The Assessment of Intraoperative Prosthetic Knee Range of Motion Using Two Methods (original) (raw)
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Accuracy of Knee Range of Motion Assessment After Total Knee Arthroplasty
The Journal of Arthroplasty, 2008
Measurement of knee joint range of motion (ROM) is important to assess after total knee arthroplasty. Our objective was to determine level of agreement and accuracy between observers with different knowledge on total ROM after total knee arthroplasty. Forty-one patients underwent x-ray of active and passive knee ROM (gold standard). Five different raters evaluated observed and measured ROM: orthopedic surgeon, clinical fellow, physician assistant, research fellow, and a physical therapist. A 1-way analysis of variance was used to determine differences in ROM between raters over both conditions. Limit of agreement for each rater for both active and passive total ROM under both conditions was calculated. Analysis of variance indicated a difference between raters for all conditions (range, P = .004 to P ≤.0001). The trend for all raters was to overestimate ROM at higher ranges. Assessment of ROM through direct observation without a goniometer provides inaccurate findings.
The Annals of The Royal College of Surgeons of England, 2012
INTRODUCTION We sought to validate radiographic measurements of range of motion of the knee after arthroplasty as part of a new system of virtual clinics. METHODS The range of motion of 52 knees in 45 patients was obtained by 2 clinicians using standardised techniques and goniometers. Inter-rater reliability and intraclass correlation coefficients (ICCs) were calculated. Radiographs of these patients’ knees in full active flexion and extension were also used to calculate intra and inter-rater reliability compared with clinical measurements using four different methods for plotting angles on the radiographs. RESULTS The ICC for inter-rater reliability using the goniometer was very high. The ICC was 0.91 in extension and 0.85 in flexion while repeatability was 8.49° (-8.03–8.99°) in extension and 5.23° (-4.54–5.74°) in flexion. The best ICC for radiographic measurement in extension was 0.86, indicating ‘near perfect’ agreement, and repeatability was 5.43° (-4.04–6.12°). The best ICC i...
Knee range of motion: reliability and agreement of 3 measurement methods
American journal of orthopedics, 2011
We conducted a study to compare 3 methods of measuring knee range of motion: visual estimation by physicians, hand goniometry by physical therapists, and radiographic goniometry. We hypothesized that reliability would be high within and across all techniques. We found intrarater and interrater reliability to be satisfactory for visual estimation, hand goniometry, and radiographic goniometry. Interrater reliability across methods did not agree satisfactorily. Between-methods differences in estimating knee range of motion may result from variations in technique among physicians and physical therapists.
Measuring flexion in knee arthroplasty patients
The Journal of Arthroplasty, 2004
Flexion following total knee arthroplasty can be visually estimated, measured with a goniometer placed against the patient's leg, or measured from a lateral radiograph of the flexed knee. Three examiners, in a blinded fashion, estimated the degree of maximal knee flexion and measured the flexion with a goniometer for 27 knees in 16 patients. A lateral knee radiograph then was taken and the flexion angle was measured from the radiograph by 2 different methods. Although interobserver and intraobserver correlation coefficients were high (0.79 and 0.92), 45% of the visual estimates and 22% of the goniometer measurements differed by 5°or greater from the radiographic measurements. These differences increased as the flexion angle increased. Body mass index did not affect the accuracy of the estimates or goniometer measurements.
Computer-assisted navigation for the assessment of fixed flexion in knee arthroplasty
Canadian journal of surgery. Journal canadien de chirurgie
Correction of a fixed flexion deformity is an important goal when performing total knee arthroplasty. The purpose of this study was to assess the accuracy of clinical assessment compared with imageless computer navigation in determining the degree of fixed flexion. We performed navigation anatomy registration using 14 cadaver knees.The knees were held in various degrees of flexion with 2 crossed pins. The degree of flexion was first recorded on the computer and then on lateral radiographs. The cadaver knees were draped as they would be for a total knee arthroplasty, and 9 examiners were asked to clinically assess by visual observation the amount of fixed flexion.Three examiners repeated the process 1 week later. The mean error from the radiographs in the navigation group was 2.18 degrees (95% confidence interval [CI] 1.23 degrees -3.01 degrees) compared with 5.57 degrees (95% CI 4.86 degrees -6.29 degrees) in the observer group. The navigation was more consistent, with a range of er...
