Inter-Observer Precision and Physiologic Variability of MRI Landmarks Used to Determine Rotational Alignment in Conventional and Patient-Specific TKA

Abstract Preoperative planning for patient-specific guides (PSGs) in total knee arthroplasty (TKA) requires identification of anatomic landmarks on three-dimensional imaging studies. The aim of this study was to assess the accuracy and precision with which landmarks commonly used to determine rotati...

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Bibliographic Details
Published in:The Journal of arthroplasty 2015-02, Vol.30 (2), p.290-295
Main Authors: Park, Andrew, MD, Nam, Denis, MD, Friedman, Michael V., MD, Duncan, Stephen T., MD, Hillen, Travis J., MD, Barrack, Robert L., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anatomic Landmarks
anatomic landmarks in TKA
Arthritis - diagnosis
Arthritis - surgery
Arthroplasty, Replacement, Knee
Female
Humans
Imaging, Three-Dimensional
Knee Joint - surgery
Magnetic Resonance Imaging
Male
malrotation
Middle Aged
Observer Variation
Orthopedics
patient-specific TKA
physiologic variability
Retrospective Studies
Rotation
rotational alignment
Surgery, Computer-Assisted
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Summary:Abstract Preoperative planning for patient-specific guides (PSGs) in total knee arthroplasty (TKA) requires identification of anatomic landmarks on three-dimensional imaging studies. The aim of this study was to assess the accuracy and precision with which landmarks commonly used to determine rotational alignment in TKA can be identified on magnetic resonance imaging (MRI). Two orthopedic surgeons and two musculoskeletal radiologists independently reviewed a sequential series of 114 MRIs of arthritic knees. The magnitude of interobserver variability was high, suggesting an inherent risk of inconsistency when these landmarks are used in PSG fabrication. Additionally, there was a high degree of physiologic variation among patients, indicating that assuming standard relationships among anatomic landmarks when placing TKA components may lead to rotational malalignment relative to each patient's native anatomy.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2014.08.015