Gopurathingal Anto A, Bhonsle Sachin
Orthopedics, Fortis Healthcare, Mumbai, IND.
Cureus. 2021 Jan 19;13(1):e12788. doi: 10.7759/cureus.12788.
Background Preoperative planning is imperative for a successful total knee replacement. Determining the valgus angle for the distal femoral cut from the preoperative 2D radiograph is a very inexpensive method that can be used to achieve the native knee alignment during a total knee arthroplasty (TKA). Objective The aim of this study was to document the intra-observer and inter-observer reliability of the valgus angle determination for distal femur cut from a preoperative digital radiograph in a TKA. Methods A total of 20 patients with bilateral grade 3-4 primary osteoarthritis were assessed independently by a medical student, five surgeons, of which one was a consultant with more than 20 years of experience, and four residents in varied levels of training. Full-length (pelvis to toes) weight-bearing radiographs of both lower limbs were obtained prior to the surgery. The measurements were made thrice at more than 24 hours interval without any possible knowledge of their own previous measurement or that of other surgeons. We assessed the angle between the mechanical and anatomical axis of both femurs. Results The single measures intraclass correlation was found to be 0.733, showing that there is a moderate reliability among the six raters when single measures were considered, whereas the average measures intraclass correlation was found to be 0.943, showing that there is an excellent reliability among the six raters when average measures were considered. For intra-observer reliability, the single measures intraclass correlation showed that there is a good-to-excellent reliability between the three trials when single measures was considered. The averages measures intraclass correlation showed that there is an excellent reliability between the three trials when average measures was considered. Conclusion A very inexpensive method of determining valgus angle for distal femur cut was found to have a moderate-to-excellent inter-observer reliability and a good-to-excellent intra-observer reliability.
背景 术前规划对于全膝关节置换术的成功至关重要。从术前二维X线片确定股骨远端截骨的外翻角度是一种非常经济的方法，可用于在全膝关节置换术（TKA）中实现自然膝关节对线。目的 本研究的目的是记录在TKA中从术前数字X线片确定股骨远端截骨外翻角度的观察者内和观察者间可靠性。方法 共有20例双侧3-4级原发性骨关节炎患者由一名医学生、五名外科医生独立评估，其中一名是具有20多年经验的顾问医生，四名处于不同培训水平的住院医生。术前获取双下肢全长（从骨盆到脚趾）负重X线片。测量在间隔超过24小时的情况下进行三次，且他们对自己之前的测量结果或其他外科医生的测量结果一无所知。我们评估了双侧股骨机械轴和解剖轴之间的角度。结果 单次测量的组内相关系数为0.733，表明在考虑单次测量时，六位评估者之间存在中等可靠性，而平均测量的组内相关系数为0.943，表明在考虑平均测量时，六位评估者之间存在极好的可靠性。对于观察者内可靠性，单次测量的组内相关系数表明，在考虑单次测量时，三次试验之间存在良好到极好的可靠性。平均测量的组内相关系数表明，在考虑平均测量时，三次试验之间存在极好的可靠性。结论 发现一种确定股骨远端截骨外翻角度的非常经济的方法具有中等至极好的观察者间可靠性和良好至极好的观察者内可靠性。
