Do CAS Measurements Correlate with EOS 3D Alignment Measurements in Primary TKA?

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2016 Feb 26

PMID 26913857

Citations 6

Authors

Marrigje F Meijer

Alexander L Boerboom

Sjoerd K Bulstra

Inge H F Reininga

Martin Stevens

Affiliations

Soon will be listed here.

Abstract

Purpose: Objective of this study was to compare intraoperative computer-assisted surgery (CAS) alignment measurements during total knee arthroplasty (TKA) with pre- and postoperative coronal alignment measurements using EOS 3D reconstructions.

Methods: In a prospective study, 56 TKAs using imageless CAS were performed and coronal alignment measurements were recorded twice: before bone cuts were made and after implantation of the prosthesis. Pre- and postoperative coronal alignment measurements were performed using EOS 3D reconstructions. Thanks to the EOS radiostereography system, measurement errors due to malpositioning and deformity during acquisition are eliminated. CAS measurements were compared with EOS 3D reconstructions. Varus/valgus angle (VV), mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were measured.

Results: Significantly different VV angles were measured pre- and postoperatively with CAS compared to EOS. For preoperative measurements, mLDFA did not differ significantly, but a significantly larger mMPTA in valgus was measured with CAS.

Conclusion: Results of this study indicate that differences in alignment measurements between CAS measurements and pre- and postoperative EOS 3D are due mainly to the difference between weight-bearing and non-weight-bearing position and potential errors in validity and reliability of the CAS system. EOS 3D measurements overestimate VV angle in lower limbs with substantial mechanical axis deviation. For lower limbs with minor mechanical axis deviation as well as for mMPTA measurements, CAS measures more valgus than EOS. Eventually the results of this study are of clinical relevance, since it raises concerns regarding the validity and reliability of CAS systems in TKA.

Level Of Evidence: IIb.

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References

Huang T, Hsu W, Peng K, Wen-Wei Hsu R, Weng Y, Shen W . Total knee arthroplasty with use of computer-assisted navigation compared with conventional guiding systems in the same patient: radiographic results in Asian patients. J Bone Joint Surg Am. 2011; 93(13):1197-202. DOI: 10.2106/JBJS.J.00325. View

Seo S, Seo J, Sohn M, Kim Y . Differences in measurement of lower limb alignment among different registration methods of navigation and radiographs in TKA using the OrthoPilot system. Orthopedics. 2012; 35(10 Suppl):50-5. DOI: 10.3928/01477447-20120919-58. View

Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J . Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br. 2004; 86(5):682-7. DOI: 10.1302/0301-620x.86b5.14927. View

Yau W, Leung A, Liu K, Yan C, Wong L, Chiu K . 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. 2007; 22(8):1150-61. DOI: 10.1016/j.arth.2006.10.010. View

Bargren J, Blaha J, Freeman M . Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res. 1983; (173):178-83. View

Yau W, Leung A, Chiu K, Tang W, Ng T . Intraobserver errors in obtaining visually selected anatomic landmarks during registration process in nonimage-based navigation-assisted total knee arthroplasty: a cadaveric experiment. J Arthroplasty. 2005; 20(5):591-601. DOI: 10.1016/j.arth.2005.02.011. View

Hong S, Kim J, Lee B, Kim D, Kim K, Bin S . Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc. 2014; 23(7):1936-42. DOI: 10.1007/s00167-014-3006-5. View

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

Specogna A, Birmingham T, Hunt M, Jones I, Jenkyn T, Fowler P . Radiographic measures of knee alignment in patients with varus gonarthrosis: effect of weightbearing status and associations with dynamic joint load. Am J Sports Med. 2006; 35(1):65-70. DOI: 10.1177/0363546506293024. View

10.

Lonner J, Laird M, Stuchin S . Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties. Clin Orthop Relat Res. 1996; (331):102-6. DOI: 10.1097/00003086-199610000-00014. View

11.

Thelen P, Delin C, Folinais D, Radier C . Evaluation of a new low-dose biplanar system to assess lower-limb alignment in 3D: a phantom study. Skeletal Radiol. 2012; 41(10):1287-93. DOI: 10.1007/s00256-012-1438-x. View

12.

Babazadeh S, Dowsey M, Bingham R, Ek E, Stoney J, Choong P . The long leg radiograph is a reliable method of assessing alignment when compared to computer-assisted navigation and computer tomography. Knee. 2012; 20(4):242-9. DOI: 10.1016/j.knee.2012.07.009. View

13.

Jeffery R, Morris R, Denham R . Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991; 73(5):709-14. DOI: 10.1302/0301-620X.73B5.1894655. View

14.

Meijer M, Boerboom A, Stevens M, Bulstra S, Reininga I . Assessment of prosthesis alignment after revision total knee arthroplasty using EOS 2D and 3D imaging: a reliability study. PLoS One. 2014; 9(9):e104613. PMC: 4172435. DOI: 10.1371/journal.pone.0104613. View

15.

Meijer M, Velleman T, Boerboom A, Bulstra S, Otten E, Stevens M . The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements. PLoS One. 2016; 11(1):e0146187. PMC: 4714906. DOI: 10.1371/journal.pone.0146187. View

16.

Lotke P, Ecker M . Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am. 1977; 59(1):77-9. View

17.

Chin P, Yang K, Yeo S, Lo N . Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty. 2005; 20(5):618-26. DOI: 10.1016/j.arth.2005.04.004. View

18.

Chauhan S, Scott R, Breidahl W, Beaver R . Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br. 2004; 86(3):372-7. DOI: 10.1302/0301-620x.86b3.14643. View

19.

Longstaff L, Sloan K, Stamp N, Scaddan M, Beaver R . Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty. 2008; 24(4):570-8. DOI: 10.1016/j.arth.2008.03.002. View

20.

Radtke K, Becher C, Noll Y, Ostermeier S . Effect of limb rotation on radiographic alignment in total knee arthroplasties. Arch Orthop Trauma Surg. 2009; 130(4):451-7. DOI: 10.1007/s00402-009-0999-1. View