1
|
Nguyen VD, LaCour MT, Dessinger GM, Komistek RD. Advancements in total knee arthroplasty kinematics: 3D implant computer aided design model creation through X-ray or fluoroscopic images. Clin Biomech (Bristol, Avon) 2023; 109:106091. [PMID: 37696164 DOI: 10.1016/j.clinbiomech.2023.106091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND 3D-to-2D fluoroscopic registration is a popular and important step for analyzing total-knee-arthroplasty weight-bearing kinematics. Unfortunately, in vivo analyses using these techniques cannot be completed if the associated computer-aided design implant models are not available. This study introduces a novel method that enables the accessible computation of knee replacement patients' kinematics from fluoroscopy, achieved through the reconstruction of 3-dimensional knee component models using a limited set of 2-dimensional X-ray or fluoroscopic images. METHODS The proposed non-rigid morphing algorithm, based on the coherent point drift algorithm, scales and transforms the shape of the template model to fit with the silhouette of the corresponding fluoroscopic images without changing the structure of the knee implant. While a greater number of fluoroscopic images can lead to higher accuracy, our study utilizes only 4 images. FINDINGS The morphed models show excellent results in comparison with known models with a 0.52 mm average root-mean-square error and a 2.82 mm largest source error for 17 tested knee models of various implant types. The proposed algorithm also enables direct output of patient kinematics using fluoroscopy, with an average error of only 0.54 ± 0.42 mm for femorotibial contact and 0.86 ± 0.34 degrees for axial rotation. INTERPRETATION A novel methodology was introduced to overcome common 3-dimentional to 2-dimensional registration limitations by recreating entire families of 3 dimensional models from a limited number of fluoroscopic images for both cruciate-retaining and posterior-stabilized knee replacement implants. Our algorithm has demonstrated high levels of accuracy with multiple potential extended applications.
Collapse
|
2
|
Soliman SB, Davis JJ, Muh SJ, Vohra ST, Patel A, van Holsbeeck MT. Ultrasound evaluations and guided procedures of the painful joint arthroplasty. Skeletal Radiol 2022; 51:2105-2120. [PMID: 35624311 DOI: 10.1007/s00256-022-04080-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to describe the use of ultrasound for the diagnosis and treatment of painful joint arthroplasty. Ultrasound plays a crucial role in the diagnosis of the painful joint arthroplasty, especially given its unique dynamic capabilities, convenience, and high resolution. Ultrasound guidance is also instrumental for procedures in both diagnosing and in select cases, treating the painful joint arthroplasty. Topics to be discussed in this article include trends in arthroplasty placement, benefits of the use of ultrasound overall, and ultrasound evaluation of periprosthetic joint infections. We will also review the sonographic findings with dissociated/displaced components and adverse reaction to metallic debris including metallosis, trunnionosis, and metal-on-metal pseudotumors. Additionally, we will discuss ultrasound evaluation of tendon pathologies with arthroplasties, including dynamic maneuvers to evaluate for tendon impingement/snapping. Finally, we will cover ultrasound-guided joint arthroplasty injection indications and precautions. KEY POINTS: • Ultrasound is preferred over MRI in patients with joint arthroplasty and plays a crucial role in diagnosis, especially given its unique dynamic capabilities, convenience and high resolution. • It is especially beneficial for US-guided aspiration in periprosthetic joint infections; effectively used to evaluate periprosthetic fluid collections, facilitating differentiation between abscesses and aseptic collections, and tracking sinus tracts. • Recently, the diagnosis of periprosthetic joint infections has shifted focus to biomarkers in the periprosthetic fluid, specifically α-defensin, which has a high sensitivity and specificity for diagnosing infection. • Cutibacterium acnes is a major pathogen responsible for shoulder arthroplasty infections, often presenting with normal laboratory values and since slow growing, must be kept for a minimum of 14 days.
