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De Angelis S, Di Laura A, Ramesh A, Henckel J, Hart A. The role of bone remodeling in measuring migration of custom implants for large acetabular defects. J Orthop Res 2024; 42:1791-1800. [PMID: 38408764 DOI: 10.1002/jor.25818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/28/2024]
Abstract
In revision total hip arthroplasty, achieving robust fixation is difficult and implant movement may occur over time. Bone may also rearrange around the implant as a result of mechanical loading, making the measurement of migration challenging. The study aimed to quantify changes in bone shape and implant position 1 year following acetabular reconstruction using custom three-dimensional-printed cups. This observational retrospective cohort study involved 23 patients with Paprosky type IIIB defects. Postop computed tomography scans taken within 1 week of surgery and at 1-year postsurgery were co-registered and analyzed. Three co-registration strategies were implemented including bone-to-bone and implant-to-implant. (1) Co-registration of the ipsilateral innominate bone (diseased anatomy) was used to measure changes in implant position. (2) Co-registration of the implant was carried out to quantify changes in the ipsilateral innominate bone shape. (3) Co-registration of the contralateral innominate bone (nondiseased anatomy) was performed to measure changes in the ipsilateral innominate bone shape and implant position. The median centroid distances (interquartile range [IQR]) were 2.3 mm (IQR: 3.7-1.7 mm) for changes in implant position, 2.4 mm (IQR: 3.6-1.6 mm) for changes in ipsilateral innominate bone shape, and 3.7 mm (IQR: 4.6-3.5 mm) for changes in ipsilateral innominate bone shape and implant position. Following acetabular reconstruction, implant movements and periprosthetic bone remodeling are physiological and of a similar extent. Surgeons and engineers should consider this when performing implant monitoring in these patients.
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Affiliation(s)
- Sara De Angelis
- Institute of Mechanical Engineering, University College London, London, UK
| | - Anna Di Laura
- Institute of Mechanical Engineering, University College London, London, UK
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Angelika Ramesh
- Institute of Mechanical Engineering, University College London, London, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Cleveland Clinic London, London, UK
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2
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Reiser D, Sagerfors M, Wretenberg P, Pettersson K, Fischer P. Clinical, Radiographic, and Patient-Perceived Outcome After Radial Hemi-Wrist Arthroplasty With a New Implant: 20 Cases With 5-Year Follow-up. Hand (N Y) 2024; 19:742-750. [PMID: 36752076 PMCID: PMC11284997 DOI: 10.1177/15589447231151427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design. METHODS In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively. RESULTS A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged. CONCLUSIONS The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.
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Affiliation(s)
- Daniel Reiser
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Marcus Sagerfors
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Wretenberg
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Kurt Pettersson
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Fischer
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
- Karlskoga Hospital, Sweden
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Kaptein BL, Pijls B, Koster L, Kärrholm J, Hull M, Niesen A, Heesterbeek P, Callary S, Teeter M, Gascoyne T, Röhrl SM, Flivik G, Bragonzoni L, Laende E, Sandberg O, Solomon LB, Nelissen R, Stilling M. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95:256-267. [PMID: 38819193 PMCID: PMC11141406 DOI: 10.2340/17453674.2024.40709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024] Open
Abstract
Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and consistent in execution, presentation, reporting, and interpretation. Both authors and reviewers of scientific papers using RSA may use these guidelines, summarized in the Checklist, as a reference. Deviations from these guidelines should have the underlying rationale stated.
