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Inter- and Intraobserver Reliability of Two-dimensional CT Scan for Total Knee Arthroplasty Component Malrotation

  • Symposium: 2013 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Rotational malalignment of total knee arthroplasty (TKA) has been correlated with patellofemoral maltracking, knee instability, and stiffness. CT is the most accurate method to assess rotational alignment of prosthetic components after TKA, but inter- and intraobserver reliability of CT scans for this use has not been well documented.

Questions/purposes

The objective of this study was to determine the inter- and intraobserver reliability and the repeatability of the measurement of TKA component rotation using two-dimensional CT scans.

Methods

Fifty-two CT scans of TKAs being evaluated for revision surgery were measured by three different physicians. An orthopaedic resident and attending measured the same scans twice (more than 2 weeks apart) and a musculoskeletal radiologist measured them once. To assess interobserver reliability, intraclass correlation coefficients (ICCs) with two-way mixed-effects analysis of variance models as well as 95% confidence intervals for each were done. The repeatability coefficient was calculated as well, which is defined as the difference in measurements that include 95% of the values. This indicates the magnitude of variability among measurements in the same scale, which in this study is degrees.

Results

The interobserver ICC measurement for the femoral component was 0.386 (poor), and it was 0.670 (good) for the tibial component. The interobserver ICC for the combined rotation measurements was 0.617 (good). The intraobserver ICC for the femoral component was 0.606 (good), and it was 0.809 (very good) for the tibial component. The intraobserver ICC for combined rotation was 0.751 (good). The intraobserver repeatability coefficient for the femoral component was 0.49°, 10.64° for the tibial component, and 12.29° for combined rotation.

Conclusions

In this study, the inter- and intraobserver reliability, and the repeatability, of TKA component rotation were variable. This raises concern about whether CT scan is diagnostic in the assessment of component malrotation after TKA.

Level of Evidence

Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Melissa Manzer MD, for her contributions to this study by her radiographic measurements of component rotation.

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Authors and Affiliations

  1. University of Nebraska Medical Center, Omaha, NE, 68198-1080, USA

    Beau Konigsberg MD, Ryan Hess MD, Curtis Hartman MD, Lynette Smith MS & Kevin L. Garvin MD

Authors
  1. Beau Konigsberg MD
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  2. Ryan Hess MD
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  3. Curtis Hartman MD
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  4. Lynette Smith MS
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  5. Kevin L. Garvin MD
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Corresponding author

Correspondence to Kevin L. Garvin MD.

Additional information

One or more of the authors (CH, KLG) have received funding that is not related to the content of this manuscript. The funding source includes Biomet (Warsaw, IN, USA) (KLG) in the amount of USD 100,000 to USD 1,000,000 and Smith & Nephew (Memphis, TN, USA) (CH) in the amount of USD 10,000 to USD 100,000. The institution of the authors has received funding from TRAK Surgical Inc (Omaha, NE, USA), Smith & Nephew, Biomet, Vanguard (Valley Forge, PA, USA), Exponent (Menlo Park, CA, USA), Gruppo Bioimplanti (St Paul, MN, USA), and Renovis (Redlands, CA, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Konigsberg, B., Hess, R., Hartman, C. et al. Inter- and Intraobserver Reliability of Two-dimensional CT Scan for Total Knee Arthroplasty Component Malrotation. Clin Orthop Relat Res 472, 212–217 (2014). https://doi.org/10.1007/s11999-013-3111-7

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  • DOI: https://doi.org/10.1007/s11999-013-3111-7

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