3D Alignment Analysis Principles: An International Delphi Consensus Study

5 pages•Published: January 5, 2026

Abstract

Introduction 3D bone models are increasingly adopted for leg alignment analysis, but there is substantial variability in the methods and underlying principles used to derive axes and joint orientations from 3D bone models. Therefore, the purpose was to reach consensus on a structured framework for standardized 3D leg alignment analysis based on 3D bone models.
Methodology A Delphi study was performed in four rounds. Rounds 1 and 2 involved a steering and rating group that developed 31 statements based on principles preserving the complexity of 3D anatomical structures, identified through a systematic review. These statements encompassed deriving joint centres and joint orientations, and defining coordinate systems using 3D bone models. In Rounds 3 and 4, an international panel of experts, evaluated these statements. Consensus was defined as ≥80% agreement.
Results Of the 31 statements, 26 achieved consensus in Round 3. Five statements were refined and subsequently all achieved consensus in Round 4. Experts agreed on utilising all available relevant surface data to define joint centres, joint orientations, and individual femoral and tibial coordinate systems alongside a combined leg coordinate system, and adopting central 3D axes for femoral version and tibial torsion.
Conclusion This international Delphi consensus study provides a structured framework for a standardized 3D leg alignment analysis based on 3D bone models. By utilizing all relevant surface data, this framework provides a more accurate representation of joint geometries compared to traditional landmark-based methods. Future research should focus on validating the methods adhering to these principles in diverse clinical settings.

Keyphrases: alignment parameters, consensus, coordinate systems, joint orientation, knee

In: Joshua William Giles and Aziliz Guezou-Philippe (editors). Proceedings of The 25th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 8, pages 156-160.

Links:	https://easychair.org/publications/paper/sdBj
	https://doi.org/10.29007/pfdc

BibTeX entry

@inproceedings{CAOS2025:3D_Alignment_Analysis_Principles,
  author    = {Quinten Veerman and Gabriëlle Tuijthof and Nico Verdonschot and Reinoud W. Brouwer and Peter Verdonk and Annemieke van Haver and Hugo van der Veen and Peter Pijpker and Judith Olde Heuvel and Roy Hoogeslag and Ahmet Erdemir and Antoine Perrier and Bastian Sigrist and Bernardo Innocenti and Carl W. Imhauser and Claudio Belvedere and Gwendolyn Vuurberg and Harrie Weinans and Julian Fürmetz and Laura Carman and Leendert Blankevoort and Mark Taylor and Mathias Donnez and Matthias J. Feucht and Matthieu Ollivier and Michael T. Hirschmann and Min Jung and Oguzhan Tanoglu and Philipp Niemeyer and Raghbir Khakha and Roel Custers and Ronald van Heerwaarden and Ruurd Kuiper and Sandro Fucentese and Steven Claes and Thor Besier and Vicente J. León-Muñoz and Wolf Petersen and Wouter van Genechten and Yuanjun Teng},
  title     = {3D Alignment Analysis Principles: An International Delphi Consensus Study},
  booktitle = {Proceedings of The 25th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Joshua William Giles and Aziliz Guezou-Philippe},
  series    = {EPiC Series in Health Sciences},
  volume    = {8},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {/publications/paper/sdBj},
  doi       = {10.29007/pfdc},
  pages     = {156-160},
  year      = {2026}}

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