Collapse
Affiliation(s)
- Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
| | - Jason J Davis
- Division of Orthopedic Surgery, Department of Orthopedics, Henry Ford Hospital, Detroit, MI, USA
| | - Stephanie J Muh
- Division of Orthopedic Surgery, Department of Orthopedics, Henry Ford Hospital, Detroit, MI, USA
| | - Saifuddin T Vohra
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Ashish Patel
- Division of Musculoskeletal Imaging, Department of Radiology, Vanderbilt University, Nashville, TN, USA
| | - Marnix T van Holsbeeck
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
3
|
Cooper AM, Connolly K, Penna S, Parvizi J. Evaluation and Management of a Painful Knee After Total Knee Arthroplasty. Orthopedics 2021; 44:341-352. [PMID: 34618636 DOI: 10.3928/01477447-20211001-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pain after total knee arthroplasty (TKA) is not infrequent and may be indicative of a broad spectrum of prosthesis-related, intra-articular, or extra-articular pathologies. To diagnose and treat the underlying cause of a painful TKA, systematic evaluation of the patient is critical to ensure that they are managed appropriately and expeditiously. This evidence-based review presents current concepts regarding the pathophysiology, etiology, and diagnosis of painful TKA and our recommended approach for management. [Orthopedics. 2021;44(6):341-352.].
Collapse
|
4
|
Hadizadeh H, Hadizadeh H, Ganjiani M, Karimpour M, Hosseinpour A. Investigation of the effect of the angle between femoral and prosthesis mechanical axes on bone remodeling of femur in total knee arthroplasty. Proc Inst Mech Eng H 2021; 235:976-984. [PMID: 33985375 DOI: 10.1177/09544119211016128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The bone remodeling is the process in which the bone adapts its structure to the variation of environmental loads. The joint might be broken or damaged as a result of aging or an accident. To remedy this situation, Total Knee Arthroplasty (TKA) and prosthesis implantation is recommended. The main goal of this research is to investigate the effects of femur implanting angle on the bone remodeling process after TKA in the Coronal, Sagittal and horizontal planes over seven years. First, the 3D CAD model from CT images is created then the bone behavior is simulated using a model with a USDFLD subroutine. The results show that as the implant rotates in one direction, the stress and density distribution increases in the same direction whereas the load and consequently the bone density decrease substantially in the opposite direction. Consequently, the bone density might even decrease 77 and 31 percent in the coronal and sagittal plane respectively, so in the total knee arthroplasty, the mechanical axes of prosthesis and femur should be parallel. The active bone which occurs as a result of mechanical axes of prosthesis and femur parallelism and consequently uniform load distribution, can protect the implant from prosthesis loosening and fracture.
Collapse
Affiliation(s)
- Hasan Hadizadeh
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Hossein Hadizadeh
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mehdi Ganjiani
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Abolfazl Hosseinpour
- Department of Mechanical Engineering, University of North Carolina, Charlotte, NC, USA
| |
Collapse
|
5
|
Creteur V, De Angelis R, Absil J, Kyriakidis T, Madani A. Sonographic and radiographic evaluation of the extensor tendons in early postoperative period after total knee arthroplasty. Skeletal Radiol 2021; 50:485-494. [PMID: 32803377 DOI: 10.1007/s00256-020-03574-x] [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: 05/19/2020] [Revised: 07/02/2020] [Accepted: 08/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To prospectively assess the early changes in the quadriceps and patellar tendons before and after total knee arthroplasty using ultrasound, shear wave elastography, and X-rays. MATERIALS AND METHODS Radiographs, ultrasound, and shear wave elastography were performed on 23 patients (16 women; aged 51-85, mean 66 ± 9 years) before and after surgery at 6 weeks and on 11 patients at 3 months. Patellar position and patellar tendon lengths were evaluated by radiography; joint effusion or synovitis, quadriceps and patellar tendon lengths, and thicknesses, echogenicity, vascularity, and stiffness were assessed with ultrasound and shear wave elastography. RESULTS In the early postoperative period, 87% of the patients had joint effusion, and 43% had signs of synovitis. There was a significant thickening of the quadriceps tendon in 51.5% (p < .0001) and of the patellar tendon in 93.8% (p < .0001) of patients with a significant shortening of the patellar tendon in 7.8% (p < .0001). A hypoechoic defect on the medial aspect of the quadriceps tendon was found in 87% of the patients. There was a significant increase in Young's modulus in the quadriceps tendon (p = .0006) but not in the patellar tendon. CONCLUSION The following should not be considered to be pathological findings at early postoperative imaging: joint effusion, synovitis, increasing of stiffness and thickening of quadriceps tendons by more than 50%, thickening of patellar tendon by more than 90%, focal defect through the medial aspect of the quadriceps tendon, and shortening of the patellar tendon by 8%.
