A Digital Photographic Technique for Knee Range of Motion Measurement: Performance in a Total Knee Arthroplasty Clinical Population

Abstract

Background: Knee range of motion is an essential outcome measure following total knee arthroplasty and it is important to measure this outcome with a simple and accurate tool. Measurement from digital photographs could provide a superior clinical alternative to the common goniometer as devices for capturing digital photographs are becoming more accessible, measurement accuracy is assisted with the associated software and images can be saved and stored for later reference. This ability to store images with measurements could be particularly useful in research involving knee range of motion. This study evaluated the validity and reliability of a simple photographic measurement technique to measure knee flexion and extension of patients following knee arthroplasty.Methods: Knee flexion and extension of 38 subjects who had undergone total knee arthroplasty were assessed at the one year post-operative review with the digital technique and a universal goniometer as the criterion reference. Digital measurements were repeated one month later by the first assessor (intra-tester reliability) and another independent assessor (inter-tester reliability).Results: Validity: the digital technique was found to have a high level of agreement with the universal goniometer measurements (all MAD < 2.35°). Reliability: small differences were observed in intra and intertester measurements for both flexion and extension with almost perfect Intra-Class Correlations (Intra-tester; flexion 0.99, extension 0.96; inter-tester; flexion 0.97, extension 0.93).Conclusion: Measurement of knee range of motion from digital photographs can be used in routine clinical total knee arthroplasty follow-up instead of, or interchangeably with the universal goniometer.

