1
|
Ten Noever de Brauw GV, Bayoumi T, Ruderman LV, Kerkhoffs GMMJ, Zuiderbaan HA, Pearle AD. Knees with isolated lateral compartment osteoarthritis show a substantial variability in functional knee phenotypes with demographic-specific variations: Phenotypic analysis of 305 knees. Knee 2024; 48:265-278. [PMID: 38820655 DOI: 10.1016/j.knee.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND The primary aim of this study was to assess and describe the phenotypic variation in the coronal plane of knees affected by isolated lateral compartment osteoarthritis (OA). The secondary aim was to investigate the potential gender-specific and age-related differences in functional knee phenotypes among knees with isolated lateral compartment OA. METHODS A comprehensive classification system was used to categorize 305 knees with isolated lateral compartment OA based on their mechanical hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). The phenotypic variation of functional knee phenotypes was assessed for the entire cohort and stratified by gender and age category. RESULTS Among knees with isolated lateral compartment OA, a total of 60 distinct functional knee phenotypes were identified, with phenotype VALHKA6°NEUFMA0°VALTMA3° being the most prevalent (10.8 %). Gender-specific differences were evident, with females exhibiting significantly greater valgus alignment in both mean HKA and TMA values compared with males (HKA: -6.4° vs. -5.4°, respectively; P = 0.02 and TMA 94.4° vs. 89.0°, respectively; P = 0.005). Age-related variations included younger patients predominantly displaying femoral deformities, while older patients primarily exhibited isolated tibial- or combined femoral and tibial deformities. CONCLUSIONS There is a broad variation of functional knee phenotypes among knees affected by isolated lateral compartment OA, with gender-specific and age-related differences. Recognizing this inherent phenotypic diversity during preoperative planning may facilitate the implementation of tailored approaches that account for the unique characteristics and bony deformities of the individual knee.
Collapse
Affiliation(s)
- G V Ten Noever de Brauw
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.
| | - T Bayoumi
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA; Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands
| | - L V Ruderman
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - G M M J Kerkhoffs
- Amsterdam UMC location University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Sports, Amsterdam, the Netherlands
| | - H A Zuiderbaan
- Medische Kliniek Velsen, Department of Orthopaedic Surgery, Velsen-Noord, the Netherlands
| | - A D Pearle
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, NY, USA
| |
Collapse
|
2
|
Ollivier M, Gulagaci F, Sahbat Y, Kim Y, Ehlinger M. Should I optimize joint line obliquity in my knee procedure? Orthop Traumatol Surg Res 2024; 110:103882. [PMID: 38583703 DOI: 10.1016/j.otsr.2024.103882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur (IML), hôpital Sainte-Marguerite, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - Firat Gulagaci
- Institut du mouvement et de l'appareil locomoteur (IML), hôpital Sainte-Marguerite, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Yavuz Sahbat
- Institut du mouvement et de l'appareil locomoteur (IML), hôpital Sainte-Marguerite, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Youngji Kim
- Institut du mouvement et de l'appareil locomoteur (IML), hôpital Sainte-Marguerite, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie du membre inférieur, pôle Locomax, hôpital de Hautepierre II, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| |
Collapse
|
3
|
Kikuchi N, Kanamori A, Okuno K, Yamazaki M. Weight-bearing line at the ankle joint level shifted laterally after total knee arthroplasty for varus knee osteoarthritis: Evaluation of the hip-to-calcaneus line. Orthop Traumatol Surg Res 2024; 110:103690. [PMID: 37741441 DOI: 10.1016/j.otsr.2023.103690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Few studies have comprehensively examined how alignment beyond the ankle joint changes after Total knee arthroplasty (TKA). This retrospective study aimed to answer the questions: (1) do the radiological parameters beyond the ankle joint, including the weight-bearing line at the ankle joint level, change after TKA in varus knee osteoarthritis? (2) Does the lower extremity alignment correlate with alignment beyond the ankle joint? HYPOTHESIS Our hypothesis was that TKA altered the radiological parameters beyond the ankle, which correlated with the lower extremity alignment. PATIENTS AND METHODS This retrospective study included 67 patients who underwent mechanically aligned TKA for varus knee osteoarthritis. The hip-knee-ankle angle (HKA), tibial plafond inclination angle (TPIA), hindfoot alignment angle (HA), talar tilt (TT), and weight-bearing line at the ankle joint level (mechanical ankle joint axis point [MAJAP]) were measured using radiographs taken before and 6 months after TKA; each parameter was compared between the two time points. The correlations between HKA and other parameters were examined preoperatively and postoperatively. RESULTS The mean HKA, TPIA, HA, TT, and MAJAP changed significantly after TKA from 15.0±6.1̊ to 2.6̊±3.5̊, from 10.8̊±5.7̊ to 4.7̊±3.9̊, from 2.3̊±5.5̊ to -2.5̊±4.5̊, from 0.2̊±1.3̊ to -0.5̊±1.4̊, and from 29.3±23.3 to 54.3±20.6, respectively. Correlations were noted between the preoperative HKA and the preoperative TPIA (r=0.58), HA (r=0.36), and MAJAP (r=-0.59), and between the postoperative HKA and the postoperative TPIA (r=0.54) and MAJAP (r=-0.38). DISCUSSION TKA for varus knee osteoarthritis altered radiological parameters beyond the ankle, with the weight-bearing line at the ankle joint level passing more laterally. The weight-bearing line at the ankle joint level was correlated with lower extremity alignment both preoperatively and postoperatively. LEVEL OF EVIDENCE IV; single-centre retrospective observational study.
