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Is computed tomography an accurate and reliable method for measuring total knee arthroplasty component rotation?

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Abstract

Purpose

Computed tomography (CT) is widely used to assess component rotation in patients with poor results after total knee arthroplasty (TKA). The purpose of this study was to simultaneously determine the accuracy and reliability of CT in measuring TKA component rotation.

Methods

TKA components were implanted in dry-bone models and assigned to two groups. The first group (n = 7) had variable femoral component rotations, and the second group (n = 6) had variable tibial tray rotations. CT images were then used to assess component rotation. Accuracy of CT rotational assessment was determined by mean difference, in degrees, between implanted component rotation and CT-measured rotation. Intraclass correlation coefficient (ICC) was applied to determine intra-observer and inter-observer reliability.

Results

Femoral component accuracy showed a mean difference of 2.5° and the tibial tray a mean difference of 3.2°. There was good intra- and inter-observer reliability for both components, with a femoral ICC of 0.8 and 0.76, and tibial ICC of 0.68 and 0.65, respectively.

Conclusions

CT rotational assessment accuracy can differ from true component rotation by approximately 3° for each component. It does, however, have good inter- and intra-observer reliability.

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References

  1. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS (2003) Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am 85-A(2):259–265

    PubMed  Google Scholar 

  2. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63. doi:10.1007/s11999-009-1119-9

    Article  PubMed  PubMed Central  Google Scholar 

  3. Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L (2000) Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 71(3):262–267. doi:10.1080/000164700317411852

    Article  CAS  PubMed  Google Scholar 

  4. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ (2007) National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg (Br) 89(7):893–900. doi:10.1302/0301-620x.89b7.19091

    Article  CAS  Google Scholar 

  5. Dunbar MJ, Richardson G, Robertsson O (2013) I can’t get no satisfaction after my total knee replacement: rhymes and reasons. Bone Joint J 95-B(11 Suppl A):148–152. doi:10.1302/0301-620x.95b11.32767

    Article  CAS  PubMed  Google Scholar 

  6. Pabinger C, Berghold A, Boehler N, Labek G (2013) Revision rates after knee replacement. Cumulative results from worldwide clinical studies versus joint registers. Osteoarthr Cartil 21(2):263–268. doi:10.1016/j.joca.2012.11.014

    Article  CAS  PubMed  Google Scholar 

  7. Hofmann S, Seitlinger G, Djahani O, Pietsch M (2011) The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sports Traumatol Arthrosc 19(9):1442–1452. doi:10.1007/s00167-011-1634-6

    Article  CAS  PubMed  Google Scholar 

  8. Mandalia V, Eyres K, Schranz P, Toms AD (2008) Evaluation of patients with a painful total knee replacement. J Bone Joint Surg (Br) 90(3):265–271. doi:10.1302/0301-620X.90B3.20140

    Article  CAS  Google Scholar 

  9. Tay KS, Lo NN, Yeo SJ, Chia SL, Tay DK, Chin PL (2013) Revision total knee arthroplasty: causes and outcomes. Ann Acad Med Singap 42(4):178–183

    PubMed  Google Scholar 

  10. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468(1):45–51. doi:10.1016/j.arth.2008.11.063

    Article  PubMed  PubMed Central  Google Scholar 

  11. Suarez J, Griffin W, Springer B, Fehring T, Mason JB, Odum S (2008) Why do revision knee arthroplasties fail? J Arthroplasty 23(6 Suppl 1):99–103. doi:10.1016/j.arth.2008.01.228

    Article  PubMed  Google Scholar 

  12. Mulhall KJ, Ghomrawi HM, Scully S, Callaghan JJ, Saleh KJ (2006) Current etiologies and modes of failure in total knee arthroplasty revision. Clin Orthop Relat Res 446:45–50. doi:10.1097/01.blo.0000214421.21712.62

    Article  PubMed  Google Scholar 

  13. Schroer WC, Berend KR, Lombardi AV, Barnes CL, Bolognesi MP, Berend ME, Ritter MA, Nunley RM (2013) Why are total knees failing today? Etiology of total knee revision in 2010 and 2011. J Arthroplast 28(8 Suppl). doi: 10.1016/j.arth.2013.04.056

  14. Berger RA, Rubash HE (2001) Rotational instability and malrotation after total knee arthroplasty. Orthop Clin North Am 32(4):639–647. doi:10.1016/s0030-5898(05)70233-9, ix

