1
|
Meynen A, Vles G, Roussot M, Van Eemeren A, Wafa H, Mulier M, Scheys L. Advanced quantitative 3D imaging improves the reliability of the classification of acetabular defects. Arch Orthop Trauma Surg 2023; 143:1611-1617. [PMID: 35149888 DOI: 10.1007/s00402-022-04372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Classifying complex acetabular defects in revision total hip arthroplasty (THA) by means of conventional radiographs comes with significant limitations. Statistical shape modelling allows the virtual reconstruction of the native pelvic morphology, hereby enabling an analytic acetabular defect assessment. Our objective was to evaluate the effect of advanced imaging augmented with analytic representations of the defect on (1) intra- and inter-rater reliability, and (2) up- or downscaling of classification scores when evaluating acetabular defects in patients undergoing revision THA. MATERIALS AND METHODS The acetabular defects of 50 patients undergoing revision THA were evaluated by three independent, fellowship-trained orthopaedic surgeons. Defects were classified according to the acetabular defect classification (ADC) using four different imaging-based representations, namely, standard radiographs, CT imaging, a virtual three-dimensional (3D) model and a quantitative analytic representation of the defect based on a statistical shape model reconstruction. Intra- and inter-rater reliabilities were quantified using Fleiss' and Cohen's kappa scores, respectively. Up- and downscaling of classification scores were compared for each of the imaging-based representations and differences were tested. RESULTS Overall inter-rater agreement across all imaging-based representations for the classification was fair (κ 0.29 95% CI 0.28-0.30). Inter-rater agreement was lowest for radiographs (κ 0.21 95% CI 0.19-0.22) and increased for other representations with agreement being highest when using analytic defect models (κ 0.46 95% CI 0.43-0.48). Overall intra-rater agreement was moderate (κ 0.51 95% CI 0.42-0.60). Intra-rater agreement was lowest for radiographs (κ 0.40 95% CI 0.23-0.57), and highest for ratings including analytic defect models (κ 0.64:95% CI 0.46-0.82). Virtual 3D models with quantitative analytic defect representations upscaled acetabular defect scores in comparison to standard radiographs. CONCLUSIONS Using 3D CT imaging with statistical shape models doubles the intra- and inter-rater reliability and results in upscaling of acetabular defect classification when compared to standard radiographs. This method of evaluating defects will aid in planning surgical reconstruction and stimulate the development of new classification systems based on advanced imaging techniques.
Collapse
Affiliation(s)
- Alexander Meynen
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Georges Vles
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Mark Roussot
- Department of Trauma and Orthopaedics, University College Hospital London, London, NW1 2BU, UK
| | - Anthony Van Eemeren
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hazem Wafa
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michiel Mulier
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lennart Scheys
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| |
Collapse
|
2
|
Grace TM, O'Rourke D, Robertson T, Perilli E, Callary S, Taylor M, Atkins GJ, Solomon LB, Thewlis D. A semiautomated method to quantitatively assess osteolytic lesion volume and bone mineral density within acetabular regions of interest from CT. J Orthop Res 2022; 40:396-408. [PMID: 33871103 DOI: 10.1002/jor.25051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
The objectives of this study were to (1) develop a semiautomated method to obtain lesion volume and bone mineral density (BMD) in terms of Hounsfield units from pelvic computed tomography (CT) scans in three regions of interest, and (2) assess accuracy and reliability of the method based on cadaveric CT scans. Image artefacts due to metal implants reduce CT clarity and are more severe with more than one implant in situ. Therefore, accuracy and reliability tests were performed with varying numbers of total hip arthroplasties implanted. To test the accuracy of lesion size measurements, microcomputed tomography was used as a reference. Mean absolute error ranged from 36 to 284 mm3 after five measurements. Intra- and inter-operator reliability of the entire method was measured for a selection of parameters. All coefficient of variation values were good to excellent for CT scans of the native pelvic anatomy and a CT scans of the same pelvis with one and two implants in situ. Accuracy of quantifying lesion volume decreased with decreasing CT image clarity by 0.6%-3.6% mean absolute relative error. Reliability of lesion volume measurement decreased with decreasing CT clarity. This was also the case for reliability of BMD measurements in the region most disrupted by metal artefact. The presented method proposes an approach for quantifying bone loss which has been proven to be accurate, reliable, and clinically applicable.
