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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(04): 656-660
DOI: 10.1055/s-0041-1726061
Artigo Original
Joelho

Radiographic Evaluation of Postoperative Alignment in Total Knee Arthroplasty[*]

Article in several languages: português | English
Leonardo Dalla Giacomassa Rocha Thomaz 
1   Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
,
João Guilherme Brochado Geist 
2   Serviço de Ortopedia e Traumatologia, Hospital Regina, Novo Hamburgo, Porto Alegre, RS, Brasil
,
Rafael De Luca De Lucena 
3   Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
,
Carlos Roberto Schwartsmann 
4   Departamento de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
5   Serviço de Ortopedia e Traumatologia, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
,
Geraldo Luiz Schuck de Freitas 
6   Grupo do Joelho, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
,
Leandro de Freitas Spinelli 
7   Faculdade de Medicina, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
8   Grupo de Cirurgia do Quadril, Serviço de Ortopedia e Traumatologia, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil
9   Laboratório de Bioengenharia, Biomecânica e Biomateriais, Programa de Pós-Graduação em Projeto e Processos de Fabricação, Universidade de Passo Fundo, RS, Brasil
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Abstract

Objective To demonstrate the greater accuracy of panoramic radiographs of the lower limbs (long) in relation to short radiographs of the knee in the measurement of the mechanical axis of the lower limb after total knee arthroplasty (TKA).

Methods A retrospective study was conducted to evaluate the accuracy of long and short postoperative radiographic images of 70 patients submitted to TKA in our service. The images were analyzed at random, at different times, by three orthopedists. In all images, the mechanical axis of the limb, femur and tibia were traced and femorotibial angles (FTAs) were calculated. The intraclass correlation coefficient (ICC) was calculated to evaluate the agreement of the measurement of the inter- and intra-observer mechanical axis.

Results It was observed that there was high intra and interobserver agreement when panoramic radiographs were used, with minimum intra and interobserver ICC of 0.89, equivalent to a very strong agreement. On short radiographs in the anteroposterior incidence (AP) of the knee, the ICC showed moderate agreement, obtaining a maximum value of 0.75.

Conclusion There is a significant difference in accuracy for the measurement of the mechanical axis of the lower limb, comparing long and short radiographs of the lower limb. Thus, for the proper measurement of the mechanical axis of the lower limb, we suggest the performance of long radiography in the postoperative period of TKA.

Keywords

arthroplasty, replacement, knee - knee joint - radiography

Financial Support

There was no financial support from public, commercial, or non-profit sources.


* Work developed at the Orthopedics and Traumatology Service of Santa Casa de Misericórdia de Porto Alegre and Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brazil.




Publication History

Received: 15 August 2020

Accepted: 28 October 2020

Article published online:
19 April 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Fernandes DA, Poeta LS, Martins CAQ, Lima F, Rosa Neto F. Equilíbrio e qualidade de vida após artroplastia total de joelho. Rev Bras Ortop 2018; 53 (06) 747-753
    CrossrefPubMedGoogle Scholar
  • 2 Carvalho Júnior LH, Castro CAC, Gonçalves MBJ, Rodrigues LCM, Lopes FL, Cunha FVP. Complicações de curto prazo da artrolastia total de joelho: avaliação de 120 casos. Rev Bras Ortop 2006; 41 (05) 162-166
    Google Scholar
  • 3 Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it?. J Arthroplasty 2009; 24 (6, Suppl) 39-43
    Google Scholar
  • 4 Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977; 59 (01) 77-79
    Google Scholar
  • 5 Abu-Rajab RB, Deakin AH, Kandasami M, McGlynn J, Picard F, Kinninmonth AW. Hip-Knee-Ankle Radiographs Are More Appropriate for Assessment of Post-Operative Mechanical Alignment of Total Knee Arthroplasties than Standard AP Knee Radiographs. J Arthroplasty 2015; 30 (04) 695-700
    CrossrefPubMedGoogle Scholar
  • 6 Felson DT, Cooke TD, Niu J. et al; OAI Investigators Group. Can anatomic alignment measured from a knee radiograph substitute for mechanical alignment from full limb films?. Osteoarthritis Cartilage 2009; 17 (11) 1448-1452
    CrossrefPubMedGoogle Scholar
  • 7 Sheehy L, Felson D, Zhang Y. et al. Does measurement of the anatomic axis consistently predict hip-knee-ankle angle (HKA) for knee alignment studies in osteoarthritis? Analysis of long limb radiographs from the multicenter osteoarthritis (MOST) study. Osteoarthritis Cartilage 2011; 19 (01) 58-64
    CrossrefPubMedGoogle Scholar
  • 8 Alhbäck S. Osteoarthritis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968; (Suppl. 277) 7-72
    Google Scholar
  • 9 Ishii Y, Ohmori G, Bechtold JE, Sherman RE, Gustilo RB. Accuracy of the short radiograph in the measurement of the tibiofemoral angle. Knee 1995; 2 (02) 81-84
    CrossrefGoogle Scholar
  • 10 Maquet PG. Biomechanics of the knee. New York: Springer-Verlag; 1976
    CrossrefGoogle Scholar
  • 11 Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 1987; 69 (05) 745-749
    Google Scholar
  • 12 Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001; 286 (02) 188-195
    Google Scholar
  • 13 Dargel J, Pennig L, Schnurr C, Boese CK, Eysel P, Oppermann J. [Should we use hip-ankle radiographs to assess the coronal alignment after total knee arthroplasty?]. Orthopade 2016; 45 (07) 591-596
    PubMedGoogle Scholar
  • 14 Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM. Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br 2004; 86 (06) 818-823
    CrossrefPubMedGoogle Scholar