Collapse
Affiliation(s)
- Naoya Kikuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575 Ibaraki, Japan.
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575 Ibaraki, Japan
| | - Kosuke Okuno
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575 Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575 Ibaraki, Japan
| |
Collapse
|
4
|
Tarassoli P, Warnock JM, Lim YP, Jagota I, Parker D. Large multiplanar changes to native alignment have no apparent impact on clinical outcomes following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:432-444. [PMID: 38294963 DOI: 10.1002/ksa.12044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE This study sought to examine if achieved postoperative alignment when compared to the native anatomy would lead to a difference in Patient Reported Outcome Measures (PROMs), and whether the achieved alignment could be broadly categorised by an accepted alignment strategy. METHODS A retrospective cohort study of prospectively collected data on patients undergoing single primary or bilateral simultaneous total knee arthroplasty (TKA) was carried out. CT scans were used to determine the mean change ("delta values") between the pre and postoperative; hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle and femoral implant rotation. Femoral implant flexion and tibial implant slope were measured postoperatively. The primary outcome was the relationship of the variables to the change in KOOS pain subscale after one year. The secondary outcome was the number of knees which could be categorised postoperatively to an alignment strategy, and the mean PROMs in each cohort. RESULTS A total of 296 knees in 261 patients were available for analysis. With regards to the primary outcome, the delta values for each variable did not demonstrate any association with the change in knee injury and osteoarthritis outcome score (KOOS) pain score. Approximately 46% of knees could not be categorised to an alignment strategy based on postoperatively measured alignment, with no significant difference between each cohort with regards to the change in KOOS Pain score. CONCLUSION Achieved alignment does not consistently match accepted alignment strategies, and appears to confer no benefit to clinical outcomes when the native anatomy is most closely approximated, nor results in poorer outcomes in outliers. This study highlights the importance of routine three dimensional pre and postoperative imaging in clinical practice and for the valid analysis of outcomes in studies on alignment. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Payam Tarassoli
- Sydney Orthopaedic Research Institute, St Leonards, Australia
| | | | - Yoong Ping Lim
- Sydney Orthopaedic Research Institute, St Leonards, Australia
- The University of Sydney, Camperdown, Australia
- Charles Darwin University, Casuarina, Australia
| | - Ishaan Jagota
- 360 Med Care Pty Ltd, Pymble, Australia
- Flinders University, Adelaide, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, St Leonards, Australia
- The University of Sydney, Camperdown, Australia
| |
Collapse
|
5
|
Jiang X, Xie K, Chen H, Zhang K, Hu Y, Kan T, Sun L, Ai S, Zhu X, Zhang L, Yan M, Wang L. A Radiographic Analysis of Coronal Morphological Parameters of Lower Limbs in Chinese Non-knee Osteoarthritis Populations. Orthop Surg 2024; 16:452-461. [PMID: 38088238 PMCID: PMC10834221 DOI: 10.1111/os.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Analyzing the lower limb coronal morphological parameters in populations without knee osteoarthritis (KOA) holds significant value in predicting, diagnosing, and formulating surgical strategies for KOA. This study aimed to comprehensively analyze the variability in these parameters among Chinese non-KOA populations, employing a substantial sample size. METHODS A cross-sectional retrospective analysis was performed on the Chinese non-KOA populations (n = 407; 49.9% females). The study employed an in-house developed artificial intelligence software to meticulously assess the coronal morphological parameters of all 814 lower limbs. The parameters evaluated included the hip-knee-ankle angle (HKAA), weight-bearing line ratio (WBLR), joint line convergence angle (JLCA), mechanical lateral-proximal-femoral angle (mLPFA), mechanical lateral-distal-femoral angle (mLDFA), mechanical medial-proximal-tibial angle (mMPTA), and mechanical lateral-distal-tibial angle (mLDTA). Differences in these parameters were compared