The long leg radiograph is a reliable method of assessing alignment when compared to computer-assisted navigation and computer tomography

Abstract Background The mechanical alignment of the knee is an important factor in planning for, and subsequently assessing the success of a knee replacement. It is most commonly measured using a long-leg anteroposterior radiograph (LLR) encompassing the hip, knee and ankle. Other modalities of measuring alignment include computer tomography (CT) and intra-operative computer navigation (Cas). Recent studies comparing LLRs to Cas in measuring alignment have shown significant differences between the two and have hypothesized that Cas is a more accurate modality. This study aims to investigate the accuracy of the above mentioned modalities. Methodology A prospective study was undertaken comparing alignment as measured by long-leg radiographs and computer tomography to intra-operative navigation measurements in 40 patients undergoing a primary total knee replacement to test this hypothesis. Alignment was measured three times by three observers. Intra- and inter-observer correlation was sought between modalities. Results Intra-observer correlation was excellent in all cases (> 0.98) with a coefficient of repeatability < 1.1°. Inter-observer correlation was also excellent measuring > 0.960 using LLRs and > 0.970 using CT with coefficient of repeatability < 2.8°. Inter-modality correlation proved to be higher when comparing LLRs and CT (> 0.893), than when comparing either of these modalities with Cas (> 0.643 and > 0.671 respectively). Pre-operative values had the greatest variability. Conclusion Given its availability and reduced radiation dose when compared to CT, LLRs should remain the mainstay of measuring the mechanical alignment of the lower limb, especially post-operatively. Level of evidence II