1
|
Niesen AE, Hull ML. State of the Art in Radiostereometric Analysis for Tibial Baseplate Migration and Future Research Directions. J Biomech Eng 2023; 145:120801. [PMID: 37792485 DOI: 10.1115/1.4063626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Radiostereometric analysis (RSA) measures movement (migration) of a baseplate relative to the underlying tibia after total knee arthroplasty (TKA) and has been used extensively to evaluate safety of new implant designs and/or surgical techniques regarding baseplate loosening. Because RSA is a complex methodology which involves various choices that researchers make, including whether to use marker-based or model-based methods, which migration metric to report, how to relate short-term migrations to long-term risk, and how these choices impact error, the objectives of this review were to: (1) lay out a comprehensive structure illustrating the multiple components/considerations for RSA and their interrelations, (2) review components of the structure using the latest RSA literature, and (3) use the preceding review as a context for identifying future areas of study. The components to be reviewed were structured using the following topics: type of RSA, migration metrics, sources of error, studies/reports of error, stability limits, and studies of error in stability limits. Based on the current RSA literature and knowledge gaps which exist, the following future research directions were identified: (1) revising the ISO standard to require reporting of clinical measurement error (bias) and recommending use of a local baseplate coordinate system, (2) identifying the migration metric and associated threshold most predictive of baseplate loosening for individual patients, (3) creating a method for data sharing to improve individual patient diagnostics, and (4) determining an appropriate stability limit for model-based RSA for group stability and individual patient diagnostics.
Collapse
Affiliation(s)
- Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Mechanical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817
| |
Collapse
|
2
|
Chung VWJ, Newell R, Kedgley A, Anglin C, Masri BA, Hodgson AJ. Verifying a C-arm-based roentgen stereophotogrammetric analysis protocol for assessing tibial implant movement in total knee arthroplasty. Med Biol Eng Comput 2022; 60:2389-2403. [DOI: 10.1007/s11517-022-02594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
|
3
|
Reorienting the tibial baseplate improves the registration accuracy of model-based radiostereometric analysis. J Biomech 2020; 113:110078. [DOI: 10.1016/j.jbiomech.2020.110078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
|
4
|
Preoperative Systemic Bone Quality Does Not Affect Tibial Component Migration in Knee Arthroplasty: A 2-Year Radiostereometric Analysis of a Hundred Consecutive Patients. J Arthroplasty 2019; 34:2351-2359. [PMID: 31202639 DOI: 10.1016/j.arth.2019.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/27/2019] [Accepted: 05/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bone quality and other preoperative predictive factors may affect implant migration and the survival of knee arthroplasty. METHODS In a prospective cohort of 100 consecutive patients (65 women) at a mean age of 67.7 years (range 39-87 years), we investigated preoperative predictors of postoperative tibial component migration in cemented and cementless total knee arthroplasties or cemented unicompartmental knee arthroplasty. Predictors consisted of Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score, questionnaires, bone turnover markers of CTX and P1NP, systemic bone mineral density (BMD), and knee osteoarthritis (OA) grade. Tibial component migration was measured with radiostereometry postoperative, at 1 and 2 years of follow-up. RESULTS Between 1 and 2 years, 19 tibial components migrated continuously (maximum total point motion [MTPM] > 0.2 mm). In general, there was no difference in age, body mass index, BMD, KOOSs, or OA grade between patients with continuous tibial migration compared to patients without continuous migration (P > .11). However, cementless tibial components with continuous migration had a lower KOOS pain score (more pain), lower vitamin D, and a higher bone turnover (CTX) value than patients without continuous migration. There was no association between the BMD and MTPM at 1-year follow-up regardless of prothesis type (P > .17). Patients with osteoporosis and normal BMD had similar mean tibial component MTPM at 2 years (3 prostheses combined; P = .34). CONCLUSION Migration of tibial components inserted with or without bone cement was not affected by the preoperative bone quality in terms of systemic BMD, bone turnover markers, and OA grade in the knee.
Collapse
|
5
|
Yuan X, Broberg JS, Naudie DD, Holdsworth DW, Teeter MG. Radiostereometric analysis using clinical radiographic views: Validation with model-based radiostereometric analysis for the knee. Proc Inst Mech Eng H 2018; 232:759-767. [PMID: 29974802 DOI: 10.1177/0954411918785662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radiostereometric analysis is a sophisticated radiographic technique with high measurement accuracy. In order to improve the accessibility of radiostereometric analysis for clinical use, a modified radiostereometric analysis procedure has been previously proposed that enables clinical radiographic views to be used for radiostereometric analysis. It has been successfully validated for its application to the hip wear study with the conventional bead-based radiostereometric analysis environment using computed radiography. In this study, we describe the implementation and validation of this technique for the knee study with the model-based radiostereometric analysis environment using digital radiography. A knee-joint phantom with 6 degrees of freedom was examined, and the bias and repeatability/reproducibility of the modified radiostereometric analysis approach were investigated following the newly updated ASTM recommendations. The bias parameters (mean ± 95% confidence interval) ranged from 0.008 ± 0.003 mm to 0.027 ± 0.006 mm for translation and from 0.014° ± 0.007° to 0.040° ± 0.020° for rotation. The repeatability standard deviation ranged from 0.004 to 0.020 mm for translation and from 0.005° to 0.015° for rotation. The 95% repeatability limit ranged from 0.011 to 0.055 mm for translation and from 0.014° to 0.041° for rotation. The reproducibility standard deviation ranged from 0.004 to 0.023 mm for translation and from 0.006° to 0.040° for rotation. The 95% reproducibility limit ranged from 0.012 to 0.063 mm for translation and from 0.016° to 0.112° for rotation. The modified procedure allows routine clinical radiographs to be used for radiostereometric analysis, which provides the possibility of adding quantitative measurements to current patient registries.
