RAPTOR: The Innovation for Making Long Leg Standing Radiography for Total Knee Arthroplasty from Conventional Radiography
Keywords:femoral anatomical mechanical angle, hip knee ankle angle, limb length discrepancy, orthoroentgenography, overlap
Purpose: To evaluate the reliability and validity of femoral anatomical-mechanical angle (fAMA), hip knee ankle angle (HKA), and overlap of long leg standing radiography (LLSR) obtained using a Rapid Orthoroentgenography Making Machine (RAPTOR) compared with a standard X-ray generator.
Methods: This observational study was conducted between July 2021 and August 2021, including patients diagnosed with primary knee osteoarthritis that underwent preoperative LLSR for total knee replacement. Three orthopedic surgeons blindly evaluated LLSR (fAMA, HKA, overlap of the femoral shaft) twice within one-month using the Visio program. Intra- and interobserver reliability and validity were analyzed.
Results: Three evaluators assessed 30 LLSRs. The intraobserver agreement levels were -0.951–1.062° for fAMA, -10.338–11.076° for HKA, and -0.418–0.418 mm for overlap of RAPTOR, while for the standard X-ray generator the agreement levels were -1.359–1.114° for fAMA, 11.844–12.467° for HKA, and 0 mm for overlap. The intraclass correlation was 0.55–0.99 for all RAPTOR measurements and 0.56–0.99 for standard X-ray generator. The interobserver’s levels of agreement were -1.441–1.175° for fAMA, -7.453–7.475° for HKA, and -0.681–0.637 mm for overlap of RAPTOR, whereas those of the standard X-ray generator were -1.149–1.424° for fAMA, -4.789–6.171° for HKA, and 0 mm for overlap. The intraclass correlation was 0.69–0.97 for all RAPTOR measurements and 0.71–0.95 for the fAMA and HKA standard X-ray generator measurements. The mean and 95% limits of agreement of the comparison between RAPTOR and standard X-ray generator were -0.131° (-1.187, 0.925) for fAMA, -0.126° (-4.724, 4.471) for HKA, and 0.363 (-) mm for overlap. Only overlap was significantly different between the two methods (p=0.0243). Intraclass correlations between the two radiographic methods were 0.75 (0.63, 0.88) for fAMA and 0.93 (0.89, 0.97) for HKA.
Conclusions: Estimation of fAMA, HKA, and overlap had moderate to excellent reliability and inter- and intra-rater reliabilities in both RAPTOR and standard X-ray generator. Only overlap was different between the two methods.
Liu HX, Shang P, Ying XZ, Zhang Y. Shorter survival rate in varus-aligned knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016;24:2663-71. DOI: https://doi.org/10.1007/s00167-015-3781-7
D'Lima DD, Chen PC, Colwell Jr CW. Polyethylene contact stresses, articular congruity, and knee alignment. Clin Orthop Relat Res 2001;(392):232-8. DOI: https://doi.org/10.1097/00003086-200111000-00029
Gioe TJ, Killeen KK, Grimm K, et al. Why are total knee replacements revised?: analysis of early revision in a community knee implant registry. Clin Orthop Relat Res 2004;(428):100-6. DOI: https://doi.org/10.1097/01.blo.0000147136.98303.9d
Andrews SN, Beeler DM, Parke EA, et al. Fixed distal femoral cut of 6° valgus in Total Knee Arthroplasty: A radiographic review of 788 consecutive cases. J Arthroplasty 2019;34:755-9. DOI: https://doi.org/10.1016/j.arth.2018.12.013
Vieira Costa MA, Mozella AP, Barros Cobra HAA. Distal femoral cut in total knee arthroplasty in a Brazilian population. Rev Bras Ortop 2015;50:295-9. DOI: https://doi.org/10.1016/j.rboe.2015.05.007
Zhou K, Ling T, Xu Y, et al. Effect of individualized distal femoral valgus resection angle in primary total knee arthroplasty: A systematic review and meta-analysis involving 1300 subjects. Int J Surg 2018;50:87-93. DOI: https://doi.org/10.1016/j.ijsu.2017.12.028
Neil MJ, Atupan JB, L.Panti JP, et al. Evaluation of lower limb axial alignment using digital radiography stitched films in pre-operative planning for total knee replacement. J Orthop 2016;13:285-9. DOI: https://doi.org/10.1016/j.jor.2016.06.013
