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Narahashi É, Guimarães JB, Filho AGO, Nico MAC, Silva FD. Measurement of tibial slope using biplanar stereoradiography (EOS®). Skeletal Radiol 2024; 53:1091-1101. [PMID: 38051424 DOI: 10.1007/s00256-023-04528-9] [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: 10/02/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Posterior tibial slope (PTS) is an important anatomic parameter of the knee related to anteroposterior instability. Biplanar stereoradiography allows for simultaneous low-dose acquisition of anteroposterior and lateral views with 3D capability, enabling separate lateral and medial plateau analyses. We aimed to evaluate the possibility and compare the reproducibility of measuring medial and lateral PTS on EOS® images with two different patient positionings and compare it with CT of the knees as the gold standard. METHODS This is a retrospective study including volunteers who underwent lower limb stereoradiography and knee CT from 01/08/2016 to 07/31/2019. Sixty legs from 30 patients were studied. PTS were measured using stereoradiography and CT by two radiologists. Intraclass correlation was used to calculate intrarater and interrater reproducibilities. Pearson's correlation coefficients were used to calculate the correlation between stereoradiography and CT. We also compared the reproducibility of the stereoradiography of volunteers with 2 different positionings. RESULTS The mean stereoradiography PTS values for right and left knees were as follows: lateral, 12.2° (SD: 4.1) and 10.1° (SD: 3.5); medial,12.2° (SD: 4.4) and 11.6° (SD: 3.9). CT PTS mean values for right and left knee are as follows: lateral, 10.3° (SD:2.5) and 10.6° (SD: 2.8); medial: 8.7° (SD: 3.7) and 10.4° (SD: 3.5). Agreement between CT and EOS for angles between lateral and medial PTS was good (right, 0.874; left, 0.871). Regarding patient positioning on stereoradiography, interrater and intrarater reproducibilities were greater for patients with nonparallel feet (0.738-0.883 and 0.870-0.975). CONCLUSIONS Stereoradiography allows for appropriate delineation of tibial plateaus, especially in patients with nonparallel feet, for the purpose of measuring PTS. The main advantage is lower radiation doses compared to radiography and CT.
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Affiliation(s)
- Érica Narahashi
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil.
| | - Júlio Brandão Guimarães
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Alípio Gomes Ormond Filho
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Marcelo Astolfi Caetano Nico
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
| | - Flávio Duarte Silva
- Department of Musculoskeletal Radiology, Fleury Medicine and Health, Rua Mato Grosso, 306, 1o andar, Higienópolis, São Paulo, São Paulo, 01239-040, Brazil
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Ziegenhorn J, Kirschberg J, Heinecke M, von Eisenhart-Rothe R, Matziolis G. Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4. Knee Surg Sports Traumatol Arthrosc 2024; 32:1199-1206. [PMID: 38511851 DOI: 10.1002/ksa.12149] [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: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The purpose of this study was to find out whether the torsions of the femur and tibia are dependent on the coronal plane alignment of the knee (CPAK) type. METHODS Five hundred patients (1000 legs) were included, who received a whole leg standing three-dimensional (3D) radiograph using EOS imaging (EOS Imaging, Paris, France). SterEOS software was used for digital reconstruction. Femoral and tibial torsions were determined by analysing 3D reconstructions of each leg. Femoral torsion was defined as the angle between the femoral neck axis (FNA) and the posterior condylar axis (PCA). Tibial torsion was defined as the angle between the axis tangent to the posterior part of the tibia plateau and the transmalleolar axis. Arithmetic hip-knee-ankle angle (aHKA) and joint-line obliquity (JLO) were also determined, allowing each leg to be assigned one of nine possible phenotypes according to CPAK. RESULTS The mean femoral torsion in CPAK type 1 was significantly higher (+ 2.6° ± 0.8°) than in CPAK type 4 (p = 0.02). All other CPAK types did not differ in the degree of femoral torsions. No differences could be demonstrated for the tibial torsion. CONCLUSION There is a correlation between the coronal alignment of the lower limb and femoral torsion. This may provide the basis for extending the CPAK classification beyond the coronal plane. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jonas Ziegenhorn
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - Julia Kirschberg
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Markus Heinecke
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- German Knee Society (DKG), Munich, Germany
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