Collapse
Affiliation(s)
- Xunhua Yuan
- 1 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jordan S Broberg
- 2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Douglas Dr Naudie
- 1 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 3 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - David W Holdsworth
- 1 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 4 Western's Bone and Joint Institute, Western University, London, ON, Canada
| | - Matthew G Teeter
- 1 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 3 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 5 Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| |
Collapse
|
6
|
Broberg JS, Yuan X, Teeter MG. Radiostereometric analysis using clinical radiographic views: Development of a universal calibration object. J Biomech 2018; 73:238-242. [PMID: 29628133 DOI: 10.1016/j.jbiomech.2018.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/14/2018] [Accepted: 03/21/2018] [Indexed: 11/24/2022]
Abstract
Radiostereometric analysis (RSA) is a highly accurate technique used to provide three-dimensional (3D) measurements of orthopaedic implant migration for clinical research applications, yet its implementation in routine clinical examinations has been limited. Previous studies have introduced a modified RSA procedure that separates the calibration examinations from the patient examinations, allowing routine clinical radiographs to be analyzed using RSA. However, in order to calibrate the wide range of clinical views, a new calibration object is required. In this study, a universal, isotropic calibration object was designed to calibrate any pair of radiographic views used in the clinic for RSA. A numerical simulation technique was used to design the calibration object, followed by a phantom validation test of a prototype to verify the performance of the novel object, and to compare the measurement reliability to the conventional calibration cage. The 3D bias for the modified calibration method using the new calibration object was 0.032 ± 0.006 mm, the 3D repeatability standard deviation was 0.015 mm, and the 3D repeatability limit was 0.042 mm. Although statistical differences were present between the universal calibration object and the conventional cage, the differences were considered to be not clinically meaningful. The 3D bias and repeatability values obtained using the universal calibration object were well under the threshold acceptable for RSA, therefore it was successfully validated. The universal calibration object will help further the adoption of RSA into a more routine practice, providing the opportunity to generate quantitative databases on joint replacement performance.
Collapse
Affiliation(s)
- Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Xunhua Yuan
- Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, Canada.
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada; Surgical Innovation Program, Lawson Health Research Institute, Canada
| |
Collapse
|
7
|
The effect of patient positioning on the precision of model-based radiostereometric analysis. J Biomech 2014; 47:1914-7. [PMID: 24735503 DOI: 10.1016/j.jbiomech.2014.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/07/2014] [Accepted: 03/27/2014] [Indexed: 11/22/2022]
Abstract
A repeatable method for in vivo and in vitro measurement of polyethylene wear in total knee replacement (TKA) is needed. This research examines the model-based radiostereometric analysis' (MBRSA) in vitro precision under different patient-radiograph orientations and flexion angles of the knee using a TKA phantom. Anterior-posterior and medial-lateral imaging orientations showed the highest precision; better than 0.036mm (3-dimensional translation) and 0.089° (3-dimensional rotation). Flexion of the knee did not affect MBRSA precision. Medial-lateral imaging is advantageous as it allows for flexion of the knee joint during an RSA examination, thus providing greater information for wear measurement.
Collapse
|
8
|
Sköldenberg O, Eisler T, Stark A, Muren O, Martinez-Carranza N, Ryd L. Measurement of the migration of a focal knee resurfacing implant with radiostereometry. Acta Orthop 2014; 85:79-83. [PMID: 24286562 PMCID: PMC3940996 DOI: 10.3109/17453674.2013.869654] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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 Articular resurfacing metal implants have been developed to treat full-thickness localized articular cartilage defects. Evaluation of the fixation of these devices is mandatory. Standard radiostereometry (RSA) is a validated method for evaluation of prosthetic migration, but it requires that tantalum beads are inserted into the implant. For technical reasons, this is not possible for focal articular resurfacing components. In this study, we therefore modified the tip of an articular knee implant and used it as a marker for RSA, and then validated the method. MATERIAL AND METHODS We modified the tip of a resurfacing component into a hemisphere with a radius of 3 mm, marked it with a 1.0-mm tantalum marker, and implanted it into a sawbone marked with 6 tantalum beads. Point-motion RSA of the "hemisphere bead" using standard automated RSA as the gold standard was compared to manual measurement of the tip hemisphere. 20 repeated stereograms with gradual shifts of position of the specimen between each double exposure were used for the analysis. The tip motion was compared to the point motion of the hemisphere bead to determine the accuracy and precision. RESULTS The accuracy of the manual tip hemisphere method was 0.08-0.19 mm and the precision ranged from 0.12 mm to 0.33 mm. INTERPRETATION The accuracy and precision for translations is acceptable when using a small hemisphere at the tip of a focal articular knee resurfacing implant instead of tantalum marker beads. Rotations of the implant cannot be evaluated. The method is accurate and precise enough to allow detection of relevant migration, and it will be used for future clinical trials with the new implant.
