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Abstract
Prosthetic loosening has been debated for decades, both in terms of the timing and nature of the triggering events. Multiple radiostereometric studies of hip prostheses have now shown that early migration poses a risk of future clinical failure, but is this enough to explain late clinical loosening?To answer this question, the progression of loosening from initiation to radiographic detection is described; and the need for explanations other than early prosthetic loosening is analysed, such as stress-shielding, particle disease, and metal sensitivity.Much evidence indicates that prosthetic loosening has already been initiated during or shortly after the surgery, and that the subsequent progression of loosening is affected by biomechanical factors, fluid pressure fluctuations and inflammatory responses to necrotic cells and cell fragments, i.e. the concept of late loosening appears to be a misinterpretation of late-detected loosening.Clinical implications: atraumatic surgery and initial prosthetic stability are crucial in ensuring low risk of prosthetic loosening. Cite this article: EFORT Open Rev 2020;5:113-117. DOI: 10.1302/2058-5241.5.190014.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopaedics, Lund University, Lund, Sweden
- Bengt Mjöberg, Västra Vallgatan 29, SE-27135 Ystad, Sweden.
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52
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Brinke BT, Kosse NM, Flikweert PE, van der Pluijm M, Eygendaal D. Long-term outcomes after Instrumented Bone Preserving total elbow arthroplasty: a radiostereometric study with a minimum follow-up of 10 years. J Shoulder Elbow Surg 2020; 29:126-131. [PMID: 31564575 DOI: 10.1016/j.jse.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic loosening is a main concern in elbow arthroplasty. Evaluation of implant migration using radiostereometric analysis (RSA) might increase understanding of implant loosening. Previously, 2-year RSA results of 16 Instrumented Bone Preserving (IBP) elbow prostheses showed migration of the humeral component in the first weeks but most components stabilized within 6 months postoperatively. In follow-up, the present study evaluated long-term survival, the relation between early migration and survival, and the long-term migration and clinical outcomes. METHODS Sixteen patients who received an IBP prosthesis were prospectively followed with a median follow-up time of 136 months (range 82-165). Migration was measured using RSA. Clinical results were described using the Elbow Function Assessment (EFA), Broberg and Morrey elbow functional rating index, Oxford Elbow Score (OES), and visual analog scale (VAS) for pain and satisfaction. RESULTS Four patients underwent a revision within 10 years, and 2 more were planned for revision surgery after 14 years. Five patients died with their prosthesis in situ. Early migration was not associated with survival. Long-term migration patterns varied widely. Median EFA score was 58.5, Broberg and Morrey score was 50, and OES score was 32. Median VAS score for pain was 2 and that for satisfaction was 7.5. CONCLUSION Ten-year survival of the IBP total elbow prosthesis was 75%, decreasing to 63% after 14 years of follow-up. Long-term implant failure could not be predicted by 2-year migration results in this study. Although short-term clinical results were promising, long-term outcomes worsened in all patients.
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf, Delft, the Netherlands.
| | - Nienke M Kosse
- Sint Maartenskliniek Research, Nijmegen, the Netherlands
| | - Petra E Flikweert
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Marco van der Pluijm
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda, the Netherlands
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Eriksson T, Maguire GQ, Noz ME, Zeleznik MP, Olivecrona H, Shalabi A, Hänni M. Are low-dose CT scans a satisfactory substitute for stereoradiographs for migration studies? A preclinical test of low-dose CT scanning protocols and their application in a pilot patient. Acta Radiol 2019; 60:1643-1652. [PMID: 31042065 DOI: 10.1177/0284185119844166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Thomas Eriksson
- Department of Radiology, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden
| | - Gerald Q Maguire
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Kista, Sweden
| | - Marilyn E Noz
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Michael P Zeleznik
- School of Computing, College of Engineering, University of Utah, Salt Lake City, UT, USA
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Adel Shalabi
- Department of Radiology, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden
| | - Mari Hänni
- Department of Radiology, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden
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Sköldenberg OG, Rysinska AD, Chammout G, Salemyr M, Mukka SS, Bodén H, Eisler T. A randomized double-blind noninferiority trial, evaluating migration of a cemented vitamin E-stabilized highly crosslinked component compared with a standard polyethylene component in reverse hybrid total hip arthroplasty. Bone Joint J 2019; 101-B:1192-1198. [PMID: 31564144 DOI: 10.1302/0301-620x.101b10.bjj-2019-0456.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS Radiostereometric analysis (RSA) studies of vitamin E-doped, highly crosslinked polyethylene (VEPE) liners show low head penetration rates in cementless acetabular components. There is, however, currently no data on cemented VEPE acetabular components in total hip arthroplasty (THA). The aim of this study was to evaluate the safety of a new cemented VEPE component, compared with a conventional polyethylene (PE) component regarding migration, head penetration, and clinical results. PATIENTS AND METHODS We enrolled 42 patients (21 male, 21 female) with osteoarthritis and a mean age of 67 years (sd 5), in a double-blinded, noninferiority, randomized controlled trial. The subjects were randomized in a 1:1 ratio to receive a reverse hybrid THA with a cemented component of either argon-gas gamma-sterilized PE component (controls) or VEPE, with identical geometry. The primary endpoint was proximal implant migration of the component at two years postoperatively measured with RSA. Secondary endpoints included total migration of the component, penetration of the femoral head into the component, and patient-reported outcome measurements. RESULTS In total, 19 control implants and 18 implants in the VEPE group were analyzed for the primary endpoint. We found a continuous proximal migration of the component in the VEPE group that was significantly higher with a difference at two years of a mean 0.21 mm (95% confidence interval (CI) 0.05 to 0.37; p = 0.013). The total migration was also significantly higher in the VEPE group, but femoral head penetration was lower. We found no difference in clinical outcomes between the groups. CONCLUSION At two years, this cemented VEPE component, although having a low head penetration and excellent clinical results, failed to meet noninferiority compared with the conventional implant by a proximal migration above the proposed safety threshold of RSA. The early proximal migration pattern of the VEPE component is a reason for continued monitoring, although a specific threshold for proximal migration and risk for later failure cannot be defined and needs further study. Cite this article: Bone Joint J 2019;101-B:1192-1198.
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Affiliation(s)
- Olof G Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Agata D Rysinska
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Ghaz Chammout
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Mats Salemyr
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Sebastian S Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Henrik Bodén
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Thomas Eisler
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
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Gao X, Fraulob M, Haïat G. Biomechanical behaviours of the bone-implant interface: a review. J R Soc Interface 2019; 16:20190259. [PMID: 31362615 PMCID: PMC6685012 DOI: 10.1098/rsif.2019.0259] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023] Open
Abstract
In recent decades, cementless implants have been widely used in clinical practice to replace missing organs, to replace damaged or missing bone tissue or to restore joint functionality. However, there remain risks of failure which may have dramatic consequences. The success of an implant depends on its stability, which is determined by the biomechanical properties of the bone-implant interface (BII). The aim of this review article is to provide more insight on the current state of the art concerning the evolution of the biomechanical properties of the BII as a function of the implant's environment. The main characteristics of the BII and the determinants of implant stability are first introduced. Then, the different mechanical methods that have been employed to derive the macroscopic properties of the BII will be described. The experimental multi-modality approaches used to determine the microscopic biomechanical properties of periprosthetic newly formed bone tissue are also reviewed. Eventually, the influence of the implant's properties, in terms of both surface properties and biomaterials, is investigated. A better understanding of the phenomena occurring at the BII will lead to (i) medical devices that help surgeons to determine an implant's stability and (ii) an improvement in the quality of implants.
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Affiliation(s)
- Xing Gao
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
- Research Centre for Medical Robotics and Minimally Invasive Surgical Devices, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Manon Fraulob
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
| | - Guillaume Haïat
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
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Sporer S, MacLean L, Burger A, Moric M. Evaluation of a 3D-printed total knee arthroplasty using radiostereometric analysis. Bone Joint J 2019; 101-B:40-47. [DOI: 10.1302/0301-620x.101b7.bjj-2018-1466.r1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aims Our intention was to investigate if the highly porous biological fixation surfaces of a new 3D-printed total knee arthroplasty (TKA) achieved adequate fixation of the tibial and patellar components to the underlying bone. Patients and Methods A total of 29 patients undergoing primary TKA consented to participate in this prospective cohort study. All patients received a highly porous tibial baseplate and metal-backed patella. Patient-reported outcomes measures were recorded and implant migration was assessed using radiostereometric analysis. Results Patient function significantly improved by three months postoperatively (p < 0.001). Mean difference in maximum total point motion between 12 and 24 months was 0.021 mm (-0.265 to 0.572) for the tibial implant and 0.089 mm (-0.337 to 0.758) for the patellar implant. The rate of tibial and patellar migration was largest over the first six postoperative weeks, with no changes in mean tibia migration occurring after six months, and no changes in mean patellar migration occurring after six weeks. One patellar component showed a rapid rate of migration between 12 and 24 months. Conclusion Biological fixation appears to occur reliably on the highly porous implant surface of the tibial baseplate and metal-backed patellar component. Rapid migration after 12 months was measured for one patellar component. Further investigation is required to assess the long-term stability of the 3D-printed components and to determine if the high-migrating components achieve fixation. Cite this article: Bone Joint J 2019;101-B(7 Supple C):40–47
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Affiliation(s)
- S. Sporer
- Rush University Medical Centre, Chicago, Illinois, USA
| | | | - A. Burger
- Halifax Biomedical Inc., Mabou, Canada
| | - M. Moric
- Rush University Medical Centre, Department of Anesthesiology, Chicago, Illinois, USA
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57
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Jørgensen PB, Lamm M, Søballe K, Stilling M. Equivalent hip stem fixation by Hi-Fatigue G and Palacos R + G bone cement: a randomized radiostereometric controlled trial of 52 patients with 2 years' follow-up. Acta Orthop 2019; 90:237-242. [PMID: 30931663 PMCID: PMC6534245 DOI: 10.1080/17453674.2019.1595390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Long-term fixation of cemented femoral stems relies on several factors including cement adhesion and fatigue. Hi-Fatigue is a newer third-generation bone cement with low-viscosity properties at room temperature, good mechanical strength, and stable bone-cement interface in a laboratory testing environment. Palacos bone cement has excellent 10-year survival and is considered gold standard. We compared stem subsidence after fixation with Hi-Fatigue and Palacos bone cements using radiostereometry. Patients and methods - In a patient-blinded randomized controlled trial, 52 patients (30 women) at mean age 76 years (71-87) with osteoarthrosis and no osteoporosis received Hi-Fatigue G or Palacos R + G cement fixation of collarless, polished, double-tapered stems (CPT). Tantalum beads were inserted in the periprosthetic bone. Supine stereoradiographs were obtained postoperatively, 3 months, 6 months, 1 year, and 2 years after surgery. Oxford Hip Score (OHS) and VAS pain were recorded preoperatively and 1 and 2 years after surgery. Cement working times and properties were registered. Results - At 2 years, mean stem subsidence of 1.12 mm (95% CI 0.96-1.29) for Hi-Fatigue and 1.19 mm (CI 1.03-1.34) for Palacos was similar. Likewise, stem version was comparable between cement groups. Mean OHS and VAS pain were similar between cement groups. Cement working times were similar between cement groups, but the mean curing time was longer for Hi-Fatigue (13.7 min) than for Palacos (11.6 min). Interpretation - We found similar and generally low migration of CPT femoral stems inserted with Hi-Fatigue and Palacos bone cement until 2 years' follow-up, which indicates a good long-term survival of polished taper femoral stems inserted with both cement types.