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Yang J, Ren P, Xin P, Wang Y, Ma Y, Liu W, Wang Y, Wang Y, Zhang G. Automatic measurement of lower limb alignment in portable devices based on deep learning for knee osteoarthritis. J Orthop Surg Res 2024; 19:232. [PMID: 38594698 PMCID: PMC11005281 DOI: 10.1186/s13018-024-04658-3] [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: 10/27/2023] [Accepted: 03/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND For knee osteoarthritis patients, analyzing alignment of lower limbs is essential for therapy, which is currently measured from standing long-leg radiographs of anteroposterior X-ray (LLR) manually. To address the time wasting, poor reproducibility and inconvenience of use caused by existing methods, we present an automated measurement model in portable devices for assessing knee alignment from LLRs. METHOD We created a model and trained it with 837 conforming LLRs, and tested it using 204 LLRs without duplicates in a portable device. Both manual and model measurements were conducted independently, then we recorded knee alignment parameters such as Hip knee ankle angle (HKA), Joint line convergence angle (JCLA), Anatomical mechanical angle (AMA), mechanical Lateral distal femoral angle (mLDFA), mechanical Medial proximal tibial angle (mMPTA), and the time required. We evaluated the model's performance compared with manual results in various metrics. RESULT In both the validation and test sets, the average mean radial errors were 2.778 and 2.447 (P<0.05). The test results for native knee joints showed that 92.22%, 79.38%, 87.94%, 79.82%, and 80.16% of the joints reached angle deviation<1° for HKA, JCLA, AMA, mLDFA, and mMPTA. Additionally, for joints with prostheses, 90.14%, 93.66%, 86.62%, 83.80%, and 85.92% of the joints reached that. The Chi-square test did not reveal any significant differences between the manual and model measurements in subgroups (P>0.05). Furthermore, the Bland-Altman 95% limits of agreement were less than ± 2° for HKA, JCLA, AMA, and mLDFA, and slightly more than ± 2 degrees for mMPTA. CONCLUSION The automatic measurement tool can assess the alignment of lower limbs in portable devices for knee osteoarthritis patients. The results are reliable, reproducible, and time-saving.
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Affiliation(s)
- Jianfeng Yang
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Ren
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Xin
- Department of Orthopedics, Chinese PLA Southern Theater Command General Hospital, Guangzhou, China
| | - Yiming Wang
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese People's Liberation Army, Beijing, China
| | - Yonglei Ma
- Department of Anesthesiology, Guangzhou First People's Hospital, Guangzhou, China
| | - Wei Liu
- Damo Academy, Alibaba Group, Hangzhou, China
| | - Yu Wang
- Damo Academy, Alibaba Group, Hangzhou, China
| | - Yan Wang
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
- Department of Orthopedics, the First Medical Center, PLA General Hospital, Fuxing Road, Haidian District, Beijing, China.
| | - Guoqiang Zhang
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
- Department of Orthopedics, the First Medical Center, PLA General Hospital, Fuxing Road, Haidian District, Beijing, China.
- Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China.
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Oh BH, Seo KD, Heo YM, Kim TK, Choi JK, Song JH. Coronal and sagittal alignment of ankle joint is significantly affected by high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4878-4885. [PMID: 37572140 DOI: 10.1007/s00167-023-07531-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Changes in coronal and sagittal alignment of the knee joint after HTO have been reported in several previous studies. However, only few of them investigated the changes only on coronal alignment of the ankle joint. The purpose of this study was to investigate changes in both coronal and sagittal alignment of the ankle joint after HTO. METHODS 46 patients (49 cases) who underwent HTO were retrospectively analyzed. Preoperative and postoperative lower extremity scanogram and EOS imaging system were investigated. The hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and knee tibia plafond angle (KTPA) were measured by scanogram to evaluate coronal alignment of the knee. Tibial anterior surface angle (TAS), talar tilt (TT), tibial plafond inclination (TPI), and ankle joint axis point on the weight-bearing-line (AAWBL) ratio were measured by scanogram to investigate coronal alignment of the ankle. Knee lateral ankle surface angle (KLAS) and tibial lateral surface angle (TLS) were measured by EOS to evaluate sagittal alignment of the ankle. RESULTS Varus alignment of the knee was corrected by significant change of the HKA angle (5.8 ± 3.1° vs. - 2.1 ± 2.8°, p < 0.001), MPTA (85.7 ± 2.9° vs. 91.7 ± 3.3°, p < 0.001), and KTPA (5.0 ± 3.5° vs. - 2.1 ± 4.2°, p < 0.001) after HTO. Regarding the ankle coronal alignment, there was significant change in TPI (3.9 ± 3.4° vs. - 0.9 ± 3.8°, p < 0.001) and AAWBL ratio (45.5 ± 14.7% vs. 61.6 ± 13.3%, p < 0.001). In sagittal alignment of the ankle, KLAS (4.5 ± 3.1° vs. 7.7 ± 3.7°, p < 0.001) significantly increased. Among the variables, the amount of correction in AAWBL ratio (R = 0.608, p < 0.01) showed strongest relationship with tibial correction angle. CONCLUSION Based on the present study, coronal and sagittal alignment of ankle joint was significantly affected by HTO. After HTO, AAWBL ratio increased due to lateralization of the ankle joint axis, and KLAS increased due to increased posterior tibial slope. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Byung Hak Oh
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Kyung Deok Seo
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Youn Moo Heo
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Tae Kyun Kim
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Jae Kyu Choi
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Jae Hwang Song
- Department of Orthopedic Surgery, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea.