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Affiliation(s)
- Bart L Kaptein
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bart Pijls
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lennard Koster
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Kärrholm
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maury Hull
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Abby Niesen
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Petra Heesterbeek
- Orthopedic Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Stuart Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Matthew Teeter
- Department of Medical Biophysics, Western University, London, Canada
| | | | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gunnar Flivik
- Department of Orthopedics, Skane University Hospital, Lund, Sweden
| | | | - Elise Laende
- Department of Surgery, Dalhousie University, Halifax, Canada
| | | | - L Bogdan Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Rob Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Nagata K, Okubo M, Saito K, Nakashizu T, Atsumi M, Kawana H. Verification of the accuracy of dynamic navigation for conventional and mouthpiece methods: in vivo study. BMC Oral Health 2024; 24:596. [PMID: 38778269 PMCID: PMC11112779 DOI: 10.1186/s12903-024-04327-1] [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: 01/22/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Dynamic navigation for implant placement is becoming popular under the concept of top-down treatment. The purpose of this study is to verify the accuracy of a dynamic navigation system for implant placement. METHODS Implant placement was performed on 38 patients using 50 implant fixtures. Patients in group C were treated using a conventional method, in which thermoplastic clips were fixed to the teeth, and patients in group M were treated using thermoplastic clips fixed to a mouthpiece attached to the teeth. The groups were compared to verify whether an accuracy difference existed. A treatment planning support program for dental implants was used to superimpose the postoperative computed tomography data on the preoperative implant design data to measure the entry point, apex point, and angular deviation. RESULTS The accuracy of group C was 1.36 ± 0.51 mm for entry point, 1.30 ± 0.59 mm for apex point, and 3.20 ± 0.74° for angular deviation. The accuracy of group M was 1.06 ± 0.31 mm for the entry point, 1.02 ± 0.30 mm for the apex point, and 2.91 ± 0.97° for angular deviation. Significant differences were observed in the entry and apex points between the two groups. CONCLUSIONS The results indicate that group M exhibited better accuracy than group C, indicating that the stability of the thermoplastic clip is important for ensuring the accuracy of the dynamic navigation system. No previous studies have verified the accuracy of this system using the mouthpiece method, and additional data is required to confirm its accuracy for dental implant placement. The mouthpiece method improves the accuracy of implant placement and provides a safer implant treatment than the conventional method. TRIAL REGISTRATION University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), Registration Number: UMIN000051949, URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view_his.cgi on August 21, 2023.
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Affiliation(s)
- Koudai Nagata
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Manabu Okubo
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Kurumi Saito
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Toshifumi Nakashizu
- Division of the Dental Practice Support, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Mihoko Atsumi
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Hiromasa Kawana
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan.
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Christensson A, Nemati HM, Flivik G. Comparison between model-based RSA and an AI-based CT-RSA: an accuracy study of 30 patients. Acta Orthop 2024; 95:39-46. [PMID: 38284788 PMCID: PMC10824248 DOI: 10.2340/17453674.2024.35749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/16/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND PURPOSE Radiostereometry (RSA) is the current gold standard for evaluating early implant migration. CT-based migration analysis is a promising method, with fewer handling requirements compared with RSA and no need for implanted bone-markers. We aimed to evaluate agreement between a new artificial intelligence (AI)-based CT-RSA and model-based RSA (MBRSA) in measuring migration of cup and stem in total hip arthroplasty (THA). PATIENTS AND METHODS 30 patients with THA for primary osteoarthritis (OA) were included. RSA examinations were performed on the first postoperative day, and at 2 weeks, 3 months, 1, 2, and 5 years after surgery. A low-dose CT scan was done at 2 weeks and 5 years. The agreement between the migration results obtained from MBRSA and AI-based CT-RSA was assessed using Bland-Altman plots. RESULTS Stem migration (y-translation) between 2 weeks and 5 years, for the primary outcome measure, was -0.18 (95% confidence interval [CI] -0.31 to -0.05) mm with MBRSA and -0.36 (CI -0.53 to -0.19) mm with AI-based CT-RSA. Corresponding proximal migration of the cup (y-translation) was 0.06 (CI 0.02-0.09) mm and 0.02 (CI -0.01 to 0.05) mm, respectively. The mean difference for all stem and cup comparisons was within the range of MBRSA precision. The AI-based CT-RSA showed no intra- or interobserver variability. CONCLUSION We found good agreement between the AI-based CT-RSA and MBRSA in measuring postoperative implant migration. AI-based CT-RSA ensures user independence and delivers consistent results.
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Affiliation(s)
- Albin Christensson
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund.
| | | | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund
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Olivecrona G, Gordon Murkes L, Olivecrona H, Gerdhem P. Assessment of the sacroiliac joint with computed tomography motion analysis: a diagnostic study of 12 patients. Acta Orthop 2024; 95:20-24. [PMID: 38240723 PMCID: PMC10798261 DOI: 10.2340/17453674.2024.35227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/09/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND AND PURPOSE Pain in the sacroiliac joint may be caused by abnormal joint motion. Diagnosis is mainly based on clinical tests. The aims of this study were to examine whether low-dose computed tomography with provocation of the hip could detect sacroiliac joint motion, and to study whether provocation of the hip results in greater sacroiliac joint motion in the ipsilateral than in the contralateral sacroiliac joint. PATIENTS AND METHODS 12 patients with sacroiliac joint pain were examined with low-dose computed tomography scans of the sacroiliac joint, one with the hips in the neutral position, and one each in provocation with the left or the right hip in a figure-of-4 position. Accuracy was tested by comparing internal rotation of the sacrum with internal rotation in the sacroiliac joint. Motion in the sacroiliac joint was assessed by comparing the position of each of the ilia with the reference, the sacrum. Data is shown as mean with 95% confidence interval (CI). RESULTS We observed greater motion in the sacroiliac joint than internally in the sacrum, i.e., 0.57° (CI 0.43-0.71) vs. 0.20° (CI 0.11-0.28). The motion of the geometric center of the moving object for the sacroiliac joint was larger on the provoked side; mean difference 0.17 mm (CI 0.01-0.33), P = 0.04. Corresponding figures for rotation were mean difference 0.19° (CI 0.10-0.28), P < 0.001. Compared with the sacrum, the largest motion was seen at the anterior superior iliac spine; mean difference 0.38 mm (CI 0.10-0.66), P = 0.001. CONCLUSION Provocation in the figure-of-4 position of the hip results in sacroiliac joint motion measurable with computed tomography motion analysis. Provocation of the hip induces larger motion on the ipsilateral than on the contralateral sacroiliac joint.
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Affiliation(s)
- Grim Olivecrona
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
| | - Lena Gordon Murkes
- Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm
| | | | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm; Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Uppsala; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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7
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Lundqvist E, Olivecrona H, Wretenberg P, Sagerfors M. CT-Based Micromotion Analysis After Locking Plate Fixation of AO Type C Distal Radius Fractures. Indian J Orthop 2023; 57:2031-2039. [PMID: 38026840 PMCID: PMC10673767 DOI: 10.1007/s43465-023-01020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023]
Abstract
Background Volar locking plate fixation (VLPF) is the most common method for operative fixation of distal radius fractures (DRF). The dorsal ulnar corner (DUC) can be difficult to stabilize as the fragment is small and not exposed when using the volar approach. The purpose of this study was to study fracture fragment migration after VLPF of AO type C DRF, using a volume registration technique of paired CT scans with special focus on the DUC fragment. Materials and Methods This pilot study included ten patients with AO type C DRF, all operated with VLPF. The primary outcome was radiographic outcome. Postoperative and 1-year scans were compared and analyzed. Fragment migration was assessed with CT-based micromotion analysis (CTMA), a software technique used for volume registration of paired CT scans. Results All plates were stable over time. Two patients showed signs of screw movement (0.2-0.35 mm and 0.35- > 1 mm respectively). Postoperative reduction was maintained, and there was no fragment migration at the 1-year follow-up except for one case with increased dorsal tilt. The DUC fragment was found in 8/10 cases, fixated in 7/8 cases, and not dislocated in any case at the 1-year follow-up. Conclusion The CTMA results indicate that variable-angle VLPF after AO type C DRF can yield and maintain a highly stable reduction of the fracture fragments. The DUC fragment remained stable regardless of the number of screws through the fragment. CT volume registration can be a valuable tool in the detailed assessment of fracture fragment migration following volar plate fixation of DRFs.
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Affiliation(s)
- Eva Lundqvist
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Per Wretenberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
| | - Marcus Sagerfors
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Orthopedics and Hand Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden
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Øhrn FD, Engseth LHW, Pripp AH, Röhrl SMH, Schulz A. Dose reduction does not impact the precision of CT-based RSA in tibial implants: a diagnostic accuracy study on precision in a porcine cadaver. Acta Orthop 2023; 94:550-544. [PMID: 37909103 PMCID: PMC10618912 DOI: 10.2340/17453674.2023.24022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/08/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiostereometric analysis (RSA) is the gold standard for evaluation of migration of implants. CT-RSA has been shown to have precision at the level of RSA in hip, shoulder, and knee joint replacements. We aimed to assess the impact of dose reduction on precision of CT-RSA on tibial implants, comparing it with previously published data on precision of standard dose CT-RSA on tibial implants. MATERIAL AND METHODS We performed a total knee arthroplasty on a porcine knee cadaver, and subsequent CT-RSA with low effective doses (0.02 mSv). We compared the results with previously published CT-RSA data with standard (0.08 mSv) dose. The primary outcome variable was the difference in precision of the maximum total translation (MTT). Secondary variables included ratios of variances and standard deviations, and precision of peripheral point translations, center-of-mass translations, and rotations. A difference of more than 0.1 mm in precision was defined as clinically relevant. Our hypothesis was that precisions of low and standard CT-RSA doses were equal. RESULTS Low dose (mean 0.07, 95% confidence interval [CI] 0.06-0.08) and standard dose CT-RSA (0.08, CI 0.07-0.09) achieve similar precision, with difference in precision of MTT of 0.01, CI 0.00-0.02 mm. The F-statistic (0.99, CI 0.63-1.55) and sdtest (1.05, CI 0.43-2.58) also supported this. CONCLUSION We conclude that the precision of low dose CT-RSA for tibial implants on a porcine cadaver is equal to standard dose CT-RSA. However, these findings should be confirmed in clinical trials.
