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Petersen ET, Vind TD, Jürgens-Lahnstein JH, Christensen R, de Raedt S, Brüel A, Rytter S, Andersen MS, Stilling M. Evaluation of automated radiostereometric image registration in total knee arthroplasty utilizing a synthetic-based and a CT-based volumetric model. J Orthop Res 2023; 41:436-446. [PMID: 35532010 PMCID: PMC10084430 DOI: 10.1002/jor.25359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/28/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
Radiostereometic analysis (RSA) is an accurate method for rigid body pose (position and orientation) in three-dimensional space. Traditionally, RSA is based on insertion of periprosthetic tantalum markers and manual implant contour selection which limit clinically application. We propose an automated image registration technique utilizing digitally reconstructed radiographs (DRR) of computed tomography (CT) volumetric bone models (autorsa-bone) as a substitute for tantalum markers. Furthermore, an automated synthetic volumetric representation of total knee arthroplasty implant models (autorsa-volume) to improve previous silhouette-projection methods (autorsa-surface). As reference, we investigated the accuracy of implanted tantalum markers (marker) or a conventional manually contour-based method (mbrsa) for the femur and tibia. The data are presented as mean (standard deviation). The autorsa-bone method displayed similar accuracy of -0.013 (0.075) mm compared to the gold standard method (marker) of -0.013 (0.085). The autorsa-volume with 0.034 (0.106) mm did not markedly improve the autorsa-surface with 0.002 (0.129) mm, and none of these reached the mbrsa method of -0.009 (0.094) mm. In conclusion, marker-free RSA is feasible with similar accuracy as gold standard utilizing DRR and CT obtained volumetric bone models. Furthermore, utilizing synthetic generated volumetric implant models could not improve the silhouette-based method. However, with a slight loss of accuracy the autorsa methods provide a feasible automated alternative to the semi-automated method.
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Affiliation(s)
- Emil Toft Petersen
- University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Dahl Vind
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan Hugo Jürgens-Lahnstein
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Rasmus Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sepp de Raedt
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Søren Rytter
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Cao H, Sesselmann S, Xu J, Seehaus F, Forst R. How Do Classic (Static) RSA and Patient Motion Artifacts Affect the Assessment of Migration of a TKA Tibial Component? An In Vitro Study. Clin Orthop Relat Res 2023; 481:400-412. [PMID: 36398327 PMCID: PMC9831201 DOI: 10.1097/corr.0000000000002453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Classic (static) Roentgen stereophotogrammetric analysis (RSA) is the current gold standard to assess, in vivo, the migration of total joint arthroplasty components. To prevent potential patient motion artifacts during the acquisition of paired radiostereometric images, images must be taken by simultaneously firing both X-ray tubes. However, the influence of nonsynchronized RSA paired images or patient motion artifacts on the precision of RSA and the assessment of implant migration is not well understood. QUESTIONS/PURPOSES We assessed (1) the effect of possible patient motion on the precision of RSA and (2) apparent differences in implant migration among axes (in-plane and out-of-plane translations and in-plane and out-of-plane rotations) of possible motion artifacts. METHODS Radiographs of two tibial knee arthroplasty components, each fixed in two bone-implant models as a customized phantom, were taken in a uniplanar measurement setup. We evaluated both model-based (implant models from reversed engineering) and marker-based (additional attached implant markers) RSA approaches. Between the simulated reference and follow-up examinations, we used one of the bone-implant models to simulate patient motion and the other to simulate no patient motion in parallel. Two defined protocols were followed for each of the bone-implant models: no-motion and simulated motion protocols. RSA image pairs were analyzed using a model-based RSA software package (MBRSA 4.1, RSA core ). Precision was calculated through repeat examinations, and migration of the two components was assessed for comparison of the components with each other. Measurements were taken along the medial-lateral and posterior-anterior axes for translations and around the cranial-caudal axis for rotations. The maximum total point motion was measured for comparison between the two components. RESULTS The effect of simulated patient motion was generally small, except in the cranial-caudal axis, but the induced imprecision associated with motion was larger in model-based RSA than it was in marker-based RSA. The mean ± standard deviation values of precision in model-based RSA were 0.035 ± 0.015 mm, 0.045 ± 0.014 mm, and 0.049 ± 0.036 mm greater than those in marker-based RSA, in accordance with the simulated motion protocol in translations along the medial-lateral axis (0.018 ± 0.004 mm; p = 0.01), along the posterior-anterior axis (0.018 ± 0.007 mm; p = 0.003), and rotations around the cranial-caudal axis (0.017 ± 0.006 mm; p = 0.02). Apparent differences in implant migration were the greatest for the maximum total point motion. The maximum total point motion increased from 0.038 ± 0.007 mm for the no-motion protocol to 1.684 ± 0.038 mm (p < 0.001) for the simulated motion protocol in marker-based RSA, and from 0.101 ± 0.027 mm for the no-motion protocol to 1.973 ± 0.442 mm (p < 0.001) for the simulated motion protocol in model-based RSA, and was the worst-case scenario regarding patient motion artifacts. CONCLUSION Patient motion exceeding 1 mm or 1° on nonsynchronized RSA images affects measurement errors regarding the detection of migration of a tibial component. In clinical RSA studies, the effect of patient motion on the assessment of implant migration should be of particular concern, even if clinical RSA systems have acceptable precision. Specially trained radiographers are crucial for correctly acquiring radiographs, especially when simultaneous radiography exposures are not electronically automated. In general, RSA requires synchronized image acquisition, and this should be the state-of-the-art. CLINICAL RELEVANCE In clinical RSA studies, precision assessed by repeat examinations may not be reliable using the current standards that are widely used in radiology departments. When assessing implant migration for reliability, comparison of the maximum total point motion between the tested (simulated motion) implant and baseline (no-motion) implant, as in this study, is advocated because of the accurate detection of patient motion artifacts.
