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Ciliberti FK, Cesarelli G, Guerrini L, Gunnarsson AE, Forni R, Aubonnet R, Recenti M, Jacob D, Jónsson H, Cangiano V, Islind AS, Gambacorta M, Gargiulo P. The role of bone mineral density and cartilage volume to predict knee cartilage degeneration. Eur J Transl Myol 2022; 32. [PMID: 35766481 PMCID: PMC9295173 DOI: 10.4081/ejtm.2022.10678] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Knee Osteoarthritis (OA) is a highly prevalent condition affecting knee joint that causes loss of physical function and pain. Clinical treatments are mainly focused on pain relief and limitation of disabilities; therefore, it is crucial to find new paradigms assessing cartilage conditions for detecting and monitoring the progression of OA. The goal of this paper is to highlight the predictive power of several features, such as cartilage density, volume and surface. These features were extracted from the 3D reconstruction of knee joint of forty-seven different patients, subdivided into two categories: degenerative and non-degenerative. The most influent parameters for the degeneration of the knee cartilage were determined using two machine learning classification algorithms (logistic regression and support vector machine); later, box plots, which depicted differences between the classes by gender, were presented to analyze several of the key features’ trend. This work is part of a strategy that aims to find a new solution to assess cartilage condition based on new-investigated features.
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Affiliation(s)
| | - Giuseppe Cesarelli
- Department of Chemical, Materials and Production Engineering (DICMaPI), University of Naples Federico II, Naples.
| | - Lorena Guerrini
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik.
| | | | - Riccardo Forni
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland; Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Cesena.
| | - Romain Aubonnet
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik.
| | - Marco Recenti
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik.
| | - Deborah Jacob
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik.
| | - Halldór Jónsson
- Department of Orthopaedics, Landspitali, University Hospital of Iceland, Reykjavik, Iceland; Medical Faculty, University of Iceland, Reykjavik.
| | - Vincenzo Cangiano
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik.
| | | | | | - Paolo Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland; Department of Science, Landspitali, University Hospital of Iceland, Reykjavik.
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2
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Esposito L, Minutolo V, Gargiulo P, Fraldi M. Symmetry breaking and effects of nutrient walkway in time-dependent bone remodeling incorporating poroelasticity. Biomech Model Mechanobiol 2022; 21:999-1020. [PMID: 35394267 PMCID: PMC9132879 DOI: 10.1007/s10237-022-01573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/07/2022] [Indexed: 12/03/2022]
Abstract
Bone is an extraordinary biological material that continuously adapts its hierarchical microstructure to respond to static and dynamic loads for offering optimal mechanical features, in terms of stiffness and toughness, across different scales, from the sub-microscopic constituents within osteons—where the cyclic activity of osteoblasts, osteoclasts, and osteocytes redesigns shape and percentage of mineral crystals and collagen fibers—up to the macroscopic level, with growth and remodeling processes that modify the architecture of both compact and porous bone districts. Despite the intrinsic complexity of the bone mechanobiology, involving coupling phenomena of micro-damage, nutrients supply driven by fluid flowing throughout hierarchical networks, and cells turnover, successful models and numerical algorithms have been presented in the literature to predict, at the macroscale, how bone remodels under mechanical stimuli, a fundamental issue in many medical applications such as optimization of femur prostheses and diagnosis of the risk fracture. Within this framework, one of the most classical strategies employed in the studies is the so-called Stanford’s law, which allows uploading the effect of the time-dependent load-induced stress stimulus into a biomechanical model to guess the bone structure evolution. In the present work, we generalize this approach by introducing the bone poroelasticity, thus incorporating in the model the role of the fluid content that, by driving nutrients and contributing to the removal of wastes of bone tissue cells, synergistically interacts with the classical stress fields to change homeostasis states, local saturation conditions, and reorients the bone density rate, in this way affecting growth and remodeling. Through two paradigmatic example applications, i.e. a cylindrical slice with internal prescribed displacements idealizing a tract of femoral diaphysis pushed out by the pressure exerted by a femur prosthesis and a bone element in a form of a bent beam, it is highlighted that the present model is capable to catch more realistically both the transition between spongy and cortical regions and the expected non-symmetrical evolution of bone tissue density in the medium–long term, unpredictable with the standard approach. A real study case of a femur is also considered at the end in order to show the effectiveness of the proposed remodeling algorithm.