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Affiliation(s)
- Frank-David Øhrn
- Orthopaedic Department, Kristiansund Hospital, Møre and Romsdal Hospital Trust, Kristiansund; Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science (INB), NTNU Norwegian University of Science and Technology.
| | - Lars H W Engseth
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo
| | - Are H Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo
| | - Stephan M H Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
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Lundin N, Olivecrona H, Bakhshayesh P, Gordon Murkes L, Enocson A. Computed tomography micromotion analysis in the follow-up of patients with surgically treated pelvic fractures: a prospective clinical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3143-3151. [PMID: 37059868 PMCID: PMC10504208 DOI: 10.1007/s00590-023-03542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE High-energy pelvic fractures are complex injuries often requiring surgical treatment. Different radiological methods exist to evaluate the reduction and healing process postoperatively but with certain limitations. The aim of this study was to evaluate Computed Tomography Micromotion Analysis (CTMA) in a clinical setting for follow-up of surgically treated pelvic fracture patients. METHODS 10 patients surgically treated for a pelvic fracture were included and prospectively followed with Computed Tomography (CT) at 0, 6, 12 and 52 weeks postoperatively. CTMA was used to measure postoperative translation and rotation of the pelvic fracture during the 52 weeks follow-up. Clinical outcomes were collected through the questionnaires EQ-5D index score and Majeed score. RESULTS 10 patients were included with mean age (± SD, min-max) 52 (16, 31-80) years and 70% (n = 7) were males. The median (IQR, min-max) global translation from 0 to 52 weeks was 6.0 (4.6, 1.4-12.6) millimeters and median global rotation was 2.6 (2.4, 0.7-4.7) degrees. The general trend was a larger translation between 0 and 6 weeks postoperatively compared to 6-12 and 12-52 weeks. For the clinical outcomes, the general trend was that all patients started from high scores which decreased in the first postoperative follow-up and recovered to different extent during the study period. CONCLUSION CTMA was successfully used in the follow-up of surgically treated pelvic fracture patients. Movement in the pelvic fractures after surgical fixation was largest between 0 and 6 weeks.
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Affiliation(s)
- Natalie Lundin
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
- Department of Trauma, Acute Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Peyman Bakhshayesh
- Leeds General Infirmary Major Trauma Centre, University of Leeds, Leeds, UK
| | - Lena Gordon Murkes
- Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Enocson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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van der Gaast N, Huitema JM, Edwards BHJ, Verbakel J, Alderlieste DS, Doornberg JN, Edwards MJR, Jaarsma RL, Hermans E. Quantifying the Differences between 3D Virtual Planning and Attained Postoperative Reduction on CT for Patients with Tibial Plateau Fractures; a Clinical Feasibility Study. J Pers Med 2023; 13:jpm13050788. [PMID: 37240958 DOI: 10.3390/jpm13050788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Three-Dimensional Virtual Planning (3DVP) has been proven to be effective for limiting intra-articular screw penetration and improving the quality of reduction for numerous fractures. However, the value of 3DVP for patients with tibial plateau fractures has yet to be determined. Purposes: The research question of this study is: Can Computed Tomography Micromotion Analysis (CTMA) provide a reliable quantification of the difference between 3DVP and the postoperative reduction on CT for tibial plateau fractures? Methods: Nine consecutive adult patients who received surgical treatment for a tibial plateau fracture and received pre- and postoperative CT scans were included from a level I trauma center in the Netherlands. The preoperative CT scans of the patients were uploaded in a 3DVP software. In this software, fracture fragments were reduced and the reduction was saved as a 3D file (STL). The quality of the reduction from the 3DVP software was compared with the postoperative results using CT Micromotion Analysis (CTMA). In this analysis, the translation of the largest intra-articular fragment was calculated by aligning the postoperative CT with the 3DVP. Coordinates and measurement points were defined in the X, Y, and Z axes. The combined values of X and Y were used to define the intra-articular gap. The Z-axis was defined as the line from cranial to caudal and was used to define intra-articular step-off. Results: The intra-articular step-off was 2.4 mm (Range 0.5-4.6). Moreover, the mean translation of the X-axis and Y-axis, which was defined as the intra-articular gap, was 4.2 mm (Range 0.6-10.7). Conclusions: 3DVP provides excellent insight into the fracture and its fragments. Utilizing the largest intra-articular fragment, it is feasible to quantify the difference between 3DVP and a postoperative CT using CTMA. A prospective study to further analyze the use of 3DVP in terms of intra-articular reduction and surgical and patient-related outcomes has been started by our team.