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M. Murphy, J. Hides and T. Russell, "A Digital Photographic Technique for Knee Range of Motion Measurement: Performance in a Total Knee Arthroplasty Clinical Population," Open Journal of Orthopedics, Vol. 3 No. 1, 2013, pp. 4-9. doi: 10.4236/ojo.2013.31002.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. A. Ritter, J. D. Lutgring, K. E. Davis and M. E. Berend, “The Effect of Postoperative Range of Motion on Functional Activities after Posterior Cruciate-Retaining Total Knee Arthroplasty,” Journal of Bone and Joint Surgery, (American), Vol. 90, No. 4, 2008, pp. 777-784.
[2] M. S. Austin, E. Ghanem, A. Joshi, R. Trappler, J. Parvizi, and W. J. Hozack, “The Assessment of Intraoperative Prosthetic Knee Range of Motion using Two Methods,” Journal of Arthroplasty, Vol 23, No. 4, 2008, pp. 515-521. doi:10.1016/j.arth.2007.12.011
[3] C. Lavernia, M. D’Apuzzo, M. D. Rossi and D. Lee, “Accuracy of Knee Range of Motion Assessment after Total Knee Arthroplasty,” Journal of Arthroplasty, Vol. 23, No. 6, 2008, pp. 85-91. doi:10.1016/j.arth.2008.05.019
[4] P. P. Gogia, J. H. Braatz, S. J. Rose and B. J. Norton, “Reliability and Validity of Goniometric Measurements at the Knee,” Physical Therapy, Vol. 67, No. 2, 1987, pp. 192-195.
[5] J. Z. Edwards, K. A. Greene, R. S. Davis, M. W. Kovacik, D. A. Noe and M. J. Askew, “Measuring Flexion in Knee Arthroplasty Patients,” Journal of Arthroplasty, Vol. 19, No. 3, 2004, pp. 69-72. doi:10.1016/j.arth.2003.12.001
[6] D. Bennett, B. Hanratty, N. Thompson and D. Beverland, “Measurement Of Knee Joint Motion Using Digital Imaging,” International Orthopaedics, Vol. 33, No. 6, 2009, pp. 1627-1631. doi:10.1007/s00264-008-0694-9
[7] P. Piriyaprasarth and M. E. Morris, “Psychometric Properties of Measurement Tools for Quantifying Knee Joint Position and Movement: A Systematic Review,” Knee, Vol. 14, No. 1, 2007, pp. 2-8. doi:10.1016/j.knee.2006.10.006
[8] T. Russell, G. Jull and R. Wootton, “Can the Internet Be Used as a Medium to Evaluate Knee Angle?” Manual Therapy, Vol. 8, No. 4, 2003, pp. 242-246. doi:10.1016/S1356-689X(03)00016-X
[9] L. Brosseau, S. Balmer, M. Tousignant J. P. O’Sullivan, C. Goudreault, M. Goudreault and S. Gringas, “Intraand Intertester Reliability and Criterion Validity of the Parallelogram and Universal Goniometers for Measuring Maximum Active Knee Flexion and Extension of Patients with Knee Restrictions,” Archives of Physical Medicine and Rehabilitaion, Vol. 82, No. 3, 2001, pp. 396-402. doi:10.1053/apmr.2001.19250
[10] L. Brosseau, M. Tousignant, J. Budd, N. Chartier, L. Duciaume, S. Plamondon, J. P. O’Sullivan, S. O’Donoghue and S. Balmer, “Intratester and Intertester Reliability and Criterion Validity of the Parallelogram and Universal Goniometers for Active Knee Flexion in Healthy Subjects,” Physiotherapy Research International, Vol. 2, No. 3, 1997, pp. 150-166. doi:10.1002/pri.97
[11] A. F. Lenssen, E. M. van Dam, Y. H. Crijns, M. Verhey, R. J. Geesink, P. A. van den Brandt and R. A. de Bie, “Reproducibility of Goniometric Measurement of the Knee in the In-Hospital Phase Following Total Knee Arthroplasty,” BMC Musculoskeletal Disorders, Vol. 8, No. 83, 2007.
[12] J. M. Naylor, V. Ko, S. Adie, C. Gaskin, R. Walker, I. A. Harris and R. Mittal, “Validity and Reliability of Using Photography for Measuring Knee Range of Motion: A Methodological Study,” BMC Musculoskelet Disorders, Vol. 12, No. 77, 2011.
[13] C. Dunlevy, M. Cooney and J. Gormely, “Procedural Considerations for Photographic-Based Joint Angle Measurements,” Physiotherapy Research International, Vol. 10, No. 4, 2005, pp. 190-200. doi:10.1002/pri.9
[14] F. Verhaegen, Y. Ganseman, N. Arnout, H. Vandenneucker and J. Bellemans, “Are Clinical Photographs Appropriate to Determine the Maximal Range of Motion of the Knee?” Acta Orthopedica Belgica, Vol. 76, No. 6, 2010, pp. 794-798.
[15] E. Karkouti and R. Marks, “Reliability of Photographic Range of Motion Measurements in a Healthy Sample: Knee and Ankle Joint Measurment,” Physiotherapy Canada, Vol. 49, 1997, pp. 24-31.
[16] D. C. Lee, D. H. Kim, R. D. Scott and K. Suthers, “Intraoperative Flexion Against Gravity as an Indication of Ultimate Range of Motion in Individual Cases after Total Knee Arthroplasty,” Journal of Arthroplasty, Vol. 13, No. 5, 1998, pp. 500-503. doi:10.1016/S0883-5403(98)90047-X
[17] R. W. Nutton, M. L. van der Linden, P. J. Rowe, P. Gaston and F. A. Wade, “A Prospective Randomised Double-Blind Study of Functional Outcome and Range of Flexion Following Total Knee Replacement with the Nexgen Standard and High Flexion Components,” Journal of Bone and Joint Surgery, (British) Vol. 90, No. 1, 2008, pp. 37-42.
[18] C. Norkin and D. White, “Measurement of Joint Motion: A Guide to Goniometry,” 2nd Edition, F. A. Davis Company, Philadelphia, 1995.
[19] J. M. Bland and D. G. Altman, “Statistical Methods for Assessing Agreement Between Two Methods of Clinical Measurement,” Lancet, Vol. 1, No. 8476, 1986, pp. 307310. doi:10.1016/S0140-6736(86)90837-8
[20] J. M. Bland and D. G. Altman, “Measuring Agreement In Method Comparison Studies,” Statistical Methods in Medical Research, Vol. 8, No. 2, 1999, pp. 135-160. doi:10.1191/096228099673819272
[21] J. R. Landis and G. G. Koch, “The Measurement of Observer Agreement for Categorical Data,” Biometrics, Vol. 33, No. 1, 1977, pp. 159-174. doi:10.2307/2529310
[22] T. M. Yehyawi, J. J. Callaghan, D. R. Pedersen, M. R. O'Rourke and S. S. Liu, “Variances in Sagittal Femoral Shaft Bowing in Patients Undergoing TKA,” Clinical Orthopaedics and Related Research, Vol. 464, No. 1, 2007, pp. 99-104.
[23] D. C. Boone, S. P. Azen, C. M. Lin, C. Spence, C. Baron and L. Lee, “Reliability of Goniometric Measurements,” Physical Therapy, Vol. 58, No. 11, 1978, pp. 1355-1390.
[24] H. M. Clarkson and G. Gilewich, “Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength,” Williams & Wilkins, Baltimore, 1989

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