Evaluation of the reliability of lower extremity alignment measurements using EOS imaging system while standing in an even weight-bearing posture

AbstractThis study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture. Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated. Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. In the inter-observer reliability analysis, all values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not. For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.

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Evaluation of the Reliability of Lower Extremity Alignment Measurements Using EOS Imaging System While Standing in an Even Weight-Bearing Posture

10.21203/rs.3.rs-798683/v1 ◽

2021 ◽

Author(s):

Byung Woo Cho ◽

Tae-Ho Lee ◽

Sungjun Kim ◽

Chong-Hyuk Choi ◽

Min Jung ◽

...

Keyword(s):

Lower Extremity ◽

Imaging System ◽

Weight Bearing ◽

Three Dimensional ◽

Lower Extremities ◽

Tibial Rotation ◽

Tibial Torsion ◽

Good Reliability ◽

Eos Imaging ◽

Significant Difference

Abstract Purpose: This study aimed to analyze the reproducibility and reliability of the alignment parameters measured using the EOS image system in both limbs while standing with an even weight-bearing posture.Methods: Overall, 104 lower extremities in 52 patients were analyzed retrospectively. The patients stood with an even load over both lower extremities then rotated 15° in both directions. Two EOS images were acquired and 104 pairs of lower extremities were compared according to the position of the indexed lower extremities. Then, the inter-observer reliability of the EOS system and the inter-modality reliability between EOS and computed tomography (CT) were evaluated.Results: Femoro-tibial rotation (FTR) and tibial torsion demonstrated a significant difference between the anterior and posterior positions of the indexed lower extremity. All values except for FTR and tibial torsion demonstrated good or very good reliability. In the anterior position, FTR demonstrated moderate, and tibial torsion demonstrated poor reliability. In the posterior position, both FTR and tibial torsion demonstrated poor reliability. In the reliability analysis between the three-dimensional (3D) EOS model and 3D CT images, all measurements of the femur demonstrated very good reliability, but measurements of the tibia did not.Conclusions: For the coronal and sagittal alignment parameters measured by the EOS 3D system with rotated standing posture, except for the measurement including tibial torsion., there were no significant difference for either position of the indexed extremities with high agreement between the observers as well as with the CT 3D model.

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Tibial Torsion and Ankle Arthritis: Is External Tibial Rotation Associated with Varus Deformity in Patients with Ankle Arthritis?

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00020 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0002

Author(s):

Collin C. Barber ◽

Teresa Hall ◽

Tyler Madden ◽

Parin D. Kothari ◽

Monica LaPointe ◽

...

Keyword(s):

Regression Analysis ◽

Standard Deviation ◽

Lower Extremity ◽

External Rotation ◽

Varus Deformity ◽

Tibial Rotation ◽

Tibial Torsion ◽

Ankle Arthritis ◽

Ankle Arthroplasty ◽

The Mean

Category: Ankle; Ankle Arthritis; Hindfoot Introduction/Purpose: The effect of tibial torsion on lower extremity mechanical alignment has been well studied in the literature, including its effect on lower extremity osteoarthritis. It has been suggested that external tibial torsion is associated with cavus hindfoot deformity and may lead to varus osteoarthritis of the ankle. To our knowledge, there are no studies investigating this relationship. The purpose of this study is to characterize the relationship of tibial torsion with ankle coronal plane deformity in patients with ankle arthritis. Methods: The study is a retrospective, cohort of 223 patients who have undergone total ankle arthroplasty at a single institution. Preoperative computerized tomography was used to measure tibial torsion and coronal deformity. Descriptive statistics and regression analysis were used to analyze the data. Results: Descriptive analysis of all 223 patients demonstrated a maximum of 23.9 degrees varus and 20.5 degrees valgus among all patients. The mean for varus deformity was 6.86 degrees with a standard deviation of +- 6.39. Tibial rotation was calculated at an average of 20.8 degrees external rotation, with a maximum of 15.2 degrees internal rotation and 59.5 degrees external rotation in all patients. Plotting overall coronal ankle tilt versus tibial torsion revealed overall varus deformity with R2 of 0.016. Regression analysis of all varus deformities against external tibial torsion revealed a R2 of 0.02. Varus deformity 1 standard deviation above the mean against external tibial torsion demonstrated a R2 of 0.072. Valgus deformity against external tibial torsion revealed a R2 of 6.75 x10-5. Conclusion: An association between external tibial torsion and varus ankle arthritis has been proposed in the literature. The results of our study did not show an association between tibial torsion and coronal deformity in ankle arthritis in all patients undergoing total ankle arthroplasty at our institution. A difference may exist in certain subgroups, such as patients with neuromuscular disorders, but further investigation will be necessary to determine this relationship.