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Affiliation(s)
- Peter B Jørgensen
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark,Correspondence:
| | - Martin Lamm
- Department of Orthopedic Surgery, Aarhus University Hospital;;
| | - Kjeld Søballe
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark
| | - Maiken Stilling
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark
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Laende EK, Astephen Wilson JL, Mills Flemming J, Valstar ER, Richardson CG, Dunbar MJ. Equivalent 2-year stabilization of uncemented tibial component migration despite higher early migration compared with cemented fixation: an RSA study on 360 total knee arthroplasties. Acta Orthop 2019; 90:172-178. [PMID: 30669909 PMCID: PMC6461081 DOI: 10.1080/17453674.2018.1562633] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Thresholds of implant migration for predicting long-term successful fixation of tibial components in total knee arthroplasty have not separated cemented and uncemented fixation. We compared implant migration of cemented and uncemented components at 1 year and as the change in migration from 1 to 2 years. Patients and methods - Implant migration of 360 tibial components measured using radiostereometric analysis was compared at 1 year and as the change in migration from 1 to 2 years in 222 cemented components (3 implant designs) and 138 uncemented components (5 implant designs). Results - 1-year maximum total point motion was lower for the cemented tibial components compared with the uncemented components (median = 0.31 mm [0.03-2.98] versus 0.63 mm [0.11-5.19] respectively, p < 0.001, mixed model). The change in migration from 1 to 2 years, however, was equivalent for cemented and uncemented components (mean [SD] 0.06 mm [0.19] and 0.07 mm [0.27] mm respectively, p = 0.6, mixed model). Interpretation - These findings suggest that current thresholds of acceptable migration at 1 year may be better optimized by considering cemented and uncemented tibial components separately as higher early migration of uncemented components was not associated with decreased stability from 1 to 2 years.
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Affiliation(s)
- Elise K Laende
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada;; ,Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;; ,Correspondence:
| | - Janie L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada;; ,Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada;;
| | - Joanna Mills Flemming
- Department of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada;;
| | - Edward R Valstar
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - C Glen Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;;
| | - Michael J Dunbar
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada;; ,Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada;;
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Campbell D, Callary S, Field J, Nilsson KG. All-polyethylene tibial components in young patients have stable fixation; a comparison RSA study. Knee 2019; 26:392-399. [PMID: 30638681 DOI: 10.1016/j.knee.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/04/2018] [Accepted: 12/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND All-polyethylene (AP) tibial components in patients aged greater than 60 years have stable tibial migration patterns and favorable survival rates when compared to identical Metal-backed (MB) designs. Tibial component migration in younger patients has not been reported. The aim of this study was to examine the migration characteristics of patients aged less than 60 years compared to a previous cohort of AP and MB tibial components of identical design in older patients. METHODS A prospective consecutive study examined tibial component migration in 21 patients aged less than 60 years undergoing a cemented total knee arthroplasty with an AP tibial component by radiostereometric analysis (RSA) to 24 months. Results were compared to the authors' previous series of 21 patients aged greater than 60 years that were randomized to either an AP or MB tibial component. RESULTS Both age groups of patients implanted with an AP component had stable migration patterns with no patient having greater than 0.2° rotation or 0.2 mm maximum total point motion. Five of 11 MB tibial components displayed continued migration between one and two years. Subsidence was similar in all groups, whilst maximum total point motion was greater for the MB cohort (0.34 mm, 0.33 mm, 0.61 mm; AP <60, AP >60, MB). CONCLUSIONS Young patients implanted with an AP tibial component had stable tibial migration patterns comparable to older patients with the same AP implant. Regardless of age, AP tibial components were at least as stable as MB tibial components. LEVEL OF EVIDENCE Level II, Prospective comparative study.
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Affiliation(s)
- David Campbell
- Wakefield Orthopaedic Clinic, 270 Wakefield Street, Adelaide, South Australia, Australia.
| | - Stuart Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia.
| | - John Field
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Kjell G Nilsson
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden.
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Belfrage O, Tägil M, Sundberg M, Kesteris U, Flivik G. Locally administered bisphosphonate in hip stem revisions using the bone impaction grafting technique: a randomised, placebo-controlled study with DXA and five-year RSA follow-up. Hip Int 2019; 29:26-34. [PMID: 29932001 DOI: 10.1177/1120700018781809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND: Bisphosphonates have previously been shown to increase the density of impacted graft bone. In the present study we hypothesise that bisphosphonates also reduce early stem subsidence. We examined the effect of locally applied bisphosphonate to allografts on prosthetic micromotion and bone density in femoral stem revision with impaction grafting. METHODS: 37 patients were randomised to either clodronate or saline as local adjunct to the morsellised allograft bone. 24 patients were finally analysed per protocol and evaluated by dual-energy x-ray absorptiometry (DXA) during the first year and with radiostereometric analysis (RSA) for 5 years. RESULTS: There were no significant differences neither in bone density, nor in migratory behaviour between the groups. The femoral stems had subsided 3.6 mm in both groups (p = 0.99) at 5 years and there was no difference as measured over time with mixed models analysis. The clinical outcome was good in both groups. CONCLUSION: Clodronate as a local addendum to allograft bone in hip revision did not increase bone density or reduce micromotion of the implant.
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Affiliation(s)
- Ola Belfrage
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Magnus Tägil
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Martin Sundberg
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Uldis Kesteris
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Gunnar Flivik
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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The reliability of radiostereometric analysis in determining physeal motion in slipped capital femoral epiphysis in standard uniplanar and low-dose EOS biplanar radiography: a phantom model study. J Pediatr Orthop B 2018; 27:496-502. [PMID: 29762188 DOI: 10.1097/bpb.0000000000000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Physeal closure after slipped capital femoral epiphysis fixation can be difficult to assess on two-dimensional conventional radiographs. Radiostereometric analysis offers improved motion detection over conventional radiography, whereas the EOS biplanar imager provides a means for low radiation weight-bearing images. This phantom study assessed the reliability of measuring motion using radiostereometric analysis in the EOS using a slipped capital femoral epiphysis model. The accuracy and precision were better than 0.09±0.05 mm and 0.20°±0.36° when centered in the imaging space, were within the limits of clinical significance, and were not different from a standard uniplanar radiostereometric system.
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Kurcz B, Lyons J, Sayeed Z, Anoushiravani AA, Iorio R. Osteolysis as it Pertains to Total Hip Arthroplasty. Orthop Clin North Am 2018; 49:419-435. [PMID: 30224004 DOI: 10.1016/j.ocl.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteolysis is a long-term complication of total hip arthroplasty (THA). As the projected number of THAs performed annually increases, osteolysis will likely continue to occur. However, because of advancements in prosthesis design, metallurgy, and enhanced bearing surfaces, fewer revision THAs will be linked to osteolysis and aseptic loosening. Despite these improvements, no preventative therapies are currently available for the management of osteolysis other than removing and replacing the source of bearing wear.
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Affiliation(s)
- Brian Kurcz
- Division of Orthopaedic Surgery, Southern Illinois University, 701 North 1st Street, Springfield, IL 62781, USA
| | - Joseph Lyons
- Department of Surgery, Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Zain Sayeed
- Department of Orthopaedic Surgery, Detroit Medical Center, 4201 Saint Antoine, Detroit, MI 48201, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA
| | - Richard Iorio
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA.
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Haversath M, Klebingat S, Jäger M. Abriebanalyse mit virtuellen CAD-basierten Röntgenaufnahmen in der Endoprothetik. DER ORTHOPADE 2018; 47:811-819. [DOI: 10.1007/s00132-018-3602-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hansen L, De Raedt S, Jørgensen PB, Mygind-Klavsen B, Kaptein B, Stilling M. Marker free model-based radiostereometric analysis for evaluation of hip joint kinematics: A validation study. Bone Joint Res 2018; 7:379-387. [PMID: 30034791 PMCID: PMC6035358 DOI: 10.1302/2046-3758.76.bjr-2017-0268.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives To validate the precision of digitally reconstructed radiograph (DRR) radiostereometric analysis (RSA) and the model-based method (MBM) RSA with respect to benchmark marker-based (MM) RSA for evaluation of kinematics in the native hip joint. Methods Seven human cadaveric hemipelves were CT scanned and bone models were segmented. Tantalum beads were placed in the pelvis and proximal femoral bone. RSA recordings of the hips were performed during flexion, adduction and internal rotation. Stereoradiographic recordings were all analyzed with DRR, MBM and MM. Migration results for the MBM and DRR with respect to MM were compared. Precision was assessed as systematic bias (mean difference) and random variation (Pitman’s test for equal variance). Results A total of 288 dynamic RSA images were analyzed. Systematic bias for DRR and MBM with respect to MM in translations (p < 0.018 mm) and rotations (p < 0.009°) were approximately 0. Pitman’s test showed lower random variation in all degrees of freedom for DRR compared with MBM (p < 0.001). Conclusion Systematic error was approximately 0 for both DRR or MBM. However, precision of DRR was statistically significantly better than MBM. Since DRR does not require marker insertion it can be used for investigation of preoperative hip kinematics in comparison with the postoperative results after joint preserving hip surgery. Cite this article: L. Hansen, S. De Raedt, P. B. Jørgensen, B. Mygind-Klavsen, B. Kaptein, M. Stilling. Marker free model-based radiostereometric analysis for evaluation of hip joint kinematics: A validation study. Bone Joint Res 2018;7:379–387. DOI: 10.1302/2046-3758.76.BJR-2017-0268.R1.
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Affiliation(s)
- L Hansen
- Department of Internal Medicine, Central Hospital of Holstebro, Holstebro, Denmark and Orthopaedic Research Unit, Aarhus University Hospital, Aarhus C, Denmark
| | - S De Raedt
- Nordisk Røntgen Teknik, Hasselager, Denmark and Orthopedic Research Unit, Aarhus University Hospital, Aarhus C, Denmark
| | - P B Jørgensen
- Orthopedic Research Unit, Aarhus University Hospital Aarhus C, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - B Mygind-Klavsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark
| | - B Kaptein
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M Stilling
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus C, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Puah KL, Yew AKS, Chou SM, Lie DTT. Comparison of a simplified skin pointer device compared with a skeletal marker for knee rotation laxity: A cadaveric study using a rotation-meter. World J Orthop 2018; 9:85-91. [PMID: 29984195 PMCID: PMC6033708 DOI: 10.5312/wjo.v9.i6.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/16/2018] [Accepted: 05/13/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the measurements of knee rotation laxity by non-invasive skin pointer with a knee rotation jig in cadaveric knees against a skeletally mounted marker.
