Reliability of Intraoperative Knee Range of Motion Measurements by Goniometer Compared with Robot-Assisted Arthroplasty

Abstract

Accurate measurement of knee range of motion (ROM) is critical to predict the outcomes of knee surgery and prognosis. We investigated the reliability of knee ROM measurements by goniometer compared with robotic system. Fifty-three patients with medial osteoarthritis who were planning to undergo unicompartmental knee arthroplasty (UKA) with robotic UKA were prospectively enrolled. During the operation, knee ROM measurement was performed in both flexion and extension before and after insertion of the implant using both a goniometer and robotic system. The intraclass correlation coefficient (ICC) of extension measured by the goniometer and robotic system showed good agreement; however, the ICC of flexion did not show good agreement. During passive flexion, the mean values measured before insertion of the implant were significantly lower by goniometer (134.6 ± 6.43) than by robot (145.4 ± 6.80; p = 0.017); likewise, the mean values after insertion of the implant were significantly lower by goniometer (138.6 ± 6.07) than by robotic system (147.0 ± 6.60; p = 0.045). A goniometer can underestimate knee ROM measurements compared with robotic system, especially in flexion. Orthopaedic surgeons should be cautious when measuring the flexion angle with a goniometer.

Keywords

knee range of motion - goniometer - unicompartmental knee arthroplasty - robot - reliability

• References

• 1 Bitton R. The economic burden of osteoarthritis. Am J Manag Care 2009; 15 (8, Suppl): S230-S235
• 2 Mihalko WM, Whiteside LA. Bone resection and ligament treatment for flexion contracture in knee arthroplasty. Clin Orthop Relat Res 2003; (406) 141-147
• 3 Scuderi GR, Kochhar T. Management of flexion contracture in total knee arthroplasty. J Arthroplasty 2007; 22 (04) (Suppl. 01) 20-24
• 4 Anouchi YS, McShane M, Kelly Jr F, Elting J, Stiehl J. Range of motion in total knee replacement. Clin Orthop Relat Res 1996; (331) 87-92
• 5 Carvalho Júnior LH, Teixeira BP, Bernardes CO, Soares LF, Gonçalves MB, Temponi EF. Range of motion predictability after total knee arthroplasty with medial pivot prosthesis. Rev Bras Ortop 2017; 52 (02) 197-202
• 6 Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KN. Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty 1998; 13 (07) 748-752
• 7 Irrgang JJ, Ho H, Harner CD, Fu FH. Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1998; 6 (02) 107-114
• 8 Jenny JY. Measurement of the knee flexion angle with a smartphone-application is precise and accurate. J Arthroplasty 2013; 28 (05) 784-787
• 9 Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN. ; Kinemax Outcomes Group. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?. J Arthroplasty 2003; 18 (03) 286-294
• 10 Myles CM, Rowe PJ, Walker CR, Nutton RW. Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry. Gait Posture 2002; 16 (01) 46-54
• 11 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
• 12 Lavernia C, D'Apuzzo M, Rossi MD, Lee D. Accuracy of knee range of motion assessment after total knee arthroplasty. J Arthroplasty 2008; 23 (06) (Suppl. 01) 85-91
• 13 Gogia PP, Braatz JH, Rose SJ, Norton BJ. Reliability and validity of goniometric measurements at the knee. Phys Ther 1987; 67 (02) 192-195
• 14 Watkins MA, Riddle DL, Lamb RL, Personius WJ. Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. Phys Ther 1991; 71 (02) 90-96
• 15 Brosseau L, Balmer S, Tousignant M. , et al. Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions. Arch Phys Med Rehabil 2001; 82 (03) 396-402
• 16 Clapper MP, Wolf SL. Comparison of the reliability of the Orthoranger and the standard goniometer for assessing active lower extremity range of motion. Phys Ther 1988; 68 (02) 214-218
• 17 Edwards JZ, Greene KA, Davis RS, Kovacik MW, Noe DA, Askew MJ. Measuring flexion in knee arthroplasty patients. J Arthroplasty 2004; 19 (03) 369-372
• 18 Bennett D, Hanratty B, Thompson N, Beverland D. Measurement of knee joint motion using digital imaging. Int Orthop 2009; 33 (06) 1627-1631
• 19 Austin MS, Ghanem E, Joshi A, Trappler R, Parvizi J, Hozack WJ. The assessment of intraoperative prosthetic knee range of motion using two methods. J Arthroplasty 2008; 23 (04) 515-521
• 20 Cleffken B, van Breukelen G, Brink P, van Mameren H, Olde Damink S. Digital goniometric measurement of knee joint motion. Evaluation of usefulness for research settings and clinical practice. Knee 2007; 14 (05) 385-389
• 21 de Achaval S, Kallen MA, Amick B. , et al. Patients' expectations about total knee arthroplasty outcomes. Health Expect 2016; 19 (02) 299-308
• 22 Saeki S, Chisaka H, Hachisuka K. Life satisfaction and functional disabilities in long-term survivors after first stroke. J UOEH 2005; 27 (02) 171-177
• 23 Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone Joint Surg Am 2016; 98 (08) 627-635
• 24 Lonner JH. Robotically assisted unicompartmental knee arthroplasty with a handheld image-free sculpting tool. Orthop Clin North Am 2016; 47 (01) 29-40
• 25 Boone DC, Azen SP, Lin CM, Spence C, Baron C, Lee L. Reliability of goniometric measurements. Phys Ther 1978; 58 (11) 1355-1360
• 26 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
• 27 Ha CW, Park YB, Song YS, Kim JH, Park YG. Increased range of motion is important for functional outcome and satisfaction after total knee arthroplasty in Asian patients. J Arthroplasty 2016; 31 (06) 1199-1203
• 28 Kim TK, Kwon SK, Kang YG, Chang CB, Seong SC. Functional disabilities and satisfaction after total knee arthroplasty in female Asian patients. J Arthroplasty 2010; 25 (03) 458-464
• 29 Tarabichi S, Tarabichi Y, Hawari M. Achieving deep flexion after primary total knee arthroplasty. J Arthroplasty 2010; 25 (02) 219-224
• 30 Tekin B, Unver B, Karatosun V. Expectations in patients with total knee arthroplasty. Acta Orthop Traumatol Turc 2012; 46 (03) 174-180
• 31 Moore ML. The measurement of joint motion; introductory review of the literature. Phys Ther Rev 1949; 29 (05) 195-205
• 32 Salter N. Methods of measurement of muscle and joint function. J Bone Joint Surg Br 1955; 37-B [phone]
• 33 Bull AM, Amis AA. Knee joint motion: description and measurement. Proc Inst Mech Eng H 1998; 212 (05) 357-372
• 34 Lonner JH, John TK, Conditt MA. Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res 2010; 468 (01) 141-146
• 35 Mofidi A, Plate JF, Lu B. , et al. Assessment of accuracy of robotically assisted unicompartmental arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1918-1925