Skyttä ET, Lohman M, Tallroth K, et al. Comparison of standard anteroposterior knee and hip-to-ankle radiographs in determining the lower limb and implant alignment after total knee arthroplasty. Scand J Surg 2009;98:250-3. DOI: https://doi.org/10.1177/145749690909800411
Dargel J, Pennig L, Schnurr C, et al. Ist die postoperative Ganzbeinaufnahme nach Knie-TEP-Implantation notwendig? [Should we use hip-ankle radiographs to assess the coronal alignment after total knee arthroplasty?]. Orthopade 2016;45:591-6. DOI: https://doi.org/10.1007/s00132-016-3264-7
Rauh MA, Boyle J, Phillips WM, et al. Reliability of measuring long-standing lower extremity radiographs. Orthopedics 2007;30:299-303. DOI: https://doi.org/10.3928/01477447-20070401-14
Aaron A, Weinstein D, Thickman D, et al. Comparison of orthoroentgenography and computed tomography in the measurement of limb-length discrepancy. J Bone Joint Surg Am 1992;74:897-902. DOI: https://doi.org/10.2106/00004623-199274060-00011
Bowman A, Shunmugam M, Watts AR, et al. Inter-observer and intra-observer reliability of mechanical axis alignment before and after total knee arthroplasty using long leg radiographs. Knee 2016;23:203-8. DOI: https://doi.org/10.1016/j.knee.2015.11.013
Nordentoft EL. The accuracy of orthoroentgenographic measurements. Acta Orthop Scand 1964;34:283-8. DOI: https://doi.org/10.3109/17453676408989324
Hunt MA, Fowler PJ, Birmingham TB, et al. Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg 2006;49:401-6.
Jiang CC, Insall JN. Effect of rotation on the axial alignment of the femur. Pitfalls in the use of femoral intramedullary guides in total knee arthroplasty. Clin Orthop Relat Res 1989;(248): 50-6. DOI: https://doi.org/10.1097/00003086-198911000-00009
Yoo HJ, Kim JE, Kim SC, et al. Pitfalls in assessing limb alignment affected by rotation and flexion of the knee after total knee arthroplasty: Analysis using sagittal and coronal whole-body EOS radiography. Knee 2020;27: 1551-9. DOI: https://doi.org/10.1016/j.knee.2020.08.008
Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991;73:709-14. DOI: https://doi.org/10.1302/0301-620X.73B5.1894655
Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16:494-502. DOI: https://doi.org/10.1136/ard.16.4.494
Kowsomjeen K. Image quality of radiography orthoview in osteoarthritis of Knee using Suphan Model 4.0. J Health Sci 2019;28:896-905.
Yu JS, Zheng YD, Tang DY, et al. A graphical method for multi-signal flow graph modeling and testability analysis based on visio control component. Proceeding for the 2017 IEEE International Conference on Industrial Engineering and Engineering Management (IEEM); 2017 Dec10-13; Suntec, Singapore. p. 1306-9. DOI: https://doi.org/10.1109/IEEM.2017.8290104
He L, Lian J. Instructional design of practice course of logistics system planning and design based on visio. Proceeding for the 9th International Conference on Information Technology in Medicine and Education (ITME); 2018 Oct 19-21; Hangzhou, China. p.526-30. DOI: https://doi.org/10.1109/ITME.2018.00122
Portney LG, Watkins MP. Foundations of clinical research: Applications to practice. 2nd ed. Prentice Hall Health, Upper Saddle River, NJ; 2000.
Gopurathingal AA, Bhonsle S. Inter-observer and intra-observer reliability of 2D radiograph-based valgus cut angle measurement in preoperative planning for primary Total Knee Arthroplasty. Cureus 2021,13:e12788. DOI: https://doi.org/10.7759/cureus.12788
Vaishya R, Vijay V, P Birla V, et al. Inter-observer variability and its correlation to experience in measurement of lower limb mechanical axis on long leg radiographs. J Clin Orthop Trauma 2016;7:260-4. DOI: https://doi.org/10.1016/j.jcot.2016.05.010
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