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A whole leg radiograph is not necessary for postoperative determination of the mechanical leg axis after total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Anteroposterior (AP) whole leg radiographs (WLR) in the standing position for assessment of the mechanical leg axis are generally performed preoperatively for the planning of total knee replacement (TKR) and postoperatively to assess the leg axis. The objective of the present study was to investigate whether, if preoperative WLR are available, postoperative AP standard knee radiographs in the standing position are sufficient for calculating the mechanical leg axis.

Methods

In the present prospective study, the mechanical and the anatomical leg axes were determined on the basis of WLR from 104 patients prior to implantation of a TKR and the difference was calculated. Twelve weeks postoperatively, standing long AP radiographs and WLR were prepared. In addition, the mechanical axis was calculated by adding the preoperative difference between the anatomical and mechanical axis to the anatomical axis from the postoperative AP radiographs. Accuracy, bias and level of agreement for calculated relative to measured mechanical alignment were determined.

Results

Mean accuracy of calculated mechanical alignment was 0.5° ± 0.4°, and mean bias was 0.0° ± 0.6° (p = 1.00). Bland–Altman analysis revealed a 95% upper and lower level of agreement of − 1.3° and 1.3°, respectively.

Conclusion

A preoperative WLR and a postoperative long AP knee standard radiograph are sufficient to determine the mechanical leg axis after TKR. If these are available, it is possible to do without WLR after TKR, particularly since they involve higher radiation exposure, are time-consuming, and are also prone to errors in the first postoperative weeks.

Level of evidence

II diagnostic study.

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Authors and Affiliations

  1. Medical School, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany

    Nina Perka

  2. Center of Orthopaedics and Traumatology, Medical School Theodor Fontane, Hospital Brandenburg an der Havel, 14770, Brandenburg, Germany

    Sebastian Kopf

  3. Clinic for Orthopaedics, Sports Medicine and Rehabilitation, Hospital Märkisch-Oderland GmbH, 16269, Wriezen, Germany

    Hagen Hommel

  4. Medical School Theodor Fontane, 16816, Neuruppin, Germany

    Hagen Hommel

Authors
  1. Nina Perka
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  2. Sebastian Kopf
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  3. Hagen Hommel
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Correspondence to Nina Perka.

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Perka, N., Kopf, S. & Hommel, H. A whole leg radiograph is not necessary for postoperative determination of the mechanical leg axis after total knee arthroplasty. Arch Orthop Trauma Surg 139, 1455–1460 (2019). https://doi.org/10.1007/s00402-019-03256-x

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  • DOI: https://doi.org/10.1007/s00402-019-03256-x

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