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Affiliation(s)
- L Esposito
- Department Engineering, University of Campania "Luigi Vanvitelli", Aversa, Italy
| | - V Minutolo
- Department Engineering, University of Campania "Luigi Vanvitelli", Aversa, Italy
| | - P Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland
- Department of Science, Landspítali Hospital, Reykjavík, Iceland
| | - M Fraldi
- Department of Structures for Engineering and Architecture, University of Napoli "Federico II", Napoli, Italy.
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3
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Ciliberti FK, Guerrini L, Gunnarsson AE, Recenti M, Jacob D, Cangiano V, Tesfahunegn YA, Islind AS, Tortorella F, Tsirilaki M, Jónsson H, Gargiulo P, Aubonnet R. CT- and MRI-Based 3D Reconstruction of Knee Joint to Assess Cartilage and Bone. Diagnostics (Basel) 2022; 12:diagnostics12020279. [PMID: 35204370 PMCID: PMC8870751 DOI: 10.3390/diagnostics12020279] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
For the observation of human joint cartilage, X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) are the main diagnostic tools to evaluate pathologies or traumas. The current work introduces a set of novel measurements and 3D features based on MRI and CT data of the knee joint, used to reconstruct bone and cartilages and to assess cartilage condition from a new perspective. Forty-seven subjects presenting a degenerative disease, a traumatic injury or no symptoms or trauma were recruited in this study and scanned using CT and MRI. Using medical imaging software, the bone and cartilage of the knee joint were segmented and 3D reconstructed. Several features such as cartilage density, volume and surface were extracted. Moreover, an investigation was carried out on the distribution of cartilage thickness and curvature analysis to identify new markers of cartilage condition. All the extracted features were used with advanced statistics tools and machine learning to test the ability of our model to predict cartilage conditions. This work is a first step towards the development of a new gold standard of cartilage assessment based on 3D measurements.
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Affiliation(s)
- Federica Kiyomi Ciliberti
- Institute of Biomedical and Neural Engineering, Reykjavik University, 101 Reykjavik, Iceland; (F.K.C.); (L.G.); (A.E.G.); (M.R.); (D.J.); (V.C.); (R.A.)
- Department of Electrical, Information Engineering and Applied Mathematics, University of Salerno, 84084 Salerno, Italy;
| | - Lorena Guerrini
- Institute of Biomedical and Neural Engineering, Reykjavik University, 101 Reykjavik, Iceland; (F.K.C.); (L.G.); (A.E.G.); (M.R.); (D.J.); (V.C.); (R.A.)
- Laboratory of Cellular and Molecular Engineering “Silvio Cavalcanti”, Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, 47521 Cesena, Italy
| | - Arnar Evgeni Gunnarsson
- Institute of Biomedical and Neural Engineering, Reykjavik University, 101 Reykjavik, Iceland; (F.K.C.); (L.G.); (A.E.G.); (M.R.); (D.J.); (V.C.); (R.A.)
| | - Marco Recenti
- Institute of Biomedical and Neural Engineering, Reykjavik University, 101 Reykjavik, Iceland; (F.K.C.); (L.G.); (A.E.G.); (M.R.); (D.J.); (V.C.); (R.A.)
| | - Deborah Jacob
- Institute of Biomedical and Neural Engineering, Reykjavik University, 101 Reykjavik, Iceland; (F.K.C.); (L.G.); (A.E.G.); (M.R.); (D.J.); (V.C.); (R.A.)
| | - Vincenzo Cangiano
- Institute of Biomedical and Neural Engineering, Reykjavik University, 101 Reykjavik, Iceland; (F.K.C.); (L.G.); (A.E.G.); (M.R.); (D.J.); (V.C.); (R.A.)
| | | | | | - Francesco Tortorella
- Department of Electrical, Information Engineering and Applied Mathematics, University of Salerno, 84084 Salerno, Italy;
| | - Mariella Tsirilaki
- Department of Radiology, Landspitali, University Hospital of Iceland, 101 Reykjavik, Iceland;
| | - Halldór Jónsson
- Department of Orthopaedics, Landspitali, University Hospital of Iceland, 101 Reykjavik, Iceland;
- Medical Faculty, University of Iceland, 101 Reykjavik, Iceland
| | - Paolo Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavik University, 101 Reykjavik, Iceland; (F.K.C.); (L.G.); (A.E.G.); (M.R.); (D.J.); (V.C.); (R.A.)