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Miao M, Cai H, Zhang L, Cai H. Analysis of lower extremity alignment (LEA) in children with recurrent patellar dislocation by EOS system. Front Pediatr 2023; 11:1291739. [PMID: 37954430 PMCID: PMC10634357 DOI: 10.3389/fped.2023.1291739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023] Open
Abstract
Objectives Recurrent patellar dislocation (RPD) greatly affects active young individuals, necessitating the identification of risk factors for a better understanding of its cause. Previous research has connected RPD to lower limb alignment (LEA) abnormalities, such as increased femoral anteversion, tibial external rotation, knee valgus, and flexion. This study aims to use EOS technology to detect RPD-related LEA anomalies, enabling three-dimensional assessment under load conditions. Methods A total of 100 limbs (50 in the RPD group, 50 in the control group) were retrospectively analyzed. In the RPD group, we included limbs with recurrent patellar dislocation, characterized by dislocations occurs at least two times, while healthy limbs served as the control group. We used EOS technology, including 2D and 3D imaging, to measure and compare the following parameters between the two groups in a standing position: Femoral neck shaft angle (NSA), Mechanical femoral tibial angle (MFTA), Mechanical lateral distal femoral angle (mLDFA), Medial proximal tibial angle (MPTA), Anatomical femoral anteversion (AFA), External tibial torsion (ETT), and Femorotibial rotation (FTR). Results The significant differences between the two groups were shown in NSA 3/2D, MFTA 3/2D, mLDFA 3/2D, MPTA 3D, AFA, FTR. No significant difference was shown in MPTA 2D, ETT between the RPD group and the control group. Further binary logistic regression analysis. Further binary logistic regression analysis was conducted on the risk factors affecting RPD mentioned above. and found four risk factors for binary logistic regression analysis: mLDFA (3D), AFA, NSA(3D), and FTR. Conclusions EOS imaging identified abnormal LEA parameters, including NSA, MFTA, mLDFA, MPTA, AFA, and FTR, as risk factors for RPD. Children with these risk factors should receive moderate knee joint protection.
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Affiliation(s)
| | | | | | - Haoqi Cai
- Department of Orthopedic Surgery, Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Yoo HJ, Choi JK, Heo YM, Moon SJ, Oh BH. Changes in Parameters after High Tibial Osteotomy: Comparison of EOS System and Computed Tomographic Analysis. J Clin Med 2023; 12:5638. [PMID: 37685705 PMCID: PMC10488862 DOI: 10.3390/jcm12175638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Unintended rotation of the distal tibia occurs during medial open-wedge high tibial osteotomy (MOWHTO). Computed tomography (CT) is the standard method of measuring lower limb alignment; however, the new low-dose EOS system allows three-dimensional limb modeling with automated measurements of lower limb alignment. This study investigated the differences between the changes in lower limb alignment profiles obtained using the EOS system and CT in patients who underwent MOWHTO. We investigated whether any factors contributed to the degree of deformation. Thirty patients were prospectively enrolled between October 2019 and February 2023. Changes in femoral and tibial torsion, femorotibial rotation, and posterior tibial slope were measured using pre- and post-MOWHTO CT and EOS images. We found no significant difference in pre- and postoperative tibial torsion or posterior tibial slope between CT and EOS. No variables showed a significant correlation with changes in the tibial torsion or posterior tibial slope. This study confirmed the possibility that the EOS system could replace CT in measuring changes in several parameters pre- and postoperatively. Furthermore, we confirmed that the distal tibia tended to be internally rotated after MOWHTO; however, we found no significantly related parameters related to deformation caused by MOWHTO.
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Affiliation(s)
| | | | | | | | - Byung-Hak Oh
- Department of Orthopedic Surgery, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Republic of Korea; (H.-J.Y.); (J.-K.C.); (Y.-M.H.); (S.-J.M.)
