CT SCAN OF KNEE JOINT

Abstract :
Knee arthroplasty is the reconstruction of the knee joint. It is more commonly
referred to as a total knee replacement and is a very reliable procedure with
predictable results. Total knee arthroplasty (TKA) is an excellent treatment option for
individuals with symptomatic osteoarthritis in at least 2 of the 3 compartments of the
knee who have failed conservative treatment. This activity describes the indications,
contraindications and complications of total knee arthroplasty and highlights the
role of the interprofessional team in the management of patients with knee arthritis.
INTRODUCTION :
A computed tomography (CT) scan is a type of X-ray that shows cross-sectional
images of a specific area on your body. For example, a CT scan of your knee
would help doctors diagnose disease or inspect injuries on your knee.
A CT scanner circles the body and sends images to a computer. The computer uses
these images to make detailed pictures. This allows doctors and trained technicians
to see the muscles, tendons, ligaments, vessels, and bones that make up your knee.
A CT scan is also sometimes referred to as a CAT scan. The scan is performed at a
hospital or specialized outpatient testing facility.
A computed tomography (CT) scan of the knee is a test that uses x-rays to take
detailed images of the knee.
The CT knee protocol serves as an examination for the bony assessment of the knee
the femoral condyles or the tibial plateau and the proximal tibiofibular joint. It is
often performed as a non-contrast study. It can also be combined with a CT
arthrogram in cases of suspected internal derangement where an MRI is
contraindicated.

In the field of medical diagnostics, technology is ever-evolving, allowing healthcare

providers to acquire a better understanding of the human body without intrusive or
surgical interventions. The CT scan, also referred to as a computed tomography

2
scan, is one such technological marvel. The very detailed cross-sectional images of
knee injuries help clinicians detect and diagnose illnesses and injuries. In this
extensive guide, we will go over the relevance of CT scans for knee injuries, their
function, preparation, method, potential hazards, significance of follow-up sessions
and treatment prognosis.
Objectives:
Describe the indications for total knee arthroplasty.
Outline the contraindications to total knee arthroplasty.
Summarize the complications of total knee arthroplasty.
Explain the importance of enhancing care coordination among interprofessional
team members to improve outcomes for patients undergoing total knee arthroplasty.

3
ANATOMY :
The knee is a hinge joint that is responsible for weight-bearing and movement. It
consists of bones, meniscus, ligaments, and tendons.
The knee is designed to fulfill a number of functions:
Support the body in an upright position without the need for muscles to work
Helps to lower and raise the body
Provides stability
Acts as a shock absorber
Allows twisting of the leg
Makes walking more efficient
Helps propel the body forward
The knee is a synovial hinge joint with minimal rotational motion. It is comprised of
the distal femur, proximal tibia, and the patella. There are 3 separate articulations
and compartments: medial femorotibial, lateral femorotibial, and patellofemoral.
The stability of the knee joint is provided by the congruity of the joint as well as by
the collateral ligaments. The capsule surrounds the entire joint and extends
proximally into the suprapatellar pouch. Articular cartilage covers the femoral
condyles, tibial plateaus, trochlear groove, and patellar facets. Menisci are
interposed in the medial and lateral compartments between the femur and tibia
which act to protect the articular cartilage and support the knee

Figure.anatomy of knee joint

4
The mechanical axis of the femur, defined by a line drawn from the center of the
femoral head to the center of the knee, is 3 degrees valgus to the vertical axis. The
anatomic axis of the femur, defined by a line bisecting the femoral shaft, is 6
degrees valgus to the mechanical axis of the femur and 9 degrees valgus to the
vertical axis.The proximal tibia is oriented to 3 degrees of varus. The varus position
of the proximal tibia, along with the offset of the hip center of rotation, results in the
weight-bearing surface of the tibia being parallel to the ground. The sagittal
alignment of the proximal tibia is sloped posteriorly approximately 5 to 7 degrees.
The asymmetry of the natural bony anatomy maintains the alignment of the joint and
ligamentous tension.