METHODS Six pairs of cadaveric legs were mounted on a knee rotation jig. One Kirscher wire was driven into the tibial tubercle as a bone marker and a skin pointer was attached. Rotational forces of 3, 6 and 9 nm applied at 0°, 30°, 45°, 60° and 90° of knee flexion were analysed using the Pearson correlation coefficient and paired t-test.
RESULTS Total rotation recorded with the skin pointer significantly correlated with the bone marker at 3 nm at 0° (skin pointer 23.9 ± 26.0° vs bone marker 16.3 ± 17.3°, r = 0.92; P = 0.0), 30° (41.7 ± 15.5° vs 33.1 ± 14.7°, r = 0.63; P = 0.037), 45° (49.0 ± 17.0° vs 40.3 ± 11.2°, r = 0.81; P = 0.002), 60° (45.7 ± 17.5° vs 34.7 ± 9.5°, r = 0.86; P = 0.001) and 90° (29.2 ± 10.9° vs 21.2 ± 6.8°, r = 0.69; P = 0.019) of knee flexion and 6 nm at 0° (51.1 ± 37.7° vs 38.6 ± 30.1°, r = 0.90; P = 0.0), 30° (64.6 ± 21.6° vs 54.3 ± 15.1°, r = 0.73; P = 0.011), 45° (67.7 ± 20.6° vs 55.5 ± 9.5°, r = 0.65; P = 0.029), 60° (62.9 ± 22.4° vs 45.8 ± 13.1°, r = 0.65; P = 0.031) and 90° (43.6 ± 17.6° vs 31.0 ± 6.3°, r = 0.62; P = 0.043) of knee flexion and at 9 nm at 0° (69.7 ± 40.0° vs 55.6 ± 30.6°, r = 0.86; P = 0.001) and 60° (74.5 ± 27.6° vs 57.1 ± 11.5°, r = 0.77; P = 0.006). No statistically significant correlation with 9 nm at 30° (79.2 ± 25.1° vs 66.9 ± 15.4°, r = 0.59; P = 0.055), 45° (80.7 ± 24.7° vs 65.5 ± 11.2°, r = 0.51; P = 0.11) and 90° (54.7 ± 21.1° vs 39.4 ± 8.2°, r = 0.55; P = 0.079). We recognize that 9 nm of torque may be not tolerated in vivo due to pain. Knee rotation was at its maximum at 45° of knee flexion and increased with increasing torque.
CONCLUSION The skin pointer and knee rotation jig can be a reliable and simple means of quantifying knee rotational laxity with future clinical application.
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Affiliation(s)
- Ken Lee Puah
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore General Hospital, Singapore 169608, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore General Hospital, Singapore 169608, Singapore
| | - Siaw Meng Chou
- School of Mechanical and Aerospace Engineering, College of Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore General Hospital, Singapore 169608, Singapore
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Intensity-Based Nonoverlapping Area Registration Supporting "Drop-Outs" in Terms of Model-Based Radiostereometric Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:8538125. [PMID: 29854367 PMCID: PMC5960567 DOI: 10.1155/2018/8538125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 01/25/2023]
Abstract
A model-based radiostereometric analysis (MBRSA) is a method for precise measurement of prosthesis migration, which does not require marking the implant with tantalum beads. Instead, the prosthesis pose is typically recovered using a feature-based 2D-3D registration of its virtual model into a stereo pair of radiographs. In this study, we evaluate a novel intensity-based formulation of previously published nonoverlapping area (NOA) approach. The registration is capable of performing with both binary radiographic segmentations and nonsegmented X-ray images. In contrast with the feature-based version, it is capable of dealing with unreliable parts of prosthesis. As the straightforward formulation allows efficient acceleration using modern graphics adapters, it is possible to involve precise high-poly virtual models. Moreover, in case of binary segmentations, the nonoverlapping area is simply interpretable and useful for indicating the accuracy of the registration outcome. In silico and phantom evaluations were performed using a cementless Zweymüller femoral stem and its reverse engineered (RE) model. For initial pose estimates with difference from the ground-truth limited to ±4 mm and ±4°, respectively, the mean absolute translational error was not higher than 0.042 ± 0.035 mm. The error in rotation around the proximodistal axis was 0.181 ± 0.265°, and the error for the remaining axes was not higher than 0.035 ± 0.037°.
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67
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Vestergaard RF, Søballe K, Hasenkam JM, Stilling M. Sternal instability measured with radiostereometric analysis. A study of method feasibility, accuracy and precision. J Cardiothorac Surg 2018; 13:41. [PMID: 29776382 PMCID: PMC5960092 DOI: 10.1186/s13019-018-0735-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background A small, but unstable, saw-gap may hinder bone-bridging and induce development of painful sternal dehiscence. We propose the use of Radiostereometric Analysis (RSA) for evaluation of sternal instability and present a method validation. Methods Four bone analogs (phantoms) were sternotomized and tantalum beads were inserted in each half. The models were reunited with wire cerclage and placed in a radiolucent separation device. Stereoradiographs (n = 48) of the phantoms in 3 positions were recorded at 4 imposed separation points. The accuracy and precision was compared statistically and presented as translations along the 3 orthogonal axes. 7 sternotomized patients were evaluated for clinical RSA precision by double-examination stereoradiographs (n = 28). Results In the phantom study, we found no systematic error (p > 0.3) between the three phantom positions, and precision for evaluation of sternal separation was 0.02 mm. Phantom accuracy was mean 0.13 mm (SD 0.25). In the clinical study, we found a detection limit of 0.42 mm for sternal separation and of 2 mm for anterior-posterior dislocation of the sternal halves for the individual patient. Conclusion RSA is a precise and low-dose image modality feasible for clinical evaluation of sternal stability in research. Trial registration ClinicalTrials.gov Identifier: NCT02738437, retrospectively registered.
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Affiliation(s)
- Rikke Falsig Vestergaard
- Dept. of Cardio-Thoracic Surgery, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Dept. of Clinical Medicine, Aarhus University, Incuba/Skejby, Bygning 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Kjeld Søballe
- Dept. of Orthopedic Surgery, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.,Dept. of Clinical Medicine, Aarhus University, Incuba/Skejby, Bygning 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - John Michael Hasenkam
- Dept. of Clinical Medicine, Aarhus University, Incuba/Skejby, Bygning 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Dept. of Orthopedic Surgery, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.,Dept. of Clinical Medicine, Aarhus University, Incuba/Skejby, Bygning 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Newell R, Esfandiari H, Anglin C, Bernard R, Street J, Hodgson AJ. An intraoperative fluoroscopic method to accurately measure the post-implantation position of pedicle screws. Int J Comput Assist Radiol Surg 2018; 13:1257-1267. [PMID: 29633081 DOI: 10.1007/s11548-018-1732-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/07/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Pedicle screw malplacement, leading to neurological symptoms, vascular injury, and premature implant loosening, is not uncommon and difficult to reliably detect intraoperatively with current techniques. We propose a new intraoperative post-placement pedicle screw position assessment system that can therefore allow surgeons to correct breaches during the procedure. Our objectives were to assess the accuracy and robustness of this proposed screw location system and to compare its performance to that of 2D planar radiography. METHODS The proposed system uses two intraoperative X-ray shots acquired with a standard fluoroscopic C-arm and processed using 2D/3D registration methods to provide a 3D visualization of the vertebra and screw superimposed on one another. Point digitization and CT imaging of the residual screw tunnel were used to assess accuracy in five synthetic lumbar vertebral models (10 screws in total). Additionally, the accuracy was evaluated with and without correcting for image distortion and for various screw lengths, screw materials, breach directions, and vertebral levels. RESULTS The proposed method is capable of localizing the implanted screws with less than 2 mm of translational error (RMSE: 0.7 and 0.8 mm for the screw head and tip, respectively) and less than [Formula: see text] angular error (RMSE: [Formula: see text]), with minimal change to the errors if image distortion is not corrected. Breaches and their anatomical locations were all correctly visualized and identified for a variety of screw lengths, screw materials, breach locations, and vertebral levels, demonstrating the robustness of this approach. In contrast, one breach, one non-breach, and the anatomical location of three screws were misclassified with 2D X-ray. CONCLUSION We have demonstrated an accurate and low-radiation technique for localizing pedicle screws post-implantation that requires only two X-rays. This intraoperative feedback of screw location and direction may allow the surgeon to correct malplaced screws intraoperatively, thereby reducing postoperative complications and reoperation rates.
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Affiliation(s)
- Robyn Newell
- Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
| | - Hooman Esfandiari
- Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - Carolyn Anglin
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Department of Civil Engineering, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Renee Bernard
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
| | - John Street
- Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Blusson Spinal Cord Center, Floor 6-818 10 Ave W, Vancouver, BC, V5Z 1M9, Canada
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Antony J Hodgson
- Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada
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Muharemovic O, Troelsen A, Thomsen MG, Kallemose T, Gosvig KK. The effect of personalized versus standard patient protocols for radiostereometric analysis (RSA). Radiography (Lond) 2018; 24:e31-e36. [PMID: 29605122 DOI: 10.1016/j.radi.2017.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Increasing pressure in the clinic requires a more standardized approach to radiostereometric analysis (RSA) imaging. The aim of this study was to investigate whether implementation of personalized RSA patient protocols could increase image quality and decrease examination time and the number of exposure repetitions. METHODS Forty patients undergoing primary total hip arthroplasty were equally randomized to either a case or a control group. Radiographers in the case group were assisted by personalized patient protocols containing information about each patient's post-operative RSA imaging. Radiographers in the control group used a standard RSA protocol. RESULTS At three months, radiographers in the case group significantly reduced (p < 0.001) the number of exposures by 1.6, examination time with 19.2 min, and distance between centrum of prosthesis and centrum of calibration field with 34.1 mm when compared to post-operative (baseline) results. At twelve months, the case group significantly reduced (p < 0.001) number of exposures by two, examination time with 22.5 min, and centrum of prosthesis to centrum of calibration field distance with 43.1 mm when compared to baseline results. No significant improvements were found in the control group at any time point. CONCLUSION There is strong evidence that personalized RSA patient protocols have a positive effect on image quality and radiation dose savings. Implementation of personal patient protocols as a RSA standard will contribute to the reduction of examination time, thus ensuring a cost benefit for department and patient safety.