Collapse
Affiliation(s)
- Thomas M Grace
- Centre of Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Dermot O'Rourke
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Thomas Robertson
- Centre of Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Stuart Callary
- Centre of Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mark Taylor
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Gerald J Atkins
- Centre of Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Centre of Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre of Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
3
|
Polyethylene liner cementation into a well-fixed metal acetabular shell for the management of periacetabular osteolysis: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1459-1468. [PMID: 34605989 DOI: 10.1007/s00590-021-03130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Although various papers have reported on the clinical performance of cup retention with cementation of a new liner and bone grafting in the management of well-fixed cups with polyethylene wear and periacetabular osteolysis after total hip arthroplasty (THA), no systematic review of this topic has been published to date. METHODS Medline, EMBASE and Cochrane Library were searched for articles published from January 1999 to January 2019 using "osteolysis" AND "well-fixed", "osteolysis" AND "retro-acetabular", "bone graft" AND ("retention" OR "retained" OR "stable") AND "cup", and "cemented liner" AND "well-fixed". RESULTS Nine articles were selected for review (186 cases, 76.1 months mean follow-up). The overall revision rate was 11.3% (21 hips) most commonly due to aseptic loosening (9/186 hips), dislocation (8/186 hips), and liner wear progression (2/186 cases). The reported square size of osteolytic lesions ranged from a mean of 465.84 mm2 to a max of 4,770 mm2. Almost all reported lesions treated with bone grafts resolved or did not progress 97% (72/74). All studies indicated improved pain and functional scores at follow-up. CONCLUSION Cementation of a new liner with periacetabular bone grafting provides an alternative option to isolated liner exchange and cup revision for the management of periacetabular osteolysis in well-fixed cups with a disrupted locking mechanism or unavailable exchange liner. Further higher quality studies are required in order to examine if the use of highly cross-linked polyethylene, highly porous-coated cups, hydroxyapatite-coated cups, and small-diameter cups influence the clinical outcome of liner cementation in well-fixed cups with periacetabular osteolysis.
Collapse
|
4
|
Alamanda VK, Demartino I, Potter HG, Koff MF, Lin B, Muskat A, Westrich GH. Multiacquisition Variable-Resonance Image Combination Magnetic Resonance Imaging Used to Study Detailed Bone Apposition and Fixation of an Additively Manufactured Cementless Acetabular Shell. Arthroplast Today 2020; 6:694-698. [PMID: 32923552 PMCID: PMC7475047 DOI: 10.1016/j.artd.2020.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/29/2020] [Accepted: 07/11/2020] [Indexed: 01/01/2023] Open
Abstract
Background The ability to utilize magnetic resonance imaging (MRI) to assess bony fixation in 3 dimensions may allow a better understanding of the implant design and bony integration. We hypothesized that a new 3-dimensionally printed cementless highly porous acetabular component (Stryker Trident II TritaniumTM) would show better fixation than an earlier cup from the same manufacturer as assessed by the noninvasive technique of multispectral MRI. Methods Multiacquisition variable-resonance image combination selective metal suppression MRI was performed in 19 patients implanted with a new 3-dimensionally printed cup and 20 patients who had received a previous-generation cup from the same manufacturer at 1-year follow-up. Each cup was graded globally as well as by 9 specific zones. Integration grades were performed for each zone: 0, full bone integration; 1, fibrous membrane present; 2, osteolysis; and 3, fluid present. A mixed-effects logistic regression model was used to compare fixation between the 2 groups. Results All cups in both cohorts showed greater than 90% estimated global bony integration (3-dimensionally printed cups, 99.4%; regular cups 91.6%) with no osteolysis or fluid observed in any cup. The 3-dimensionally printed cup had 1 of 171 zones (0.6%) graded as fibrous membrane present, while the 2-dimensional group had 15 of 180 zones (8.3%) graded as fibrous. Of note, screw hole regions were omitted but may be read as fibrous membrane areas. Conclusion Using multiacquisition variable-resonance image combination selective MRI, our analysis showed greater osteointegration and less fibrous membrane formation in the 3-dimensionally printed cups than the control group at 1-year follow-up.