5
INDICATION :
•Distal femoral fractures
•Proximal tibial fractures
•Preoperative planning
•Osteoarthritis
•Trochlear dysplasia
•Patellar translation
•Knee implants and complications
•Inflammatory or septic arthritis
•Bone and soft tissue tumors
•Image guidance
•Presence of metallic implants
•Internal derangement
•This view demonstrates the distal femur and proximal tibia/fibula in their natural
anatomical position allowing for assessment of suspected dislocations, fractures,
localizing foreign bodies and osteoarthritis.
Clinical symptoms of osteoarthritis include:
•Knee pain
Pain with activity and improving with rest
Pain gradually worsens over time
Decreased ambulatory capacity
•Clinical evaluation includes:
Full knee exam including range of motion and ligamentous testing
Knee radiographs include standing anteroposterior, lateral, 45-degree
posteroanterior, and skyline view of the patella

6
•Joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophyte formation
•Conservative treatment includes:
Non-steroidal anti-inflammatory medication
Weight loss
•Activity modification
Bracing
Physical therapy
Viscosupplementation
Intra-articular steroid injection

7
Contraindications :
•Active or latent (less than 1 year) knee sepsis
•Presence of active infection elsewhere in body
Extensor mechanism dysfunction
•Medically unstable patient
Relative
•Neuropathic joint
Poor overlying skin condition
•Morbid obesity
•Noncompliance due to major psychiatric disorder, alcohol, or drug abuse
•Insufficient bone stock for reconstruction
•Poor patient motivation or unrealistic expectation
•Severe peripheral vascular disease

8
Equipment :
A TKA system will consist of instrumentation that helps the surgeon prepare the ends
of the femur, tibia, and patella to receive an implant. The instrumentation will be
specific to the brand and type of implant being used with each company and
model having specific intricacies.

Figure.CT Scan (Computed Tomography "CAT Scan") | HSS Radiology

In general, the instrumentation will consist of:

Intramedullary femoral guide to help establish the distal femoral alignment
Distal femoral cutting guide
Femoral sizing guide
4-in-1 femoral cutting guide
Extramedullary or intramedullary tibial guide
Proximal tibial cutting guide
Patella sizing guide
Femoral component trial
Tibial baseplate trial

9
Patellar button trial
Trial plastic bearing
The final implants will come in individual sterile packages and will consist of:
Femoral component, typically made of cobalt-chrome
Tibial component, typically made of cobalt-chrome or titanium
Tibial polyethylene bearing, made of an ultra high molecular weight (UHMW)
polyethylene
Patellar button, made of UHMW polyethylene

Technique:
•Tube voltage
≤120 kVp
•Tube current
As suggested by the automated current adjustment mode
Scout
Distal third of the femur and proximal half of the tibia
Scan extent
The whole patella and the fibular head should be included
Scan direction
Craniocaudal
Scan geometry
Field of view (FOV): 120-250 mm (should be adjusted to increase in-plane
resolution)
Slice thickness: ≤1.25 mm, interval: ≤0.625 mm
Reconstruction algorithm: bone, soft tissue
Axial images: parallel to the femorotibial joint line

10
Practical points :
Patient positioning with slight internal rotation of the lower limb before scanning
The extent of the examination should be tailored to the specific indication or clinical
The whole implant should be captured
Use metal artifact reduction algorithms
Use monochromatic reconstructions in dual-energy CT scans
Use additional wide window setting
In the setting of preoperative planning, 3D reconstruction techniques are highly
recommended
The fibula head is a great indication of rotation, if the fibula head is entirely
superimposed, the image is not AP; to correct this you must internally rotate until the
knee is in even contact with the image detector.
Very slim patients may require a slight caudal angle to better visualize the joint
space in an AP fashion. The opposite applies for larger patients (thicker thighs mean
the leg may be naturally flexed at rest) and would require a slight cephalic angle.
Whether cephalic or caudal, an angle of approximately 5-8° is adequate.