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Affiliation(s)
- Nynke van der Gaast
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Jellina M Huitema
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Britt H J Edwards
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Joy Verbakel
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Dagmar S Alderlieste
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Job N Doornberg
- Department of Orthopaedic Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Ruurd L Jaarsma
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Erik Hermans
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Engseth LHW, Schulz A, Pripp AH, Röhrl SMH, Øhrn FD. CT-based migration analysis is more precise than radiostereometric analysis for tibial implants: a phantom study on a porcine cadaver. Acta Orthop 2023; 94:207-214. [PMID: 37114404 PMCID: PMC10141323 DOI: 10.2340/17453674.2023.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiostereometric analysis (RSA) is the gold standard for migration analysis, but computed tomography analysis methods (CTRSA) have shown comparable results in other joints. We attempted to validate precision for CT compared with RSA for a tibial implant. MATERIAL AND METHODS RSA and CT were performed on a porcine knee with a tibial implant. Marker-based RSA, model-based RSA (MBRSA), and CT scans from 2 different manufacturers were compared. CT analysis was performed by 2 raters for reliability evaluation. RESULTS 21 double examinations for precision measurements for RSA and CT-based Micromotion Analysis (CTMA) were analysed. Mean (95% confidence interval) precision data for maximum total point motion (MTPM) using marker-based RSA was 0.45 (0.19-0.70) and 0.58 (0.20-0.96) using MBRSA (F-statistic 0.44 [95% CI 0.18-1.1], p = 0.07). Precision data for total translation (TT) for CTMA was 0.08 (0.03-0.12) for the GE scanner and 0.11 (0.04-0.19) for the Siemens scanner (F-statistic 0.37 [0.15-0.91], p = 0.03). When comparing the aforementioned precision for both RSA methods with both CTMA analyses, CTMA was more precise (p < 0.001). The same pattern was seen for other translations and migrations. Mean effective radiation doses were 0.005 mSv (RSA) (0.0048-0.0050) and 0.08 mSv (CT) (0.078-0.080) (p < 0.001). Intra- and interrater reliability were 0.79 (0.75-0.82) and 0.77 (0.72-0.82), respectively. CONCLUSION CTMA is more precise than RSA for migration analysis of a tibial implant, has overall good intra- and interrater reliability but higher effective radiation doses in a porcine cadaver.
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Affiliation(s)
- Lars H W Engseth
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo.
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo
| | - Are H Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo
| | - Stephan M H Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo
| | - Frank-David Øhrn
- Orthopaedic Department, Kristiansund Hospital, Møre and Romsdal Hospital Trust, Kristiansund; Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science (INB), NTNU Norwegian University of Science and Technology, Norway
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12
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Cao H. Accuracy of radiostereometric analysis using a motorized Roentgen system in a pilot study for clinical simulation. Med Eng Phys 2023; 111:103929. [PMID: 36792244 DOI: 10.1016/j.medengphy.2022.103929] [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: 05/31/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
Radiostereometric analysis (RSA) is routinely implemented with two paired Roentgen tubes for three-dimensional (3D) implant migration measurements. A conventional set-up of one stationary tube and one mobile could be time-consuming. Utilizing two customized ceiling-mounted tubes is normally associated with investment costs. Thus, a pilot set-up of a motorized system (single Roentgen source) for radiostereometric image acquisition may be a time-saving and space-efficient alternative. RSA using the motorized system is feasible in this study as a non-synchronized image acquisition technique, however, patient motion may occur and influence the assessment of implant migration. The phantom study aimed to assess accuracy of RSA using the motorized Roentgen system in this in vitro study. Accuracy values of translations and rotations were ±0.29 mm and ±0.48° for the single Roentgen source RSA set-up and ±0.26 mm and ±0.48° for the conventional RSA set-up. This study was also performed to simulate potential patient motion during exposure intervals between paired image acquisition. RSA using the motorized system is able to implement RSA with acceptable accuracy. In general, RSA with synchronized image acquisition is the gold standard to access in vivo implant migration with the highest accuracy. Patient motion exists in non-synchronized image acquisition techniques and results in RSA-related motion artifacts. Then we introduced what RSA-related motion artifacts are. The uniplanar calibration cage applied in the study has a few fiducial and control markers, and some of the markers were occluded in radiographs. Whereas, the number of markers in the calibration cage is correlated with accuracy of 3D implant reconstruction.
