Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2017

Open Access 01-09-2017 | Knee

Do CAS measurements correlate with EOS 3D alignment measurements in primary TKA?

Authors: Marrigje F. Meijer, Alexander L. Boerboom, Sjoerd K. Bulstra, Inge H. F. Reininga, Martin Stevens

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2017

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Babazadeh S, Dowsey MM, Bingham RJ, Ek ET, Stoney JD, Choong PF (2013) The long leg radiograph is a reliable method of assessing alignment when compared to computer-assisted navigation and computer tomography. Knee 20:242–249CrossRefPubMed
2.
Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183
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 86:682–687CrossRefPubMed
4.
Blakeney WG, Khan RJ, Wall SJ (2011) Computer-assisted techniques versus conventional guides for component alignment in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 93:1377–1384CrossRefPubMed
5.
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310CrossRefPubMed
6.
Brouwer RW, Jakma TS, Brouwer KH, Verhaar JA (2007) Pitfalls in determining knee alignment: a radiographic cadaver study. J Knee Surg 20:210–215CrossRefPubMed
7.
Brouwer RW, Jakma TS, Bierma-Zeinstra SM, Ginai AZ, Verhaar JA (2003) The whole leg radiograph: standing versus supine for determining axial alignment. Acta Orthop Scand 74:565–568CrossRefPubMed
8.
Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86:372–377CrossRefPubMed
9.
Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplast 20:618–626CrossRef
10.
Choong PF, Dowsey MM, Stoney JD (2009) Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplast 24:560–569CrossRef
11.
Cohen JA (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 33:159–174
12.
Domholdt E (2001) Physical therapy research. In: Principles and applications, WB Saunders, Philadelphia
13.
Dubousset J, Charpak G, Dorion I, Skalli W, Lavaste F, Deguise J et al (2005) A new 2D and 3D imaging approach to musculoskeletal physiology and pathology with low-dose radiation and the standing position: the EOS system. Bull Acad Natl Med 189:287–300PubMed
14.
Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplast 24:39–43CrossRef
15.
Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A (2014) What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop 85:480–487CrossRefPubMedPubMedCentral
16.
Guenoun B, Zadegan F, Aim F, Hannouche D, Nizard R (2012) Reliability of a new method for lower-extremity measurements based on stereoradiographic three-dimensional reconstruction. Orthop Traumatol Surg Res 98:506–513CrossRefPubMed
17.
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 17:1143–1151CrossRefPubMed
18.
Hauschild O, Konstantinidis L, Baumann T, Niemeyer P, Suedkamp NP, Helwig P (2010) Correlation of radiographic and navigated measurements of TKA limb alignment: a matter of time? Knee Surg Sports Traumatol Arthrosc 18:1317–1322CrossRefPubMed
19.
Huang TW, Hsu WH, Peng KT, Wen-Wei Hsu R, Weng YJ, Shen WJ (2011) 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 93:1197–1202CrossRefPubMed
20.
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714PubMed
21.
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 9:161–165CrossRefPubMed
22.
Kalifa G, Charpak Y, Maccia C, Fery-Lemonnier E, Bloch J, Boussard JM et al (1998) Evaluation of a new low-dose digital X-ray device: first dosimetric and clinical results in children. Pediatr Radiol 28:557–561CrossRefPubMed
23.
Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA et al (2015) 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 23(7):1936–1942CrossRefPubMed
24.
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMed
25.
Longstaff L, Sloan K, Stamp N, Scaddan M, Beaver R (2009) Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplast 24:570–578CrossRef
26.
Lonner JH, Laird MT, Stuchin SA (1996) Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties. Clin Orthop Relat Res 331:102–106CrossRef
27.
Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59:77–79CrossRefPubMed
28.
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89:236–243PubMed
29.
Meijer MF, Boerboom AL, Stevens M, Bulstra SK, Reininga IHF (2014) Assessment of prosthesis alignment after revision total knee arthroplasty using EOS 2D and 3D imaging: a reliability study. PLoS One 9(9):p104613CrossRef
30.
Meijer MF, Velleman T, Boerboom AL, Bulstra SK, Otten E, Stevens M et al (2016) The validity of a new low-dose stereoradiography system to perform 2D and 3D knee prosthesis alignment measurements. PLoS One 11(1):p0146187CrossRef
31.
Nakahara H, Okazaki K, Hamaj S, Okamoto S, Kuwashima U, Higaki H et al (2015) Does knee stability in the coronal plane in extension affect function and outcome after total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 23(6):1693–1698CrossRefPubMed
32.
Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 15(92):2143–2149CrossRef
33.
Radtke K, Becher C, Noll Y, Ostermeier S (2010) Effect of limb rotation on radiographic alignment in total knee arthroplasties. Arch Orthop Trauma Surg 130:451–457CrossRefPubMed
34.
Rankin G, Stokes M (1998) Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil 12:187–199CrossRefPubMed
35.
Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93:1588–1596CrossRefPubMed
36.
Sabharwal S, Zhao C (2008) Assessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph. J Bone Joint Surg Am 90:43–51CrossRefPubMed
37.
Seo SS, Seo JH, Sohn MW, Kim YJ (2012) Differences in measurement of lower limb alignment among different registration methods of navigation and radiographs in TKA using the OrthoPilot system. Orthopedics 35:50–55CrossRefPubMed
38.
Specogna AV, Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ et al (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 35:65–70CrossRefPubMed
39.
Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186CrossRef
40.
Swanson KE, Stocks GW, Warren PD, Hazel MR, Janssen HF (2000) Does axial limb rotation affect the alignment measurements in deformed limbs? Clin Orthop Relat Res 371:246–252CrossRef
41.
Thelen P, Delin C, Folinais D, Radier C (2012) Evaluation of a new low-dose biplanar system to assess lower-limb alignment in 3D: a phantom study. Skelet Radiol 41:1287–1293CrossRef
42.
Willcox NM, Clarke JV, Smith BR, Deakin AH, Deep K (2012) A comparison of radiological and computer navigation measurements of lower limb coronal alignment before and after total knee replacement. J Bone Joint Surg Br 94:1234–1240CrossRefPubMed
43.
Yaffe MA, Koo SS, Stulberg SD (2008) Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res 466:2736–2744CrossRefPubMedPubMedCentral
44.
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 Arthroplast 20:591–601CrossRef
45.
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 Arthroplast 22:1150–1161CrossRef
Metadata
Title
Do CAS measurements correlate with EOS 3D alignment measurements in primary TKA?
Authors
Marrigje F. Meijer
Alexander L. Boerboom
Sjoerd K. Bulstra
Inge H. F. Reininga
Martin Stevens
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4031-3

Other articles of this Issue 9/2017

Knee Surgery, Sports Traumatology, Arthroscopy 9/2017 Go to the issue

Knee

Comparison of monoplanar versus biplanar medial opening-wedge high tibial osteotomy techniques for preventing lateral cortex fracture

Knee

Gait analysis before and after corrective osteotomy in patients with knee osteoarthritis and a valgus deformity

Knee

Comparison of in vivo polyethylene wear particles between mobile- and fixed-bearing TKA in the same patients

Knee

Outpatient surgery for unicompartmental knee arthroplasty is effective and safe

Knee

A cadaveric assessment of the risk of nerve injury during open subpectoral biceps tenodesis using a bicortical guidewire

Knee

High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial