Smartphone assessment of knee flexion compared to radiographic standards.
BACKGROUND
Measuring knee range of motion (ROM) is an important assessment for the outcomes of total knee arthroplasty. Recent technological advances have led to the development and use of accelerometer-based smartphone applications to measure knee ROM. The purpose of this study was to develop, standardize, and validate methods of utilizing smartphone accelerometer technology compared to radiographic standards, visual estimation, and goniometric evaluation.


METHODS
Participants used visual estimation, a long-arm goniometer, and a smartphone accelerometer to determine range of motion of a cadaveric lower extremity; these results were compared to radiographs taken at the same angles.


RESULTS
The optimal smartphone position was determined to be on top of the leg at the distal femur and proximal tibia location. Between methods, it was found that the smartphone and goniometer were comparably reliable in measuring knee flexion (ICC=0.94; 95% CI: 0.91-0.96). Visual estimation was found to be the least reliable method of measurement.


CONCLUSIONS
The results suggested that the smartphone accelerometer was non-inferior when compared to the other measurement techniques, demonstrated similar deviations from radiographic standards, and did not appear to be influenced by the person performing the measurements or the girth of the extremity.
Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196, USA. Electronic address: mdietz@hsc.wvu.edu.
Matthew J
MJ
Dietz
Washington and Jefferson College, 60 South Lincoln Street, Washington, PA 15301, USA.
Daniel
D
Sprando
Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196, USA.
Andrew E
AE
Hanselman
Department of Biostatistics, West Virginia University, PO Box 9190, Morgantown, WV 26506-9190, USA.
Michael D
MD
Regier
Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196, USA.
Benjamin M
BM
Frye
D053587:Arthrometry, Articular / Q000295:instrumentation* / Q000379:methods; D002102:Cadaver; D003936:Diagnosis, Computer-Assisted; D005269:Femur / Q000000981:diagnostic imaging; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging*; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D000068997:Smartphone; D013977:Tibia / Q000000981:diagnostic imaging
Accelerometer; Measurement; Motion; Smartphone