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Correlation of radiographic and navigated measurements of TKA limb alignment: a matter of time?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Valid and reproducible measurements of limb alignment are prerequisites for planning, performing and evaluating TKAs. Although navigation systems have been shown to be reproducible tool for intraoperative TKA alignment measurements, particular doubt has been raised on the correlation with postoperative radiographic measurements. The aim of the present study was to evaluate whether the association of postoperative radiographic and navigation measurements of limb alignment was dependent on the time of acquisition. For this purpose, we retrospectively compared two groups of patients who underwent computer-assisted cemented TKA for osteoarthritis of the knee. Intraoperative navigation measurements (OrthoPilot™, Aesculap, Tuttlingen, Germany) were recorded before any cuts were made and again after implants had been placed. Long leg standing radiographs were acquired preoperatively in both the groups and either 2 weeks or 3 months postoperatively and AP limb alignment measurements were correlated with those of the respective navigation assessments. Preoperative deformity was similar in both the groups and correlation between radiographic and navigation measurements was excellent in both groups (ρ = 0.845 and 0.945, respectively). However, both mean and maximum discrepancies between radiographic and navigation measurements of leg alignment were significantly larger when radiographs were obtained 2 weeks (2.6° ± 2.1°, max. 10°) when compared with 3 months (1.8° ± 1.4°, max. 5°) postoperatively (P = 0.026). Accordingly, correlation between radiographic and navigation measurements was poor when radiographs were obtained 2 weeks postoperatively (ρ = 0.26, n.s.) but in the range of preoperative assessments when obtained 3 months postoperatively (ρ = 0.841, P < 0.001). Radiographic and navigation measurements of TKA limb alignment correlate well preoperatively. Equally good correlations can only be achieved when postoperative radiographic measurements are delayed to a time when more patients achieve full or near-full extension and are able to bear full weight leading to more valid radiographs.

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References

  1. Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183

    PubMed  Google Scholar 

  2. Bathis H, Perlick L, Tingart M, Luring C, Perlick C, Grifka J (2004) Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty. Int Orthop 28:87–90

    Article  CAS  PubMed  Google Scholar 

  3. Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86:682–687

    Article  CAS  PubMed  Google Scholar 

  4. Bathis H, Shafizadeh S, Paffrath T, Simanski C, Grifka J, Luring C (2006) Are computer assisted total knee replacements more accurately placed? A meta-analysis of comparative studies. Orthopade 35:1056–1065

    Article  CAS  PubMed  Google Scholar 

  5. Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P (1997) Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthritis Cartilage 5:39–47

    Article  CAS  PubMed  Google Scholar 

  6. Cooke TD, Scudamore RA, Bryant JT, Sorbie C, Siu D, Fisher B (1991) A quantitative approach to radiography of the lower limb. Principles and applications. J Bone Joint Surg Br 73:715–720

    CAS  PubMed  Google Scholar 

  7. Hauschild O, Konstantinidis L, Strohm PC, Niemeyer P, Suedkamp NP, Helwig P (2009) Reliability of leg alignment using the OrthoPilot system depends on knee position: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 17:1143–1151

    Article  PubMed  Google Scholar 

  8. Henckel J, Richards R, Lozhkin K, Harris S, Baena FM, Barrett AR, Cobb JP (2006) Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. J Bone Joint Surg Br 88:1513–1518

    Article  CAS  PubMed  Google Scholar 

  9. Hinman RS, May RL, Crossley KM (2006) Is there an alternative to the full-leg radiograph for determining knee joint alignment in osteoarthritis? Arthritis Rheum 55:306–313

    Article  PubMed  Google Scholar 

  10. Hinterwimmer S, Graichen H, Vogl TJ, Abolmaali N (2008) An MRI-based technique for assessment of lower extremity deformities-reproducibility, accuracy, and clinical application. Eur Radiol 18:1497–1505

    Article  PubMed  Google Scholar 

  11. Huang TL, Wu HT, Liu JC, Chen WM, Chen TH (2004) Do we get a “real” alignment of knee in the preoperative planning of high tibia osteotomy: a prospective study of reproducibility. J Chin Med Assoc 67:185–188

    PubMed  Google Scholar 

  12. Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714

    CAS  PubMed  Google Scholar 

  13. Jenny JY, Boeri C, Picard F, Leitner F (2004) Reproducibility of intra-operative measurement of the mechanical axes of the lower limb during total knee replacement with a non-image-based navigation system. Comput Aided Surg 9:161–165