- Department of Science, Landspitali, University Hospital of Iceland, 101 Reykjavik, Iceland
- Correspondence:
| | - Romain Aubonnet
- Institute of Biomedical and Neural Engineering, Reykjavik University, 101 Reykjavik, Iceland; (F.K.C.); (L.G.); (A.E.G.); (M.R.); (D.J.); (V.C.); (R.A.)
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4
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Recenti M, Ricciardi C, Edmunds K, Jacob D, Gambacorta M, Gargiulo P. Testing soft tissue radiodensity parameters interplay with age and self-reported physical activity. Eur J Transl Myol 2021; 31. [PMID: 34251162 PMCID: PMC8495362 DOI: 10.4081/ejtm.2021.9929] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022] Open
Abstract
Aging well is directly associated to a healthy lifestyle. The focus of this paper is to relate individual wellness with medical image features. Non-linear trimodal regression analysis (NTRA) is a novel method that models the radiodensitometric distributions of x-ray computed tomography (CT) cross-sections. It generates 11 patient-specific parameters that describe the quality and quantity of muscle, fat, and connective tissues. In this research, the relationship of these 11 NTRA parameters with age, physical activity, and lifestyle is investigated in the 3,157 elderly volunteers AGES-I dataset. First, univariate statistical analyses were performed, and subjects were grouped by age and self-reported past (youth–midlife) and present (within 12 months of the survey) physical activity to ascertain which parameters were the most influential. Then, machine learning (ML) analyses were conducted to classify patients using NTRA parameters as input features for three ML algorithms. ML is also used to classify a Lifestyle index using the age groups. This classification analysis yielded robust results with the lifestyle index underlying the relevant differences of the soft tissues between age groups, especially in fat and connective tissue. Univariate statistical models suggested that NTRA parameters may be susceptible to age and differences between past and present physical activity levels. Moreover, for both age and physical activity, lean muscle parameters expressed more significant variation than fat and connective tissues.
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Affiliation(s)
- Marco Recenti
- Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík.
| | - Carlo Ricciardi
- Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland; Department of Electrical Engineering and Information Technology, University of Naples 'Federico II', Naples.
| | - Kyle Edmunds
- Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík.
| | - Deborah Jacob
- Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík.
| | | | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavík University, Reykjavík, Iceland; Department of Science, Landspítali, Reykjavík.
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5
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Latessa I, Ricciardi C, Jacob D, Jónsson H, Gambacorta M, Improta G, Gargiulo P. Health technology assessment through Six Sigma Methodology to assess cemented and uncemented protheses in total hip arthroplasty. Eur J Transl Myol 2021; 31. [PMID: 33709655 PMCID: PMC8056159 DOI: 10.4081/ejtm.2021.9651] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study is to use Health Technology Assessment (HTA) through the Six Sigma (SS) and DMAIC (Define, Measure, Analyse, Improve, Control) problem-solving strategies for comparing cemented and uncemented prostheses in terms of the costs incurred for Total hip arthroplasty (THA) and the length of hospital stay (LOS). Multinomial logistic regression analysis for modelling the data was also performed. Quantitative parameters extracted from gait analysis, electromyography and computed tomography images were used to compare the approaches, but the analysis did not show statistical significance. The variables regarding costs were studied with the Mann-Whitney and Kruskal-Wallis tests. No statistically significant difference between cemented and uncemented prosthesis for the total cost of LOS was found, but the cost of the surgeon had an influence on the overall expenses, affecting the cemented prosthetic approach. The material costs of surgery for the uncemented prosthesis and the cost of theatre of surgery for the cemented prosthesis were the most influential. Multinomial logistic regression identified the Vastus Lateralis variable as statistically significant. The overall accuracy of the model is 93.0%. The use of SS and DMAIC cycle as tools of HTA proved that the cemented and uncemented approaches for THA have similar costs and LOSy.
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Affiliation(s)
- Imma Latessa
- University Hospital of Naples "Federico II", Department of Public Health, Naples, Italy; Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík.
| | - Carlo Ricciardi
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík, Iceland; University Hospital of Naples 'Federico II', Department of Advanced Biomedical Sciences, Naples.
| | - Deborah Jacob
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík.
| | - Halldór Jónsson
- University of Iceland, Faculty of Medicine, Reykjavík, Iceland; Landspítali Hospital, Orthopaedic Clinic, Reykjavík.
| | | | - Giovanni Improta
- University Hospital of Naples "Federico II", Department of Public Health, Naples.
| | - Paolo Gargiulo
- Reykjavík University, Institute for Biomedical and Neural Engineering, Reykjavík, Iceland; Landspítali Hospital, Department of Science, Reykjavík.
