Department of Radiology, Norfolk & Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
Eur Radiol. 2022 Jun;32(6):3790-3798. doi: 10.1007/s00330-021-08483-8. Epub 2022 Feb 10.
Rotational malalignment of knee replacements as measured on CT is understood to be associated with poor outcomes. The aim of this study is to measure the inter-rater and intra-rater reliability of measures of femoral and tibial version in the native arthritic knee and postoperative TKR component position using CT.
Eighty patients underwent CT of the knee before and after total knee replacement. Preoperative femoral and tibial version and component rotation were independently measured by two musculoskeletal radiologists.
Mean differences between and within raters were small (< 1.6°). Maximum 95% limits of agreement for inter-rater and intra-rater comparisons were 8.1° and 7.6° for preoperative femoral version, 9.0° and 7.9° for postoperative femoral rotation, 26.0° and 20.5° for preoperative tibial version, and 24.9° and 23.6° for postoperative tibial rotation respectively. Postoperative ICCs varied from 0.68 to 0.81 (lower 95% CI:0.55-0.72) for both intra- and inter-rater comparisons. Preoperative ICCs were lower: 0.55-0.75 (lower 95% CI:0.40-0.65).
The lower 95% confidence level for ICC of version and rotational measurements using the Berger protocol of TKRs on CT are all less than 0.73 and that the normal range of differences between observers is up to 9° for the femoral component and 26° for the tibial component. This suggests that CT measurements derived from the Berger protocol may not be consistent enough for clinical practice.
• CT is commonly used to measure the rotational profile of knee replacements in symptomatic patients using the Berger protocol. • The limits of agreement for both femoral and tibial component rotation are wide even for experienced observers. • CT measurements of the rotation of knee arthroplasty are not reliable enough for routine clinical use.
CT 测量的膝关节置换术后旋转对线不良与不良结局有关。本研究旨在使用 CT 测量原发性关节炎膝关节和全膝关节置换术后 TKR 组件位置的股骨和胫骨版本的测量值的组内和组间可靠性。
80 例患者在全膝关节置换前后进行膝关节 CT 检查。两名肌肉骨骼放射科医生分别独立测量术前股骨和胫骨版本以及组件旋转。
组内和组间测量值的平均差异较小（<1.6°）。组内和组间比较的最大 95%一致性界限分别为术前股骨版本的 8.1°和 7.6°，术后股骨旋转的 9.0°和 7.9°，术前胫骨版本的 26.0°和 20.5°，以及术后胫骨旋转的 24.9°和 23.6°。术后 ICC 分别为 0.68 至 0.81（下 95%置信区间：0.55-0.72），均低于组内和组间比较。术前 ICC 较低：0.55-0.75（下 95%置信区间：0.40-0.65）。
使用 CT 对 TKR 进行 Berger 方案测量时，版本和旋转测量的 ICC 的下 95%置信区间均小于 0.73，观察者之间差异的正常范围高达 9°股骨组件和 26°胫骨组件。这表明 Berger 方案从 CT 获得的测量值可能不足以满足临床实践的需要。
• CT 通常用于使用 Berger 方案测量有症状患者膝关节置换术的旋转轮廓。• 即使对于经验丰富的观察者，股骨和胫骨组件旋转的一致性界限也很宽。• CT 测量膝关节置换术的旋转角度不够可靠，无法常规用于临床。
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