11
PATIENT POSITION :
Patient is supine on the table with the knee and ankle joint in contact with the table
Leg is extended
Ensure the knee is not rotated

Figure patient positioning

12
Technical Factors :
•Anteroposterior projection
Centering point -
Center of the knee 1.5 cm distal to the apex of the patella
Collimation -
Superior to include the distal femur
Inferior to include the proximal tibia/fibula
Lateral to include the skin margin
Medial to include medial skin margin
•Orientation -Portrait
•Detector size - 24 cm x 30 cm
•Exposure - 60-70 kVp ,7-10 mAs
•SID - 100 cm
•Grid - No

13
Preparation :
If you require a CT scan for knee injuries, you will not have any preparation to do
for your appointment.
You will be asked to lie back on a flat bed that will pass into the scanner, which is a
ring that rotates around your knee as it passes through it. You must stay still and
breathe normally. The sensation of claustrophobia is minimise as the scanner never
surrounds your whole body at once and you will be able to see both ends of it.
The entire procedure usually only lasts for several minutes on the scan table.
A radiologist, a medical doctor specialised in interpreting medical images for the
purposes of providing a diagnosis, will then review the images and provide a
formal written report.
Any blood-thinning medications, such as aspirin, warfarin, Plavix, or discover, that
you are taking must be disclosed to us, and you must cease taking them temporarily
prior to your treatment. Please get in touch with us if you need advice
When undergoing a knee arthrogram? You will be settled onto the examination
table upon being moved to the CT room.
Full medical and drug history before surgery
Appropriate pre-surgical workup, clearance, and optimization
Pre-operative radiographs of the affected knee
Pre-operative templating of the affected knee to estimate the component size
Primary TKA system of choice
Have various final implant sizes ready and available in the hospital
Have increasing prosthesis constraint options ready and available in the hospital
Have revision total knee replacement system of choice ready and available if
needed
antibiotic cement, surgeon preference

14
During Procedure:
After cleaning your skin, a local anaesthetic will be injected into the area. This could
sting for up to 30 seconds, or until the skin goes numb.
After that, the radiologist will pierce your knee joint with a thin needle. After the
needle is inserted, the needle site will receive two to ten millilitres of X-ray dye
(contrast) after the needle is guided into position using CT or ultrasound. After that,
the joint will be CT-scanned by the team.
The process will take roughly 40 minutes.
The obtained images will be evaluated by the doctor and interpret the data.

Technique or Treatment :
The goal of TKA is the same regardless of surgeon, implant, or technique. The
variability in the procedure lies in the technique. Some of the variations in operative
technique for TKA are listed below.
General anesthesia versus regional anesthesia
Tourniquet versus tourniquet-less surgery
Standard versus patient-specific instrumentation
Standard versus patient-specific implants
Traditional versus robotic-assisted TKA
Traditional versus navigation-assisted TKA
Traditional versus sensor-assisted TKA
Measured resection versus gap balancing
Cruciate-retaining implant versus cruciate stabilized the implant
Resurfaced versus non-resurfaced patella
Cement versus cement-less (press fit) TKA

15
Why Is a Knee CT Scan Done?
A CT scan provides your doctor with more detailed images of the inside of your
knee than traditional X-rays do. It gives your doctor an internal view of your knee
without making an incision and performing exploratory surgery. This can help your
doctor provide a more accurate diagnosis for knee problems, which can include:
Arthritis
Collection of pus (abscess)
Fractured bone
Infection
Torn ligaments or tendons
Tumors

Why Is a Knee CT Scan Done?

A CT scan provides your doctor with more detailed images of the inside of your
knee than traditional X-rays do. It gives your doctor an internal view of your knee
without making an incision and performing exploratory surgery. This can help your
doctor provide a more accurate diagnosis for knee problems, which can include:

Arthritis
Collection of pus (abscess)
Fractured bone
Infection
Torn ligaments or tendons
Tumors

16
The Risks of a Knee CT Scan
There are very few risks associated with a CT scan. Occasionally, the dye used in
the procedure can cause temporary damage to your kidneys. This risk is greater if
your kidneys have already been affected by disease or infection. There are newer
dyes that carry much less risk to the kidneys.
As with any X-ray, there is some exposure to radiation. The level is so low that it’s
usually harmless. If you’re pregnant or could be pregnant, speak with your doctor.
Any potential exposure to radiation could be harmful to a developing fetus.