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6
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Ricciardi C, Jónsson H, Jacob D, Improta G, Recenti M, Gíslason MK, Cesarelli G, Esposito L, Minutolo V, Bifulco P, Gargiulo P. Improving Prosthetic Selection and Predicting BMD from Biometric Measurements in Patients Receiving Total Hip Arthroplasty. Diagnostics (Basel) 2020; 10:diagnostics10100815. [PMID: 33066350 PMCID: PMC7602076 DOI: 10.3390/diagnostics10100815] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
There are two surgical approaches to performing total hip arthroplasty (THA): a cemented or uncemented type of prosthesis. The choice is usually based on the experience of the orthopaedic surgeon and on parameters such as the age and gender of the patient. Using machine learning (ML) techniques on quantitative biomechanical and bone quality data extracted from computed tomography, electromyography and gait analysis, the aim of this paper was, firstly, to help clinicians use patient-specific biomarkers from diagnostic exams in the prosthetic decision-making process. The second aim was to evaluate patient long-term outcomes by predicting the bone mineral density (BMD) of the proximal and distal parts of the femur using advanced image processing analysis techniques and ML. The ML analyses were performed on diagnostic patient data extracted from a national database of 51 THA patients using the Knime analytics platform. The classification analysis achieved 93% accuracy in choosing the type of prosthesis; the regression analysis on the BMD data showed a coefficient of determination of about 0.6. The start and stop of the electromyographic signals were identified as the best predictors. This study shows a patient-specific approach could be helpful in the decision-making process and provide clinicians with information regarding the follow up of patients.
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Affiliation(s)
- Carlo Ricciardi
- Department of Advanced Biomedical Sciences, University Hospital of Naples ‘Federico II’, 80131 Naples, Italy
- Institute for Biomedical and Neural Engineering, Reykjavík University, 102 Reykjavík, Iceland; (D.J.); (M.R.); (M.K.G.); (P.G.)
- Correspondence:
| | - Halldór Jónsson
- Faculty of Medicine, University of Iceland, 102 Reykjavík, Iceland;
- Landspítali Hospital, Orthopaedic Clinic, 102 Reykjavík, Iceland
| | - Deborah Jacob
- Institute for Biomedical and Neural Engineering, Reykjavík University, 102 Reykjavík, Iceland; (D.J.); (M.R.); (M.K.G.); (P.G.)
| | - Giovanni Improta
- Department of Public Health, University Hospital of Naples ‘Federico II’, 80125 Naples, Italy;
| | - Marco Recenti
- Institute for Biomedical and Neural Engineering, Reykjavík University, 102 Reykjavík, Iceland; (D.J.); (M.R.); (M.K.G.); (P.G.)
| | - Magnús Kjartan Gíslason
- Institute for Biomedical and Neural Engineering, Reykjavík University, 102 Reykjavík, Iceland; (D.J.); (M.R.); (M.K.G.); (P.G.)
| | - Giuseppe Cesarelli
- Department of Chemical, Materials and Production Engineering, University of Naples “Federico II”, 80125 Naples, Italy;
- Istituto Italiano di Tecnologia, 80125 Naples, Italy
| | - Luca Esposito
- Department Engineering, University of Campania Luigi Vanvitelli, 81100 Aversa (CE), Italy; (L.E.); (V.M.)
| | - Vincenzo Minutolo
- Department Engineering, University of Campania Luigi Vanvitelli, 81100 Aversa (CE), Italy; (L.E.); (V.M.)
| | - Paolo Bifulco
- Department of Electrical Engineering and Information Technologies, University Hospital of Naples ‘Federico II’, 80125 Naples, Italy;
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavík University, 102 Reykjavík, Iceland; (D.J.); (M.R.); (M.K.G.); (P.G.)