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Corbett J, Tai J, Salmon L, Roe J. Comparison of CT and EOS in assessing coronal lower limb alignment when planning total knee arthroplasty. Knee 2023; 42:400-408. [PMID: 37182443 DOI: 10.1016/j.knee.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND As surgical technologies and alignment strategies develop, accuracy of lower limb alignment assessment gains increasing importance. The current gold standard remains long leg (4ft) radiographs. Other measures include computed tomography (CT) and EOS scans. This study aimed to compare CT and EOS long leg views to determine the reliability of assessment of hip-knee-angle (HKA) in arthritic knees. MATERIALS AND METHODS A retrospective study of 96 knees in patients undergoing total knee arthroplasty (TKA) was performed comparing HKA alignment data from EOS and CT. Coronal HKA and sagittal flexion angle were assessed by two independent observers. Inter-observer correlation was calculated. RESULTS The coronal alignment on EOS was strongly positively correlated to coronal alignment on CT (r = 0.927, p = 0.001). 12 knees (13 %) exceeded CT vs EOS difference of 3°. Inter-rater reliability was excellent (intra-class coefficients >0.9). The mean difference between CT and EOS was significantly greater for patients with fixed flexion >10° (0.68) vs <10° (-0.2) p = 0.004. Mean difference in HKA did not differ between those 0-10° varus and >10° varus (p = 0.273). Valgus HKA had a higher mean difference (1.9°) compared to varus knees (-0.4°) (p = 0.001). CONCLUSION CT and EOS showed excellent inter-rater reliability and correlated well. Increased sagittal plane deformity does effect coronal HKA assessment. Extreme varus did not affect the mean difference significantly, while valgus did. For the majority of patients either CT or EOS will give a reliable assessment of HKA but beware those with significant valgus or sagittal deformity where both modalities may be necessary to plan TKA.
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Affiliation(s)
- James Corbett
- North Sydney Orthopaedic Research Group, Australia; North Sydney Orthopaedic & Sports Medicine Centre, Australia
| | - Jeffrey Tai
- North Sydney Orthopaedic Research Group, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Lucy Salmon
- North Sydney Orthopaedic Research Group, Australia; North Sydney Orthopaedic & Sports Medicine Centre, Australia; School of Medicine, University of Notre Dame, Sydney, Australia
| | - Justin Roe
- North Sydney Orthopaedic Research Group, Australia; North Sydney Orthopaedic & Sports Medicine Centre, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia.
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Gasparutto X, Besonhe P, DiGiovanni PL, Zingg M, Boudabbous S, Armand S, Hannouche D. Reliability of the pelvis and femur anatomical landmarks and geometry with the EOS system before and after total hip arthroplasty. Sci Rep 2022; 12:21420. [PMID: 36504199 PMCID: PMC9742167 DOI: 10.1038/s41598-022-25997-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Bi-plane X-ray provides 3D measurements of the lower limb based on the identification of anatomical landmarks in sagittal and frontal X-rays. In clinical practice, such measurements involve multiple operators and sessions. This study aimed at evaluating the reliability of anatomical landmarks identification and geometric parameters of the pelvis and femur measured with bi-plane X-rays before and after total hip arthroplasty (THA). Twenty-eight patients undergoing primary THA were selected retrospectively. Two operators performed three reconstructions for each patient before and after THA. Intraclass correlation (ICC) and smallest detectable change (SDC) were computed for intra-operator, inter-operator, and test-retest conditions. Most anatomical landmark positions had good to excellent SDC (< 5 mm) apart from the centre of the sacral slope, greater trochanter, and anterior superior iliac spines (up to 7.1, 16.9, and 21.5 mm respectively). Geometric parameters had moderate to excellent SDC, apart from femoral and stem torsion, pelvic incidence, and APP inclination with poor SDC (9-12°). The sagittal view had significantly higher measurement errors than the frontal view. Test-retest and inter-operator conditions had no significant differences suggesting a low influence of patient posture. Osteoarthritis and the presence of implants did not seem to influence reliability and measurement error. This study could be used as a reference when assessing lower limb structure with bi-plane X-rays.