Collapse
Affiliation(s)
- Viviane Creteur
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Riccardo De Angelis
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Theofylaktos Kyriakidis
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium
| | - Afarine Madani
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, 1070, Brussels, Belgium.
| |
Collapse
|
6
|
Messina C, Usuelli FG, Maccario C, Di Silvestri CA, Gitto S, Cortese MC, Albano D, Sconfienza LM. Precision of Bone Mineral Density Measurements Around Total Ankle Replacement Using Dual Energy X-ray Absorptiometry. J Clin Densitom 2020; 23:656-663. [PMID: 30792098 DOI: 10.1016/j.jocd.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Joint prosthesis survival is associated with the quality of surrounding bone. Dual-energy X-ray absorptiometry (DXA) is capable to evaluate areal bone mineral density (BMD) around different prosthetic implants, but no studies evaluated periprosthetic bone around total ankle replacement (TAR). Our aim is to determine the precision of the DXA periprosthetic BMD around TAR. METHODOLOGY Short-term precision was evaluated on 15 consecutive patients. Each ankle was scanned 3 times both in the posteroanterior (PA) and lateral views with a dedicated patient positioning protocol. Up to four squared regions of interest (ROIs) were placed in the periprosthetic bone around tibial and talar implants, with an additional ROI to include the calcaneal body in the lateral scan. Coefficient of variation (CV%) and least significant change were calculated according to the International Society for Clinical Densitometry. RESULTS The lateral projection showed lower mean CV values compared to the PA projection, with an average precision error of 2.21% (lateral scan) compared to 3.34% (PA scans). Overall, the lowest precision error was found at both "global" ROIs (CV = 1.25% on PA and CV = 1.3% on lateral). The highest CV value on PA was found at the medial aspect of talar side (ROI 3; CV = 4.89%), while on the lateral scan the highest CV value was found on the posterior aspect of talar side (ROI 2; CV = 2.99%). CONCLUSIONS We found very good reproducibility BMD values of periprosthetic bone around TAR, that were comparable or even better compared to other studies that evaluated periprosthetic BMD around different prosthetic implants. DXA can be used to precisely monitor bone density around ankle prostheses, despite further long-term longitudinal studies are required to assess the clinical utility of such measurements.
Collapse
Affiliation(s)
- Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Carlo Pascal, 36, 20133, Milan, Italy.
| | | | - Camilla Maccario
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | | | - Salvatore Gitto
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Maria Cristina Cortese
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, IRCCS Fondazione Policlinico Universitario A. Gemelli, Roma, Italia; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Carlo Pascal, 36, 20133, Milan, Italy
| |
Collapse
|
7
|
Christopher ZK, Deckey DG, Chung AS, Spangehl MJ. Patellar osteolysis after total knee arthroplasty with patellar resurfacing: a potentially underappreciated problem. Arthroplast Today 2019; 5:435-441. [PMID: 31886386 PMCID: PMC6921183 DOI: 10.1016/j.artd.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022] Open
Abstract
Osteolysis of the patella following total knee arthroplasty is both uncommon and poorly described in the literature. We describe 3 cases of total knee arthroplasty with patella resurfacing that later presented with anterior knee pain with patellar osteolysis without evidence of patellar implant failure: 2 males and 1 female patient, all with bilateral knee osteoarthritis. Osteolysis of the patella was identified radiographically between 2 and 16 years from the index procedure. We theorize that high pressures across the patella-femoral joint, in obese or muscular patients, may play a role in the formation of these patellar osteolytic lesions. We suspect that the prevalence of this phenomenon is under-recognized in the literature and may increase with longer term follow-up and awareness.
Collapse
Affiliation(s)
| | | | | | - Mark J. Spangehl
- Corresponding author. Department of Orthopedics, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. Tel.: +1 480 342 6202.
| |
Collapse
|
8
|
Blum A, Noël A, Regent D, Villani N, Gillet R, Gondim Teixeira P. Tomosynthesis in musculoskeletal pathology. Diagn Interv Imaging 2018; 99:423-441. [DOI: 10.1016/j.diii.2018.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/15/2018] [Indexed: 01/08/2023]
|