Collapse
Affiliation(s)
- Vignesh K Alamanda
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Ivan Demartino
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Bin Lin
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Ahava Muskat
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
5
|
Computed Tomographic Osteolytic Analysis of a First-Generation Remelted Highly Cross-Linked Polyethylene in Total Hip Arthroplasty-At a Minimum of 15-Year Follow-Up. J Arthroplasty 2020; 35:1417-1423. [PMID: 31948813 DOI: 10.1016/j.arth.2019.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Low polyethylene wear rate and low incidence of osteolysis have been reported after total hip arthroplasty (THA) using first-generation remelted highly cross-linked polyethylene (HXLPE). However, osteolysis has not been evaluated in long-term studies of these patients (15 years or more). The present study assessed computed tomography (CT) images to determine the incidence of osteolysis associated with HXLPE in THA during at least 15 years of follow-up. METHODS We evaluated 105 primary THAs in 84 patients (77 women and 7 men). Mean follow-up was 15.9 years (range, 15-18 years). All THAs used a Longevity HXLPE liner and a 26-mm zirconia femoral head. Areas of osteolysis were identified from CT images using 3D and multiplanar reconstruction views. RESULTS CT 3D multiplanar reconstruction images at 15-year follow-up showed no obvious osteolysis in the acetabulum or femur of any patient. No patients developed cup loosening or liner breakage. CONCLUSION Our study indicates that first-generation remelted HXLPE liners do not increase the risk of osteolysis during 15-year follow-up and suggests that the wear particles from first-generation remelted HXLPE are less biologically active than those generated by conventional polyethylene devices.
Collapse
|
6
|
Augustine AS, Ewen AM, Wallace DT, Picard F. Variations in pelvic dimensions: An anatomical and computed tomography study. Clin Anat 2018; 31:981-987. [PMID: 30203862 DOI: 10.1002/ca.23273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 11/09/2022]
Abstract
The anterior pelvic plane (APP) is a useful anatomical reference with both clinical and research applications in orthopedic surgery and rehabilitation medicine. It is used as a marker for computer-assisted total hip replacement and image-guided assessment of the hip center in clinical gait analysis. Despite its common use, no published data exist on the variations in height and width in an adult population. The aim of this study was to determine the range of dimensions for the anterior pelvic plane found in the Scottish adult population. Thirty-five human cadavers and 100 pelvic computed tomography (CT) scans were examined. Pelvic height and width were measured, and the ratios were determined. The mean width and height for combined cadaver and CT pelves were found to be 238.0 mm (SD 20.1, range 188.3-273.8) and 92.7 mm (SD 10.5, range 71.2-114.7), respectively. The mean width-to-height ratio for all pelves was 2.59 (SD 0.31, range 1.73-3.50). There were no statistically significant differences in means between males and females. The variations of APP dimensions within an adult population are presented. These will be of value in the validation of algorithms for computer navigation and hip joint center calculation in total hip arthroplasty and gait analysis. Furthermore, differences in dimensions between cadaveric and CT measurements have been shown which may have implications for further research and the validity of reference data dependent on data-point acquisition. Clin. Anat. 31:981-987, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Angelica S Augustine
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - Alistair M Ewen
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - David T Wallace
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - Frederic Picard
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| |
Collapse
|
7
|
Solid Cup vs Cluster Hole in Total Hip Arthroplasty: A 10-Year Randomized Control Trial. J Arthroplasty 2018; 33:1113-1119. [PMID: 29289446 DOI: 10.1016/j.arth.2017.10.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Acetabular osteolysis is a major complication of total hip arthroplasty. It is caused in part by wear debris. It has been suggested that this debris can migrate through screw holes in the acetabular component. Solid-backed components have been used to prevent this migration and reduce osteolysis. Newer materials, however, have reduced wear debris. This study aimed to evaluate whether using solid-backed instead of cluster-hole components actually reduces osteolysis. This could open up the possibility of screws being used for greater stability where required. METHODS This prospective trial randomized 100 patients undergoing cementless total hip arthroplasty to receive either cluster-hole or solid-backed acetabular components. A cementless cup and highly cross-linked polyethylene was used in all patients. Computed tomography, performed at 5 and 10 years after surgery, was assessed by a blinded radiologist for the presence of osteolysis. RESULTS Of the 100 patients, 14 required screws for stability, and so were moved into a third "screw" group for per-protocol analysis. At 10 years after surgery, osteolytic lesions were discovered in 18.2% of patients. There was no difference in incidence or volume of osteolysis between patients with cluster-hole acetabular components and those with solid-backed components. CONCLUSION This study reveals a low number of patients with osteolytic lesions 10 years after total hip arthroplasty performed with a modern cup design and highly cross-linked polyethylene liner. There was no clear benefit to using solid-backed acetabular components. Cluster-hole components, however, offer the option of screw augmentation when required.
