Three-dimensional assessment of lower limb alignment: Accuracy and reliability

Three-dimensional (3D) surgical planning and patient-specific implants are becoming increasingly popular in orthopedics and trauma surgery. In contrast to the established and standardized alignment assessment on two-dimensional (2D) long standing radiographs (LSRs) there is neither a standardized no...

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Bibliographic Details
Published in:The knee 2019-01, Vol.26 (1), p.185-193
Main Authors: Fürmetz, J., Sass, J., Ferreira, T., Jalali, J., Kovacs, L., Mück, F., Degen, N., Thaller, P.H.
Format: Article
Language:English
Subjects:
3D anatomy
3D bone modeling
Alignment
Ankle
Bone surgery
Bones
Computed tomography
Geometry
Knee
Medical imaging
NMR
Nuclear magnetic resonance
Patient-specific implant
Patients
Pre-operative planning
Radiography
Software
Surgeons
Surgery
Trauma
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Summary:Three-dimensional (3D) surgical planning and patient-specific implants are becoming increasingly popular in orthopedics and trauma surgery. In contrast to the established and standardized alignment assessment on two-dimensional (2D) long standing radiographs (LSRs) there is neither a standardized nor a validated protocol for the analysis of 3D bone models of the lower limb. This study aimed to create a prerequisite for pre-operative planning. According to 2D analysis and after meticulous research, 24 landmarks were defined on 3D bone models obtained from computed axial tomography (CT) scans for a 3D alignment assessment. Three observers with different experience levels performed the test three different times on three specimens. Intraobserver and interobserver variability of the landmarks and the intraclass correlation coefficient (ICC) of the resulting axes and joint angles were evaluated. Overall, the intraobserver and interobserver variability was low, with a mean deviation 0.8, except for tibial torsion (ICC = 0.69). All knee joint angles showed excellent ICC (>0.95). Using the defined landmarks, a standardized 3D alignment assessment with low intraobserver and interobserver variability and high ICC values for the knee joint angles can be performed regardless of examiner's experience. The described method serves as a reliable standardized protocol for a 3D malalignment test of the lower limb. Three-dimensional pre-operative analysis might enhance understanding of deformities and lead to a new focus in surgical planning.
ISSN:0968-0160
1873-5800
DOI:10.1016/j.knee.2018.10.011