How to Prepare for a Knee CT Scan

Before your exam, your doctor will provide you with complete instructions on how
to prepare for your knee CT scan.
In some cases, your doctor may use contrast dye. Contrast dye helps provide better
images by reacting with the imaging equipment. If you’ve had an allergic reaction
to similar dyes in the past, tell your doctor before the test. The most common dye
used contains iodine, so tell your doctor if you’re allergic to iodine.
If you’re receiving dye, your doctor may instruct you to avoid foods and liquids for
four to six hours before the CT scan.
You’ll also have to remove all your jewelry and change into a hospital gown
before the surgery. You’ll need to remove any braces or bandaging worn over
your affected knee.

How a Knee CT Scan Is Performed

If your doctor is using contrast dye for the scan, you’ll be given the dye
intravenously. This means that a nurse will inject the contrast dye into one of your
veins. You’ll typically need to wait an hour for the dye to work its way through your
body before the scan can begin.
The CT machine looks like a large doughnut made of metal and plastic that is
standing on its side. It has a sliding, moveable bench in its center. During the scan,
you’ll lie on the bench. The technician will move the bench in and out of the

17
machine using a remote control.
The technician may require you to lie in a specific position during the test. They may
use pillows or straps to ensure you stay in the correct position long enough to get a
quality image. You may also have to hold your breath briefly during specific scans.
Talk to your doctor beforehand if you think you’ll have trouble staying still.
After a round of scans, you may be required to wait for a short time while the
technician reviews the images to ensure they are clear enough for your doctor to
read them correctly.
A typical CT scan of the knee takes between 30 and 45 minutes to complete.

Injury prevention :
The following tips may help prevent common knee injuries:
Warm up by walking and stretching gently before and after playing sports.
Keep the leg muscles strong by using stairs, riding a stationary bicycle, or working
out with weights.
Avoid sudden changes in the intensity of exercise.
Replace worn out shoes. Choose ones that fit properly and provide good traction.
Maintain a healthy weight to avoid added pressure on the knees.
Always wear a seatbelt.
Use knee guards in sports where knees could get injured.
Maintaining strong, flexible leg muscles and seeking prompt medical attention for
all knee injuries is essential to assure accurate diagnosis and appropriate treatment
of the injury. Additionally, keeping the supporting leg muscles strong and practicing
injury prevention will help keep the knee healthy across the lifespan.
Injury of knee joint :
The following are some knee problems that can be diagnosed with a CT scan;
Arthritis
Fractured bone

18
Tumours
Infection
Pre operative knee replacement assessment for the purposes of obtaining a patient
specific implant (PSI)

Remedies to Prevent Knee Injuries:

Maintain a Healthy Weight: Extra weight stresses the knee joints, increasing injury
risk.
Regular Exercise: Strengthening the muscles around the knee helps support and
protect the joint.
Proper Technique: Learn and use correct techniques in sports or exercises to avoid
unnecessary strain on the knees.
Appropriate Footwear: Wear shoes that provide proper support and cushioning for
your activities.
Warm-Up and Stretch: Always warm up before exercising and stretch to improve
flexibility.
Avoid Overtraining: Give your knees adequate rest between workouts or high-
impact activities.

19
Conclusion :
A knee CT scan is a strong diagnostic tool that allows healthcare providers to
acquire a better knowledge of knee conditions as well as injuries without intrusive
treatments. Patients can obtain accurate diagnoses using innovative imaging
technologies, which leads to more effective treatment options and better outcomes.
People can more effectively regulate their health by being aware of the need for
CT scan of knee and being proactive in obtaining timely medical assistance. For
any further information on Knee CT Scans,

3D scan of knee joint

is an imaging scan to visualize the internal structure of the knee joint without an
incision in 3D reconstruction.

Why is it done?
Doctors recommend this scan to look:
To detect fracture in distal femur or proximal tibia
In case of knee implants
For preoperative planning
Osteoarthritis
Soft tissue tumor
In which case 3D CT Knee Joint not performed?
>>Pregnancy is a condition in which 3D CT Knee Joint is not performed.

