780 DOI: 10.1007/s11832-016-0761-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/12/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There are over 500 medically related applications (apps) for mobile devices. Very few of these applications undergo testing and peer-review for accuracy. The purpose of this study is to assess the accuracy of limb deformity measurements on the Bone Ninja app compared to PACS and to determine the intra- and inter-observer variability among different orthopaedic practitioners. METHODS Four participants (attending, senior and junior resident, and physician assistant) measured the leg length (LL), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) of 48 limbs (24 patients), twice with both Bone Ninja and PACS. The difference between the measurements obtained with the Bone Ninja app and PACS were measured. We determined the consistency of the intra-observer intra-class correlation coefficient (ICC) for both systems. RESULTS There were no statistical differences in leg length discrepancy (LLD), MPTA, or LDFA measurements between Bone Ninja and PACS (p = 0.96, 0.87, and 0.97, respectively). The intra-observer ICC for the LL, LDFA, and MPTA was similar between Bone Ninja and PACS (0.83, 0.89, and 0.96 vs. 0.96, 0.93, and 0.95, respectively). The inter-observer ICC was similar between Bone Ninja and PACS (0.95, 0.96, and 0.99 vs. 0.99, 0.98, and 0.98, respectively). CONCLUSIONS This study demonstrates that Bone Ninja is an accurate educational tool for measuring LLD, LDFA, and MPTA. Both systems are reliable instruments for evaluating limb length differences and angles on standing radiographs for pre-operative deformity planning and education. This is the first study to evaluate the accuracy of Bone Ninja compared to the gold standard of PACS.
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Affiliation(s)
- Amanda T Whitaker
- Department of Orthopaedic Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Martin G Gesheff
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD, 21215, USA
| | - Julio J Jauregui
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD, 21215, USA
| | - John E Herzenberg
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, MD, 21215, USA
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Neil MJ, Atupan JB, Panti JPL, Massera RAJ, Howard S. Evaluation of lower limb axial alignment using digital radiography stitched films in pre-operative planning for total knee replacement. J Orthop 2016; 13:285-9. [PMID: 27408505 DOI: 10.1016/j.jor.2016.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/21/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For patients with knee osteoarthritis, even slight anatomical variations in the femur or the tibia could affect total limb alignment during total knee replacement (TKR). Our hypothesis implies that the femoral valgus correction angle (VCA) in patients indicated for TKR, is variable and higher than the reported norm of 6° utilized in most intramedullary instrumentation systems, and that tibial bowing may result to a disparity of the tibial mechanical axis to the anatomical axis. METHODS Our study is a retrospective review of 216 pre-operative arthritic knees, which investigated the lower limb axial alignment using digitally-stitched films. Patients excluded from the study are those with history of previous tibial or femoral osteotomy, secondary gonarthrosis, rheumatoid arthritis, previous femoral or tibial fracture, patients for bilateral TKR, or history of hip surgery. RESULTS The mean age was 68-years old (range 39-86 years). The mean VCA was 7° (4.7-9.3) for men and 6.6° (4.9-9) for women. However, 71 patients (33%) had more than 7° VCA. Subsequently, 46 patients (21%) had tibial bowing producing an angle >1.5° between its mechanical and anatomic axis. CONCLUSIONS The 6° standard when used as a guide may result in suboptimal prosthesis positioning during conventional TKR surgery. Therefore our findings suggest that the femoral valgus correction angle has a broad range, and using standard femoral intramedullary guides should not be overlooked.