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An evaluation of the lower extremity muscle strength of patients with chronic venous insufficiency

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515577323 ◽

2015 ◽

Vol 31 (3) ◽

pp. 203-208 ◽

Cited By ~ 7

Author(s):

Cem Cetin ◽

Mustafa O Serbest ◽

Sabriye Ercan ◽

Turhan Yavuz ◽

Ali Erdogan

Keyword(s):

Muscle Strength ◽

Lower Extremity ◽

Visual Analog Scale ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Plantar Flexion ◽

Lower Extremities ◽

Analog Scale ◽

Lower Extremity Muscle ◽

Significant Difference

Objective In this study, the aim was to evaluate the lower extremity muscle strength in patients with chronic venous insufficiency using an isokinetic dynamometer. Methods The study comprised a group of 36 lower extremities of 23 patients diagnosed with chronic venous insufficiency and a control group of 40 lower extremities of 20 patients who did not have chronic venous insufficiency. In the diagnosis and evaluation of chronic venous insufficiency, photoplethysmography was used to evaluate the venous return circulation time. Visual Analog Scale scoring was applied to define the level of pain of the patients. Muscle strength measurements were made in all the lower extremities by using an isokinetic dynamometer. Results A statistically significant difference was detected between the groups in terms of the muscle strength parameters in the ankle plantar flexion, and knee flexor and extensor muscles. However, no statistically significant difference was found between the groups in the ankle dorsiflexion muscle strength parameters. A significant difference was determined in the ratio of ankle dorsiflexion/plantar flexion muscle strength between the mild, moderate and severe venous insufficiency groups. A statistically considerable negative correlation was found between the Visual Analog Scale scores and the photoplethysmography results. According to the Visual Analog Scale results, as the degree of venous insufficiency increased, so did the level of pain. Conclusion Impaired lower extremity muscle strength was observed in chronic venous insufficiency patients. Although the current study was consistent with literature in respect of impaired calf muscle strength, this finding was also seen in the thigh muscles. Furthermore, we concluded that if venous insufficiency becomes more severe, impaired calf muscle strength becomes more evident.

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Can Foraminal Stenosis Due to Lumbar Isthmic Spondylolisthesis Cause Axonopathy in the Lower Extremity?

Healthcare ◽

10.3390/healthcare9050511 ◽

2021 ◽

Vol 9 (5) ◽

pp. 511

Author(s):

Seong Hyeon Jo ◽

Jang Hyuk Cho ◽

Dong Gyu Lee

Keyword(s):

Lower Extremity ◽

Action Potential ◽

Sural Nerve ◽

Sensory Nerve ◽

Lower Extremities ◽

University Hospital ◽

Foraminal Stenosis ◽

Isthmic Spondylolisthesis ◽

Age Related ◽

Significant Difference

This study aimed to investigate, using electrodiagnosis, whether foraminal stenosis due to isthmic spondylolisthesis (IS) causes peripheral nerve axonopathy. We retrospectively reviewed the medical records of the Yeungnam University Hospital and included 46 patients (mean age = 60.8 ± 13.7 years; male:female = 24:22) with foraminal stenosis due to IS. We classified foraminal stenosis grading based on T2 and T1 sagittal spinal magnetic resonance imaging (MRI). Patients were divided into mild (n = 18) and severe foraminal stenosis (n = 28) groups. To evaluate axonopathy in the lower extremity, results of compound motor action potential (CMAP) of the extensor digitorum brevis muscle (EDB) and abductor hallucis brevis muscle (AHB), and sensory nerve action potential (SNAP) of the sural nerve were retrieved. No statistically significant difference was observed in the amplitude of CMAP of the EDB and AHB and SNAP of the sural nerve with the severity of foraminal stenosis. However, age showed a statistically significant relationship with the amplitude of NCS in the EDB, AHB, and sural nerves (p < 0.001). The severity of foraminal stenosis due to IS showed no relationship with axonopathy beyond age-related degeneration of the lower extremities. Therefore, if there is robust axonopathy in lower extremities, physicians should consider pathologies other than foraminal stenosis due to IS.