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Affiliation(s)
- Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; Department of Orthopaedic Surgery, Taizhou Second People's Hospital, 225599 Taizhou, China.
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ANGELOMENOS V, MOHADDES M, ITAYEM R, SHAREGHI B. Precision of low-dose CT-based micromotion analysis technique for the assessment of early acetabular cup migration compared with gold standard RSA: a prospective study of 30 patients up to 1 year. Acta Orthop 2022; 93:459-465. [PMID: 35478261 PMCID: PMC9047498 DOI: 10.2340/17453674.2022.2528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Computed tomography micromotion analysis (CTMA) can be used to determine implant micro-movements using low-dose CT scans. By using CTMA, a non-invasive measurement of joint implant movement is enabled. We evaluated the precision of CTMA in measuring early cup migration. Standard marker-based radiostereometric analysis (RSA) was used as reference. We hypothesised that CTMA can be used as an alternative to RSA in assessing implant micromotions. PATIENTS AND METHODS We included 30 patients undergoing total hip arthroplasty (THA). Acetabular cup migration at 1 year was measured with RSA and CTMA. To determine the precision of both methods, 20 double examinations (postoperatively) with repositioning of the patients were performed. The precision was calculated from zero by assuming that there was no motion of the prosthesis between the 2 examinations. RESULTS The precision of RSA ranged from 0.06 to 0.15 mm for translations and 0.21° to 0.63° for rotations. Corresponding values for CTMA were 0.06 to 0.13 mm and 0.23° to 0.35°. A good level of agreement was found between the methods regarding cup migration and rotation at 1 year. INTERPRETATION The precision of CTMA in measuring acetabular cup migration and rotation is comparable to marker-based RSA. CTMA could possibly thus be used as an alternative method to detect early implant migration.
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Affiliation(s)
- Vasileios ANGELOMENOS
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maziar MOHADDES
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raed ITAYEM
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bita SHAREGHI
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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14
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BRODÉN C, REILLY P, KHANNA M, POPAT R, OLIVECRONA H, GRIFFITHS D, SKÖLDENBERG O, EMERY R. CT-based micromotion analysis method can assess early implant migration and development of radiolucent lines in cemented glenoid components: a clinical feasibility study. Acta Orthop 2022; 93:277-283. [PMID: 35113169 PMCID: PMC8808478 DOI: 10.2340/17453674.2022.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE CT micromotion analysis (CTMA) has been considered as an alternative to radiostereometry (RSA) for assessing early implant migration of orthopedic implants. We investigated the feasibility of CTMA to assess early migration and the progression of radiolucent lines in shoulder arthroplasties over 24 months using sequential low-dose CT scans. PATIENTS AND METHODS 7 patients were included and underwent 9 primary total shoulder arthroplasties. We made CT scans preoperatively, within 1 week postoperatively, and after 3, 6, 12, and 24 months. At each follow-up, postoperative glenoid migration and any development of radiolucent lines were assessed. Clinical outcomes were recorded at all time points except within 1 week postoperatively. RESULTS For the glenoid component, the median translation and median rotation were 0.00-0.10 mm and -1.53° to 1.05° at 24 months. Radiolucent lines could be observed around all glenoid components. The radiolucent lines developed from the periphery to the center of the implant for 6 glenoid components during follow-up. The Constant Score improved from a mean of 30 (21-51) preoperatively to 69 (41-88) at 24 months. INTERPRETATION CTMA can be used to identify early migration and the development of radiolucent lines over time in glenoid components. Clinical trials with a larger sample size and longer follow-up are needed to establish the relationship between migration, radiolucent lines, loosening, and clinical outcome.