    Article  CAS  PubMed  Google Scholar 

  15. Merkow RL, Soudry M, Insall JN (1985) Patellar dislocation following total knee replacement. J Bone Joint Surg Am 67(9):1321–1327

    CAS  PubMed  Google Scholar 

  16. Briard JL, Hungerford DS (1989) Patellofemoral instability in total knee arthroplasty. J Arthroplasty 4(Suppl):S87–S97. doi:10.1016/s0883-5403(89)80013-0

    Article  PubMed  Google Scholar 

  17. Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153. doi:10.1097/00003086-199811000-00021

    Article  PubMed  Google Scholar 

  18. Bédard M, Vince KG, Redfern J, Collen SR (2011) Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res 469(8):2346–2355. doi:10.1007/s11999-011-1889-8

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF, Cobb JP (2011) The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Joint Surg (Br) 93(5):629–633. doi:10.1302/0301-620x.93b5.25893

    Article  CAS  Google Scholar 

  20. White D, Chelule KL, Seedhom BB (2008) Accuracy of MRI vs CT imaging with particular reference to patient specific templates for total knee replacement surgery. Int J Med Robot 4(3):224–231. doi:10.1002/rcs.201

    Article  CAS  PubMed  Google Scholar 

  21. Jazrawi LM, Birdzell L, Kummer FJ, Di Cesare PE (2000) The accuracy of computed tomography for determining femoral and tibial total knee arthroplasty component rotation. J Arthroplasty 15(6):761–766. doi:10.1054/arth.2000.8193

    Article  CAS  PubMed  Google Scholar 

  22. Konigsberg B, Hess R, Hartman C, Smith L, Garvin KL (2014) Inter- and intraobserver reliability of two-dimensional CT scan for total knee arthroplasty component malrotation. Clin Orthop Relat Res 472(1):212–217. doi:10.1007/s11999-013-3111-7

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zimmer® MIS Multi-Reference® 4 – in – 1 Femoral instrumentation. Surgical Technique. Rev. 6 5 ML Printed in USA 2003, 2005, 2008 Zimmer, Inc.

  24. Vail T, Lang J (2006) Surgical techniques and instrumentation in total knee arthroplasty. In: Scott W, Insall J (eds) Insall & Scott surgery of the knee, 4th edn. Elsevier/Churchill Livingstone, Philadelphia

    Google Scholar 

  25. Walter SD, Eliasziw M, Donner A (1998) Sample size and optimal designs for reliability studies. Stat Med 17:101–110. doi:10.1002/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-E

    Article  CAS  PubMed  Google Scholar 

  26. Kim YH, Park JW, Kim JS, Park SD (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38(2):379–385. doi:10.1007/s00264-013-2097-9

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zhao Z, Wang W, Wang S, Jiang L, Zhang S, Zhao Y (2015) Femoral rotation influences dynamic alignment of the lower extremity in total knee arthroplasty. Int Orthop 39(1):55–60. doi:10.1007/s00264-014-2484-x

    Article  PubMed  Google Scholar 

  28. Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM (2004) Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg (Br) 86(6):818–823. doi:10.1302/0301-620X.86B6.15456

    Article  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required, as it was done on artificial models.

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Authors and Affiliations

  1. Knee Surgery Unit, Hospital Militar de Santiago, Av. Alcalde Fernando Castillo Velasco 9100, Santiago, Chile

    José Figueroa & Mario Orrego

  2. Knee Surgery Unit, Clínica Dávila, Avenida Recoleta 464, Santiago, Chile

    José Figueroa

  3. Department of Orthopedics, School of Medicine, Universidad de los Andes, Mons. Álvaro del Portillo, 12.455, Santiago, Chile

    José Figueroa, Juan Pablo Guarachi, José Matas & Mario Orrego

  4. Knee Surgery Unit, Clínica Meds, Las Condes, 13.451, Santiago, Chile

    José Matas

  5. Knee Surgery Unit, Clínica Universidad de los Andes, Santiago, Chile

    José Matas & Mario Orrego

  6. Department of Orthopaedic Surgery St George’s Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK

    Magnus Arnander

Authors
  1. José Figueroa
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  2. Juan Pablo Guarachi
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  5. Mario Orrego
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Correspondence to Juan Pablo Guarachi.

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Figueroa, J., Guarachi, J.P., Matas, J. et al. Is computed tomography an accurate and reliable method for measuring total knee arthroplasty component rotation?. International Orthopaedics (SICOT) 40, 709–714 (2016). https://doi.org/10.1007/s00264-015-2917-1

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  • DOI: https://doi.org/10.1007/s00264-015-2917-1

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