20
What is The Preparation for 3D CT Knee Joint?
In this CT scan of the knee you have to remove metallic things from the region of
interest and no other special preparation is needed.

What is The Procedure for 3D CT Knee Joint?

You need to lie supine on the CT table feet first and scan is performed then the
image is reconstructed in 3D view.

Role of CT Scans for Knee :

CT scan is a non-invasive procedure that provides more detail than a general X-ray.
Through CT scan images the knee joint can be in three-dimension.
A knee CT scan is extremely helpful in modern medicine, particularly in orthopedics
and sports medicine. It offers unmatched knowledge and comprehension of the
internal knee joint components as well as the bones, arteries, tendons, ligaments,
and muscles. Healthcare practitioners can accurately diagnose a variety of knee
conditions and injuries with the aid of these detailed images of knee injuries, which
helps them create
Case examples:
1. Anterior cruciate ligament (ACL) tear
MRI of the knee demonstrates a full thickness tear of the anterior cruciate ligament
(ACL). The ligament is typically taught, unlike this case (arrows).
2. Meniscus injury
MRI of the knee confirms the presence of a large tear of the lateral meniscus
(arrow). Compare the appearance of the torn meniscus with the normal medial
meniscus (circled) which is triangular and hypointense (dark).
3. Use of CT to identify bone lesions
CT can be used to assess focal bone lesions, such as in this case where two
cortical desmoids (arrows) are noted. Cortical desmoids are an incidental finding
and require no further follow up

21
Reasons for Knee Joint CT Scan :
CT scan detects the following conditions:-
Keep an eye out for fractures that are hard to find with standard X-rays.
Evaluate the healing of fractures.
Examine degenerative alterations and look for loose bodies in joints.
Look for any unusual lumps, growths, or tumors.

Risks and Adverse Consequences of CT Scan :

An extremely low risk procedure is a knee arthrogram guided by CT. Learn about
the Side Effects and Risks of CT.
Additional dangers connected to this procedure consist of:
Bruising following the procedure, or pain or discomfort at the site of the needle
insertion.
There may occasionally be tingling or momentary numbness. Inflammation that, after
48 hours, may include redness, swelling, and increased pain. Notifying your
referring physician right away of any worsening pain or redness is necessary.
Shortly following the procedure, you might feel lightheaded or faint.
Unpredictable risks may be connected to any medical procedure.

22
Risk Factors for Knee Injuries:
Sports Participation: High-impact sports or activities increase the likelihood of knee
injuries.
Previous Injuries: Past knee injuries raise the risk of future ones.
Age: Aging can weaken the joint structures, making them more susceptible to
injuries.
Improper Footwear: Inadequate shoes can affect knee alignment and contribute to
injuries.
Muscle Imbalances: Weak or tight muscles around the knee can lead to instability
and injury.

Conclusion :
The interpretation of the cut scan highlights the need for targeted remedies to
prevent knee injuries. Through a combination of maintaining a healthy lifestyle,
proper exercise techniques, and being mindful of risk factors, the risk of knee injuries
can be significantly reduced, ensuring better joint health and mobility. Regular care
and attention to these factors play a pivotal role in safeguarding the knee joint’s
health and functionality.

Complications :
Potential complications include:
Infection, superficial and deep
Blood clot
Pulmonary embolism
Fracture
Dislocation
Instability
Osteolysis resulting in component loosening

23
Pain
Stiffness
Vascular injury
Nerve injury

Clinical Significance :
The number of patients suffering from knee pain secondary to osteoarthritis will
continue to rise, especially as the average life expectancy and obesity rates
increase. These 2 factors contribute to the wear and tear of articular cartilage in the
major weight-bearing joints seen in primary osteoarthritis.Patients can also suffer
from secondary osteoarthritis, or osteoarthritis caused by an abnormal
concentration of force across the joint such as in rheumatoid or post-traumatic cases.
In either case, a thorough history and physical and appropriate radiographs are
essential to the appropriate diagnosis. Initial treatment is conservative and includes
any and all combinations listed above. Once conservative treatment is no longer
effective, surgical intervention may be considered. TKA is a reliable surgical
procedure with a predictable outcome in the appropriate patient. Reported survival
rates are upward of 85% with 10 to 25 years of follow-up. Improvements in pain
scores and functional scores are commonly recognized with the procedure as well.

