title: Radiographic parameters improve lower extremity prosthetic alignment.
abstract: OBJECTIVE
  The goal of prosthetic fitting is to provide comfort and functionality to the patient. It is thought that incorporating the use of standing anterior-posterior long leg radiographs (LLR) into the fitting of lower extremity prostheses will provide an objective guide when making adjustments, and be a better assessment of alignment. This study compares prosthetic alignment before and after radiography-guided adjustments.
  
  
  METHODS
  This retrospective study was performed at a multidisciplinary amputee clinic on patients with congenital and/or acquired limb deficiencies. Their prosthetic alignment was evaluated by LLR and adjusted as needed. Satisfactory alignment was defined as a mechanical axis angular deviation of ≤1° and a leg length discrepancy of ≤10 mm.
  
  
  RESULTS
  A total of 45 unique prostheses from 24 subjects (10 female and 14 male) were included. Post-adjustment radiographs were obtained from 29 prostheses. After the initial prosthetic fitting, the probability of a satisfactory fit was 20.0 % (95 % CI 10.9-34.9 %). Following the baseline adjustment, the probability of a satisfactory fit improved to 53.3 % (95 % CI 37.5-70.9 %). After adjustment number 4, the probability of a satisfactory fit further improved to 76.7 % (95 % CI 41.9-98.0 %). There were also significant improvements in distal offset distance (p = 0.0040) and leg length discrepancy (p = 0.0206). The distal offset distance decreased by an average of 10.7 mm (95 % CI 3.6-17.8), and leg length discrepancy decreased by an average of 3.0 mm (95 % CI 00.48-5.5).
  
  
  CONCLUSIONS
  The addition of LLRs to existing fitting methods significantly improves prosthetic alignment and length.
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital Colorado, 13123 East 16th Ave, B060, Aurora, CO 80045 USA ; The University of Colorado, Anschutz Medical Campus, Aurora, CO USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Mooney
authors.affiliation: Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Carry
authors.affiliation: Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Wylie
authors.affiliation: Musculoskeletal Research Center, Children's Hospital Colorado, Aurora, CO USA.
authors.forename: Abby
authors.initials: A
authors.lastname: Schultz
authors.affiliation: Research Institute, Children's Hospital Colorado, Aurora, CO USA ; The University of Colorado, Anschutz Medical Campus, Aurora, CO USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: McNair
authors.affiliation: Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado, Aurora, CO USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Page
authors.affiliation: Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado, Aurora, CO USA ; The University of Colorado, Anschutz Medical Campus, Aurora, CO USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Biffl
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital Colorado, 13123 East 16th Ave, B060, Aurora, CO 80045 USA ; The University of Colorado, Anschutz Medical Campus, Aurora, CO USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Heare
keywords: Amputees; Long leg radiographs; Lower extremity; Prosthetic alignment