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Affiliation(s)
- O Muharemovic
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark. mailto:
| | - A Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - M G Thomsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - T Kallemose
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Clinical Research Center, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
| | - K K Gosvig
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
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Muharemovic O, Troelsen A, Thomsen MG, Kallemose T, Gosvig KK. A pilot study to determine the effect of radiographer training on radiostereometric analysis imaging technique. Radiography (Lond) 2018; 24:e37-e43. [PMID: 29605123 DOI: 10.1016/j.radi.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/21/2017] [Accepted: 12/02/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Producing x-ray images for radiostereometric analysis (RSA) is a demanding technique. Suboptimal examinations result in a high percentage of exposure repetition. The aim of this pilot study was to use an experiential training approach to sharpen the skills of radiographers in acquiring images of an optimal quality. METHODS A controlled trial using action research strategy was used. The study entailed a two phased approach. Radiographers were purposefully recruited and trained to perform the required investigations. Each phase included 12 examinations of a total knee arthroplasty phantom followed by 10 patient examinations. The quality of all x-ray images performed during the two phases was characterized by measuring the number of visible beads, the center position of the prosthesis (CP) compared to the center of calibration field (CCF). The number of re-exposures used to obtain a usable image during patient examinations was also recorded. RESULTS The radiographers undergoing the training resulted in a significant improvement in the quality of images produced and visualization of the beads. That is, the ability to move the CP on average 36.1 mm closer to the CCF (p < 0.001), the number of visible beads increased by 3.1 (p < 0.001) and radiographers needed 2.1-2.9 exposures less to obtain RSA images of sufficient qualities during patient examinations in phase 2 (p < 0.001). CONCLUSION This study illustrates the value of experiential method of teaching and learning with minimal compromise on patient safety but a significant contribution in terms of establishing quality of RSA images.
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Affiliation(s)
- O Muharemovic
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - A Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - M G Thomsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - T Kallemose
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Clinical Research Center, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - K K Gosvig
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
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Changes in cervical motion after cervical spinal motion preservation surgery. Acta Neurochir (Wien) 2018; 160:397-404. [PMID: 29101465 DOI: 10.1007/s00701-017-3375-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND For patients with single-level cervical radiculopathy, various types of motion preservation surgeries, such as total disc replacement (TDR), posterior cervical foraminotomy (PCF) and posterior percutaneous endoscopic foraminotomy and discectomy (PECF), are available. In addition to motion preservation, the quality of motion is an important issue. The aim of the present study was to evaluate the influence of these surgeries on cervical motion by comparing the instantaneous axis of rotation (IAR) among PECF, TDR and PCF at the index and superior/inferior adjacent segments. METHODS A retrospective review was performed of patients who underwent index surgery at C5-6 for cervical single-level foraminal disc herniation or foraminal stenosis. Patients with minimal degeneration at the index and other cervical spinal levels and flexion/extension cervical lateral radiographs both preoperatively and 6 months postoperatively were included (PECF, 11 patients; TDR, 11 patients; PCF, 12 patients). The IARs were calculated at the index segment and segments above and below the index segment from the flexion and extension cervical lateral radiographs, which were obtained preoperatively and 6 months postoperatively. A standardized cervical normogram was referenced to qualify shifts in the IAR. RESULTS Postoperatively, neck pain was significantly decreased, with no difference among the surgical methods. The IARs were not significantly changed after the PECF. Although significant inferior shift occurred at C6-7 after TDR (p = 0.02), the shift occurred within the normal range in the cervical normogram. However, significant inferior shifts in the IARs occurred after PCF at C5-6 (p = 0.02) and C6-7 (p = 0.02), and the IARs moved out of the normal range. CONCLUSIONS The IARs were significantly changed after PCF at either the index segment or the adjacent segment below. The shifts in IAR at the index and adjacent segments were not significant after PECF and TDR. The sample size was too small to allow definitive conclusions, but the present study showed that PECF may be another alternative to motion preservation surgeries.
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Impact Force, Polar Gap and Modal Parameters Predict Acetabular Cup Fixation: A Study on a Composite Bone. Ann Biomed Eng 2018; 46:590-604. [DOI: 10.1007/s10439-018-1980-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
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Conlisk N, Howie CR, Pankaj P. Quantification of interfacial motions following primary and revision total knee arthroplasty: A verification study versus experimental data. J Orthop Res 2018; 36:387-396. [PMID: 28708301 DOI: 10.1002/jor.23653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/11/2017] [Indexed: 02/04/2023]
Abstract
Motion at the bone-implant interface, following primary or revision knee arthroplasty, can be detrimental to the long-term survival of the implant. This study employs experimentally verified computational models of the distal femur to characterize the relative motion at the bone-implant interface for three different implant types; a posterior stabilizing implant (PS), a total stabilizing implant (TS) with short stem (12 mm × 50 mm), and a total stabilizing implant (TS) with long offset stem (19 mm × 150 mm with a 4 mm lateral offset). Relative motion was investigated for both cemented and uncemented interface conditions. Monitoring relative motion about a single reference point, though useful for discerning global differences between implant types, was found to not be representative of the true pattern and distribution of motions which occur at the interface. The contribution of elastic deformation to apparent reference point motion varied based on implant type, with the PS and TSSS implanted femurs experiencing larger deformations (43 and 39 μm, respectively) than the TSLS implanted femur (22 μm). Furthermore, the pattern of applied loading was observed to greatly influence location and magnitude of peak motions, as well as the surface area under increased motion. Interestingly, the influence was not uniform across all implant types, with motions at the interface of long stemmed prosthesis found to be less susceptible to changes in pattern of loading. These findings have important implications for the optimization and testing of orthopedic implants in vitro and in silico. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:387-396, 2018.
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Affiliation(s)
- Noel Conlisk
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, United Kingdom.,School of Engineering, The University of Edinburgh, Edinburgh, United Kingdom
| | - Colin R Howie
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, United Kingdom.,Department of Orthopaedics, New Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh, United Kingdom
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, Edinburgh, United Kingdom
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Sarnäs KV, Rune B, Aberg M. Maxillary and Mandibular Displacement in Hemifacial Microsomia: A Longitudinal Roentgen Stereometric Study of 21 Patients with the Aid of Metallic Implants. Cleft Palate Craniofac J 2017; 41:290-303. [PMID: 15151450 DOI: 10.1597/02-123.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To record maxillary and mandibular displacement with articular growth and in response to bimaxillary surgical repositioning in patients with hemifacial microsomia (HFM) and to observe ipsilateral corpus/ramus growth in severely affected children. Design Prospective roentgen stereometric analysis (mean age 7 years 10 months to 18 years 0 months) and retrospective profile and panoramic roentgenograms. Mean total observation period was 9 years 1 month. Setting Department of Plastic and Reconstructive Surgery, Malmö University Hospital (Malmö, Sweden). Patients Twenty-one patients consecutively diagnosed from 1976 through 1988 with HMF, five of whom had bimaxillary surgery. Interventions Surgery was performed at the Department of Plastic and Reconstructive Surgery. Implants were inserted at the initial reconstructive surgical procedure under general anesthesia. Roentgen examinations were performed in connection with continued clinical evaluations and treatment. Main Outcome Measures Stereo roentgenograms were digitized at the Department of Orthopedic Surgery, Malmö University Hospital (Malmö, Sweden). Results Displacement of the jaws with articular growth and in response to bimaxillary surgical repositioning varied interindividually with no apparent common pattern. Relapse displacement occurred several years after bimaxillary surgery. Mandibular growth changes were found in the corpus/ramus area and alveolar process on the affected side. Conclusions A marked interindividual variability of maxillary and mandibular displacement indicates that the relevance of statistical analysis of HFM growth data may be questioned. We would suggest that precise and accurate longitudinal recordings of growth and response to surgery in individual HFM patients be more appropriate.
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Affiliation(s)
- Karl-Victor Sarnäs
- Center for Craniofacial Anomalies, Malmö University Hospital, Malmö, Sweden
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Abstract
STUDY DESIGN Systematic review of literature. OBJECTIVES This systematic review was conducted to investigate the accuracy of radiostereometric analysis (RSA), its assessment of spinal motion and disorders, and to investigate the limitations of this technique in spine assessment. METHODS Systematic review in all current literature to invesigate the role of RSA in spine. RESULTS The results of this review concluded that RSA is a very powerful tool to detect small changes between 2 rigid bodies such as a vertebral segment. The technique is described for animal and human studies for cervical and lumbar spine and can be used to analyze range of motion, inducible displacement, and fusion of segments. However, there are a few disadvantages with the technique; RSA percutaneous procedure needs to be performed to implant the markers (and cannot be used preoperatively), one needs a specific knowledge to handle data and interpret the results, and is relatively time consuming and expensive. CONCLUSIONS RSA should be looked at as a very powerful research instrument and there are many questions suitable for RSA studies.
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Affiliation(s)
- Ali Humadi
- The Alfred Hospital, Melbourne, Victoria, Australia,Ali Humadi, Department of Orthopaedics and Trauma, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Sulaf Dawood
- The Alfred Hospital, Melbourne, Victoria, Australia,Ali Humadi, Department of Orthopaedics and Trauma, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Klas Halldin
- Sahlgrenska University Hospital, Gothenburg, Sweden,Ali Humadi, Department of Orthopaedics and Trauma, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Brian Freeman
- Royal Adelaide Hospital, Adelaide, SA, Australia,Ali Humadi, Department of Orthopaedics and Trauma, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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Restriction of Cervical Intervertebral Movement With Different Types of External Immobilizers: A Cadaveric 3D Analysis Study. Spine (Phila Pa 1976) 2017; 42:E1182-E1189. [PMID: 28230622 DOI: 10.1097/brs.0000000000002107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cadaveric radiostereometric analysis study. OBJECTIVE To quantify the ability of five commonly used immobilizers to restrict cervical spine movement, including intervertebral movement, in three directions. SUMMARY OF BACKGROUND DATA Evidence about the ability of many clinically used cervical immobilizers to restrict cervical movement is limited. Furthermore, their effect on intervertebral movement is unknown. METHODS Radiographic inert beads were implanted in the cervical vertebral bodies of five fresh-frozen human cadavers. After application of different immobilizers (Stifneck, Sternal Occipital Mandibular Immobilizer (SOMI), halo-traction, spineboard, halo-vest) and controlled flexion-extension, lateral bending, and rotation torques, radiostereometric analysis was used to determine the overall and intervertebral three-dimensional movement of each vertebral level. Restriction of cervical movement was described as a mean restriction percentage (MRP) and classified on an arbitrary basis (poor: <20%, fair: 20%-40%, moderate: 40%-60%, substantial: 60%-80%, nearly complete: >80%). RESULTS Most of the restriction of flexion/extension was observed at C0-C1, while most rotational restriction was seen at C1-C2. Lateral bending was restricted at C1 to C7.The Stifneck provided the least immobilization with a moderate restriction of flexion-extension (MRP: 41%, SD: 14%), fair restriction of lateral bending (MRP: 29%, SD: 13%), and substantial restriction of rotation (MRP: 64%, SD: 15%). The halo-vest was the most restrictive immobilizer and reduced movement of the cervical spine substantially for flexion-extension (MRP: 70%, SD: 11%), substantially for lateral bending (MRP: 77%, SD: 14%), and nearly complete for rotation (MRP: 92%, SD: 3%). CONCLUSION The restriction of movement from lowest to highest was: Stifneck, SOMI, halo-traction, head blocks on a spine board, and halo-vest. Notably, the standard deviations of the restrictions were smaller for the cranio-thoracic devices than for the cervico thoracic devices. With this new knowledge of external immobilizers and their ability to restrict intervertebral cervical movement, their indication and application in clinical practice can be improved for all patients with (suspected) cervical injury. LEVEL OF EVIDENCE N/A.