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A Validated, Automated, 3-Dimensional Method to Reliably Measure Tibial Torsion

The American Journal of Sports Medicine ◽

10.1177/0363546520986873 ◽

2021 ◽

Vol 49 (3) ◽

pp. 747-756

Author(s):

Joanna M. Stephen ◽

Robert A. Teitge ◽

Andy Williams ◽

James D.F. Calder ◽

Hadi El Daou

Keyword(s):

Intraclass Correlation ◽

Ct Scanning ◽

Tibial Torsion ◽

Good Reliability ◽

Automated Method ◽

Clinical Methods ◽

Significant Difference ◽

Mri Scans ◽

Males And Females ◽

The Difference

Background: Tibial torsion is a twist in the tibia measured as an angle between a proximal axis line and a distal axis line. Abnormal torsion has been associated with a variety of painful clinical syndromes of the lower limb. Measurements of normal tibial torsion reported by different authors vary by 100% (ranging from 20° to 42°), making it impossible to determine normal and pathological levels. Purpose: To address the problem of unreliable measurements, this study was conducted to define an automated, validated computer method to calculate tibial torsion. Reliability was compared with current clinical methods. The difference between measurements of torsion generated from computed tomography (CT) and magnetic resonance imaging (MRI) scans of the same bone, and between males and females, was assessed. Study Design: Controlled laboratory study. Methods: Previous methods of analyzing tibial torsion were reviewed, and limitations were identified. An automated measurement method to address these limitations was defined. A total of 56 cadaveric and patient tibiae (mean ± SD age, 37 ± 15 years; range, 17-71 years; 28 female) underwent CT scanning, and 3 blinded assessors made torsion measurements by applying 2 current clinical methods and the automated method defined in the present article. Intraclass correlation coefficient (ICC) values were calculated. Further, 12 cadaveric tibiae were scanned by MRI, stripped of tissue, and measured using a structured light (SL) scanner. Differences between torsion values obtained from CT, SL, and MRI scans, and between males and females, were compared using t tests. SPSS was used for all statistical analysis. Results: When the automated method was used, the tibiae had a mean external torsion of 29°± 11° (range, 9°-65). Automated torsion assessment had excellent reliability (ICC, 1), whereas current methods had good reliability (ICC, 0.78-0.81). No significant difference was found between the torsion values calculated from SL and CT ( P = .802), SL and MRI ( P = .708), or MRI and CT scans ( P = .826). Conclusion: The use of software to automatically perform measurements ensures consistency, time efficiency, validity, and accuracy not possible with manual measurements, which are dependent on assessor experience. Clinical Relevance: We recommend that this method be adopted in clinical practice to establish databases of normal and pathological tibial torsion reference values and ultimately guide management of related conditions.

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The Influence of Percentile Weight Bearing on Foot Radiographs

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00436 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0043 ◽

Cited By ~ 1

Author(s):

Trevor Shelton ◽

Sohni Singh ◽

Christopher Kreulen ◽

Eric Giza

Keyword(s):

