Article

Informed clinical decision making for femoral and/or tibial de-rotation
osteotomies requires accurate measurement of patient function through gait
analysis and anatomy through physical examination of bony torsions. Validity of
gait analysis has been extensively studied; however, controversy remains
regarding the accuracy of physical examination measurements of femoral and tibial
torsion. Comparison between CT-scans and physical examination measurements of
femoral neck anteversion (FNA) and external tibial torsion (ETT) were
retrospectively obtained for 98 (FNA) and 64 (ETT) patients who attended a
tertiary hospital for instrumented gait analysis between 2007 and 2010. The
physical examination methods studied for femoral neck anteversion were the
trochanteric prominence angle test (TPAT) and the maximum hip rotation arc
midpoint (Arc midpoint) and for external tibial torsion the transmalleolar axis
(TMA). Results showed that all physical examination measurements statistically
differed to the CT-scans (bias(standard deviation): -2(14) for TPAT, -10(12) for
Arc midpoint and -16(9) for TMA). Bland and Altman plots showed that method
disagreements increased with increasing bony torsions in all cases but notably
for TPAT. Regression analysis showed that only TMA and CT-scan measurement of
external tibial torsion demonstrated good (R(2)=57%) correlation. Correlations
for both TPAT (R(2)=14%) and Arc midpoint (R(2)=39%) with CT-scan measurements of
FNA were limited. We conclude that physical examination should be considered as
screening techniques rather than definitive measurement methods for FNA and ETT.
Further research is required to develop more accurate measurement methods to
accompany instrumented gait analysis.
CI - Copyright (c) 2013. Published by Elsevier B.V.

Langue : ANGLAIS