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Conlisk N, Howie CR, Pankaj P. Computational modelling of motion at the bone-implant interface after total knee arthroplasty: The role of implant design and surgical fit. Knee 2017; 24:994-1005. [PMID: 28778499 DOI: 10.1016/j.knee.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 05/12/2017] [Accepted: 07/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aseptic loosening, osteolysis, and infection are the most commonly reported reasons for revision total knee arthroplasty (TKA). This study examined the role of implant design features (e.g. condylar box, pegs) and stems in resisting loosening, and also explored the sensitivity of the implants to a loose surgical fit due to saw blade oscillation. METHODS Finite element models of the distal femur implanted with four different implant types: cruciate retaining (CR), posterior stabilising (PS), total stabilising (TS) with short stem (12mm×50mm), and a total stabilising (TS) with long stem (19mm×150mm) were developed and analysed in this study. Two different fit conditions were considered: a normal fit, where the resections on the bone exactly match the internal profile of the implant, and a loose fit due to saw blade oscillation, characterised by removal of one millimetre of bone from the anterior and posterior surfaces of the distal femur. Frictional interfaces were employed at the bone-implant interfaces to allow relative motions to be recorded. RESULTS The results showed that interface motions increased with increasing flexion angle and loose fit. Implant design features were found to greatly influence the surface area under increased motion, while only slightly influencing the values of peak motion. Short uncemented stems behaved similarly to PS implants, while long canal filling stems exhibited the least amount of motion at the interface under any fit condition. CONCLUSION In conclusion, long stemmed prostheses appeared less susceptible to surgical cut errors than short stemmed and stemless implants.
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Affiliation(s)
- Noel Conlisk
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; School of Engineering, The University of Edinburgh, Edinburgh, UK.
| | - Colin R Howie
- School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK; Department of Orthopaedics, New Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh, UK
| | - Pankaj Pankaj
- School of Engineering, The University of Edinburgh, Edinburgh, UK
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Schotanus MGM, Pilot P, Kaptein BL, Draijer WF, Tilman PBJ, Vos R, Kort NP. No difference in terms of radiostereometric analysis between fixed- and mobile-bearing total knee arthroplasty: a randomized, single-blind, controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2978-2985. [PMID: 27120194 DOI: 10.1007/s00167-016-4138-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/14/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE A concern that arises with any new prosthesis is whether it will achieve satisfactory long-term implant stability. The gold standard of assessing the quality of fixation in a new or relatively new implant is to undertake a randomized controlled trial using radiostereometric analysis. It was hypothesized that both mobile-bearing total knee arthroplasty and fixed-bearing total knee arthroplasty have comparable migration patterns at 2-year follow-up. This study investigated two types of cemented total knee arthroplasty, the mobile- or fixed-bearing variant from the same family with use of radiostereometric analysis. METHODS This prospective, patient-blinded, randomized, controlled trial was designed to investigate early migration of the tibia component after two years of follow-up with use of radiostereometric analysis. A total of 50 patients were randomized to receive a mobile- or fixed-bearing TKA from the same family. Patients were evaluated during 2-year follow-up, including radiostereometric analysis, physical and clinical examination and patient reported outcome measures (PROMs). RESULTS At two-year follow-up, the mean (±SD) maximum total point motion (MTPM) in the fixed-bearing group was 0.82 (±1.16) versus 0.92 mm (±0.64) in the mobile-bearing group (p = n.s) with the largest migration seen during the first 6 weeks (0.45 ± 0.32 vs. 0.54 ± 0.30). The clinical outcome and PROMs significantly improved within each group, not between both groups. CONCLUSIONS Measuring early micromotion is useful for predicting clinical loosening that can lead to revision. The results of this study demonstrate that early migration of the mobile-bearing is similar to that of the fixed-bearing component at two years and was mainly seen in the first weeks after implantation. LEVEL OF EVIDENCE Randomized, single-blind, controlled trial, Level I.
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Affiliation(s)
- M G M Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
| | - P Pilot
- Department of Orthopaedic Surgery, Reinier de Graafweg Hospital, Delft, The Netherlands
| | - B L Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W F Draijer
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - P B J Tilman
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - R Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N P Kort
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
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Mid-term migration of a cementless, porous acetabular cup: A 5 year Radiostereometric analysis. J Orthop 2017; 14:454-460. [PMID: 28819343 DOI: 10.1016/j.jor.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of the study was to determine the 5 year migratory and wear patterns, adverse events and clinical outcomes of a cementless, porous acetabular cup. METHODS RSA imaging of a cohort of 11 patients was retrospective analysed at 5 years post Total Hip Arthroplasty (THA). Changes in pain, function and symptoms of the hip at 5 years post-THA were compared to preoperative and 2 year postoperative assessments on the Harris Hip Score (HHS) and Hip dysfunction and Osteoarthritis Outcome Score (HOOS). RESULTS The majority of cup migration occurred up to 6 months and stabilised thereafter (6 months to 5 years, p = 0.091-0.866, Wilcoxon Signed Rank test). The direction of rotation around the 3 axes was evenly distributed among the cups between anterior-posterior rotation, internal-external rotation and increased-decreased inclination. The majority of the cups translated proximally, at an average migration of 0.36 mm (±95%CI 0.17) at 5-years post-THA. Following initial bedding in, up to 6 months, there was no detectable polyethylene wear between 6 months and 5 years. At 5 years postoperatively, a statistically significant difference was observed across all HOOS subscales in comparison to preoperative values, with higher means reported at 5 years (p < 0.001). The total mean HHS displayed a statistically significant improvement, increasing from 'poor' preoperatively to 'good' at 5 years post-THA. CONCLUSION Following initial migration between discharge and 6 months, the cementless porous acetabular cup demonstrated a tendency for stabilisation from 6 months up to 5 years post-THA, suggesting good mid-term fixation. Additionally, improvements in clinical outcome measures of pain, function and quality-of-life remained high following THA at 5 years post-surgery.
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80
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Barré A, Aminian K. Error performances of a model-based biplane fluoroscopic system for tracking knee prosthesis during treadmill gait task. Med Biol Eng Comput 2017; 56:307-316. [PMID: 28726074 DOI: 10.1007/s11517-017-1680-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 07/03/2017] [Indexed: 11/25/2022]
Abstract
Roentgen stereophotogrammetry analysis technique allows an accurate measurement of knee joint prosthesis position and orientation using two X-ray images. Although this technique is used generally during static procedure, it is possible to use it with a biplane fluoroscopic system to measure the prosthesis kinematics during functional tasks (e.g., gait, squat, jump) performed in a laboratory environment. However, the performance of the system in terms of errors for the measurements and the model-based matching algorithm are not well known for dynamic tasks such as walking. The goal of this study was to estimate the static and dynamic errors of a model-based biplane fluoroscopic system for a treadmill gait task and analyze the error performance according to the speed and location of the knee joint prosthesis relative to X-ray sources. The results show a static maximum error (RMSE) of 0.13° for orientation and 0.06 mm for position for prosthesis components. The dynamic errors were different for each axis of the acquisition system and each prosthesis component. The largest dynamic error was along the vertical axis for the position (RMSE = 2.42 mm) and along the medio-lateral axis (perpendicular to movement) for the orientation (RMSE = 0.95°). As expected, the error depends on the distance between the prosthesis and the source in the acquisition system as well as the linear and angular velocity of the movement. The most accurate dynamic measure was around the centroid of the acquisition system, while kinematics measurements close to the X-rays detectors gave the worst errors.
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Affiliation(s)
- Arnaud Barré
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Federale de Lausanne, Station 9, 1015, Lausanne, Switzerland
- Digital Imagery Research and Development Center (CDRIN), 608, Avenue Saint-Rédempteur, Matane, QC, G4W 0E1, Canada
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Federale de Lausanne, Station 9, 1015, Lausanne, Switzerland.
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81
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Zügner R, Tranberg R, Lisovskaja V, Shareghi B, Kärrholm J. Validation of gait analysis with dynamic radiostereometric analysis (RSA) in patients operated with total hip arthroplasty. J Orthop Res 2017; 35:1515-1522. [PMID: 27591554 DOI: 10.1002/jor.23415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/19/2016] [Indexed: 02/04/2023]
Abstract
We simultaneously examined 14 patients with OTS and dynamic radiostereometric analysis (RSA) to evaluate the accuracy of both skin- and a cluster-marker models. The mean differences between the OTS and RSA system in hip flexion, abduction, and rotation varied up to 9.5° for the skin-marker and up to 11.3° for the cluster-marker models, respectively. Both models tended to underestimate the amount of flexion and abduction, but a significant systematic difference between the marker and RSA evaluations could only be established for recordings of hip abduction using cluster markers (p = 0.04). The intra-class correlation coefficient (ICC) was 0.7 or higher during flexion for both models and during abduction using skin markers, but decreased to 0.5-0.6 when abduction motion was studied with cluster markers. During active hip rotation, the two marker models tended to deviate from the RSA recordings in different ways with poor correlations at the end of the motion (ICC ≤0.4). During active hip motions soft tissue displacements occasionally induced considerable differences when compared to skeletal motions. The best correlation between RSA recordings and the skin- and cluster-marker model was found for studies of hip flexion and abduction with the skin-marker model. Studies of hip abduction with use of cluster markers were associated with a constant underestimation of the motion. Recordings of skeletal motions with use of skin or cluster markers during hip rotation were associated with high mean errors amounting up to about 10° at certain positions. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1515-1522, 2017.