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Affiliation(s)
- Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Orthopaedic Surgery, Taizhou Second People’s Hospital, Taizhou, PR China
| | - Stefan Sesselmann
- Institute for Medical Technology, Ostbayerische Technische Hochschule Amberg-Weiden, Weiden, Germany
| | - Jing Xu
- Department of Orthopaedic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Frank Seehaus
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Orthopaedic and Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Grupp RB, Murphy RJ, Hegeman RA, Alexander CP, Unberath M, Otake Y, McArthur BA, Armand M, Taylor RH. Fast and automatic periacetabular osteotomy fragment pose estimation using intraoperatively implanted fiducials and single-view fluoroscopy. Phys Med Biol 2020; 65:245019. [PMID: 32590372 DOI: 10.1088/1361-6560/aba089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Accurate and consistent mental interpretation of fluoroscopy to determine the position and orientation of acetabular bone fragments in 3D space is difficult. We propose a computer assisted approach that uses a single fluoroscopic view and quickly reports the pose of an acetabular fragment without any user input or initialization. Intraoperatively, but prior to any osteotomies, two constellations of metallic ball-bearings (BBs) are injected into the wing of a patient's ilium and lateral superior pubic ramus. One constellation is located on the expected acetabular fragment, and the other is located on the remaining, larger, pelvis fragment. The 3D locations of each BB are reconstructed using three fluoroscopic views and 2D/3D registrations to a preoperative CT scan of the pelvis. The relative pose of the fragment is established by estimating the movement of the two BB constellations using a single fluoroscopic view taken after osteotomy and fragment relocation. BB detection and inter-view correspondences are automatically computed throughout the processing pipeline. The proposed method was evaluated on a multitude of fluoroscopic images collected from six cadaveric surgeries performed bilaterally on three specimens. Mean fragment rotation error was 2.4 ± 1.0 degrees, mean translation error was 2.1 ± 0.6 mm, and mean 3D lateral center edge angle error was 1.0 ± 0.5 degrees. The average runtime of the single-view pose estimation was 0.7 ± 0.2 s. The proposed method demonstrates accuracy similar to other state of the art systems which require optical tracking systems or multiple-view 2D/3D registrations with manual input. The errors reported on fragment poses and lateral center edge angles are within the margins required for accurate intraoperative evaluation of femoral head coverage.
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Affiliation(s)
- R B Grupp
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States of America
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[Early assessment of the risk of later implantloosening using Roentgen Sterophotogrammetric Analysis (RSA)]. DER ORTHOPADE 2020; 49:1042-1048. [PMID: 33108489 DOI: 10.1007/s00132-020-04027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aseptic implant loosening is the most common cause of implant revisions in total hip and total knee arthroplasty. Roentgen Stereophotogrammetric Analysis (RSA) represents the current gold standard for the in-vivo assessment of implant fixation. PRESENT SITUATION Long-term clinical trials have shown that continuous implant migration within the first two postoperative years correlates strongly with a later aseptic loosening. Thus, the implant migration measured with RSA can be regarded as a reliable surrogate marker for later implant loosening. Over the past 40 years, RSA has been continuously further developed, and the model-based RSA approach has reduced the effort involved since markers attached to implant are no longer needed. PERSPECTIVES The RSA method is gaining importance in the certification process of new orthopaedic implants-for example, the Dutch Orthopedic Society has recommended phased-introduction and RSA studies for new hip implants. Furthermore, in the context of the new EU Medical Device Regulation (MDR), which took effect in May 2017, RSA gained relevance for investigating clinically unproven implants. Critics who associate MDR with hindering innovation can be countered in that the RSA method provides a predictive assessment of implant fixation after only two years of follow-up, which is significantly shorter than standard long-term clinical trials.
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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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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.
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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
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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.