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Affiliation(s)
- Cyrus BRODÉN
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK,Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Peter REILLY
- Department of Bioengineering, Imperial College London, London, UK
| | - Monica KHANNA
- Department of Clinical Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Ravi POPAT
- Department of Bioengineering, Imperial College London, London, UK
| | - Henrik OLIVECRONA
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Dylan GRIFFITHS
- Trauma & Orthopaedic Department, Imperial NHS Trust, London, UK
| | - Olof SKÖLDENBERG
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Roger EMERY
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
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15
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Mjöberg B. Hip prosthetic loosening: A very personal review. World J Orthop 2021; 12:629-639. [PMID: 34631447 PMCID: PMC8472441 DOI: 10.5312/wjo.v12.i9.629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Hip prosthetic loosening is often difficult to detect at an early stage, and there has been uncertainty for a long time as to when the loosening occurs and thus to the basic causes. By comparing different diagnostic methods, we found that loosening is best defined as prosthetic migration and measured by radiostereometric analysis. Convincing evidence indicates that poor interlock, poor bone quality, and resorption of a necrotic bone bed may initiate loosening during or shortly after surgery; this forms the basis of the theory of early loosening. Biomechanical factors do affect the subsequent progression of loosening, which may increase subclinically during a long period of time. Eventually, the loosening may be detected on standard radiographs and may be interpreted as late loosening but should to be interpreted as late detection of loosening. The theory of early loosening explains the rapid early migration, the development of periprosthetic osteolysis and granulomas, the causality between wear and loosening, and largely the epidemiology of clinical failure of hip prostheses. Aspects discussed are definition of loosening, the pattern of early migration, the choice of migration threshold, the current understanding of loosening, a less exothermic bone cement, cemented taper-slip stems, a new exciting computed tomography-based technique for simpler implant migration studies, and research suggestions.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopedics, Lund University, Lund SE-221 00, Sweden
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Brodén C, Sandberg O, Olivecrona H, Emery R, Sköldenberg O. Precision of CT-based micromotion analysis is comparable to radiostereometry for early migration measurements in cemented acetabular cups. Acta Orthop 2021; 92:419-423. [PMID: 33821746 PMCID: PMC8381926 DOI: 10.1080/17453674.2021.1906082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - CT (computed tomography) based methods have lately been considered an alternative to radiostereometry (RSA) for assessing early implant migration. However, no study has directly compared the 2 methods in a clinical setting. We estimated the precision and effective radiation dose of a CT-based method and compared it with marker-based RSA in 10 patients with hip arthroplasty.Patients and methods - We included 10 patients who underwent total hip replacement with a cemented cup. CT and RSA double examinations were performed postoperatively, and precision and effective dose data were compared. The CT data was analyzed with CT micromotion analysis (CTMA) software both with and without the use of bone markers. The RSA images were analyzed with RSA software with the use of bone markers.Results - The precision of CTMA with bone markers was 0.10-0.16 mm in translation and 0.31°-0.37° in rotation. Without bone markers, the precision of CTMA was 0.10-0.16 mm in translation and 0.21°-0.31° in rotation. In comparison, the precision of RSA was 0.09-0.26 mm and 0.43°-1.69°. The mean CTMA and RSA effective dose was estimated at 0.2 mSv and 0.04 mSv, respectively.Interpretation - CTMA, with and without the use of bone markers, had a comparable precision to RSA. CT radiation doses were slightly higher than RSA doses but still at a considerably low effective dose.
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Affiliation(s)
- Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | | | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Roger Emery
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | - Olof Sköldenberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
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Sandberg O, Tholén S, Carlsson S, Wretenberg P. The anatomical SP-CL stem demonstrates a non-progressing migration pattern in the first year: a low dose CT-based migration study in 20 patients. Acta Orthop 2020; 91:654-659. [PMID: 33063555 PMCID: PMC8023890 DOI: 10.1080/17453674.2020.1832294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - RSA is the gold standard for evaluation of early implant migration. We report the results of a new CT-based method Sectra CT micromotion analysis (CTMA) applied to assess the migration pattern in 20 patients in the 1st year after surgery, both with and without the use of tantalum beads in the bone. The patients had an SP-CL anatomical stem that uses an S-shape, designed to better fit the curvature of the femur. Patients and methods - 20 THA patients (mean age 61 years, 10 female) received SP-CL stems, tantalum markers in the femur, and low-dose CT scans at 1 day, 3 months and 12 months postoperatively. In addition, precision as well as inter- and intra-observer variability of the 12-month migration was measured. Results - The 3-month subsidence was median 0.5 mm (95% CI 0.3-1.0) and the internal rotation 1.8° (CI 0.9-2.6). At 12 months the corresponding values were 0.6 (CI 0.3-1.6) mm and 1.9° (CI 0.8-2.4). Precision was 0.1 to 0.3 mm and 0.1° to 0.4° at 3 and 12 months. Intra- and inter- observer variability yielded R-values averaging 0.96 and 0.98. Interpretation - The migration mainly took place during the 1st 3 months, in line with other uncemented stems. The number of patients with subsidence over 2 mm in the first year (5) might be due to the design of the prosthesis with an anatomical shape. Alternatively, our results might indicate a challenge when choosing the correct size for these new anatomical stems. CTMA provided precise and highly repeatable measurements of migration without the need for tantalum markers.