between left and right limbs, different genders, and different age groups (with 50 years as the cut-off point). RESULTS HKAA and JLCA exhibited left-right differences (left vs. right: 178.2° ± 3.0° vs. 178.6° ± 2.9° for HKAA, p = 0.001; and 1.8° ± 1.5° vs. 1.4° ± 1.6° for JLCA, p < 0.001); except for the mLPFA, all other parameters show gender-related differences (male vs. female: 177.9° ± 2.8° vs. 179.0° ± 3.0° for HKAA, p < 0.001; 1.5° ± 1.5° vs. 1.8° ± 1.7° for JLCA, p = 0.003; 87.1° ± 2.1° vs. 88.1° ± 2.1° for mMPTA, p < 0.001; 90.2° ± 4.0° vs. 91.1° ± 3.2° for mLDTA, p < 0.001; 38.7% ± 12.9% vs. 43.6% ± 14.1% for WBLR, p < 0.001; and 87.7° ± 2.3° vs. 87.4° ± 2.7° for mLDTA, p = 0.045); mLPFA increase with age (younger vs. older: 90.1° ± 7.2° vs. 93.4° ± 4.9° for mLPFA, p < 0.001), while no statistical difference exists for other parameters. CONCLUSIONS There were differences in lower limb coronal morphological parameters among Chinese non-KOA populations between left and right sides, different genders, and age.
Collapse
Affiliation(s)
- Xu Jiang
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Kai Xie
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Hongyu Chen
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Kai Zhang
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Yuqi Hu
- School of Biomedical EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Tianyou Kan
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Lin Sun
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Songtao Ai
- Department of RadiologyShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Xianping Zhu
- Department of Orthopaedic SurgeryTaizhou Central HospitalTaizhouChina
| | - Lichi Zhang
- School of Biomedical EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Mengning Yan
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| | - Liao Wang
- Shanghai Frontiers Science Center of Degeneration and Regeneration in Skeletal System, Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic SurgeryShanghai Jiao Tong University of Medicine affiliated Ninth People's HospitalShanghaiChina
| |
Collapse
|
6
|
Dufrénot M, Dagneaux L, Fernando C, Chabrand P, Ollivier M, Lintz F. Three-dimensional biometrics using weight-bearing imaging shows relationship between knee and hindfoot axial alignment. Orthop Traumatol Surg Res 2023; 109:103482. [PMID: 36435375 DOI: 10.1016/j.otsr.2022.103482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/15/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Existence of a relationship between knee and hindfoot alignments is commonly accepted, but not clearly proven. While studied in the coronal plane using 2D imaging, axial alignment has not been studied yet, likely requiring 3D measurements. We aimed to investigate how knee and hindfoot rotational alignments are related using 3D biometrics and modern 3D weight-bearing technologies. HYPOTHESIS Hindfoot alignment is correlated with femoral and tibial torsions. PATIENTS AND METHODS All patients who underwent both weight-bearing CT (WBCT) and low dose biplanar radiographs (LDBR) were selected in this retrospective observational study, resulting in a cohort of 157 lower limbs from 99 patients. Patients' pathologies were stratified in subgroups and those with a history of trauma or surgery affecting lower limb alignment were excluded. Foot Ankle Offset was calculated from WBCT; femoral and tibial torsions and coronal alignment were calculated from LDBR, respectively. RESULTS Overall, mean Foot Ankle Offset was 1.56% (SD 7.4), mean femoral anteversion was 15.6° (SD 9.5), and mean external tibial torsion was 32.6° (SD 7.6). Moderate negative correlation between Tibial Torsion and Foot Ankle Offset was found in the whole series (rho=-0.23, p=0.003) and for non-pathologic patients (rho=-0.27, p=0.01). Linear models to estimate Tibial Torsion with Foot Ankle Offset and conversely were found, with a low adjusted R2 (3% DISCUSSION External tibial rotation was associated with varus hindfoot configuration in the group without pathologies, suggesting that compensatory mechanisms may occur between knee and hindfoot alignments. In pathological cases, however, the same relationship wasn't found, raising concerns about compensatory failure in spite of the numbers available. We didn't find similar correlations with the femur possibly because the hip has a degree of liberty in the axial plane. LEVEL OF EVIDENCE III, retrospective comparative study.
