Difference between revisions of "X-ray of knee prosthesis"
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==Post-operative evaluation== | ==Post-operative evaluation== | ||
| − | File:X-ray of knee prosthesis with overhang, annotated.jpg|thumb|150px|Overhang (arrow) does not seem to have any detrimental effect.<ref>{{cite journal|title=The Impact Of Tibial Component Overhang On Outcome Scores And Pain In Total Knee Replacement|date=2018-02-21|author=S.G.F. Abram, A.G Marsh, F. Nicol, A.S. Brydone, A. Mohammed, S.J. Spencer|journal=Orthopaedic Proceedings}}</ref> It is therefore not necessary to measure or report.]] | + | [[File:X-ray of knee prosthesis with overhang, annotated.jpg|thumb|150px|Overhang (arrow) does not seem to have any detrimental effect.<ref>{{cite journal|title=The Impact Of Tibial Component Overhang On Outcome Scores And Pain In Total Knee Replacement|date=2018-02-21|author=S.G.F. Abram, A.G Marsh, F. Nicol, A.S. Brydone, A. Mohammed, S.J. Spencer|journal=Orthopaedic Proceedings}}</ref> It is therefore not necessary to measure or report.]] |
Knee replacement is evaluated by the following measures: | Knee replacement is evaluated by the following measures: | ||
<gallery mode=packed heights=380> | <gallery mode=packed heights=380> | ||
File:X-ray of HKA angle with knee prosthesis.jpg|'''HKA''': Hip-knee-ankle angle, which is ideally between 3° [[genu varum|varum]] to 3° [[Genu valgum|valgum]] from a [[right angle]].<ref name=Inui2013>{{cite journal|last1=Inui|first1=Hiroshi|last2=Taketomi|first2=Shuji|last3=Nakamura|first3=Kensuke|last4=Takei|first4=Seira|last5=Takeda|first5=Hideki|last6=Tanaka|first6=Sakae|last7=Nakagawa|first7=Takumi|title=Influence of navigation system updates on total knee arthroplasty|journal=Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology|volume=5|issue=1|pages=10|year=2013|issn=1758-2555|doi=10.1186/2052-1847-5-10|pmid=23638774|pmc=3653716}} [https://creativecommons.org/licenses/by/2.0 (CC-BY-2.0)]</ref> | File:X-ray of HKA angle with knee prosthesis.jpg|'''HKA''': Hip-knee-ankle angle, which is ideally between 3° [[genu varum|varum]] to 3° [[Genu valgum|valgum]] from a [[right angle]].<ref name=Inui2013>{{cite journal|last1=Inui|first1=Hiroshi|last2=Taketomi|first2=Shuji|last3=Nakamura|first3=Kensuke|last4=Takei|first4=Seira|last5=Takeda|first5=Hideki|last6=Tanaka|first6=Sakae|last7=Nakagawa|first7=Takumi|title=Influence of navigation system updates on total knee arthroplasty|journal=Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology|volume=5|issue=1|pages=10|year=2013|issn=1758-2555|doi=10.1186/2052-1847-5-10|pmid=23638774|pmc=3653716}} [https://creativecommons.org/licenses/by/2.0 (CC-BY-2.0)]</ref> | ||
File:Postoperative X-ray of normal knee prosthesis, anteroposterior view, annotated.jpg|- '''FFC''': frontal femoral component angle. It is typically regarded as optimal when being 2–7° in valgus.<ref name="GromovKorchi2014">{{cite journal|last1=Gromov|first1=Kirill|last2=Korchi|first2=Mounim|last3=Thomsen|first3=Morten G|last4=Husted|first4=Henrik|last5=Troelsen|first5=Anders|title=What is the optimal alignment of the tibial and femoral components in knee arthroplasty?|journal=Acta Orthopaedica|volume=85|issue=5|year=2014|pages=480–487|issn=1745-3674|doi=10.3109/17453674.2014.940573|pmid=25036719|pmc=4164865}}</ref><br>- '''FTC''': frontal tibial component angle, which is regarded as optimal when being at a [[right angle]]. A varus position of more than 3° has generally been found to increase the failure rate of the prosthesis.<ref name="GromovKorchi2014"/> | File:Postoperative X-ray of normal knee prosthesis, anteroposterior view, annotated.jpg|- '''FFC''': frontal femoral component angle. It is typically regarded as optimal when being 2–7° in valgus.<ref name="GromovKorchi2014">{{cite journal|last1=Gromov|first1=Kirill|last2=Korchi|first2=Mounim|last3=Thomsen|first3=Morten G|last4=Husted|first4=Henrik|last5=Troelsen|first5=Anders|title=What is the optimal alignment of the tibial and femoral components in knee arthroplasty?|journal=Acta Orthopaedica|volume=85|issue=5|year=2014|pages=480–487|issn=1745-3674|doi=10.3109/17453674.2014.940573|pmid=25036719|pmc=4164865}}</ref><br>- '''FTC''': frontal tibial component angle, which is regarded as optimal when being at a [[right angle]]. A varus position of more than 3° has generally been found to increase the failure rate of the prosthesis.<ref name="GromovKorchi2014"/> | ||
| − | File:Postoperative X-ray of normal knee prosthesis, lateral view, annotated.jpg|- '''Anterior femoral notching''' (the femoral component causing reduced thickness of the distal femur anteriorly), seems to cause an increased risk of fractures when exceeding about 3 mm.<ref name="LeeWang2015">{{cite journal|last1=Lee|first1=Ju Hong|last2=Wang|first2=Seong-Il|title=Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty|journal=Clinics in Orthopedic Surgery|volume=7|issue=2|year=2015|pages=217|issn=2005-291X|doi=10.4055/cios.2015.7.2.217}}</ref><br>- '''LTC''': lateral (or sagittal) tibial component angle, which is ideally positioned so that the tibia is 0–7° flexed compared to at a right angle with the tibial plate.<ref name="GromovKorchi2014"/> | + | File:Postoperative X-ray of normal knee prosthesis, lateral view, annotated.jpg|- '''Anterior femoral notching''' (the femoral component causing reduced thickness of the distal femur anteriorly), seems to cause an increased risk of fractures when exceeding about 3 mm.<ref name="LeeWang2015">{{cite journal|last1=Lee|first1=Ju Hong|last2=Wang|first2=Seong-Il|title=Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty|journal=Clinics in Orthopedic Surgery|volume=7|issue=2|year=2015|pages=217|issn=2005-291X|doi=10.4055/cios.2015.7.2.217}}</ref><br>- '''LTC''': lateral (or sagittal) tibial component angle, which is ideally positioned so that the tibia is 0–7° flexed compared to at a right angle with the tibial plate.<ref name="GromovKorchi2014"/> |
</gallery> | </gallery> | ||
Revision as of 13:31, 2 July 2019
Author:
Mikael Häggström [notes 1]
Contents
Post-operative evaluation
File:X-ray of knee prosthesis with overhang, annotated.jpg
Overhang (arrow) does not seem to have any detrimental effect.[1] It is therefore not necessary to measure or report.