Collapse
Affiliation(s)
- Olof Sköldenberg
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Thomas Eisler
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - André Stark
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Olle Muren
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Nicolas Martinez-Carranza
- Department of Orthopaedics, Karolinska University Hospital, Stockholm and Karolinska Institutet, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Stockholm
| | - Leif Ryd
- Episurf Medical AB, Stockholm, Sweden
| |
Collapse
|
9
|
Seslija P, Teeter MG, Yuan X, Naudie DDR, Bourne RB, MacDonald SJ, Peters TM, Holdsworth DW. Measurement of joint kinematics using a conventional clinical single-perspective flat-panel radiography system. Med Phys 2012; 39:6090-103. [DOI: 10.1118/1.4752205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
10
|
Dunbar MJ, Fong JW, Wilson DA, Hennigar AW, Francis PA, Glazebrook MA. Longitudinal migration and inducible displacement of the Mobility Total Ankle System. Acta Orthop 2012; 83:394-400. [PMID: 22880712 PMCID: PMC3427631 DOI: 10.3109/17453674.2012.712890] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [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 RSA can be used for early detection of unstable implants. We assessed the micromotion of the Mobility Total Ankle System over 2 years, to evaluate the stability of the bone-implant interface using radiostereometric analysis measurements of longitudinal migration and inducible displacement. PATIENTS AND METHODS 23 patients were implanted with the Mobility system. Median age was 62 (28-75) years and median BMI was 28.8 (26.0-34.5). Supine radiostereometric analysis examinations were done from postoperatively to the 2-year follow-up. Standing examinations were taken from the 3-month to the 2-year follow-up. Migrations and displacements were assessed using model-based RSA software (v. 3.2). RESULTS The median maximum total point motion (MTPM) for the implants at 2 years was 1.19 (0.39-1.95) mm for the talar component and 0.90 (0.17-2.28) mm for the spherical tip of the tibial component. The general pattern for all patients was that the slope of the migration curves decreased over time. The main direction of motion for both components was that of subsidence. The median 2-year MTPM inducible displacement for the talar component was 0.49 (0.27-1.15) mm, and it was 0.07 (0.03-0.68) mm for the tibial component tip. INTERPRETATION The implants subside into the bone over time and under load. This corresponds to the direction of primary loading during standing or walking. This statistically significant motion may become a clinically significant finding that would correspond with premature implant failure.
Collapse
Affiliation(s)
- Michael J Dunbar
- Division of Orthopaedics, Department of Surgery,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason W Fong
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Mark A Glazebrook
- Division of Orthopaedics, Department of Surgery,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
11
|
Fong JWY, Veljkovic A, Dunbar MJ, Wilson DA, Hennigar AW, Glazebrook MA. Validation and precision of model-based radiostereometric analysis (MBRSA) for total ankle arthroplasty. Foot Ankle Int 2011; 32:1155-63. [PMID: 22381201 DOI: 10.3113/fai.2011.1155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The goal of this study was to design a RSA marker insertion protocol to evaluate the stability of the bone-implant interface of a TAA prosthesis, and to validate that this marker insertion protocol can be combined with MBRSA technology to provide clinically adequate precision in assessing the micromotion of the TAA prosthesis. METHODS The Mobility™ Total Ankle System was used in this study. A marker placement protocol was developed with a Phantom Protocol. The Improved Marker Placement Protocol was used in 20 patients. Postoperative RSA double exams were taken. Condition Numbers (CN) were used to assess the marker distribution. The system precision was defined as the standard deviation of the double exams (MTE, MRE). MBRSA software was used to evaluate the double exams. RESULTS The RSA marker insertion technique for the 20 {\it in vivo} cases provided satisfactory results. CNs in all subjects but one were below 50 mm(-1) and implied a desirable marker configuration. The tibial sphere MTE was 0.07 mm and the talar was 0.09 mm. The talar MRE was 0.51 degrees. CONCLUSION The system precision for these {\it in vivo} TAA implants was within the normal range identified by RSA studies, and comparable to the existing TAA RSA studies. This study demonstrated a reliable RSA marker insertion technique in both the tibia and talus. The study confirms that the insertion and MBRSA technique allows the typical high precision demonstrated in other RSA studies (standard deviation less than or equal to 0.25 mm or 0.6 degrees). CLINICAL RELEVANCE This method may allow more accurate assessment of prosthetic subsidence clinically.
Collapse
|