Body Weight ◽

Weight Bearing ◽

Intraclass Correlation ◽

Radiographic Measurement ◽

Hindfoot Alignment ◽

Observer Reliability ◽

Percent Body Weight ◽

Orthopaedic Patients ◽

Significant Difference ◽

Partial Weight

Category: Midfoot/Forefoot Introduction/Purpose: Clinical decisions are often made based on the measurements of foot radiographs. Orthopaedic patients who have had lower extremity trauma or surgery are often given different weight bearing conditions including non-weight bearing, touch-down weight bearing, partial weight bearing (of various percent of body weight), and weight bearing as tolerated. However, it is largely unknown how these various weight bearing conditions alter specific parameters of foot radiographs. As such, the purpose of this study was to determine whether percent weight bearing influences radiographic measurements of the foot on anteroposterior (AP) and lateral radiographs? Methods: A total of 20 healthy subjects had AP and lateral radiographs of the foot under five weight bearing conditions (non-weight bearing, 10% body weight, 25% body weight, 50% body weight, and 100% body weight). Measurements were then made of hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), talonavicular coverage angle (TNCA), talo-calcaneal angle (TCA), forefoot width, LisFranc distance, cuboid height to ground (CHG), and talo-1st metatarsal angle (TMA) of each weight bearing condition. Statistical differences of each measurement for each weight bearing condition were then determined. Measurements were made by a radiologist and orthopaedic surgeon and inter-observer reliability determined for each measurement. For each radiographic measurement, a single factor ANOVA determined whether measurements were different between non-weight bearing, touchdown weight bearing, 25% weight bearing, 50% weight bearing, and 100% weight bearing. When a significant difference was detected, a post-hoc Tukey’s determined which categories of weight bearing were different. Results: The inter-observer reliability determined by the intraclass correlation coefficient was excellent to good in all measurements except for the TCA which was fair. For measurements made on the AP radiographs of the foot, the measurements that changed with percent weight bearing were the TNCA (p = 0.0009) and TCA (p = 0.0446) (Table 1). Weight bearing did not change the HVA (p = 0.2564, IMA (p = 0.1698), forefoot width (p = 0.2431), or LisFranc distance (p = 0.9854). For measurements made on the lateral radiographs of the foot, the measurement that changed with percent weight bearing was the CHG (p = 0.006). Weight bearing did not change the TMA (p = 0.9889). Conclusion: This study demonstrates a flattening of the medial arch with increasing percent body weight applied to a foot. This results in an increase in the TNCA as well as a decrease in the CHG. In addition, increasing percent body weight to the foot increases the hindfoot alignment. However, percent body weight does not alter measurements of the forefoot. Percentage body weight increase may not influence clinical preoperative/non-operative treatment as much as we expect; however, our findings do show that certain parameters increase with increasing weight bearing.

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Perception of Unilateral Lower Extremity Weightbearing during Bilateral Upright Stance

Perceptual and Motor Skills ◽

10.1177/00315125890693-130 ◽

1989 ◽

Vol 69 (3-1) ◽

pp. 875-880 ◽

Cited By ~ 2

Author(s):

Richard W. Bohannon ◽

Gregory Waters ◽

Judith Cooper

Keyword(s):

Lower Extremity ◽

Analysis Of Variance ◽

Healthy Subjects ◽

Weight Bearing ◽

Lower Extremities ◽

Target Level ◽

Upright Stance ◽

Absolute Value ◽

Secondary Purpose ◽

The Mean

The primary purpose of this study was to describe the error in 61 healthy subjects’ perceptions of weight-bearing at three target levels during bilateral upright stance. The secondary purpose was to describe the effects of age, sex, lower extremity dominance and target weightbearing level on the error in perceptions of weightbearing. Weightbearing was determined while subjects stood on digital scales. They adjusted their weight in an attempt to bear 25, 50, and 75% of their weight through a designated lower extremity. Three trials were allowed at each weightbearing target, and the results were averaged. Each subject's error in perception of weightbearing at each target level was determined by taking the absolute value of the target percent weightbearing minus the mean actual percent weightbearing. The mean errors at the 25, 50, and 75% targets were 7.3, 3.3, and 7.7%, respectively. The magnitude of the error was unrelated to age. An analysis of variance showed that error was not dependent on sex or whether the dominant lower extremity was used for making judgements. The error did differ between target levels. Clinicians cannot assume, based on the findings of this study, that individuals can accurately judge the percent weightbearing they are placing through one of their lower extremities during bilateral upright stance.

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Problems of rendering primary prosthetic and orthopedic help in the megapolis

Vestnik of Russian military medical Academy ◽

10.17816/brmma12259 ◽

2018 ◽

Vol 20 (2) ◽

pp. 90-98

Author(s):

V G Suslyaev ◽

O N Vladimirova ◽

A V Sokurov ◽

T V Ermolenko ◽

Yu I Zhdanov ◽

...

Keyword(s):

