Comparing supine CT scanogram and standing long-leg radiograph for postoperative alignment in total knee arthroplasty: a prospective study.

Autor: Mhaskar VA; Sitaram Bhartia Institute of Science and Research, New Delhi, India. drvikrammhaskar@gmail.com.; Max Super Speciality Hospital, Delhi, India. drvikrammhaskar@gmail.com., Saggar R; Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India. saggarrachit15@gmail.com., Karan S; Max Super Speciality Hospital, Delhi, India., Maheshwari J; Sitaram Bhartia Institute of Science and Research, New Delhi, India.; Max Super Speciality Hospital, Delhi, India.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Dec 28; Vol. 145 (1), pp. 102. Date of Electronic Publication: 2024 Dec 28.
DOI: 10.1007/s00402-024-05743-2
Abstrakt: Purpose: Achieving precise postoperative alignment is critical for the long-term success of total knee arthroplasty (TKA). Long-leg standing radiograph (LLR) at 6 weeks post-op is the gold standard for assessing alignment, but its reliance on weight-bearing and positioning makes it less practical in the early postoperative period. Supine computed tomography scanogram (CTS) offers a potential alternative. This study compares CTS and LLR in patients undergoing TKA with patient-specific valgus correction angles (VCA).
Methods: A prospective study of 108 knees from 57 patients undergoing primary TKA was conducted. CTS was performed on postoperative day three in a supine non-weight-bearing position, and LLR at six weeks in an upright standing position. Coronal alignment was assessed using hip-knee-ankle angle (HKA) and compared using Bland-Altman plots, paired-samples t-tests, and Cohen's d.
Results: CTS showed 57% of knees were within 3° of neutral alignment, while LLR showed 61%. The mean difference between modalities was 0.52° (SD, 3.56°; p = 0.07). Inter-observer reliability was excellent for both CTS and LLR (all ICCs > 0.9).
Conclusion: While CTS provides a useful alternative for early postoperative alignment assessment-particularly in situations where a standing LLR is not feasible-the observed variability suggests that LLR remains the more reliable modality when precise alignment is critical. Surgeons should therefore consider CTS as an adjunct tool for early decision-making or non-ambulatory patients in the immediate postoperative setting.
Level of Evidence: Level II, Prospective Comparative Study.
Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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