The accuracy of preoperative implant size prediction achieved by digital templating in total knee arthroplasty is not affected by the quality of lateral knee radiographs

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-07-24 DOI:10.1002/jeo2.12102

Lorenz Pichler, Leonhard Klein, Carsten F. Perka, Clemens Gwinner, Moses K. D. El Kayali

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Abstract

Background

Digital templating software can be used for preoperative implant size prediction in total knee arthroplasty (TKA). However, the accuracy of its prediction is reported to be low, and the impact of radiograph quality is unclear.

Purpose

To investigate on the application of lateral knee radiograph quality criteria for knee rotation (KR) and knee abduction/adduction (KA) and their impact on the accuracy of final implant size prediction achieved by preoperative digital templating for TKA.

Methods

A total of 191 radiographs of patients undergoing TKA were allocated into four groups according to their KR as measured at the posterior femoral condyles and their KA as measured at the distal femoral condyles on lateral knee radiographs: group A (KR ≤ 5 mm, KA ≤ 5 mm), B1 (KR > 5 mm, KA ≤ 5 mm), B2 (KR ≤ 5 mm, KA > 5 mm) and B3 (KR > 5 mm, KA > 5 mm). Preoperative templating of femoral and tibial implant size using digital templating software was carried out by two observers. Correlation coefficients (CCs) between planned and final implant size, percentage of cases with planned to final size match as well as percentage of cases within ±1 and ±2 of planned to final size were reported according to groups.

Results

Group A showed the highest percentage of cases with matching planned to final femoral implant size (45%) and the highest percentage of cases with ±1 planned to final implant size (86%) as compared to B1 (match 28%, ±1 84%), B2 (match 41%, ±1 84%) and B3 (match 35%, ±1 78%). CCs for planned to final implant size were reported at >0.75 in all groups. No statistically significant difference in the CCs of planned to final implant size amongst groups was found.

Conclusion

The accuracy of implant size prediction achieved by preoperative digital templating for TKA is neither affected by KR nor KA on lateral knee radiographs.

Level of evidence

Level III.

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在全膝关节置换术中，通过数字模板实现的术前植入物尺寸预测的准确性不受膝关节侧位X光片质量的影响。

背景：数字模板软件可用于全膝关节置换术（TKA）的术前假体尺寸预测。目的：研究膝关节旋转（KR）和膝关节外展/内收（KA）的膝关节侧位片质量标准的应用及其对通过 TKA 术前数字模板预测最终植入物大小的准确性的影响：根据膝关节侧位片上股骨后髁处测量的KR和股骨远髁处测量的KA，将接受TKA手术的191名患者分成四组：A组（KR≤5毫米，KA≤5毫米）、B1组（KR>5毫米，KA≤5毫米）、B2组（KR≤5毫米，KA>5毫米）和B3组（KR>5毫米，KA>5毫米）。术前由两名观察员使用数字模板软件对股骨和胫骨植入物的尺寸进行模板化。各组报告了计划植入尺寸与最终植入尺寸的相关系数（CC）、计划植入尺寸与最终植入尺寸匹配的病例百分比以及计划植入尺寸与最终植入尺寸在±1和±2范围内的病例百分比：与 B1（匹配率 28%，±1 84%）、B2（匹配率 41%，±1 84%）和 B3（匹配率 35%，±1 78%）相比，A 组股骨种植体计划尺寸与最终尺寸匹配的病例比例最高（45%），计划尺寸与最终尺寸±1 的病例比例最高（86%）。所有组的计划种植体大小与最终种植体大小的 CC 值均大于 0.75。各组间计划种植体大小与最终种植体大小的 CCs 差异无统计学意义：结论：通过 TKA 术前数字模板预测植入物尺寸的准确性不受膝关节侧位片 KR 或 KA 的影响：证据等级：三级。

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