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Affiliation(s)
- Xavier Gasparutto
- grid.150338.c0000 0001 0721 9812Laboratoire de Cinésiologie Willy Taillard, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Pauline Besonhe
- grid.150338.c0000 0001 0721 9812Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Peter Luca DiGiovanni
- grid.150338.c0000 0001 0721 9812Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Matthieu Zingg
- grid.150338.c0000 0001 0721 9812Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- grid.150338.c0000 0001 0721 9812Division of Radiology, Diagnosis Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- grid.150338.c0000 0001 0721 9812Laboratoire de Cinésiologie Willy Taillard, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Didier Hannouche
- grid.150338.c0000 0001 0721 9812Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Chen X, Myers CA, Clary CW, Varga P, Coombs D, DeWall RJ, Fritz B, Rullkoetter PJ. Impact of bone health on the mechanics of plate fixation for Vancouver B1 periprosthetic femoral fractures. Clin Biomech (Bristol, Avon) 2022; 100:105801. [PMID: 36327548 DOI: 10.1016/j.clinbiomech.2022.105801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/23/2022] [Accepted: 10/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Condyle-spanning plate-screw constructs have shown potential to lower the risks of femoral refractures after the healing of a primary Vancouver type B1 periprosthetic femoral fracture. Limited information exists to show how osteoporosis (a risk factor for periprosthetic femoral fractures) may affect the plate fixation during activities of daily living. METHODS Using total hip arthroplasty and plate-implanted finite element models of three osteoporotic femurs, this study simulated physiological loads of three activities of daily living, as well as osteoporosis associated muscle weakening, and compared the calculated stress/strain, load transfer and local stiffness with experimentally validated models of three healthy femurs. Two plating systems and two construct lengths (a diaphyseal construct and a condyle-spanning construct) were modeled. FINDINGS Osteoporotic femurs showed higher bone strain (21.9%) and higher peak plate stress (144.3%) as compared with healthy femurs. Compared with shorter diaphyseal constructs, condyle-spanning constructs of two plating systems reduced bone strains in both healthy and osteoporotic femurs (both applying 'the normal' and 'the weakened muscle forces') around the most distal diaphyseal screw and in the distal metaphysis, both locations where secondary fractures are typically reported. The lowered resultant compressive force and the increased local compressive stiffness in the distal diaphysis and metaphysis may be associated with strain reductions via condyle-spanning constructs. INTERPRETATION Strain reductions in condyle-spanning constructs agreed with the clinically reported lowered risks of femoral refractures in the distal diaphysis and metaphysis. Multiple condylar screws may mitigate the concentrated strains in the lateral condyle, especially in osteoporotic femurs.
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Affiliation(s)
- Xiang Chen
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Casey A Myers
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Chadd W Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | | | | | | | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
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Schlégl ÁT, Nyakas V, Kovács D, Maróti P, Józsa G, Than P. Neck-shaft angle measurement in children: accuracy of the conventional radiography-based (2D) methods compared to 3D reconstructions. Sci Rep 2022; 12:16494. [PMID: 36192625 PMCID: PMC9529964 DOI: 10.1038/s41598-022-20832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 09/19/2022] [Indexed: 12/29/2022] Open
Abstract
Aim of this study was to examine the accuracy of widely used conventional radiography-based (2D) neck-shaft angle measurements compared to 3D reconstruction. In our retrospective study, EOS 2D/3D images of 156 patients (312 limbs) were selected from our database (4-16 years old: 6 girls and 6 boys/year), where no pathology was revealed. Using the 2D modality of the EOS method neck-shaft angle was measured using the "biggest diameter" and "circle fitting" techniques to define the femoral neck axis and 1/3, 1/2 and full femur to determine the femoral shaft axis. EOS 3D reconstructions of same images were also performed and a comparison of 2D and 3D results was made. We did not find any significant difference between accuracy of the four examined 2D methods, although the deviation between 2 and 3D results was considerable (average difference: 5.11-5.58°, p < 0,001). In 31% of the cases, difference was more than 10°. Only femoral torsion showed significant influence on the difference (correlation coefficient: 0.380, p < 0.001). We did not find a clinically significant difference between the examined 2D methods, although their accuracy was highly questionable compared to 3D results. We suggest using any 3D imaging method for surgical planning and in uncertain cases.
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Affiliation(s)
- Ádám Tibor Schlégl
- grid.9679.10000 0001 0663 9479Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1., Pecs, 7632 Hungary
| | - Viktória Nyakas
- grid.9679.10000 0001 0663 9479Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1., Pecs, 7632 Hungary
| | - Dániel Kovács
- grid.9679.10000 0001 0663 9479Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1., Pecs, 7632 Hungary
| | - Péter Maróti
- grid.9679.10000 0001 0663 94793D Printing and Visualization Centre, University of Pécs, Medical School, Boszorkány str. 2., Pecs, 7624 Hungary
| | - Gergő Józsa
- grid.9679.10000 0001 0663 9479Division of Surgery, Traumatology and Otorhinolaryngology, Department of Pediatrics, Medical School, University of Pécs, József A str. 7, Pecs, 7623 Hungary
| | - Péter Than
- grid.9679.10000 0001 0663 9479Department of Orthopaedics, Medical School, University of Pécs, Akác str. 1., Pecs, 7632 Hungary
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