Collapse
Affiliation(s)
- Maryama Dufrénot
- CNRS, institut des sciences du mouvement Étienne-Jules Marey, UMR 7287, Aix-Marseille université, 163, avenue de Luminy, 13009 Marseille, France; Institut du membre inférieur et de l'appareil locomoteur, APHM, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; Newclip Technics, PA de la Lande Saint-Martin, 45, rue des Garottières, 44115 Haute-Goulaine, France.
| | - Louis Dagneaux
- Département de chirurgie orthopédique du membre inférieur, CHU de Montpellier, hôpital Lapeyronie, 371 avenue du Doyen Gaston-Giraud, 39295 Montpellier cedex 05, France; Laboratoire de mécanique et génie civil (LMGC), université de Montpellier, 860, rue de Saint-Priest, 34090 Montpellier, France
| | - Celine Fernando
- Service de chirurgie du pied et de la cheville, Ramsay Santé - clinique de l'Union, boulevard de Ratalens, 31240 Saint-Jean, France
| | - Patrick Chabrand
- CNRS, institut des sciences du mouvement Étienne-Jules Marey, UMR 7287, Aix-Marseille université, 163, avenue de Luminy, 13009 Marseille, France; Institut du membre inférieur et de l'appareil locomoteur, APHM, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Matthieu Ollivier
- CNRS, institut des sciences du mouvement Étienne-Jules Marey, UMR 7287, Aix-Marseille université, 163, avenue de Luminy, 13009 Marseille, France; Institut du membre inférieur et de l'appareil locomoteur, APHM, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - François Lintz
- Service de chirurgie du pied et de la cheville, Ramsay Santé - clinique de l'Union, boulevard de Ratalens, 31240 Saint-Jean, France
| |
Collapse
|
7
|
Kuiper RJA, Seevinck PR, Viergever MA, Weinans H, Sakkers RJB. Automatic Assessment of Lower-Limb Alignment from Computed Tomography. J Bone Joint Surg Am 2023; 105:700-712. [PMID: 36947661 DOI: 10.2106/jbjs.22.00890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Preoperative planning of lower-limb realignment surgical procedures necessitates the quantification of alignment parameters by using landmarks placed on medical scans. Conventionally, alignment measurements are performed on 2-dimensional (2D) standing radiographs. To enable fast and accurate 3-dimensional (3D) planning of orthopaedic surgery, automatic calculation of the lower-limb alignment from 3D bone models is required. The goal of this study was to develop, validate, and apply a method that automatically quantifies the parameters defining lower-limb alignment from computed tomographic (CT) scans. METHODS CT scans of the lower extremities of 50 subjects were both manually and automatically segmented. Thirty-two manual landmarks were positioned twice on the bone segmentations to assess intraobserver reliability in a subset of 20 subjects. The landmarks were also positioned automatically using a shape-fitting algorithm. The landmarks were then used to calculate 25 angles describing the lower-limb alignment for all 50 subjects. RESULTS The mean absolute difference (and standard deviation) between repeat measurements using the manual method was 2.01 ± 1.64 mm for the landmark positions and 1.05° ± 1.48° for the landmark angles, whereas the mean absolute difference between the manual and fully automatic methods was 2.17 ± 1.37 mm for the landmark positions and 1.10° ± 1.16° for the landmark angles. The manual method required approximately 60 minutes of manual interaction, compared with 12 minutes of computation time for the fully automatic method. The intraclass correlation coefficient showed good to excellent reliability between the manual and automatic assessments for 23 of 25 angles, and the same was true for the intraobserver reliability in the manual method. The mean for the 50 subjects was within the expected range for 18 of the 25 automatically calculated angles. CONCLUSIONS We developed a method that automatically calculated a comprehensive range of 25 measurements that defined lower-limb alignment in considerably less time, and with differences relative to the manual method that were comparable to the differences between repeated manual assessments. This method could thus be used as an efficient alternative to manual assessment of alignment. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Ruurd J A Kuiper
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- MRIguidance B.V., Utrecht, the Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ralph J B Sakkers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|