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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
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8
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Van de Kleut ML, Yuan X, Athwal GS, Teeter MG. Validation of radiostereometric analysis in six degrees of freedom for use with reverse total shoulder arthroplasty. J Biomech 2018; 68:126-131. [DOI: 10.1016/j.jbiomech.2017.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 11/15/2022]
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Schröder FF, Verdonschot NJJ, Ten Haken B, Peters A, Vochteloo AJH, Pakvis DFM, Huis In't Veld R. Low-field magnetic resonance imaging offers potential for measuring tibial component migration. J Exp Orthop 2018; 5:4. [PMID: 29330713 PMCID: PMC5766455 DOI: 10.1186/s40634-017-0116-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Roentgen stereophotogrammetric analysis (RSA) is used to measure early prosthetic migration and to predict future implant failure. RSA has several disadvantages, such as the need for perioperatively inserted tantalum markers. Therefore, this study evaluates low-field MRI as an alternative to RSA. The use of traditional MRI with prostheses induces disturbing metal artifacts which are reduced by low-field MRI. The purpose of this study is to assess the feasibility to use low-field (0.25 Tesla) MRI for measuring the precision of zero motion. This was assessed by calculating the virtual prosthetic motion of a zero-motion prosthetic reconstruction in multiple scanning sessions. Furthermore, the effects of different registration methods on these virtual motions were tested. RESULTS The precision of zero motion for low-field MRI was between 0.584 mm and 1.974 mm for translation and 0.884° and 3.774° for rotation. The manual registration method seemed most accurate, with μ ≤ 0.13 mm (σ ≤ 0.931 mm) for translation and μ ≤ 0.15° (σ ≤ 1.63°) for rotation. CONCLUSION Low-field MRI is not yet as precise as today's golden standard (marker based RSA) as reported in the literature. However, low-field MRI is feasible of measuring the relative position of bone and implant with comparable precision as obtained with marker-free RSA techniques. Of the three registration methods tested, manual registration was most accurate. Before starting clinical validation further research is necessary and should focus on improving scan sequences and registration algorithms.
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Affiliation(s)
- F F Schröder
- Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands. .,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.
| | - N J J Verdonschot
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands.,Radboud Institute for Health Sciences, Orthopaedic Research Lab, Radboud university medical center, Nijmegen, The Netherlands
| | - B Ten Haken
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - A Peters
- Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands
| | - A J H Vochteloo
- Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands
| | - D F M Pakvis
- Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands
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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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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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Chimhundu C, Smit J, Sivarasu S, Douglas TS. Interlandmark Measurements From Lodox Statscan Images1. J Med Device 2014. [DOI: 10.1115/1.4027102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Chipo Chimhundu
- Biomedical Engineering Programme and MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town 7701, South Africa
| | - Julian Smit
- Division of Geomatics, University of Cape Town, Cape Town 7701, South Africa
| | - Sudesh Sivarasu
- Biomedical Engineering Programme and MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town 7701, South Africa
| | - Tania S. Douglas
- Biomedical Engineering Programme and MRC/UCT Medical Imaging Research Unit, University of Cape Town, Cape Town 7701, South Africa
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Seehaus F, Emmerich J, Kaptein BL, Windhagen H, Hurschler C. Dependence of model-based RSA accuracy on higher and lower implant surface model quality. Biomed Eng Online 2013; 12:32. [PMID: 23587251 PMCID: PMC3637620 DOI: 10.1186/1475-925x-12-32] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background Model-based Roentgen Stereophotogrammetric Analysis (MBRSA) allows the accurate in vivo measurement of the relative motion between an implant and the surrounding bone (migration), using pose-estimation algorithms and three dimensional geometric surface models of the implant. The goal of this study was thus to investigate the effect of surface model resolution on the accuracy of the MBRSA method. Methods Four different implant geometries (knee femoral and tibial components, and two different hip stems) were investigated, for each of which two reversed engineering (RE) models of differing spatial digitizing resolution were generated. Accuracy of implant migration measurement using MBRSA was assessed in dependence on surface model resolution using an experimental phantom-model set up. Results When using the lower quality RE models, the worst bias observed ranged from -0.048 to 0.037 mm, and -0.057 to 0.078 deg for translation and rotation respectively. For higher quality reverse engineering models, bias ranged from -0.042 to 0.048 mm, and -0.449 to 0.029 deg. The pair-wise comparisons of digitizing resolution (higher vs. lower quality) within the different implant type revealed significant differences only for the hip stems (p < 0.001). Conclusion The data suggest that the application of lower resolution RE models for MBRSA is a viable alternative method for the in vivo measurement of implant migration, in particular for implants with non symmetrical geometries (total knee arthroplasty). Implants with larger length to width aspect ratio (total hip arthroplasty) may require high resolution RE models in order to achieve acceptable accuracy. Conversely, for some axis the bias for translation are clearly worse for translation, and are marginally better for rotations using the lower resolution RE models instead of the higher ones. However, performed box plots ranges were well within what has been reported in the literature. The observed lower accuracy and precision of the measurements for hip stem components for rotations about the superior-inferior direction is presumably the result of the nature of the MBRSA method. This well known effect within MBRSA for rotations about the axis of symmetry of axially-symmetric objects do not change the contour of the projected image to as large a degree as motion about a non-symmetric axes. It is not possible to detected this small motion as accurately using pose-estimation methods. This may affect the “higher” accuracy for the applied lower resolution RE models.
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