    Article  PubMed  Google Scholar 

  14. Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case–control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 20:832–839

    Article  PubMed  Google Scholar 

  15. Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, Krettek C, Hufner T (2008) Navigated lower limb axis measurements: Influence of mechanical weight-bearing simulation. J Orthop Res 26:553–561

    Article  PubMed  Google Scholar 

  16. Kim SJ, MacDonald M, Hernandez J, Wixson RL (2005) Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty 20:123–131

    Article  PubMed  Google Scholar 

  17. Lonner JH, Laird MT, Stuchin SA (1996) Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties. Clin Orthop Relat Res 331:102–106

    Article  PubMed  Google Scholar 

  18. McGrory JE, Trousdale RT, Pagnano MW, Nigbur M (2002) Preoperative hip to ankle radiographs in total knee arthroplasty. Clin Orthop Relat Res 404:196–202

    Article  PubMed  Google Scholar 

  19. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465

    CAS  PubMed  Google Scholar 

  20. Rauh MA, Boyle J, Mihalko WM, Phillips MJ, Bayers-Thering M, Krackow KA (2007) Reliability of measuring long-standing lower extremity radiographs. Orthopedics 30:299–303

    PubMed  Google Scholar 

  21. Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement: its effect on survival. Clin Orthop Relat Res 299:153–156

    PubMed  Google Scholar 

  22. Ritter MA, Herbst SA, Keating EM, Faris PM, Meding JB (1994) Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop Relat Res 309:136–145

    PubMed  Google Scholar 

  23. Rosenberger RE, Hoser C, Quirbach S, Attal R, Hennerbichler A, Fink C (2008) Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:249–257

    Article  PubMed  Google Scholar 

  24. Sabharwal S, Zhao C (2008) Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg Am 90:43–51

    Article  PubMed  Google Scholar 

  25. Sailer J, Scharitzer M, Peloschek P, Giurea A, Imhof H, Grampp S (2005) Quantification of axial alignment of the lower extremity on conventional and digital total leg radiographs. Eur Radiol 15:170–173

    Article  CAS  PubMed  Google Scholar 

  26. Specogna AV, Birmingham TB, DaSilva JJ, Milner JS, Kerr J, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR (2004) Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. J Knee Surg 17:203–210

    PubMed  Google Scholar 

  27. Specogna AV, Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR (2007) Radiographic measures of knee alignment in patients with varus gonarthrosis: effect of weightbearing status and associations with dynamic joint load. Am J Sports Med 35:65–70

    Article  PubMed  Google Scholar 

  28. Vanwanseele B, Parker D, Coolican M (2009) Frontal knee alignment: three-dimensional marker positions and clinical assessment. Clin Orthop Relat Res 467:504–509

    Article  PubMed  Google Scholar 

  29. Yaffe MA, Koo SS, Stulberg SD (2008) Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res 466:2736–2744

    Article  PubMed  Google Scholar 

  30. Yau WP, Leung A, Chiu KY, Tang WM, Ng TP (2005) Intraobserver errors in obtaining visually selected anatomic landmarks during registration process in nonimage-based navigation-assisted total knee arthroplasty: a cadaveric experiment. J Arthroplasty 20:591–601

    Article  CAS  PubMed  Google Scholar 

  31. Yau WP, Leung A, Liu KG, Yan CH, Wong LL, Chiu KY (2007) Interobserver and intra-observer errors in obtaining visually selected anatomical landmarks during registration process in non-image-based navigation-assisted total knee arthroplasty. J Arthroplasty 22:1150–1161

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Traumatology, Freiburg University Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany

    Oliver Hauschild, Lukas Konstantinidis, Philipp Niemeyer, Norbert P. Suedkamp & Peter Helwig

  2. Department of Diagnostic Radiology, Freiburg University Medical Center, Freiburg, Germany

    Tobias Baumann

Authors
  1. Oliver Hauschild
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  2. Lukas Konstantinidis
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  3. Tobias Baumann
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  4. Philipp Niemeyer
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  5. Norbert P. Suedkamp
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  6. Peter Helwig
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Correspondence to Oliver Hauschild.

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Hauschild, O., Konstantinidis, L., Baumann, T. et al. Correlation of radiographic and navigated measurements of TKA limb alignment: a matter of time?. Knee Surg Sports Traumatol Arthrosc 18, 1317–1322 (2010). https://doi.org/10.1007/s00167-010-1144-y

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  • DOI: https://doi.org/10.1007/s00167-010-1144-y

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