Collapse
|
8
|
Whitmarsh T, Treece GM, Gee AH, Poole KES. An exploratory study into measuring the cortical bone thickness from CT in the presence of metal implants. Int J Comput Assist Radiol Surg 2017; 12:2079-2086. [PMID: 28233167 PMCID: PMC5702383 DOI: 10.1007/s11548-017-1539-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 02/08/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study was to develop and evaluate a method for measuring the cortical bone thickness from computed tomography (CT) scans with metallic implants and to assess the benefits of metal artefact removal software. METHODS A previously validated technique based on the fitting of a cortical model was modified to also model metal structures when required. Cortical thickness measurements were taken over intact bone segments and compared with the corresponding contralateral bone segment. The evaluation dataset includes post-operative CT scans of a unipolar hemi-arthroplasty, a dynamic hip screw fixation, a bipolar hemi-arthroplasty, a fixation with cannulated screws and a total hip arthroplasty. All CT scans were analysed before and after processing with metal artefact removal software. RESULTS Cortical thickness validity and accuracy were improved through the use of a modified metalwork-optimised model and metal artefact removal software. For the proximal femoral segments of the aforementioned cases, the cortical thickness was measured with a mean absolute error of 0.55, 0.39, 0.46, 0.53 and 0.69 mm. The hemi-pelvis produced thickness errors of 0.51, 0.52, 0.52, 0.47 and 0.67 mm, respectively. CONCLUSIONS The proposed method was shown to measure cortical bone thickness in the presence of metalwork at a sub-millimetre accuracy. This new technique might be helpful in assessing fracture healing near implants or fixation devices, and improve the evaluation of periprosthetic bone after hip replacement surgery.
Collapse
Affiliation(s)
- Tristan Whitmarsh
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, Cambridgeshire, CB2 1PZ, UK.
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, Cambridgeshire, CB2 1PZ, UK
| | - Andrew H Gee
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, Cambridgeshire, CB2 1PZ, UK
| | - Kenneth E S Poole
- Department of Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| |
Collapse
|
9
|
Broomfield JAJ, Malak TT, Thomas GER, Palmer AJR, Taylor A, Glyn-Jones S. The Relationship Between Polyethylene Wear and Periprosthetic Osteolysis in Total Hip Arthroplasty at 12 Years in a Randomized Controlled Trial Cohort. J Arthroplasty 2017; 32:1186-1191. [PMID: 27998657 DOI: 10.1016/j.arth.2016.10.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Polyethylene acetabular components are common in hip arthroplasty. Highly cross-linked polyethylene (HXLPE) has lower wear than ultra-high molecular weight polyethylene (UHMWPE). Evidence suggests that wear particles induce inflammation causing periprosthetic osteolysis contributing to implant loosening with wear rates of 0.05 mm/y were considered safe. We aimed to compare incidence and volume of periacetabular osteolysis between HXLPE and UHMWPE using computed tomography. METHODS Initially, 54 hips in 53 patients were randomized to HXLPE or UHMWPE acetabular liner. At 10 years, 39 hips in 38 patients remained for the radiostereometric analysis' demonstrating significantly lower wear in the HXLPE group. At 12 years, 14 hips in 13 patients were lost to follow-up leaving 25 hips for computed tomography assessment. Images were reconstructed to detect osteolysis and where identified, areas were segmented and volumized. RESULTS Osteolysis was observed in 8 patients, 7 from the UHMWPE group and only 1 from the HXLPE group (Fisher exact, P = .042). There was no correlation between the amount of polyethylene wear and osteolysis volume; however, the radiostereometric analysis-measured wear rate in patients with osteolysis from both groups was significantly higher than overall average wear rate. CONCLUSION This data demonstrates lower incidence of periacetabular osteolysis in the HXLPE group of a small cohort. Although numbers are too low to estimate causation, in the context of lower wear in the HXLPE group, this finding supports the hypothesis that HXLPE may not elevate osteolysis risk, and hence does not suggest that HXLPE wear particles are more biologically active than those generated by earlier generations of polyethylene.