The Journal of Arthroplasty, 2017
Background Accelerometer-based navigation (ABN) is a novel navigation system that attempts to combine the accuracy of computer-assisted navigation (CAS) with the familiarity of conventional instrumentation (CON). No studies have compared the clinical outcomes of this new technology with existing techniques to date. Methods From July 2013 to April 2014, 152 consecutive patients (152 knees) underwent TKA using ABN (n = 38), CAS (n = 38) or CON (n = 76). We prospectively matched the groups in a 1:1:2 ratio for age, gender, BMI, preoperative Range of Motion, Knee Society Score, Oxford Knee Score, SF-36 Physical and Mental Component Scores, and preoperative deformity using preoperative data in isolation, thus controlling for potential confounding factors. All patients were prospectively followed for 2 years. Results The ABN and CAS groups had a significantly improved mean Mechanical Axis (p=0.018), Femoral (p=0.050) and Tibial Component Alignment (p=0.008) compared to the CON group. There were significantly less MA outliers in the ABN and CAS groups (p=0.034). The duration of surgery for the ABN group (83.9±21 min) was significantly shorter than the CAS group (101±11 min) (p<0.001) but similar to the CON group (76.6±17 min) (p=0.
MUSCULOSKELETAL SURGERY, 2016
Introduction This retrospective study examined the relationship between the mechanical axis throughout a functional arc of motion and functional outcome scores in patients undergoing computer-assisted navigation-based total knee arthroplasty (CAN-TKA) at 6-year follow-up. Materials and methods The Stryker eNact Precision Knee Navigation System was utilized to obtain pre-and postoperative alignment measurements throughout the functional arc of motion. Patients were contacted via telephone and asked to complete the Short Form-12 and Western Ontario and McMaster Universities, which have been demonstrated to be reliable, valid, and sensitive assessment tools in this patient population. Statistical analysis was performed to determine the correlation between arc alignment and patient-reported functional outcome measures. Results A total of 47 patients at a mean of 76.1 (±6.3)month follow-up and mean age of 65.9 (±7.9) years were surveyed. No correlation was found between the postoperative alignment or degree of intraoperative correction and the functional outcome scores. In a planned subgroup analysis of patients with a mean functional arc alignment greater than 3°from neutral, mean intraoperative degree of correction correlated with decreasing physical function (Spearman's q = 0.772, p = 0.04) and mean postoperative arc alignment positively correlated with increasing stiffness (q = 0.798, p = 0.03). Conclusion This study suggests that patients undergoing CAN-TKA with mean functional arc range of motion greater than 3°may be at increased risk for suboptimal patient-reported functional outcomes. This study also illustrates the ability of CAN-TKA to measure the varus or valgus alignment of the knee throughout the entire range of motion.
"Given the importance of component position in knee function following total knee arthroplasty (TKA), computer-assisted navigation has emerged as a tool for reducing the occurrence of significant malalignment. Intraoperative navigation data was collected prospectively for 134 knees undergoing cemented, posterior stabilized TKA. Partial least squares regression analysis was used to test the association between patient demographics and intraoperative data collected with a computer assisted navigation system (coronal alignment, ligament balance, range of motion, external tibio-femoral rotation ) with one year outcomes (SF36, Oxford Knee Score, range of motion). Age at surgery displayed the largest coefficients of any other predictor. In contrast, navigation coefficients were variable in the strength and direction of their association with the outcomes variable. Static knee alignment data obtained intraoperatively have limited capacity to explain the variance in functional outcome at one-year. While alignment and component position can be precisely measured intraoperatively, intrinsic patient factors remain dominant in determining outcome."
The Journal of …, 2012
Intraoperative navigation data were collected prospectively for 134 knees undergoing cemented, posterior-stabilized total knee arthroplasty. Partial least squares regression analysis was used to test the association between patient demographics and intraoperative data collected with a computer-assisted navigation system (coronal alignment, ligament balance, range of motion, external tibiofemoral rotation) with 1-year outcomes (36-item Short-Form Health Survey, Oxford Knee Score, range of motion). Age at surgery displayed the largest coefficients of any other predictor. In contrast, navigation coefficients were variable in the strength and direction of their association with the outcome variables. Static knee alignment data obtained intraoperatively have limited capacity to explain the variance in functional outcome at 1 year. Although alignment and component position can be precisely measured intraoperatively, intrinsic patient factors remain dominant in determining the outcome.
Feasibility Review of Wearable Kinematic Sensors in Post Knee Arthroplasty Patients
Open Access Journal of Biogeneric Science and Research, 2021
Introduction: Post-operative surveillance of joint range of motion after knee arthroplasty is a necessity. However, as the number of these surgeries increase, there has been a significantly increased burden to have sufficient follow up. In this light, the primary purpose of this study was to assess feasibility of novel wearable kinematic sensors in detecting patient mobility limitation compared to clinical and goniometer measurements in post knee arthroplasty patients. A secondary objective of the study was to identify gaps in goniometry used in typical current follow up protocol for this population. Methods: Two separate searches were conducted to fulfill the two objectives of this study. The databases of Medline, PubMed and Cochrane library were searched using medical subject headings and keywords during August 2020. Titles and abstracts were screened based on specified inclusion criteria and then full text reviewed. Results: The search for the feasibility of wearable kinematic se...