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Affiliation(s)
| | - Simon Tholén
- Department of Radiology, Lindesberg Hospital, Örebro University Hospital
| | - Sofia Carlsson
- Department of Radiology, Lindesberg Hospital, Örebro University Hospital
| | - Per Wretenberg
- Department of Medical Sciences, Section of Orthopaedics, Örebro University Hospital, Sweden
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18
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Affiliation(s)
- Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway,
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19
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Stigbrand H, Brown K, Olivecrona H, Ullmark G. Implant migration and bone mineral density measured simultaneously by low-dose CT scans: a 2-year study on 17 acetabular revisions with impaction bone grafting. Acta Orthop 2020; 91:571-575. [PMID: 32452289 PMCID: PMC8023911 DOI: 10.1080/17453674.2020.1769295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Early postoperative implant migration predicts failure of joint replacements. Bone mineral density reflects bone quality and bone-graft incorporation. Implant migration and bone densitometry analysis usually require special equipment. We investigated cup migration and bone mineral density changes simultaneously with low-dose CT scans after acetabular revision hip arthroplasty using impaction bone grafting.Patients and methods - We performed a low-dose CT postoperatively, after 6 weeks, and after 2 years in 17 patients, all revised using impaction bone grafting and a graft-compressing titanium shell in the acetabulum. 6 patients had combined segmental and cavitary acetabular defects. Cup migration was analyzed using CT-based micromotion analysis (CTMA). Bone mineral density was determined in the graft and in surrounding native bone using volumetric quantitative computed tomography (QCT). The bone graft volume was calculated from 3D reconstructions.Results - At 2 years, the translations were 1.5 (95% CI 0.4-2.6) mm in proximal direction, -0.6 (CI -1.6 to 0.4) in the medial direction and 0.3 (CI 0.0-0.6) in the anterior direction. The mean volume of impacted bone graft was 40 cm³ (CI 28-52). In the graft bone mineral density increased 14% after 6 weeks and 23% after 2 years. There was 1 mechanical failure.Interpretation - Proximal migration of the acetabular component was low and comparable to previous reports. There was a rapid increase of bone mineral density in the bone graft. Low-dose CT scans make migration analysis and bone densitometry measurements possible in the same setting, offering great diagnostic potential for hip arthroplasty patients.
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Affiliation(s)
- Hampus Stigbrand
- Department of Orthopedics Gävle Hospital, Center for Research & Development, Uppsala University/County Council of Gävleborg, Sweden; ,Department of Surgical Sciences/Orthopedics, Uppsala University, Sweden; ,Correspondence:
| | | | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Gösta Ullmark
- Department of Orthopedics Gävle Hospital, Center for Research & Development, Uppsala University/County Council of Gävleborg, Sweden; ,Department of Surgical Sciences/Orthopedics, Uppsala University, Sweden;
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Abstract
Background and purpose - Radiostereometric analysis (RSA) is the gold standard to study micromotion of joint replacements. RSA requires the acquisition of additional radiographs increasing the radiation dose of patients included in RSA studies. It is important to keep this dose as low as possible. Effective radiation dose (ED) measurements of RSA radiographs for different joints were done by Teeuwisse et al. some years ago using conventional radiology (CR); for total hip arthroplasty (THA), Teeuwisse et al. reported an ED of 0.150 milliSievert (mSv). With the modern digital radiography (DR) roentgen technique the ED is expected to be less.Material and methods - In this phantom study, simulating a standard patient, the ED for hip RSA radiographs is determined using DR under a variety of different roentgen techniques. The quality of the RSA radiographs was assessed for feasibility in migration analysis using a (semi-)automatic RSA analysis technique in RSA software.Results - A roentgen technique of 90 kV and 12.5 mAs with additional 0.2 copper (Cu) + 1 mm aluminum (Al) external tube filters results in an ED of 0.043 mSv and radiographs suitable for analysis in RSA software.Interpretation - The accumulated ED for a standard patient in a 2-year clinical hip RSA study with 5 follow-up moments and a double acquisition is below the acceptable threshold of 1.0 mSv provided by the EU radiation guideline for studies increasing knowledge for general health.
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Affiliation(s)
- Ian F Blom
- Department of Radiology, Reinier de Graaf Groep, Delft, The Netherlands
| | - Lennard A Koster
- Department of Orthopaedic Surgery, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
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