Detection of bone defects around zirconium component after total knee arthroplasty

MRI as Diagnostic Modality for Analyzing the Problematic Knee Arthroplasty: A Systematic Review

Background

Various diagnostic modalities are available to assess the problematic knee arthroplasty. Visualization of soft‐tissue structures in relation to the arthroplasty and bone remains difficult. Recent developments in MRI sequences could make MRI a viable addition to the diagnostic arsenal.

Purpose

To review the diagnostic properties of MRI, to identify certain causes of complaints that may be directly related to implant failure of total (TKA) or unicompartmental knee arthroplasty (UKA); infection, loosening and wear, instability, malalignment, arthrofibrosis, or patellofemoral problems.

Study Type

Systematic review.

Population

Twenty‐three studies were included: 16 TKA, four UKA, and three cadaveric studies. Causes of knee arthroplasty complaints analyzed were; infection (three), loosening and wear (11), malalignment (five) and instability (four).

Field Strength and Sequences

No field strength or sequence restrictions.

Assessment

PubMed, SCOPUS, and EMBASE were searched. Risk of bias was assessed using the COnsensus‐based Standards for the selection of health Measurement Instruments (COSMIN) and the QUality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2).

Statistical Tests

The results of the original research articles are stated.

Results

Fifteen studies assessed the reproducibility of analyzing infection, loosening and wear, and malalignment. Fourteen of 15 studies were deemed as adequate to good quality. Results showed a moderate to excellent agreement (ICC/K 0.55–0.97). Fourteen studies addressed the accuracy. For infection and loosening and wear the sensitivity and specificity estimates varied between 0.85–0.97 and 0.70–1.00, respectively. The accuracy for malalignment was excellent (r ≥ 0.81). For these studies QUADAS‐2 analysis suggested few risks of bias. A meta‐analysis was not possible due to the heterogeneity of the data.

Data Conclusion

This study supports that MRI can be used with overall reproducible and accurate results for diagnosing infection, loosening and wear, and malalignment after knee arthroplasty. Nonetheless, studies regarding the diagnosis of instability, arthrofibrosis or patellofemoral complaints using MRI are limited and inconclusive.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2020;51:446–458.

Building an orthopaedic CT phantom for under £50

OBJECTIVE:

In procuring a CT scanner for orthopaedic imaging, the ability of the scanner to cope with metal artefacts for visualising bone and bone lesions around orthopaedic implants is an important feature. A durable and easily transportable CT phantom would help to compare this feature between CT scanners.The aims of this study were to develop a CT phantom that is easy to build, easily transportable, stable over time, cheap and challenging CT scanner performance.

METHODS:

A CT phantom resembling a femur and tibia with a total knee replacement was constructed from spare components of a knee replacement, wall filler and polystyrene. A number of plastic strips and cylinders were placed between metal implant and bone substitute during construction to act as "bone lesions". The phantom was fixed in a watertight acrylic box with epoxy resin.

RESULTS:

The total manufacturing time was below 3 h staggered over several days and the total cost was below £50. When empty, the phantom is easily transportable. The box can be filled with water on site visits ensuring a reproducible attenuation. This phantom is stable (i.e. not affected by decay of biological tissue).

CONCLUSION:

The phantom was easy to construct and is well transportable and stable in time. The phantom can be used in a procurement process allowing direct comparison of different scanners regarding technical factors and software performance. It can further be used for quality assurance, scan parameter optimisation and research. We conclude that a simple and transportable CT phantom can be built using few resources that allows to compare CT scanners with respect to their ability to visualise bone lesions around metal implants.

ADVANCES IN KNOWLEDGE:

It is possible to build a CT knee replacement phantom in a few hours and for less than £50. Other than the total knee implant, this CT phantom can be built with material available from any DIY store and simple tools. This CT phantoms allows objective comparisons in CT procurement. This CT phantom allows objective assessment of imaging protocols for clinical practice.