Collapse
Affiliation(s)
- John A J Broomfield
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Tamer T Malak
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Geraint E R Thomas
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Antony J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Adrian Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| |
Collapse
|
10
|
Kim YH, Park JW, Kim JS. Long-Term Results of Third-Generation Ceramic-on-Ceramic Bearing Cementless Total Hip Arthroplasty in Young Patients. J Arthroplasty 2016; 31:2520-2524. [PMID: 27172862 DOI: 10.1016/j.arth.2016.03.058] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 03/11/2016] [Accepted: 03/30/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The results of third-generation of alumina-on-alumina ceramic bearing in a large number of patient cohorts are limited. The purpose of this study was to determine clinical and radiologic outcome, prevalence of osteolysis detected with radiographs and computerized tomographic scan, and survivorship of a cementless total hip arthroplasty using a third-generation of alumina-on-alumina ceramic bearing in a large number of active patients aged younger than 65 years. METHODS We reviewed the cases of 871 patients (1131 hips) who underwent a cementless total hip arthroplasty when they were aged 65 years or younger at the time of surgery. The most common diagnoses were osteonecrosis (53%) and osteoarthritis (20%). Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles activity scores were recorded. Radiographic and computerized tomographic evaluations were used to evaluate implant fixation and osteolysis. The mean follow-up interval was 18.8 years (range, 15-20 years). RESULTS At the time of final follow-up, the mean Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles activity score were 90 points, 15 points, and 8 points, respectively. All the femoral stem and acetabular components were well-fixed at the time of final follow-up. No hip had aseptic loosening or osteolysis or fracture of ceramic material at the time of the final follow-up. CONCLUSION The current results with the use of the third-generation of alumina-on-alumina ceramic bearings in young patients suggest that cementless acetabular and femoral components provide outstanding long-term fixation and provide a high rate of survivorship without evidence of osteolysis.
Collapse
Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Ewha Womans University School of Medicine, SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University School of Medicine, MokDong Hospital, Seoul, Republic of Korea
| | - Jun-Shik Kim
- The Joint Replacement Center, Ewha Womans University School of Medicine, MokDong Hospital, Seoul, Republic of Korea
| |
Collapse
|
11
|
Long-Term Clinical and Radiographic Outcomes of Porous Tantalum Monoblock Acetabular Component in Primary Hip Arthroplasty: A Minimum of 15-Year Follow-Up. J Arthroplasty 2016; 31:110-4. [PMID: 26781387 DOI: 10.1016/j.arth.2015.12.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The porous tantalum monoblock cup has demonstrated excellent short-term and midterm clinical and radiographic outcomes in primary THA, but longer follow-up is necessary to confirm the durability of these results into the second decade. The purpose of this study is to report the clinical and radiographic outcomes for this monoblock cup with a minimum 15-year follow-up. METHODS From June 1998 to December 1999, 61 consecutive patients (63 hips) underwent primary THA with a tantalum monoblock acetabular component. All patients were followed clinically and radiographically for a minimum of 15 years. At a mean of 15.6 years (range, 15-16 years) of follow-up, 5 patients had died, and 4 had been lost to follow-up, leaving 52 patients (54 hips) for analysis. The underlying diagnosis that led to the primary THA was primary osteoarthritis in 43 hips, avascular necrosis in 4, developmental hip dysplasia in 3, rheumatoid arthritis in 3 and post-traumatic osteoarthritis in 1. RESULTS One cup was revised for deep infection; at surgery, the cup showed osseointegration. At a mean follow-up of 15.6 years (range, 15-16 years), the survivorship with cup revision for aseptic loosening as end point was 100%. There was no radiographic evidence of loosening, migration, or gross polyethylene wear at last follow-up. The mean Harris Hip Scores improved from 47 points preoperatively to 94 points. CONCLUSION The porous tantalum monoblock cup in primary THA demonstrated excellent clinical and radiographic outcomes with no failures because of osteolysis or loosening at a minimum follow-up of 15 years.
