Inter-Rater Reliability of Clinical Testing for Laxity After Knee Arthroplasty
The clinical examination for laxity has been considered a mainstay in evaluation of the painful knee arthroplasty, especially for the diagnosis of instability. More than 10 mm of anterior-posterior (AP) translation in flexion has been described as important in the diagnosis of flexion instability. T...
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Veröffentlicht in: | The Journal of arthroplasty 2022-07, Vol.37 (7), p.1296-1301 |
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creator | Mears, Simon C. Severin, A. Cecilia Wang, Junsig Thostenson, Jeff D. Mannen, Erin M. Stambough, Jeffrey B. Edwards, Paul K. Barnes, C. Lowry |
description | The clinical examination for laxity has been considered a mainstay in evaluation of the painful knee arthroplasty, especially for the diagnosis of instability. More than 10 mm of anterior-posterior (AP) translation in flexion has been described as important in the diagnosis of flexion instability. The inter-observer reliability of varus/valgus and AP laxity testing has not been tested.
Ten subjects with prior to total knee arthroplasty (TKA) were examined by 4 fellowship-trained orthopedic knee arthroplasty surgeons. Each surgeon evaluated each subject in random order and was blinded to the results of the other surgeons. Each surgeon performed an anterior drawer test at 30 and 90 degrees of flexion and graded the instability as 0-5 mm, 5-10 mm or >10 mm. Varus-valgus testing was also graded. Motion capture was used during the examination to determine the joint position and estimate joint reaction force during the examination.
Inter-rater reliability (IRR) was poor at 30 and 90 degrees for both the subjective rater score and the measured AP laxity in flexion (k = 018-0.22). Varus-valgus testing similarly had poor reliability. Force applied by the rater also had poor IRR.
Clinical testing of knee laxity after TKA has poor reliability between surgeons using motion analysis. It is unclear if this is from differences in examiner technique or from differences in pain or quadriceps function of the subjects. Instability after TKA should not be diagnosed strictly by clinical testing and should involve a complete clinical assessment of the patient. |
doi_str_mv | 10.1016/j.arth.2022.03.044 |
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Ten subjects with prior to total knee arthroplasty (TKA) were examined by 4 fellowship-trained orthopedic knee arthroplasty surgeons. Each surgeon evaluated each subject in random order and was blinded to the results of the other surgeons. Each surgeon performed an anterior drawer test at 30 and 90 degrees of flexion and graded the instability as 0-5 mm, 5-10 mm or >10 mm. Varus-valgus testing was also graded. Motion capture was used during the examination to determine the joint position and estimate joint reaction force during the examination.
Inter-rater reliability (IRR) was poor at 30 and 90 degrees for both the subjective rater score and the measured AP laxity in flexion (k = 018-0.22). Varus-valgus testing similarly had poor reliability. Force applied by the rater also had poor IRR.
Clinical testing of knee laxity after TKA has poor reliability between surgeons using motion analysis. It is unclear if this is from differences in examiner technique or from differences in pain or quadriceps function of the subjects. Instability after TKA should not be diagnosed strictly by clinical testing and should involve a complete clinical assessment of the patient.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2022.03.044</identifier><identifier>PMID: 35307526</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arthroplasty, Replacement, Knee - adverse effects ; Arthroplasty, Replacement, Knee - methods ; Biomechanical Phenomena ; clinical examination ; flexion instability ; Humans ; Joint Instability - surgery ; Knee Joint - surgery ; knee laxity ; Pain - surgery ; painful TKA ; physical examination ; Range of Motion, Articular ; Reproducibility of Results</subject><ispartof>The Journal of arthroplasty, 2022-07, Vol.37 (7), p.1296-1301</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-1ba6219fac23e1ad751b7cbe0d0617cb33a3cf5e76a0913e1892b25a27191ab03</citedby><cites>FETCH-LOGICAL-c400t-1ba6219fac23e1ad751b7cbe0d0617cb33a3cf5e76a0913e1892b25a27191ab03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arth.2022.03.044$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35307526$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mears, Simon C.</creatorcontrib><creatorcontrib>Severin, A. Cecilia</creatorcontrib><creatorcontrib>Wang, Junsig</creatorcontrib><creatorcontrib>Thostenson, Jeff D.</creatorcontrib><creatorcontrib>Mannen, Erin M.</creatorcontrib><creatorcontrib>Stambough, Jeffrey B.</creatorcontrib><creatorcontrib>Edwards, Paul K.</creatorcontrib><creatorcontrib>Barnes, C. Lowry</creatorcontrib><title>Inter-Rater Reliability of Clinical Testing for Laxity After Knee Arthroplasty</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>The clinical examination for laxity has been considered a mainstay in evaluation of the painful knee arthroplasty, especially for the diagnosis of instability. More than 10 mm of anterior-posterior (AP) translation in flexion has been described as important in the diagnosis of flexion instability. The inter-observer reliability of varus/valgus and AP laxity testing has not been tested.
Ten subjects with prior to total knee arthroplasty (TKA) were examined by 4 fellowship-trained orthopedic knee arthroplasty surgeons. Each surgeon evaluated each subject in random order and was blinded to the results of the other surgeons. Each surgeon performed an anterior drawer test at 30 and 90 degrees of flexion and graded the instability as 0-5 mm, 5-10 mm or >10 mm. Varus-valgus testing was also graded. Motion capture was used during the examination to determine the joint position and estimate joint reaction force during the examination.