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Affiliation(s)
- Michael J Neil
- Department of Orthopaedic Surgery, St. Vincent's Clinic, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Jereme B Atupan
- Department of Orthopaedic Surgery, St. Vincent's Clinic, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Juan Paulo L Panti
- Department of Orthopaedic Surgery, St. Vincent's Clinic, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Robert A J Massera
- Department of Orthopaedic Surgery, St. Vincent's Clinic, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Stewart Howard
- College of Medicine, University of Notre Dame, Darlinghurst, Sydney, New South Wales 2010, Australia
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Chen JY, Loh B, Woo YL, Chia SL, Lo NN, Yeo SJ. Fixed Flexion Deformity After Unicompartmental Knee Arthroplasty: How Much Is Too Much. J Arthroplasty 2016; 31:1313-1316. [PMID: 26748406 DOI: 10.1016/j.arth.2015.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/20/2015] [Accepted: 12/08/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The detrimental impact of postoperative fixed flexion deformity (FFD) after unicompartmental knee arthroplasty (UKA) is manifold. This study aims to define the amount of postoperative FFD that is clinically relevant after UKA. METHODS Between 2005 and 2012, 803 patients who underwent a primary UKA at a tertiary hospital were prospectively followed up. They were categorized into 3 groups based on the amount of postoperative FFD: (1) 0° (control); (2) 1°-10° (mild FFD); and (3) >10° (severe FFD). RESULTS There were 26 patients (3%) with severe FFD at 2 years after UKA. The Knee Society Function Score and Knee Score in the severe FFD group were 10 ± 4 and 10 ± 2 points lower than in the control group, respectively (P = .017 and P = .001). Similarly, the Oxford Knee Score and Physical Component Score in the severe FFD group was 5 ± 1 and 7 ± 2 points lower than in the control group, respectively (P = .033 and P < .001). CONCLUSION This study suggests that postoperative FFD of >10° after UKA is associated with significantly poorer functional outcomes.
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Affiliation(s)
- Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Bryan Loh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Sorin G, Pasquier G, Drumez E, Arnould A, Migaud H, Putman S. Reproducibility of digital measurements of lower-limb deformity on plain radiographs and agreement with CT measurements. Orthop Traumatol Surg Res 2016; 102:423-8. [PMID: 27052940 DOI: 10.1016/j.otsr.2016.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Five angles (HKA, HKS, alpha, beta, tibial slope) are used for goniometry in total knee arthroplasty. The reproducibility of the measurement of these angles has been assessed on plain and digitized x-rays, but to our knowledge, this has not been confirmed on x-rays taken on the PACS system and they have not been compared to computed tomography (CT) measurements, the reference for angle measurement. This prospective study aimed to: (1) evaluate the inter- and intrarater reliability of the measurement of these angles on digital x-rays taken on a PACS; (2) determine the agreement of these measurements with those obtained using a CT protocol. HYPOTHESIS The measurements of these five angles on digitized radiographs are reproducible and in agreement with CT values. MATERIAL AND METHODS Forty-two patients suffering from knee osteoarthritis and scheduled for total knee arthroplasty were included in the study. Each patient had a PACS digitized x-ray and a CT intended to produce patient-specific instrumentation (Symbios, Yverdon, Switzerland) including measurements of the angles evaluated. Four senior orthopaedic surgeon-raters measured all the angles twice. Inter- and intrarater reliability was then calculated as well as the agreement between the second measurement of each rater and the CT measurement using interclass correlation and kappa coefficients (data provided as means and 95% confidence intervals). RESULTS The inter- and intrarater reliability values were excellent for the HKA, alpha, and beta angles (with, respectively, a coefficient of 0.99 [0.97-0.99], 0.84 [0.76-0.9], and 0.94 [0.86-0.96] interrater reliability and 0.98 [0.96-0.99], 0.86 [0.75-0.92], and 0.65 [0.44-0.8] intrarater reliability). Interrater reliability was low for HKS and tibial slope angles (coefficients all<0.4 for interrater reliability and <0.7 for intrarater reliability). The x-ray/CT agreement was very good for the HKA, alpha, and beta angles (0.81 [0.67-0.99], 0.74 [0.56-0.91], and 0.74 [0.45-0.92], respectively) and low for the HKS and tibial slope angles (all<0.45). DISCUSSION/CONCLUSION The HKA, alpha, and beta angles were reproducible for digital radiographs and showed good agreement with CT measurements. HKS and tibial slope angles should be used with greater caution, and other navigation methods or patient-specific instrumentation should be explored. LEVEL OF EVIDENCE Level III, prospective, comparative diagnostic case-control study.