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Affiliation(s)
- Roland Zügner
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University, SE 413 45, Göteborg, Sweden
| | - Roy Tranberg
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University, SE 413 45, Göteborg, Sweden
| | - Vera Lisovskaja
- Department of Economics, Institute of Communication in Statistics, University of Gothenburg, Gothenburg, Sweden
| | - Bita Shareghi
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University, SE 413 45, Göteborg, Sweden
| | - Johan Kärrholm
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University, SE 413 45, Göteborg, Sweden
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Stentz-Olesen K, Nielsen ET, De Raedt S, Jørgensen PB, Sørensen OG, Kaptein BL, Andersen MS, Stilling M. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017; 6:376-384. [PMID: 28600383 PMCID: PMC5492337 DOI: 10.1302/2046-3758.66.bjr-2016-0113.r3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/13/2017] [Indexed: 11/05/2022] Open
Abstract
Objectives Static radiostereometric analysis (RSA) using implanted markers is considered the most accurate system for the evaluation of prosthesis migration. By using CT bone models instead of markers, combined with a dynamic RSA system, a non-invasive measurement of joint movement is enabled. This method is more accurate than current 3D skin marker-based tracking systems. The purpose of this study was to evaluate the accuracy of the CT model method for measuring knee joint kinematics in static and dynamic RSA using the marker method as the benchmark. Methods Bone models were created from CT scans, and tantalum beads were implanted into the tibia and femur of eight human cadaver knees. Each specimen was secured in a fixture, static and dynamic stereoradiographs were recorded, and the bone models and marker models were fitted to the stereoradiographs. Results Results showed a mean difference between the two methods in all six degrees of freedom for static RSA to be within -0.10 mm/° and 0.08 mm/° with a 95% limit of agreement (LoA) ranging from ± 0.49 to 1.26. Dynamic RSA had a slightly larger range in mean difference of -0.23 mm/° to 0.16 mm/° with LoA ranging from ± 0.75 to 1.50. Conclusions In a laboratory-controlled setting, the CT model method combined with dynamic RSA may be an alternative to previous marker-based methods for kinematic analyses. Cite this article: K. Stentz-Olesen, E. T. Nielsen, S. De Raedt, P. B. Jørgensen, O. G. Sørensen, B. L. Kaptein, M. S. Andersen, M. Stilling. Validation of static and dynamic radiostereometric analysis of the knee joint using bone models from CT data. Bone Joint Res 2017;6:376–384. DOI: 10.1302/2046-3758.66.BJR-2016-0113.R3.
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Affiliation(s)
- K Stentz-Olesen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - E T Nielsen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - S De Raedt
- Nordisk Røntgen Teknik, Birkegårdsvej 16, 8361 Hesselager, Denmark
| | - P B Jørgensen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 9A, 8000 Aarhus C, Denmark
| | - O G Sørensen
- Orthopaedic Research Group, Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10A, Office 15, 8000 Aarhus C, Denmark
| | - B L Kaptein
- Biomechanics and Imaging Group, Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherland
| | - M S Andersen
- Department of Mechanical Engineering and Manufacturing, Aalborg University, Fibigerstræde 16, 9220 Aalborg East, Denmark
| | - M Stilling
- Orthopaedic Research Group, Departments of Orthopaedic Surgery and Clinical Medicine, Aarhus University Hospital, University of Aarhus, Tage-Hansens Gade 2, Building 10A, 8000 Aarhus C, Denmark
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83
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Goyal P, Howard JL, Yuan X, Teeter MG, Lanting BA. Effect of Acetabular Position on Polyethylene Liner Wear Measured Using Simultaneous Biplanar Acquisition. J Arthroplasty 2017; 32:1670-1674. [PMID: 28087161 DOI: 10.1016/j.arth.2016.11.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 11/10/2016] [Accepted: 11/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies that have previously examined the relationship between acetabular component inclination angle and polyethylene wear have shown increased wear of conventional polyethylene with high inclination angles. To date, there are no long-term in vivo studies examining the correlation between cup position and polyethylene wear with highly crosslinked polyethylene. METHODS An institutional arthroplasty database was used to identify patients who had metal-on-highly crosslinked polyethylene primary total hip arthroplasty using the same component design with a minimum follow-up of 10 years. A modified radiostereometric analysis examination setup was utilized, recreating standard anteroposterior and cross-table lateral examinations in a single stereo radiostereometric analysis acquisition. The same radiographs were used to measure inclination angle and anteversion. RESULTS A total of 43 hips were included for analysis in this study. Average follow-up was 12.3 ± 1.2 years. The average linear wear rate was calculated to be 0.066 ± 0.066 mm/y. Inclination angle was not correlated with polyethylene wear rate (P = .82). Anteversion was also not correlated with polyethylene wear rate (P = .11). CONCLUSION At long-term follow-up of >10 years, highly crosslinked polyethylene has a very low wear rate. This excellent tribology is independent of acetabular position. The low wear rate highlights the excellent results of metal on highly crosslinked polyethylene, and supports its use in total hip arthroplasty.
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Affiliation(s)
- Prateek Goyal
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Xunhua Yuan
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Matthew G Teeter
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Shareghi B, Johanson PE, Kärrholm J. Clinical evaluation of model-based radiostereometric analysis to measure femoral head penetration and cup migration in four different cup designs. J Orthop Res 2017; 35:760-767. [PMID: 26825861 DOI: 10.1002/jor.23177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/15/2016] [Indexed: 02/04/2023]
Abstract
In conventional Radiostereometric analysis (RSA) implants with attached tantalum markers are frequently used, which may be difficult to visualize. This problem can be avoided with model-based RSA (MBRSA), but it is uncertain if this method has the same precision as marker-based RSA. We evaluated the influence of cup design for the precision of MBRSA in four uncemented cups to study if the design had any influence on the precision. Stereo radiographs were analyzed postoperatively (double-examinations) and after 2 years (single examinations). The difference between the double-examinations was used to compute the precision for the methods and for each type of implant. Femoral head penetration and cup translation up to 2 years were compared using marker-based RSA as reference. The precision of proximal penetration and migration measurements did not differ between the methods for Trilogy, TMT and ABG. For Ringloc design a poorer precision was observed using MBRSA. Comparison between the methods regarding proximal penetration and cup migration at 2 years did not differ for three of the designs (p = 0.12-0.91). However, for the group with porous plasma sprayed surface (Ringloc) a significant difference between the methods was observed (ppenetration <0.01 and pmigration <0.01). Poorer precision, different penetration and migration values at 2 years for one of the designs indicate that the resolution of MBRSA might vary depending on surface coating and implant geometry. Therefore, we conclude that the resolution of MBRSA has to be studied for each type of basic cup design. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:760-767, 2017.
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Affiliation(s)
- Bita Shareghi
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Erik Johanson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Stentz-Olesen K, Nielsen ET, de Raedt S, Jørgensen PB, Sørensen OG, Kaptein B, Søballe K, Stilling M. Reconstructing the anterolateral ligament does not decrease rotational knee laxity in ACL-reconstructed knees. Knee Surg Sports Traumatol Arthrosc 2017; 25:1125-1131. [PMID: 28314889 DOI: 10.1007/s00167-017-4500-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 02/27/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE Little is known about the anterolateral ligament's (ALL) influence on knee laxity. The purpose of this study was to investigate rotational knee laxity against a pure axial rotational stress using radiostereometric analysis (RSA) after cutting and reconstructing both the anterior cruciate ligament (ACL) and the ALL. METHODS Eight human donor legs were positioned and stereoradiographically recorded at 0°, 30° and 60° of knee flexion using a motorised fixture, while an internally rotating force of 4 Nm was applied to the foot. Anterior-posterior and rotational laxity were investigated for knees with intact ligaments and compared with those observed after successive ACL and ALL resection and reconstruction. RESULTS After cutting the ALL in ACL-deficient knees, the internal rotation was increased in all three knee flexion angles, 0° (p = 0.04), 30° (p = 0.03) and 60° (p < 0.01) by 1.0°, 1.6° and 2.5°, respectively. However, no decrease in laxity was found after reconstructing the ALL in ACL-reconstructed knees. CONCLUSIONS The ALL was confirmed as a stabiliser of internal rotation in ACL-deficient knees. However, reconstructing the ALL using a gracilis autograft tendon did not decrease the internal rotation laxity in the ACL-reconstructed knee. Based on the results of this study, we do not recommend reconstructing the ALL in ACL-reconstructed knees to decrease internal knee laxity.
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Affiliation(s)
- Kasper Stentz-Olesen
- Orthopedic Research Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.
| | - Emil Toft Nielsen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark
| | - Sepp de Raedt
- Orthopedic Research Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark
- Nordisk Røntgen Teknik, Birkegaardsvej 16, 8361, Hasselager, Denmark
| | - Peter Bo Jørgensen
- Orthopedic Research Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Ole Gade Sørensen
- Orthopedic Research Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Bart Kaptein
- Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, The Netherlands
| | - Kjeld Søballe
- Orthopedic Research Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Maiken Stilling
- Orthopedic Research Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus C, Denmark
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Steady state acetabular cartilage wear after bipolar hemiarthroplasty: a case series of 10 patients with radiostereometric analysis. Hip Int 2017; 27:193-197. [PMID: 27911454 DOI: 10.5301/hipint.5000437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Cartilage wear is a concern after hemiarthroplasty. The precise pattern of the progression of wear has not been evaluated. We previously reported the application of radiostereonetric analysis (RSA) for the measurement of cartilage wear in patients. The purpose of this study was to report the amount and the orientation of the steady state wear of cartilage between 1 and 3 years after bipolar hemiarthroplasty. METHODS 22 patients with a bipolar hemiarthroplasty for displaced femoral neck fracture were included. 10 patients completed the mean follow up of 37 months. The cartilage wear was evaluated by calculating the migration of the bipolar head in reference to the markers in the acetabulum using RSA. RESULTS The mean age of the patients at the final follow-up was 80 (range 67-91) years. The 3-D migration was -0.02 mm (SD 0.30) between 1 and 3 years. The migration in each direction was 0.03 mm (SD 0.49) in medial, 0.03 mm (SD 0.14) in proximal and 0.11 mm (SD 0.29) in posterior directions. 2 patients showed migration of more than 0.2 mm. The large initial migration seen in some patients up to 1 year did not progress further. Total wear after 37 months was 0.43 mm (SD 0.17). CONCLUSIONS Cartilage wear progressed slowly in 2 of 10 patients from 1 to 3 years. No pelvic penetration was seen. We believe that RSA will give a basic knowledge about the development and the progression of cartilage wear after hemiarthroplasty.
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Validity of rotational laxity coupled with anterior translation of the knee: A cadaveric study comparing radiostereometry and the Rotab®. Knee 2017; 24:289-294. [PMID: 28139332 DOI: 10.1016/j.knee.2017.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In current practice, anterior cruciate ligament (ACL) tears can be diagnosed using several devices to measure anterior tibial translation and rotational knee laxity, but these measures are never collected together. The Rotab®, which yields simultaneous measurements of anterior tibial translation and passive lower limb rotation under stress, would therefore be advantageous in current practice, but its reliability has never been tested. AIM OF STUDY To evaluate the accuracy and reliability of the Rotab® compared to the reference system, radiostereometric analysis (RSA). METHODS This anatomical study was conducted on 14 lower limbs collected from fresh cadavers. Simultaneous measurements of anterior tibial translation and rotation were obtained with both systems, with antero-posterior (AP) forces of 134N and 250N using the Rotab®. Measurements were made on intact ACL and then repeated after ACL section. Variables were analyzed in univariate analysis by ANOVA, and the intraclass correlation coefficient (ICC) between the systems was determined by the Bland and Altman method. RESULTS The difference between the two methods for evaluating anterior tibial translation was 0.05±0.98mm at 134N and 0.29±1.04mm at 250N. The correlation between the tests was high (r134=r250=0.97, p=0.8). The difference between the two methods for rotational laxity was 0.69±2.7° at 134N and 0.5±0.6° at 250N. The Rotab® showed a significant difference only at 250N for rotational laxity after the ACL tear. CONCLUSION The Rotab® is a reliable device to measure rotational laxity coupled with anterior translation of the knee.