Enhancing Healthcare :
While knee arthroplasty is done by the orthopedic surgeon, to ensure good
outcomes an interprofessional team is required that includes a physical therapist,
nurses, an internist, and the primary care provider. After surgery, the patients require
physical therapy to regain muscle mass and joint function. In addition, for good
outcomes, the patients need to exercise and maintain a healthy weight. Nurses
should educate the patient on a healthy diet, avoidance of tobacco and taking part
in regular exercise.

24
Reference :
1.Davies PS, Graham SM, Maqungo S, Harrison WJ. Total joint replacement in
sub-Saharan Africa: a systematic review. Trop Doct. 2019 Apr;49(2):120-128.
[PMC free article] [PubMed]
2.Adie S, Harris I, Chuan A, Lewis P, Naylor JM. Selecting and optimising patients
for total knee arthroplasty. Med J Aust. 2019 Feb;210(3):135-141. [PubMed]
3.
Naziri Q, Mixa PJ, Murray DP, Abraham R, Zikria BA, Sastry A, Patel PD. Robotic-
Assisted and Computer-Navigated Unicompartmental Knee Arthroplasties: A
Systematic Review. Surg Technol Int. 2018 Jun 01;32:271-278. [PubMed]
4.
Stilling M, Mechlenburg I, Jepsen CF, Rømer L, Rahbek O, Søballe K, Madsen F.
Superior fixation and less periprosthetic stress-shielding of tibial components with a
finned stem versus an I-beam block stem: a randomized RSA and DXA study with
minimum 5 years’ follow-up. Acta Orthop. 2019 Apr;90(2):165-171. [PMC free
article] [PubMed]
5.
Wang Z, Cheng X, Zhang Y, Zhang X, Zhou Y. Restoration of Constitutional
Alignment in TKA with a Novel Osteotomy Technique. J Knee Surg. 2020
Feb;33(2):190-199. [PubMed]
6.
Minciullo L, Parkes MJ, Felson DT, Cootes TF. Comparing image analysis
approaches versus expert readers: the relation of knee radiograph features to knee
pain. Ann Rheum Dis. 2018 Nov;77(11):1606-1609. [PMC free article] [PubMed]
7.
Deng QF, Gu HY, Peng WY, Zhang Q, Huang ZD, Zhang C, Yu YX. Impact of
enhanced recovery after surgery on postoperative recovery after joint arthroplasty:
results from a systematic review and meta-analysis. Postgrad Med J. 2018
Dec;94(1118):678-693. [PubMed]

25
8.
Curtis GL, Chughtai M, Khlopas A, Newman JM, Sultan AA, Sodhi N, Barsoum
WK, Higuera CA, Mont MA. Perioperative Outcomes and Short-Term
Complications Following Total Knee Arthroplasty in Chronically, Immunosuppressed
Patients. Surg Technol Int. 2018 Jun 01;32:263-269. [PubMed]
9.
Law RJ, Nafees S, Hiscock J, Wynne C, Williams NH. A lifestyle management
programme focused on exercise, diet and physiotherapy support for patients with
hip or knee osteoarthritis and a body mass index over 35: A qualitative study.
Musculoskeletal Care. 2019 Mar;17(1):145-151. [PubMed]
10.
McMahon SE, Doran E, O’Brien S, Cassidy RS, Boldt JG, Beverland DE.
Seventeen to Twenty Years of Follow-Up of the Low Contact Stress Rotating-Platform
Total Knee Arthroplasty With a Cementless Tibia in All Cases. J Arthroplasty. 2019
Mar;34(3):508-512. [PubMed]
11.
Sartawi M, Zurakowski D, Rosenberg A. Implant Survivorship and Complication
Rates After Total Knee Arthroplasty With a Third-Generation Cemented System: 15-
Year Follow-Up. Am J Orthop (Belle Mead NJ). 2018 Mar;47(3) [PubMed]

26