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Affiliation(s)
- G Sorin
- Département d'orthopédie, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France.
| | - G Pasquier
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - E Drumez
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Unité de biostatistiques et d'é́pidémiologie, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - A Arnould
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - H Migaud
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
| | - S Putman
- Département de chirurgie orthoépdique et de traumatologie, CHRU de Lille, université de Lille, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille cedex, France
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Bowman A, Shunmugam M, Watts AR, Bramwell DC, Wilson C, Krishnan J. Inter-observer and intra-observer reliability of mechanical axis alignment before and after total knee arthroplasty using long leg radiographs. Knee 2016; 23:203-8. [PMID: 26796777 DOI: 10.1016/j.knee.2015.11.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Long leg radiographs (LLRs) are commonly performed for assessment of mechanical alignment and operative planning in patients undergoing total knee arthroplasty (TKA). The aim of this study was to determine the inter- and intra-observer reliability of alignment measured by observers of different levels of experience. METHODS Forty patients on the waiting list for a TKA had pre- and post-operative standardised LLRs. We analysed the measurements of mechanical axis alignment between an orthopaedic surgeon, a senior orthopaedic registrar, a junior orthopaedic registrar, and a medical student. Reviewers performed blinded measurements on the same computer screen. These measurements were repeated three months later to assess intra-observer reliability. Furthermore high-resolution screens were compared with standard hospital computer screens to investigate whether monitoring quality influenced the accuracy of measurements of alignment. RESULTS Inter-observer reliability was high for pre-operative LLRs with an intra-class correlation (ICC) of >0.9 at all experience levels. Post-operative ICC was lowest between the surgeon and the medical student at 0.7. Intra-observer reliability was high at all experience levels. Larger deformities appeared to have exaggerated measurements for both pre- and post-operative images. There appeared to be no effect of the monitor size and quality on the accuracy of measurement. CONCLUSIONS Long leg radiographs can be used to measure mechanical axis alignment with strong reliability across different levels of experience. This information is important for the evaluation of knee alignment measurements in current clinical practice, to assess severity of deformity and to accompany pre-operative planning and post-operative evaluation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anneka Bowman
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia; International Musculoskeletal Research Institute, Repatriation General Hospital, Daws Road, Daw Park, SA, Australia
| | - Meenalochani Shunmugam
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
| | - Amy R Watts
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia; International Musculoskeletal Research Institute, Repatriation General Hospital, Daws Road, Daw Park, SA, Australia.
| | - Donald C Bramwell
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia; International Musculoskeletal Research Institute, Repatriation General Hospital, Daws Road, Daw Park, SA, Australia
| | - Christopher Wilson
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia; International Musculoskeletal Research Institute, Repatriation General Hospital, Daws Road, Daw Park, SA, Australia
| | - Jeganath Krishnan
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia; International Musculoskeletal Research Institute, Repatriation General Hospital, Daws Road, Daw Park, SA, Australia
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Wojciechowski W, Molka A, Tabor Z. Automated measurement of parameters related to the deformities of lower limbs based on x-rays images. Comput Biol Med 2016; 70:1-11. [PMID: 26773234 DOI: 10.1016/j.compbiomed.2015.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/01/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
Abstract
Measurement of the deformation of the lower limbs in the current standard full-limb X-rays images presents significant challenges to radiologists and orthopedists. The precision of these measurements is deteriorated because of inexact positioning of the leg during image acquisition, problems with selecting reliable anatomical landmarks in projective X-ray images, and inevitable errors of manual measurements. The influence of the random errors resulting from the last two factors on the precision of the measurement can be reduced if an automated measurement method is used instead of a manual one. In the paper a framework for an automated measurement of various metric and angular quantities used in the description of the lower extremity deformation in full-limb frontal X-ray images is described. The results of automated measurements are compared with manual measurements. These results demonstrate that an automated method can be a valuable alternative to the manual measurements.
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Affiliation(s)
- Wadim Wojciechowski
- Medical Center iMed24, ul. Życzkowskiego 29, 31-864 Krakow, Poland; Jagiellonian University Medical College, Kopernika 19, 31-501 Krakow, Poland
| | - Adrian Molka
- Cracow University of Technology, ul. Warszawska 24, 31-155 Krakow, Poland
| | - Zbisław Tabor
- Cracow University of Technology, ul. Warszawska 24, 31-155 Krakow, Poland.
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