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A New Protocol For Obtaining Whole Leg Radiographs With Excellent Reproducibility

A New Protocol For Obtaining Whole Leg Radiographs With Excellent Reproducibility

Chien Nguyen, MSc., NETHERLANDS Nienke Van Egmond, MD, PhD, NETHERLANDS Mario Hevesi, MD, PhD, UNITED STATES Harrie Weinans, Prof., PhD, Ir. , NETHERLANDS Willem Paul Gielis, MD, NETHERLANDS Roel J.H. Custers, MD, PhD, NETHERLANDS

Universitair Medisch Centrum Utrecht, Utrecht, Utrecut, NETHERLANDS

2021 Congress   Abstract Presentation   6 minutes   rating (1)


Sports Medicine

Anatomic Structure

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Summary: Whole Leg Radiograph guidelines provides excellent reproducible radiographs


Whole Leg Radiographs (WLR) are the gold standard for diagnosing malalignment and for pre-operative osteotomy planning. Positioning can affect the reproducibility of the measured hip knee angle (HKA), resulting in insufficient diagnostics and preoperative plans. We developed an easy-to-use WLR protocol by standardizing patient positioning and focusing on reproducibility. This study aims on testing this reproducibility.


This study enrolled 30 patients for a test-retest analysis. Each patient underwent two bilateral WLRs on the same day using the investigated positioning protocol. Three observers measured the HKA, mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal femoral angle (mLDFA), and joint line convergence angle (JLCA) on the two radiographs. Twice each, with one week between.


The intra-observer and inter-observer reliabilities were excellent, with intraclass correlation coefficients (ICCs) between 0.990 and 0.996. The ICCs between the measured HKA (0.985), mMPTA (0.922), and mLDFA (0.903) on the two separate radiographs were excellent. The ICC between the JLCA measured on the first and second WLR was moderate with 0.632. The mean absolute error between the HKA, mMPTA, mLDFA, and JLCA measurements on the first and second WLR were respectively: 0.442°, 0.783°, 0.828°, and 0.794°.


The investigated novel WLR positioning protocol produced excellent and reproducible HKA measurements, with clinically acceptable degrees of error. We recommend applying this easy-to-use protocol when obtaining WLRs for osteotomy planning.