Jagadeesh Nuthan, Kariya Ankur, Pammi Srinath, Shivalingappa Vishwanath M, Ramakrishna Chethana
Department of Orthopedics, Vydehi Institute of Medical Sciences, Whitefield, Bangalore, Karnataka, India.
Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK.
J Orthop. 2022 Aug 12;34:132-136. doi: 10.1016/j.jor.2022.07.019. eCollection 2022 Nov-Dec.
A picture archiving and communication system (PACS) is a means wherein the images are acquired, displayed, transmitted, and stored digitally. Bone Ninja is an application on iPad (Apple Inc.) on the IOS platform, developed as a teaching tool for deformity corrections around the knee. The principal objective of this study is to determine the reliability and consistency of Bone Ninja application in measuring the preoperative and postoperative alignment in patients undergoing a total knee arthroplasty and compare it with the PACS.
This retrospective cross-sectional study was done using preoperative and postoperative leg-length radiographs of 50 consecutive patients (50 knees) who underwent unilateral total knee arthroplasty. Using Bone Ninja application and PACS, preoperative Lateral Distal Femoral Angle (LDFA), Tibiofemoral Angle (TFA), Medial Proximal Tibial Angle (MPTA) and postoperative Tibial alignment angle (TAA), Tibiofemoral angle (TFA), Femoral alignment angle (FAA) were measured independently by three doctors (two orthopedists and one radiologist). The measurements were repeated after an interval to determine intra and interobserver reliability.
Both preoperative (TFA, LDFA, MPTA) and postoperative measurements (TFA, TAA, FAA) showed highly correlated intraobserver and interobserver correlation coefficients. Cohen kappa values for all the measurements were greater than 0.80 but the values were higher for PACS compared to Bone Ninja application.
PACS remains the gold standard, but bone ninja application is a reliable alternative for preoperative and postoperative alignment measures in total knee arthroplasty where PACS is not available.
图像存档与通信系统（PACS）是一种以数字方式获取、显示、传输和存储图像的手段。Bone Ninja是IOS平台上iPad（苹果公司）的一款应用程序，作为膝关节周围畸形矫正的教学工具开发。本研究的主要目的是确定Bone Ninja应用程序在测量全膝关节置换术患者术前和术后对线情况时的可靠性和一致性，并将其与PACS进行比较。
本回顾性横断面研究使用了50例连续接受单侧全膝关节置换术患者（50个膝关节）的术前和术后下肢长度X线片。由三位医生（两名骨科医生和一名放射科医生）分别使用Bone Ninja应用程序和PACS独立测量术前的股骨远端外侧角（LDFA）、胫股角（TFA）、胫骨近端内侧角（MPTA）以及术后的胫骨对线角（TAA）、胫股角（TFA）、股骨对线角（FAA）。间隔一段时间后重复测量以确定观察者内和观察者间的可靠性。
术前（TFA、LDFA、MPTA）和术后测量值（TFA、TAA、FAA）在观察者内和观察者间的相关系数均显示出高度相关性。所有测量值的Cohen kappa值均大于0.80，但与Bone Ninja应用程序相比，PACS的值更高。
PACS仍然是金标准，但在无法使用PACS的情况下，Bone Ninja应用程序是全膝关节置换术术前和术后对线测量的可靠替代方法。
