title: Correlation of radiographic and navigated measurements of TKA limb alignment: a matter of time?
abstract: Valid and reproducible measurements of limb alignment are prerequisites for planning, performing and evaluating TKAs. Although navigation systems have been shown to be reproducible tool for intraoperative TKA alignment measurements, particular doubt has been raised on the correlation with postoperative radiographic measurements. The aim of the present study was to evaluate whether the association of postoperative radiographic and navigation measurements of limb alignment was dependent on the time of acquisition. For this purpose, we retrospectively compared two groups of patients who underwent computer-assisted cemented TKA for osteoarthritis of the knee. Intraoperative navigation measurements (OrthoPilot™, Aesculap, Tuttlingen, Germany) were recorded before any cuts were made and again after implants had been placed. Long leg standing radiographs were acquired preoperatively in both the groups and either 2 weeks or 3 months postoperatively and AP limb alignment measurements were correlated with those of the respective navigation assessments. Preoperative deformity was similar in both the groups and correlation between radiographic and navigation measurements was excellent in both groups (ρ = 0.845 and 0.945, respectively). However, both mean and maximum discrepancies between radiographic and navigation measurements of leg alignment were significantly larger when radiographs were obtained 2 weeks (2.6° ± 2.1°, max. 10°) when compared with 3 months (1.8° ± 1.4°, max. 5°) postoperatively (P = 0.026). Accordingly, correlation between radiographic and navigation measurements was poor when radiographs were obtained 2 weeks postoperatively (ρ = 0.26, n.s.) but in the range of preoperative assessments when obtained 3 months postoperatively (ρ = 0.841, P < 0.001). Radiographic and navigation measurements of TKA limb alignment correlate well preoperatively. Equally good correlations can only be achieved when postoperative radiographic measurements are delayed to a time when more patients achieve full or near-full extension and are able to bear full weight leading to more valid radiographs.
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Medical Center, Hugstetter Str. 55, 79106 Freiburg, Germany. oliver.hauschild@uniklinik-freiburg.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Hauschild
authors.forename: Lukas
authors.initials: L
authors.lastname: Konstantinidis
authors.forename: Tobias
authors.initials: T
authors.lastname: Baumann
authors.forename: Philipp
authors.initials: P
authors.lastname: Niemeyer
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Suedkamp
authors.forename: Peter
authors.initials: P
authors.lastname: Helwig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D017760:Bone Malalignment / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
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