Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty: an analysis of 2,156 knees using a deep learning tool
Aims: Distal femoral resection in conventional total knee arthroplasty (TKA) utilizes an intramedullary guide to determine coronal alignment, commonly planned for 5° of valgus. However, a standard 5° resection angle may contribute to malalignment in patients with variability in the femoral anatomica...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2024-02-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.52.BJO-2023-0056.R1 |
| _version_ | 1797289584642490368 |
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| author | Seong J. Jang Kyle N. Kunze Jack C. Casey Jack R. Steele David J. Mayman Seth A. Jerabek Peter K. Sculco Jonathan M. Vigdorchik |
| author_facet | Seong J. Jang Kyle N. Kunze Jack C. Casey Jack R. Steele David J. Mayman Seth A. Jerabek Peter K. Sculco Jonathan M. Vigdorchik |
| author_sort | Seong J. Jang |
| collection | DOAJ |
| description | Aims: Distal femoral resection in conventional total knee arthroplasty (TKA) utilizes an intramedullary guide to determine coronal alignment, commonly planned for 5° of valgus. However, a standard 5° resection angle may contribute to malalignment in patients with variability in the femoral anatomical and mechanical axis angle. The purpose of the study was to leverage deep learning (DL) to measure the femoral mechanical-anatomical axis angle (FMAA) in a heterogeneous cohort. Methods: Patients with full-limb radiographs from the Osteoarthritis Initiative were included. A DL workflow was created to measure the FMAA and validated against human measurements. To reflect potential intramedullary guide placement during manual TKA, two different FMAAs were calculated either using a line approximating the entire diaphyseal shaft, and a line connecting the apex of the femoral intercondylar sulcus to the centre of the diaphysis. The proportion of FMAAs outside a range of 5.0° (SD 2.0°) was calculated for both definitions, and FMAA was compared using univariate analyses across sex, BMI, knee alignment, and femur length. Results: The algorithm measured 1,078 radiographs at a rate of 12.6 s/image (2,156 unique measurements in 3.8 hours). There was no significant difference or bias between reader and algorithm measurements for the FMAA (p = 0.130 to 0.563). The FMAA was 6.3° (SD 1.0°; 25% outside range of 5.0° (SD 2.0°)) using definition one and 4.6° (SD 1.3°; 13% outside range of 5.0° (SD 2.0°)) using definition two. Differences between males and females were observed using definition two (males more valgus; p < 0.001). Conclusion: We developed a rapid and accurate DL tool to quantify the FMAA. Considerable variation with different measurement approaches for the FMAA supports that patient-specific anatomy and surgeon-dependent technique must be accounted for when correcting for the FMAA using an intramedullary guide. The angle between the mechanical and anatomical axes of the femur fell outside the range of 5.0° (SD 2.0°) for nearly a quarter of patients. Cite this article: Bone Jt Open 2024;5(2):101–108. |
| first_indexed | 2024-03-07T19:07:13Z |
| format | Article |
| id | doaj.art-3c8ac71c5d1346c7ac1e2759063d5e9c |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-03-07T19:07:13Z |
| publishDate | 2024-02-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-3c8ac71c5d1346c7ac1e2759063d5e9c2024-03-01T06:37:37ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622024-02-015210110810.1302/2633-1462.52.BJO-2023-0056.R1Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty: an analysis of 2,156 knees using a deep learning toolSeong J. Jang0https://orcid.org/0000-0002-9967-9476Kyle N. Kunze1https://orcid.org/0000-0002-0363-3482Jack C. Casey2Jack R. Steele3David J. Mayman4Seth A. Jerabek5Peter K. Sculco6Jonathan M. Vigdorchik7Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USAAdult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USAAdult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USADepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USAAims: Distal femoral resection in conventional total knee arthroplasty (TKA) utilizes an intramedullary guide to determine coronal alignment, commonly planned for 5° of valgus. However, a standard 5° resection angle may contribute to malalignment in patients with variability in the femoral anatomical and mechanical axis angle. The purpose of the study was to leverage deep learning (DL) to measure the femoral mechanical-anatomical axis angle (FMAA) in a heterogeneous cohort. Methods: Patients with full-limb radiographs from the Osteoarthritis Initiative were included. A DL workflow was created to measure the FMAA and validated against human measurements. To reflect potential intramedullary guide placement during manual TKA, two different FMAAs were calculated either using a line approximating the entire diaphyseal shaft, and a line connecting the apex of the femoral intercondylar sulcus to the centre of the diaphysis. The proportion of FMAAs outside a range of 5.0° (SD 2.0°) was calculated for both definitions, and FMAA was compared using univariate analyses across sex, BMI, knee alignment, and femur length. Results: The algorithm measured 1,078 radiographs at a rate of 12.6 s/image (2,156 unique measurements in 3.8 hours). There was no significant difference or bias between reader and algorithm measurements for the FMAA (p = 0.130 to 0.563). The FMAA was 6.3° (SD 1.0°; 25% outside range of 5.0° (SD 2.0°)) using definition one and 4.6° (SD 1.3°; 13% outside range of 5.0° (SD 2.0°)) using definition two. Differences between males and females were observed using definition two (males more valgus; p < 0.001). Conclusion: We developed a rapid and accurate DL tool to quantify the FMAA. Considerable variation with different measurement approaches for the FMAA supports that patient-specific anatomy and surgeon-dependent technique must be accounted for when correcting for the FMAA using an intramedullary guide. The angle between the mechanical and anatomical axes of the femur fell outside the range of 5.0° (SD 2.0°) for nearly a quarter of patients. Cite this article: Bone Jt Open 2024;5(2):101–108.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.52.BJO-2023-0056.R1artificial intelligencedeep learningfemoral mechanical anatomical axis angleintramedullary guiderevision total knee arthroplastykneesvalgusfemurtotal knee arthroplasty (tka)osteoarthritisradiographsdiaphysisbmicoronal alignment |
| spellingShingle | Seong J. Jang Kyle N. Kunze Jack C. Casey Jack R. Steele David J. Mayman Seth A. Jerabek Peter K. Sculco Jonathan M. Vigdorchik Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty: an analysis of 2,156 knees using a deep learning tool Bone & Joint Open artificial intelligence deep learning femoral mechanical anatomical axis angle intramedullary guide revision total knee arthroplasty knees valgus femur total knee arthroplasty (tka) osteoarthritis radiographs diaphysis bmi coronal alignment |
| title | Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty: an analysis of 2,156 knees using a deep learning tool |
| title_full | Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty: an analysis of 2,156 knees using a deep learning tool |
| title_fullStr | Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty: an analysis of 2,156 knees using a deep learning tool |
| title_full_unstemmed | Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty: an analysis of 2,156 knees using a deep learning tool |
| title_short | Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty: an analysis of 2,156 knees using a deep learning tool |
| title_sort | variability of the femoral mechanical anatomical axis angle and its implications in primary and revision total knee arthroplasty an analysis of 2 156 knees using a deep learning tool |
| topic | artificial intelligence deep learning femoral mechanical anatomical axis angle intramedullary guide revision total knee arthroplasty knees valgus femur total knee arthroplasty (tka) osteoarthritis radiographs diaphysis bmi coronal alignment |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.52.BJO-2023-0056.R1 |
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