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Adebayo OO, Ko FC, Goldring SR, Goldring MB, Wright TM, van der Meulen MC. Kinematics of meniscal- and ACL-transected mouse knees during controlled tibial compressive loading captured using roentgen stereophotogrammetry. J Orthop Res 2017; 35:353-360. [PMID: 27153222 PMCID: PMC5349862 DOI: 10.1002/jor.23285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/29/2016] [Indexed: 02/04/2023]
Abstract
Pre-clinical studies of post-traumatic OA have examined the pathways that lead to disease after injury by using surgical models such as the destabilization of the medial meniscus (DMM) and anterior cruciate ligament transection (ACLT). While the morphological, molecular, and genetic pathways leading to OA have been examined extensively; the effects of these injuries on joint kinematics, and thus disease progression, have yet to be fully characterized. To this end, we sought to understand the kinematics in the DMM and ACLT joints compared to intact joints subjected to controlled tibial compressive loading. We hypothesized that the DMM and ACLT models would result in different patterns of joint instability compared to intact joints, thus explaining the different patterns of OA initiation and severity in these models. Cadaver adult C57BL/6 mice were subjected to either a DMM or ACLT in their right knee joints, while the left limbs remained as intact controls. All limbs were labeled with fiducial markers, and the rigid body kinematics of the tibia and femur were examined using roentgen stereophotogrammetry (RSA) with application of compressive loads from 0 to 9 N. DMM and intact joints demonstrated similar kinematics under compressive loading, in contrast to ACLT joints, which dislocated even before load application. These results demonstrate the importance of rigorous kinematic analysis in defining the role of joint instability in animal models of OA and suggest significant differences in DMM and ACLT joint instabilities in the context of controlled mechanical loading. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:353-360, 2017.
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Affiliation(s)
| | - Frank C. Ko
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY
| | | | | | | | - Marjolein C.H. van der Meulen
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY,Research Division, Hospital for Special Surgery, New York, NY
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89
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Are CT Scans a Satisfactory Substitute for the Follow-Up of RSA Migration Studies of Uncemented Cups? A Comparison of RSA Double Examinations and CT Datasets of 46 Total Hip Arthroplasties. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3681458. [PMID: 28243598 PMCID: PMC5294349 DOI: 10.1155/2017/3681458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/18/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
As part of the 14-year follow-up of a prospectively randomized radiostereometry (RSA) study on uncemented cup fixation, two pairs of stereo radiographs and a CT scan of 46 hips were compared. Tantalum beads, inserted during the primary operation, were detected in the CT volume and the stereo radiographs and used to produce datasets of 3D coordinates. The limit of agreement between the combined CT and RSA datasets was calculated in the same way as the precision of the double RSA examination. The precision of RSA corresponding to the 99% confidence interval was 1.36°, 1.36°, and 0.60° for X-, Y-, and Z-rotation and 0.40, 0.17, and 0.37 mm for X-, Y-, and Z-translation. The limit of agreement between CT and RSA was 1.51°, 2.17°, and 1.05° for rotation and 0.59, 0.56, and 0.74 mm for translation. The differences between CT and RSA are close to the described normal 99% confidence interval for precision in RSA: 0.3° to 2° for rotation and 0.15 to 0.6 mm for translation. We conclude that measurements using CT and RSA are comparable and that CT can be used for migration studies for longitudinal evaluations of patients with RSA markers.
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90
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Comparable Stability of Cemented vs Press-Fit Placed Stems in Revision Total Knee Arthroplasty With Mild to Moderate Bone Loss: 6.5-Year Results From a Randomized Controlled Trial With Radiostereometric Analysis. J Arthroplasty 2017; 32:197-201. [PMID: 27554783 DOI: 10.1016/j.arth.2016.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Short-term stability after revision total knee arthroplasty (TKA) with either fully cemented or hybrid-placed implants is comparable. Interestingly, implant micromotion >1 mm/degree occurred with both techniques which might increase the risk of loosening in the midterm or long-term. Therefore, the present study investigated midterm stability and clinical results of fully cemented vs hybrid-placed revision TKA, with mild to moderate bone loss, using radiostereometric analysis (RSA). METHODS This study involves the prolonged follow-up of a previous randomized controlled trial. RSA images taken at baseline, 6 weeks, 3 and 6 months, and 1, 2 and 6.5 years of follow-up were analyzed. Stability of the femoral and tibial implants was evaluated using total translation and rotation, based on the micromotion determined with model-based RSA. RESULTS Of the 30 patients who completed the 2-year follow-up in the original randomized controlled trial, 23 (12 cement, 11 hybrid) were available for follow-up at 6.5-year (range 5.4-7.3). There were no differences in median total translation and rotation of the femoral and tibial components between the 2 groups, and none of the clinical scores differed between the groups. Interestingly, in the group with cemented stems, 5 tibia implants showed >1 mm/degree micromotion compared to none in the hybrid group. CONCLUSION There was no difference in median micromotion and clinical outcome between fully cemented and hybrid-placed revision TKA 6.5 years postoperatively. Two femur components showed progressive migration over time whereas tibia components migrate especially in the first year followed by a stable situation. Whether this will lead to loosening and re-revisions remains to be investigated.
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91
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Mattsson P, Larsson S. Stability of Internally Fixed Femoral Neck Fractures Augmented with Resorbable Cement. Scand J Surg 2016; 92:215-9. [PMID: 14582545 DOI: 10.1177/145749690309200309] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: Internal fixation of displaced femoral neck fractures is associated with a high risk for complications such as non-union or avascular necrosis. A stable fracture fixation can improve prognosis although stability is often counteracted by weak osteoporotic bone. The aim with this study was to evaluate whether augmentation with resorbable calcium-phosphate cement could improve fracture stability during the early period after surgery as shown in biomechanical studies. Material and Methods: 40 ambulatory patients with a displaced femoral neck fracture were randomized to treatment with cannulated screws alone (controls) or screws combined with calcium-phosphate cement for augmentation (augmented). All patients were allowed unrestricted weight bearing after surgery. Fracture movement was measured with radiostereometry (RSA) at 1 and 6 weeks. Results: At 1 week the augmented fractures had moved on average 1.9±1.0 mm while movement in the controls was 5.5±3.4 mm (p < 0.0001). The average total movement at weeks was 6.9±2.9 mm and 10.9±5.1 mm, respectively (p < 0.005). Varus angulation and distal migration of the femoral head were the most common movements for both groups although augmented fractures had moved significantly less at both 1 and 6 weeks. There were no significant differences in angulation between groups around the longitudinal and transversal axes or in migration along the transverse or sagittal axes. Conclusion: Augmentation with calcium-phosphate cement improved the stability of internally fixed femoral neck fractures during the first six weeks after surgery, with improvement being less pronounced at six weeks compared with at one week.
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Affiliation(s)
- P Mattsson
- Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden.
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92
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Abstract
Background and Aims: Internally fixed unstable trochanteric fractures might be difficult to retain in position during healing. Secondary displacement might lead to malunion and poor functional result. The aim with this study was to measure whether augmentation with resorbable calcium-phosphate cement could improve fracture stability as shown in biomechanical studies. Material and Methods: 26 ambulatory patients with an unstable trochanteric fracture were randomized to treatment with a sliding screw device alone (Controls) or the same device combined with calcium-phosphate cement for augmentation (Augmented). All patients were allowed unrestricted weight bearing after surgery. Fracture movement was measured with radiostereometry (RSA) at 1 and 6 weeks and at 6 months. Results: Two patients died during the study period due to unrelated causes and another three were excluded due to technical problems with the RSA in two and concomitant illness in one. 21 patients (11 Augmented and 10 Controls) were followed according to the study protocol. At 1 week the augmented fractures had moved on average 1.9 ± 1.7 mm while movement in the controls was 4.0 ± 2.4 mm (p < 0.05). The average total movement from the day after surgery until 6 months, when all fractures had healed, was 7.8 ± 6.2 mm for the augmented fractures and 13.2 ± 4.3 mm for the controls (p < 0.05). Varus angulation was the most pronounced rotational movement for both groups although augmented fractures revealed less varus angulation compared with controls at all time points. Rotation around the longitudinal and transversal axes were small with no significant differences between treatment groups. Conclusion: Augmentation with calcium-phosphate cement improved the stability of unstable trochanteric fractures fixed with a sliding screw device. The improvement was most pronounced for varus angulation and lateral and distal migration of the head and neck fragment.
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Affiliation(s)
- P Mattsson
- Department of Orthopedics, Uppsala University Hospital, Uppsala, Sweden.
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93
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Ten Brinke B, Mathijssen NMC, Blom I, Deijkers RLM, Ooms EM, Kraan GA. Model-based roentgen stereophotogrammetric analysis of the surface replacement trapeziometacarpal total joint arthroplasty. J Hand Surg Eur Vol 2016; 41:925-929. [PMID: 26852245 DOI: 10.1177/1753193416629070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The primary aim of this clinical and radiostereometric study was to study the migration pattern of the surface replacement trapeziometacarpal joint prosthesis (SRTMTMC, Avanta®, San Diego, CA). The secondary aims were to assess patient-related outcomes and prosthesis survival 5 years after surgery. Ten patients received the prosthesis. Radiostereometric radiographs were obtained 6 weeks, 6 months, 1 year and 5 years post-operatively and were analysed using model-based software. All patients completed DASH and Nelson Hospital scores at these follow-ups. Mean translations varied between 0.0 and 0.5 mm after 5 years. Rotation values could be calculated in six patients and mean rotations varied between -0.3 and 2.3°, although the precision of rotation values seems to be poor. The 5-year survival rate was 80%. Mean pre-operative DASH and Nelson Hospital scores were 53 (SD 14) and 51 (SD 13), respectively. Six months post-operatively, the DASH and Nelson Hospital scores had both significantly improved to 25 (SD 20) and 74 (SD 18) and remained high after 5 years. Implant stability was good 5 years post-operatively, and early migration did not predict implant failure in this study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- B Ten Brinke
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | - N M C Mathijssen
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | - I Blom
- 2 Department of Radiology, Reinier de Graaf Groep, Delft, The Netherlands
| | - R L M Deijkers
- 3 Department of Orthopaedic Surgery, Haga Ziekenhuis, Den Haag, The Netherlands
| | - E M Ooms
- 4 Centre for Orthopaedic Surgery, OCON, Hand and Wrist unit, Hengelo, The Netherlands
| | - G A Kraan
- 1 Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
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94
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Figueras G, Planell RV, Fernàndez RS, Biayna JC. Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature. Open Orthop J 2016; 10:512-521. [PMID: 27857822 PMCID: PMC5093867 DOI: 10.2174/1874325001610010512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/20/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023] Open
Abstract
Background: As a consequence of use of metal-on-metal hip arthroplasties some patients have precised revision for pain or metal hipersensivity reactions among other causes. We propose to salvage monoblock acetabular component and femoral component using a dual-mobility head and perform a lower morbidity operation in young patients preserving host bone stock in cases with well fixed and positioned components. Objective: (1) What clinical problems have been reported in patients with Metal-on-metal hip arthroplasties? (2) Could the tribocorrosion potentially cause a fracture of neck femoral component? (3) Can be the dual-mobility head a recourse in metal-on-metal hip revision? Methods: Ten patients were revised for pain or/and raised Cobalt/Chromium levels between August 2012 and December 2015. In three cases femoral neck component was fractured and femoral revision was necessary. In four hips, acetabular and femoral components could be maintained. Age, body index mass, ion levels, acetabular position, size of acetabular component and femoral head, approach, blood transfunsion and time of hospitalization were analized. Results: At a mean follow-up of 25,6 months (6 to 45) the mean postoperative HHS was 92. It was not statistically significant because several patients were low sintomatic before surgery, but had raised Cobalt/Chromium levels in the blood. All patients had near-normal levels of Cobalt/Chromium during the first 6 months after revision surgery. No relevant complications were reported. Conclusion: The use of dual-mobility head can be an acceptable option to revise metal-on-metal arthroplasties correctly oriented with abscence of loosening or infection signs and keeping bone stock in young patients.