Lower Extremity ◽

Elderly People ◽

Weight Bearing ◽

Circulatory System ◽

Lower Extremities ◽

Specific Weight ◽

Learning Ability ◽

Express Method ◽

Scientific Center ◽

Early Primary

On the basis of studying of statistical data, medical documents, results of the carried-out questioning in 2012-2015 the specific weight of the patients who have transferred amputation of the lower extremity owing to complications of diabetes and the obliterating diseases of vessels of the lower extremities, their distribution for the reason and level of amputating defects is estimated. Circulation periods of citizens on primary prosthetics of the lower extremities are studied and analysed. The problems of primary prosthetics connected with presence at patients of the accompanying pathology of the blood circulatory system, breath and the musculoskeletal device are designated. The prevalence of elderly people with amputating defects of the lower extremities is revealed. Features of prosthetics for elderly people, which have decreasing of weight-bearing on safe lower extremity, physical weakness, decreasing of the cognitive functions leading to difficulty of use of technical means of rehabilitation, decrease in learning ability to skills of use of artificial limbs is characteristic are specified. Problems of early rendering the prosthetic and orthopedic help and primary prosthetics of patients after amputation of the lower extremities in the megalopolis are considered. The new technology of early primary prosthetics of the lower extremities developed by specialists of Federal Scientific Center Rehabilitation of the Disabled named after G.A. Albrecht is presented by express method. Results of introduction of modern techniques of prosthetics by express method and their value for rendering primary parotezno-ortopedicheskoyy the help in the megalopolis are discussed. This type of the help can be rendered before formation of the individual program of rehabilitation and an abilitation of disabled people in the conditions of the medical organizations when rendering out-patient and stationary medical care. Rendering early primary prosthetic and orthopedic help is feasible when healing a wound of a stump after amputation, lack of contraindications to prosthetics, high motivation of the patient. Advantages of this technology of early primary prosthetics by express method is restoration of ability of the patient to movement and self-service, decrease in dependence on assistance and leaving, prevention of emergence of some defects and diseases of a stump at uluchsheny the general condition of an organism.

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Application of Stabilometry at Orthopaedic Clinic in Lower Extremity Joints Pathology

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto200916442-48 ◽

2009 ◽

Vol 16 (4) ◽

pp. 42-48

Author(s):

Evgeniy Aleksandrovich Nazarov ◽

A V Seleznev ◽

M N Ryabova ◽

E A Nazarov ◽

A V Seleznyov ◽

...

Keyword(s):

Surgical Treatment ◽

Lower Extremity ◽

Hip Joint ◽

Weight Bearing ◽

Lower Extremities ◽

Ankle Arthrodesis ◽

Joint Arthroplasty ◽

Ankle Injuries ◽

Orthopaedic Clinic ◽

Conservative And Surgical Treatment

Weight bearing response in patients with degenerative-dystrophic diseases and sequelae of hip, knee and ankle injuries was studied using the elaborated hardware-software stabilometric comp-lex Appliance for Registration and Analysis of Distribution of Loads to Lower Extremities. Evaluation of the efficacy of conservative and surgical treatment was performed. New data on stabilometric status of patients after hip joint arthroplasty and ankle arthrodesis were obtained.

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Sural Flap Use for the Treatment of Wounds With Underlying Osteomyelitis: Graft Size a Predictor in Outcome, a Systematic Review

Foot & Ankle Specialist ◽

10.1177/1938640017729496 ◽

2017 ◽

Vol 10 (6) ◽

pp. 560-566 ◽

Cited By ~ 3

Author(s):

Sham Persaud ◽

Anthony Chesser ◽

Ryan Pereira ◽

Adrianne Ross

Keyword(s):

Systematic Review ◽

Lower Extremity ◽

Weight Bearing ◽

Successful Outcome ◽

Graft Size ◽

Sural Flap ◽

Flap Failure ◽

Significant Difference ◽

Versatile Technique ◽

Treatment Of Wounds

The sural flap procedure is a versatile technique that can be used to cover many types of defects about the lower extremity. The management of soft tissue defects of the lower extremity with underlying osteomyelitis is difficult. The goal for any of these patients is to create a biomechanically stable foot for weight-bearing purposes with no continued infection. Data were gathered using multiple databases from the years 2000 to 2016. Data were compiled looking at the number of subjects, age, comorbidities, number of complications, number of failures, and average flap size of complications/failures. A total of 110 patients were gathered using 5 separate articles. Twenty-two of the 110 patients had short-term complications. Flap failure was seen in 9/110 patients. A significant difference was noticed in flap size between flap failure and complication groups and nonfailure groups. The average flap size of patients who had some form of complication or failure was 51.87 cm2 in size. The average graft size for patients without complications during their recovery was 36.54 cm2. Within our study, the failure rate of 8.9% and complication rate of 13.7% are consistent with previous reports on sural perforator flaps. Last, with regard to the effect of flap size, there were significant differences between patients with a successful outcome and those who experienced complications or failures. Levels of Evidence: Therapeutic, Level III: Systematic review

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