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Presence of rotational errors in long leg radiographs after total knee arthroplasty and impact on measured lower limb and component alignment

International Orthopaedics volume 41, pages 1553–1560 (2017)Cite this article

Abstract

Purpose

Rotation of the lower limb in weight bearing long leg radiographs has a great impact on measured component and lower limb alignment parameters. We asked which rotational errors of long leg radiographs are present in a high volume centre and which radiological and clinical consequences arise regarding measured coronal component and lower limb alignment after total knee arthroplasty.

Methods

In 100 long leg radiographs coronal femoral and tibial component alignment and hip knee ankle angle (HKA) were measured. Present rotational errors in long leg radiographs were determined by fibular overlap and its impact on alignment parameters calculated.

Results

A mean internal rotation of 8.1° (9.3 SD) with a range between 36° of internal and 16° of external rotation was found in long leg radiographs. This resulted in mean differences between measurements before and after rotational correction regarding femoral and tibial component alignment and HKA of 0.6–0.8° (range 3.5° valgus and 1.6° varus error). Clinically, 11 out of 100 patients were wrongly assigned to either mal- or well-alignment (neutral mechanical alignment within ±3° varus or valgus).

Conclusion

Surgeons should be aware of potential rotational errors in long leg radiographs after total knee arthroplasty resulting in wrong measurements. In case of rotational errors, radiographs should be repeated or rotational corrections calculated. For study purposes only radiographs after rotational correction should be accepted.

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Affiliations

  1. Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany

    Günther Maderbacher, Clemens Baier, Achim Benditz, Ferdinand Wagner, Felix Greimel, Joachim Grifka & Armin Keshmiri

Authors
  1. Günther Maderbacher
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  2. Clemens Baier
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  3. Achim Benditz
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  4. Ferdinand Wagner
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  5. Felix Greimel
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  6. Joachim Grifka
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  7. Armin Keshmiri
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Corresponding author

Correspondence to Günther Maderbacher.

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The authors declare that they have no conflict of interest.

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There is no funding source.

Ethical approval

Because no radiograph were conducted for the sole purpose of this study, no approval was necessary according to a statement by our local ethical committee.

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Maderbacher, G., Baier, C., Benditz, A. et al. Presence of rotational errors in long leg radiographs after total knee arthroplasty and impact on measured lower limb and component alignment. International Orthopaedics (SICOT) 41, 1553–1560 (2017). https://doi.org/10.1007/s00264-017-3408-3

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  • DOI: https://doi.org/10.1007/s00264-017-3408-3

Keywords

  • TKA
  • Long leg radiographs
  • Rotational error
  • Alignment
  • Rotation
  • Knee