Knee replacement is evaluated by the following measures:
- X-ray of HKA angle with knee prosthesis.jpg
HKA: Hip-knee-ankle angle, which is ideally between 3° varum to 3° valgum from a right angle.[2]
- Postoperative X-ray of normal knee prosthesis, anteroposterior view, annotated.jpg
- FFC: frontal femoral component angle. It is typically regarded as optimal when being 2–7° in valgus.[3]
- FTC: frontal tibial component angle, which is regarded as optimal when being at a right angle. A varus position of more than 3° has generally been found to increase the failure rate of the prosthesis.[3] - Postoperative X-ray of normal knee prosthesis, lateral view, annotated.jpg
- Anterior femoral notching (the femoral component causing reduced thickness of the distal femur anteriorly), seems to cause an increased risk of fractures when exceeding about 3 mm.[4]
- LTC: lateral (or sagittal) tibial component angle, which is ideally positioned so that the tibia is 0–7° flexed compared to at a right angle with the tibial plate.[3]
Report
In Swedish healthcare[5], the numbers of the angles are not reported if being within normal limits. Example of an normal case:
- Postoperative images of knee implant in unremarkable position.
Also, unless you know the referring physician is familiar with the same angle terminology, preferably report deviating angles as varus/valgus deviation or ventral/dorsal angulation of either:
- The femur component in relation to femoral diaphysis
- The tibial diaphysis in relation to the tibial component.
- See also: General notes on reporting
Follow-up
Potential complications that need to be evaluated on follow-up are as follows.
Radiolucent lines
Radiolucent lines may indicate loosening of the implant. A radiolucent line thinner than than 2 mm can be tolerated at the cement-bone interface (for cemented implants) or implant-bone interface (for cementless implants) if it remains stable and appears within the first 6 months (cemented implants) or the first 2 years (cementless implants) after surgery.[6]
Displacement
A change in position is indicated by a significant change in either of the angles listed in the post-operative evaluation section above.[6]
Infection
Signs of infection include:[6]
- Rapidly progressing radiolucency and/or osteolysis
- Periosteal reaction
- Bubbles of air within soft tissue or fluid collection.
Other complications
- Fractures of prosthesis components.
- Wear of the polyethylene insert, which is the case when progressive thinning occurs over time.
- Dissociation of the polyethylene insert from the patellar component or tibial baseplate.
Reporting
In Swedish healthcare[7], an example report of a normal case may be:
- No changes since previous images on <date>.
- See also: General notes on reporting
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
References
- ↑ S.G.F. Abram, A.G Marsh, F. Nicol, A.S. Brydone, A. Mohammed, S.J. Spencer (2018-02-21). "The Impact Of Tibial Component Overhang On Outcome Scores And Pain In Total Knee Replacement ". Orthopaedic Proceedings.
- ↑ Inui, Hiroshi; Taketomi, Shuji; Nakamura, Kensuke; Takei, Seira; Takeda, Hideki; Tanaka, Sakae; Nakagawa, Takumi (2013). "Influence of navigation system updates on total knee arthroplasty ". Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 5 (1): 10. doi:. ISSN 1758-2555. PMID 23638774. (CC-BY-2.0)
- ↑ 3.0 3.1 3.2 Gromov, Kirill; Korchi, Mounim; Thomsen, Morten G; Husted, Henrik; Troelsen, Anders (2014). "What is the optimal alignment of the tibial and femoral components in knee arthroplasty? ". Acta Orthopaedica 85 (5): 480–487. doi:. ISSN 1745-3674. PMID 25036719.
- ↑ Lee, Ju Hong; Wang, Seong-Il (2015). "Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty ". Clinics in Orthopedic Surgery 7 (2): 217. doi:. ISSN 2005-291X.
- ↑ NU Hospital Group, Sweden, Sep 2018
- ↑ 6.0 6.1 6.2 Cyteval, C. (2016). "Imaging of knee implants and related complications ". Diagnostic and Interventional Imaging 97 (7-8): 809–821. doi:. ISSN 22115684.
- ↑ NU Hospital Group, Sweden, Oct 2018