Inter-rater reliability (IRR) was poor at 30 and 90 degrees for both the subjective rater score and the measured AP laxity in flexion (k = 018-0.22). Varus-valgus testing similarly had poor reliability. Force applied by the rater also had poor IRR.
Clinical testing of knee laxity after TKA has poor reliability between surgeons using motion analysis. It is unclear if this is from differences in examiner technique or from differences in pain or quadriceps function of the subjects. Instability after TKA should not be diagnosed strictly by clinical testing and should involve a complete clinical assessment of the patient.</description><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Arthroplasty, Replacement, Knee - methods</subject><subject>Biomechanical Phenomena</subject><subject>clinical examination</subject><subject>flexion instability</subject><subject>Humans</subject><subject>Joint Instability - surgery</subject><subject>Knee Joint - surgery</subject><subject>knee laxity</subject><subject>Pain - surgery</subject><subject>painful TKA</subject><subject>physical examination</subject><subject>Range of Motion, Articular</subject><subject>Reproducibility of Results</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kF1LwzAUhoMoOqd_wAvppTet5yRNu4I3Y_iFQ2HM65Cmp5rRtTPpxP17U6ZeepME8rwv5zyMXSAkCJhdrxLt-veEA-cJiATS9ICNUAoeT1LIDtkIJhMRyxTECTv1fgWAKGV6zE6EFJBLno3Y82Pbk4sXOpzRghqrS9vYfhd1dTRrbGuNbqIl-d62b1HduWiuv4bvaT0EnlqiaBqGcN2m0b7fnbGjWjeezn_uMXu9u13OHuL5y_3jbDqPTQrQx1jqjGNRa8MFoa5yiWVuSoIKMgwPIbQwtaQ801BgQCYFL7nUPMcCdQlizK72vRvXfWzDeGptvaGm0S11W694lqKEHLMioHyPGtd576hWG2fX2u0Ugho8qpUaPKrBowKhgscQuvzp35Zrqv4iv-ICcLMHKGz5ackpbyy1hirryPSq6ux__d_JCoOF</recordid><startdate>202207</startdate><enddate>202207</enddate><creator>Mears, Simon C.</creator><creator>Severin, A. Cecilia</creator><creator>Wang, Junsig</creator><creator>Thostenson, Jeff D.</creator><creator>Mannen, Erin M.</creator><creator>Stambough, Jeffrey B.</creator><creator>Edwards, Paul K.</creator><creator>Barnes, C. Lowry</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202207</creationdate><title>Inter-Rater Reliability of Clinical Testing for Laxity After Knee Arthroplasty</title><author>Mears, Simon C. ; Severin, A. Cecilia ; Wang, Junsig ; Thostenson, Jeff D. ; Mannen, Erin M. ; Stambough, Jeffrey B. ; Edwards, Paul K. ; Barnes, C. 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Cecilia</creatorcontrib><creatorcontrib>Wang, Junsig</creatorcontrib><creatorcontrib>Thostenson, Jeff D.</creatorcontrib><creatorcontrib>Mannen, Erin M.</creatorcontrib><creatorcontrib>Stambough, Jeffrey B.</creatorcontrib><creatorcontrib>Edwards, Paul K.</creatorcontrib><creatorcontrib>Barnes, C. Lowry</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mears, Simon C.</au><au>Severin, A. Cecilia</au><au>Wang, Junsig</au><au>Thostenson, Jeff D.</au><au>Mannen, Erin M.</au><au>Stambough, Jeffrey B.</au><au>Edwards, Paul K.</au><au>Barnes, C. Lowry</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inter-Rater Reliability of Clinical Testing for Laxity After Knee Arthroplasty</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2022-07</date><risdate>2022</risdate><volume>37</volume><issue>7</issue><spage>1296</spage><epage>1301</epage><pages>1296-1301</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>The clinical examination for laxity has been considered a mainstay in evaluation of the painful knee arthroplasty, especially for the diagnosis of instability. More than 10 mm of anterior-posterior (AP) translation in flexion has been described as important in the diagnosis of flexion instability. The inter-observer reliability of varus/valgus and AP laxity testing has not been tested.
Ten subjects with prior to total knee arthroplasty (TKA) were examined by 4 fellowship-trained orthopedic knee arthroplasty surgeons. Each surgeon evaluated each subject in random order and was blinded to the results of the other surgeons. Each surgeon performed an anterior drawer test at 30 and 90 degrees of flexion and graded the instability as 0-5 mm, 5-10 mm or >10 mm. Varus-valgus testing was also graded. Motion capture was used during the examination to determine the joint position and estimate joint reaction force during the examination.
Inter-rater reliability (IRR) was poor at 30 and 90 degrees for both the subjective rater score and the measured AP laxity in flexion (k = 018-0.22). Varus-valgus testing similarly had poor reliability. Force applied by the rater also had poor IRR.
Clinical testing of knee laxity after TKA has poor reliability between surgeons using motion analysis. It is unclear if this is from differences in examiner technique or from differences in pain or quadriceps function of the subjects. Instability after TKA should not be diagnosed strictly by clinical testing and should involve a complete clinical assessment of the patient.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35307526</pmid><doi>10.1016/j.arth.2022.03.044</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Arthroplasty, Replacement, Knee - adverse effects Arthroplasty, Replacement, Knee - methods Biomechanical Phenomena clinical examination flexion instability Humans Joint Instability - surgery Knee Joint - surgery knee laxity Pain - surgery painful TKA physical examination Range of Motion, Articular Reproducibility of Results |
title | Inter-Rater Reliability of Clinical Testing for Laxity After Knee Arthroplasty |
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