- Department of Science, Landspítali Hospital, 102 Reykjavík, Iceland
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7
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Towards an App to Estimate Patient-Specific Perioperative Femur Fracture Risk. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10186409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Total Hip Arthroplasty has been one of the most successful surgical procedure in terms of patient outcomes and satisfaction. However, due to increase in life expectancy and the related incidence of age-dependent bone diseases, a growing number of cases of intra-operative fractures lead to revision surgery with high rates of morbidity and mortality. Surgeons choose the type of the implant, either cemented or cementless prosthesis, on the basis of the age, the quality of the bone and the general medical conditions of the patients. Generally, no quantitative measures are available to assess the intra-operative fracture risk. Consequently, the decision-making process is mainly based on surgical operators’ expertise and qualitative information obtained from imaging. Motivated by this scenario, we here propose a mechanical-supported strategy to assist surgeons in their decisions, by giving intelligible maps of the risk fracture which take into account the interplay between the actual mechanical strength distribution inside the bone tissue and its response to the forces exerted by the implant. In the presented study, we produce charts and patient-specific synthetic “traffic-light” indicators of fracture risk, by making use of ad hoc analytical solutions to predict the stress levels in the bone by means of Computed Tomography-based mechanical and geometrical parameters of the patient. We felt that if implemented in a friendly software or proposed as an app, the strategy could constitute a practical tool to help the medical decision-making process, in particular with respect to the choice of adopting cemented or cementless implant.
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Gislason MK, Lupidio F, Jónsson H, Cristofolini L, Esposito L, Bifulco P, Fraldi M, Gargiulo P. Three dimensional bone mineral density changes in the femur over 1 year in primary total hip arthroplasty patients. Clin Biomech (Bristol, Avon) 2020; 78:105092. [PMID: 32590143 DOI: 10.1016/j.clinbiomech.2020.105092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to compare the bone mineral density changes between unmatched patients undergoing total hip arthroplasty receiving uncemented and cemented type of implants. Previous studies have used DEXA or a two dimensional analysis to estimate the bone quality following total joint replacement, whereas this study presents the changes in three dimensions. METHODS Fifty subjects both male and females receiving both cemented and uncemented type of implant were recruited. Two CT scans were taken of each subject, the first at 24 h post surgery and the second one 1 year after surgery. The scans were calibrated using a phantom converting the Hounsfield units to bone mineral density values in g/cm3. The two scans were registered together using anatomical landmarks and resliced to compare the two femurs in the identical frame of reference. The bone density gain and loss was calculated by comparing density values between the two sets of scans. FINDINGS The results showed that most of the bone loss was located around the Lesser Trochanter and some bone density gain at the distal tip of the implant. The three dimensional density changes occur differently between individuals and the study showed no correlation of bone loss with age. INTERPRETATION The bone loss occurred mostly at the proximal femur, which is in agreement with previously presented studies. By carrying out three dimensional analysis on the bone gain and loss on the femur, it is possible to identify the patients that are showing high degree of bone loss.
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Affiliation(s)
| | - Francesca Lupidio
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; University of Bologna, Department of Industrial Engineering, Italy
| | - Halldór Jónsson
- Landspitali University Hospital, Department of Orthopaedics, Iceland
| | | | - Luca Esposito
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Bifulco
- University of Naples Federico II, Department of Electrical Engineering and Information Technologies, Italy
| | - Massimiliano Fraldi
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; Department of Science, Landspitali University Hospital, Iceland
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9
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Viceconti M. Predicting bone strength from CT data: Clinical applications. Morphologie 2019; 103:180-186. [PMID: 31630964 DOI: 10.1016/j.morpho.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
In this review we summarise over 15 years of research and development around the prediction of whole bones strength from Computed Tomography data, with particular reference to the prediction of the risk of hip fracture in osteoporotic patients. We briefly discuss the theoretical background, and then provide a summary of the laboratory and clinical validation of these modelling technologies. We then discuss the three current clinical applications: in clinical research, in clinical trials, and in clinical practice. On average the strength predicted with finite element models (QCT-FE) based on computed tomography is 7% more accurate that that predicted with areal bone mineral density from Dual X-ray Absorptiometry (DXA-aBMD), the current standard of care, both in term of laboratory validation on cadaver bones and in terms of stratification accuracy on clinical cohorts of fractured and non-fractured women. This improved accuracy makes QCT-FE superior to DXA-aBMD in clinical research and in clinical trials, where the its use can cut in half the number of patients to be enrolled to get the same statistical power. For routine clinical use to decide who to treat with antiresorptive drugs, QCT-FE is more accurate but less cost-effective than DXA-aBMD, at least when the decision is on first line treatment like bisphosphonates. But the ability to predict skeletal strength from medical imaging is now opening a number of other applications, for example in paediatrics and oncology.
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Affiliation(s)
- M Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Italy; Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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