The accuracy of preoperative implant size prediction achieved by digital templating in total knee arthroplasty is not affected by the quality of lateral knee radiographs

Background: Digital templating software can be used for preoperative implant size prediction in total knee arthroplasty (TKA). However, the accuracy of its prediction is reported to be low, and the impact of radiograph quality is unclear. Purpose: To investigate on the application of lateral knee radiograph quality criteria for knee rotation (KR) and knee abduction/adduction (KA) and their impact on the accuracy of final implant size prediction achieved by preoperative digital templating for TKA. Methods: A total of 191 radiographs of patients undergoing TKA were allocated into four groups according to their KR as measured at the posterior femoral condyles and their KA as measured at the distal femoral condyles on lateral knee radiographs: group A (KR <= 5 mm, KA <= 5 mm), B1 (KR > 5 mm, KA <= 5 mm), B2 (KR <= 5 mm, KA > 5 mm) and B3 (KR > 5 mm, KA > 5 mm). Preoperative templating of femoral and tibial implant size using digital templating software was carried out by two observers. Correlation coefficients (CCs) between planned and final implant size, percentage of cases with planned to final size match as well as percentage of cases within +/- 1 and +/- 2 of planned to final size were reported according to groups. Results: Group A showed the highest percentage of cases with matching planned to final femoral implant size (45%) and the highest percentage of cases with +/- 1 planned to final implant size (86%) as compared to B1 (match 28%, +/- 1 84%), B2 (match 41%, +/- 1 84%) and B3 (match 35%, +/- 1 78%). CCs for planned to final implant size were reported at >0.75 in all groups. No statistically significant difference in the CCs of planned to final implant size amongst groups was found. Conclusion: The accuracy of implant size prediction achieved by preoperative digital templating for TKA is neither affected by KR nor KA on lateral knee radiographs.