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Accuracy of biplanar linear radiography versus conventional radiographs when used for lower limb and implant measurements

  • Orthopaedic Surgery
  • Published:
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Abstract

Introduction

The current standard of care for measuring lower extremity length and angular discrepancies is using a full-length standing anteroposterior radiograph. However, there has been increasing interest to use biplanar linear EOS imaging as an alternative. This study aims to compare lower extremity length and implant measurements between biplanar linear and conventional radiographs.

Materials and methods

In this 5-year retrospective study, all patients who had a standing full-length anteroposterior and biplanar linear radiographs (EOS®) that include the lower extremities done within one year of each other were included. Patients who underwent surgery in between the imaging, underwent surgeries that could result in graduated length or angulated corrections and inadequate exposure of the lower extremity were excluded. Four radiographic segments were measured to assess lower limb alignment and length measurements. Height and width measurements of implants were performed for patients who had implants in both imaging.

Results

When comparing imaging and actual implant dimensions, biplanar linear radiographs were accurate in measuring actual implant height (median difference = − 0.14 cm, p = 0.66), and width (median difference = − 0.13 cm, p = 0.71). However, conventional radiographs were inaccurate in measuring actual implant height (median difference = 0.19 cm, p = 0.01) and width (median difference = 0.61 cm, p < 0.01). When comparing conventional and biplanar linear radiographs, there was statistically significant difference in all measurements. This includes anatomical femoral length (median difference = 3.53 cm, p < 0.01), mechanical femoral length (median difference = 3.89 cm, p < 0.01), anatomical tibial length (median difference = 2.34 cm, p < 0.01) and mechanical tibial length (median difference = 2.20 cm, p < 0.01).

Conclusion

First, there is a significant difference in the lower extremity length when comparing conventional and biplanar linear radiographs. Second, biplanar linear radiographs are found to be accurate while conventional radiographs are not as accurate in implant measurements of length and width in the lower extremity.

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Abbreviations

MA:

Mechanical axis

AFL:

Anatomical femoral length

MFL:

Mechanical femoral length

ATL:

Anatomical tibial length

MTL:

Mechanical tibial length

HTO:

High tibial osteotomy

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119074, Singapore

    Chen Xi Kasia Chua, Si Heng Sharon Tan, Andrew Kean Seng Lim & James Hoipo Hui

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  1. Chen Xi Kasia Chua
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Chua, C.X.K., Tan, S.H.S., Lim, A.K.S. et al. Accuracy of biplanar linear radiography versus conventional radiographs when used for lower limb and implant measurements. Arch Orthop Trauma Surg 142, 735–745 (2022). https://doi.org/10.1007/s00402-020-03700-3

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