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Affiliation(s)
- Guillem Figueras
- Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Traumatology and Orthopedic Surgery Department, C/Dr Joan Soler S/N 08243 Manresa, (93-8759300), Spain
| | - Ramón Vives Planell
- Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Traumatology and Orthopedic Surgery Department, C/Dr Joan Soler S/N 08243 Manresa, (93-8759300), Spain
| | - Ramón Serra Fernàndez
- Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Traumatology and Orthopedic Surgery Department, C/Dr Joan Soler S/N 08243 Manresa, (93-8759300), Spain
| | - Joan Camí Biayna
- Fundació Althaia, Xarxa Assistencial Universitària de Manresa, Traumatology and Orthopedic Surgery Department, C/Dr Joan Soler S/N 08243 Manresa, (93-8759300), Spain
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95
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Abstract
Background and purpose - Randomized trials have found that treating spinal burst fractures with reduction and posterior fixation is adequate without the use of bone grafting for definitive fusion. Restitution of intervertebral mobility of such an unfused segment after fracture healing may unload the adjacent parts of the spine and reduce the risk of degeneration of these segments. We used radiostereometry (RSA) to study whether late implant removal would restore the intervertebral mobility of a thoracolumbar segment treated with posterior instrumentation but no bone grafting for unstable spinal fracture. Patients and methods - We identified 7 patients with implant-related back pain at least 1.5 years after a thoracolumbar fracture (Th12 or L1) treated with reduction and posterior instrumentation. The implants were removed and tantalum indicators for RSA were inserted. 3 months later, each patient was examined with RSA. The intervertebral translations and rotations of the thoracolumbar segment, induced by change in position from flexion to extension, were measured. Progressive deformity was registered by conventional radiography and the overall clinical outcome was assessed by the patients. Results - According to RSA, all 7 patients regained some mobility of the fractured thoracolumbar segment. In 1 patient who was primarily treated for a flexion-distraction type of injury, conventional radiography revealed a progressive kyphotic deformity 3 months after implant removal and the clinical outcome was poor. According to the patients, 1 had a fair clinical outcome and 5 had good outcome. Interpretation - Late implant removal may restore segmental mobility after posterior fracture fixation of the thoracolumbar segment if bone grafting has not been used. The clinical consequences, positive or negative, of the residual mobility demonstrated in our small number of patients should be evaluated in studies based on extended patient series and with different fracture types.
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96
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Meinardi JE, Valstar ER, Van Der Voort P, Kaptein BL, Fiocco M, Nelissen RGHH. Palacos compared to Palamed bone cement in total hip replacement: a randomized controlled trial. Acta Orthop 2016; 87:473-8. [PMID: 27329869 PMCID: PMC5016905 DOI: 10.1080/17453674.2016.1199146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Stability and survival of cemented total hip prostheses is dependent on a multitude of factors, including the type of cement that is used. Bone cements vary in viscosity, from low to medium and high. There have been few clinical RSA studies comparing the performance of low- and high-viscosity bone cements. We compared the migration behavior of the Stanmore hip stem cemented using novel low-viscosity Palamed bone cement with that of the same stem cemented with conventional high-viscosity Palacos bone cement. Patients and methods - We performed a randomized controlled study involving 39 patients (40 hips) undergoing primary total hip replacement for primary or secondary osteoarthritis. 22 patients (22 hips) were randomized to Palacos and 17 patients (18 hips) were randomized to Palamed. Migration was determined by RSA. Results - None of these 40 hips had been revised at the 10-year follow-up mark. To our knowledge, the patients who died before they reached the 10-year endpoint still had the implant in situ. No statistically significant or clinically significant differences were found between the 2 groups for mean translations, rotations, and maximum total-point motion (MTPM). Interpretation - We found similar migration of the Stanmore stem in the high-viscosity Palacos cement group and the low-viscosity Palamed cement group. We therefore expect that the risk of aseptic loosening with the new Palamed cement would be comparable to that with the conventional Palacos cement. The choice of which type of bone cement to use is therefore up to the surgeon's preference.
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Affiliation(s)
- Joris E Meinardi
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden;,Correspondence:
| | - Edward R Valstar
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden;,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft
| | - Paul Van Der Voort
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center (LUMC), Leiden;,Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center (LUMC), Leiden
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97
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Minten MJM, Heesterbeek PJC, Spruit M. No effect of additional screw fixation of a cementless, all-polyethylene press-fit socket on migration, wear, and clinical outcome. Acta Orthop 2016; 87:363-7. [PMID: 27299418 PMCID: PMC4967278 DOI: 10.1080/17453674.2016.1190244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Additional screw fixation of the all-polyethylene press-fit RM cup (Mathys) has no additional value for migration, in the first 2 years after surgery. However, the medium-term and long-term effects of screw fixation remain unclear. We therefore evaluated the influence of screw fixation on migration, wear, and clinical outcome at 6.5 years using radiostereometric analysis (RSA). Patients and methods - This study involved prolonged follow-up from a previous randomized controlled trial (RCT). We analyzed RSA radiographs taken at baseline and at 1-, 2-, and 6.5-year follow-up. Cup migration and wear were assessed using model-based RSA software. Wear was calculated as translation of the femoral head model in relation to the cup model. Total translation, rotation, and wear were calculated mathematically from results of the orthogonal components. Results - 27 patients (15 with screw fixation and 12 without) were available for follow-up at 6.5 (5.6-7.2) years. Total translation (0.50 mm vs. 0.56 mm) and rotation (1.01 degrees vs. 1.33 degrees) of the cup was low, and was not significantly different between the 2 groups. Wear increased over time, and was similar between the 2 groups (0.58 mm vs. 0.53 mm). Wear rate (0.08 mm/year vs. 0.09 mm/year) and clinical outcomes were also similar. Interpretation - Our results indicate that additional screw fixation of all-polyethylene press-fit RM cups has no additional value regarding medium-term migration and clinical outcome. The wear rate was low in both groups.
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Affiliation(s)
| | | | - Maarten Spruit
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
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98
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Mäkinen TJ, Mattila KT, Määttänen H, Aro HT. Comparison of Digital and Conventional Radiostereometric Image Analysis in an Ankle Phantom Model. Scand J Surg 2016; 94:233-8. [PMID: 16259174 DOI: 10.1177/145749690509400311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: Radiostereometric analysis (RSA) allows accurate three-dimensional measurements of micromotion in skeletal structures. The current RSA techniques are based on the analysis of scanned plain films. This study was undertaken to compare digital filmless RSA technique to conventional scanning technique using a phantom model of the ankle mortise. Material and Methods: In the first experiment, the relative displacement of the markers inserted to the fibula in relation to the markers inserted to the tibia was studied by means of double examinations and the precision of DICOM images were compared to scanned images of printed radiographs. In the second experiment, the film pair of double examination was re-imported or re-scanned and self-compared in order to show merely the error related to the image processing. Results: The precision of RSA using scanned images of printed radiographs was compatible to DICOM images. However, the mean error of rigid body fitting (ME) values were significantly lower in use of DICOM images compared with scanned radiographs, indicating less deformation of rigid body segments in filmless analysis. Conclusions: Precision of the RSA method was improved under the completely filmless environment. Therefore, this technique can be recommended for clinical studies of radiostereometric analysis.
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Affiliation(s)
- T J Mäkinen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku, Turku, Finland
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99
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Madanat R, Moritz N, Larsson S, Aro HT. RSA Applications in Monitoring of Fracture Healing in Clinical Trials. Scand J Surg 2016; 95:119-27. [PMID: 16821655 DOI: 10.1177/145749690609500207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radiostereometric analysis (RSA) was originally developed as a method for performing highly accurate three-dimensional measurements in vivo over time from sequential radiographs. Since its introduction over twenty years ago, the RSA method has proven itself as a powerful tool with numerous orthopaedic applications. RSA has been used extensively in studies of prosthetic fixation and has been shown to be the method of choice for these studies. RSA has, however, also been successfully applied to a limited number of studies examining fracture healing, namely in fractures of the radius, ankle, tibial plateau, trochanter and femoral neck, as well as studies of bone healing following spinal fusion and tibial osteotomies. RSA follow-up of a fracture will provide definitive demonstration of the exact time of union, i.e. the achievement of fracture stability. This information can be invaluable in randomized clinical trials of fracture treatment. Phantom model studies have proven useful for effective preoperative planning and interpretation of RSA results. The RSA method is a highly accurate, precise and safe objective method for studying fracture healing in clinical trials. The RSA method may serve as a scientific tool to accurately evaluate the significance of supporting novel biomaterials for the early stability and the rate of healing in fractures.
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Affiliation(s)
- R Madanat
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku, Turku, Finland
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100
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Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures. Skeletal Radiol 2016; 45:763-9. [PMID: 26922189 DOI: 10.1007/s00256-016-2350-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the present study was to compare the reliability and agreement between a computer tomography-based method (CT) and digitalised 2D radiographs (XR) when measuring change in dorsal angulation over time in distal radius fractures. MATERIALS AND METHODS Radiographs from 33 distal radius fractures treated with external fixation were retrospectively analysed. All fractures had been examined using both XR and CT at six times over 6 months postoperatively. The changes in dorsal angulation between the first reference images and the following examinations in every patient were calculated from 133 follow-up measurements by two assessors and repeated at two different time points. The measurements were analysed using Bland-Altman plots, comparing intra- and inter-observer agreement within and between XR and CT. RESULTS The mean differences in intra- and inter-observer measurements for XR, CT, and between XR and CT were close to zero, implying equal validity. The average intra- and inter-observer limits of agreement for XR, CT, and between XR and CT were ± 4.4°, ± 1.9° and ± 6.8° respectively. CONCLUSIONS For scientific purpose, the reliability of XR seems unacceptably low when measuring changes in dorsal angulation in distal radius fractures, whereas the reliability for the semi-automatic CT-based method was higher and is therefore preferable when a more precise method is requested.
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