Collapse
|
12
|
Sandgren B, Skorpil M, Nowik P, Olivecrona H, Crafoord J, Weidenhielm L, Persson A. Assessment of wear and periacetabular osteolysis using dual energy computed tomography on a pig cadaver to identify the lowest acceptable radiation dose. Bone Joint Res 2016; 5:307-13. [PMID: 27445358 PMCID: PMC5005473 DOI: 10.1302/2046-3758.57.2000566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/29/2016] [Indexed: 12/25/2022] Open
Abstract
Objectives Computed tomography (CT) plays an important role in evaluating wear and periacetabular osteolysis (PAO) in total hip replacements. One concern with CT is the high radiation exposure since standard pelvic CT provides approximately 3.5 millisieverts (mSv) of radiation exposure, whereas a planar radiographic examination with three projections totals approximately 0.5 mSv. The objective of this study was to evaluate the lowest acceptable radiation dose for dual-energy CT (DECT) images when measuring wear and periacetabular osteolysis in uncemented metal components. Materials and Methods A porcine pelvis with bilateral uncemented hip prostheses and with known linear wear and acetabular bone defects was examined in a third-generation multidetector DECT scanner. The examinations were performed with four different radiation levels both with and without iterative reconstruction techniques. From the high and low peak kilo voltage acquisitions, polychrmoatic images were created together with virtual monochromatic images of energies 100 kiloelectron volts (keV) and 150 keV. Results We could assess wear and PAO while substantially lowering the effective radiation dose to 0.7 mSv for a total pelvic view with an accuracy of around 0.5 mm for linear wear and 2 mm to 3 mm for PAO. Conclusion CT for detection of prosthetic wear and PAO could be used with clinically acceptable accuracy at a radiation exposure level equal to plain radiographic exposures. Cite this article: B. Sandgren, M. Skorpil, P. Nowik, H. Olivecrona, J. Crafoord, L. Weidenhielm, A. Persson. Assessment of wear and periacetabular osteolysis using dual energy computed tomography on a pig cadaver to identify the lowest acceptable radiation dose. Bone Joint Res 2016;5:307–313. DOI: 10.1302/2046-3758.57.2000566.
Collapse
Affiliation(s)
- B Sandgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - M Skorpil
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - P Nowik
- Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden
| | - H Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - J Crafoord
- Department of Radiology, Ersta Hospital, Stockholm, Sweden
| | - L Weidenhielm
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - A Persson
- Center for Medical Image Science and Visualization, Linköping University, Hêlsouniversitetet, Linköping, Sweden
| |
Collapse
|
13
|
Guimarães RP, Yonamine AM, Faria CEN, Rudelli M. Is the size of the acetabular bone lesion a predictive factor for failure in revisions of total hip arthroplasty using an impacted allograft? Rev Bras Ortop 2016; 51:412-417. [PMID: 27517019 PMCID: PMC4974165 DOI: 10.1016/j.rboe.2015.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/25/2015] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the acetabular bone lesion size (in millimeters) from which impacted bone graft failure starts to occur more frequently, through simple anteroposterior hip radiographs, and whether measurement of the defect on simple radiographs maintains the same pattern in inter and intraobserver assessments. METHODS Thirty-eight anteroposterior pelvic-view radiographs from patients undergoing revision of an acetabular prosthesis were retrospectively analyzed and assessed. In the vertical plane, the bilacrimal line was measured in millimeters from the farthest point found on the bone edge of the acetabular osteolysis to the top edge of the cementation or of the acetabular implant in uncemented cases. The base was taken to be a line perpendicular to bilacrimal line, with the aim of eliminating any pelvic tilt effects. This measurement was named the vertical size of failure. Radiographs produced four years after the operation were analyzed to investigate any failure of the technique. RESULTS The graft failure rate in the study group was 26.3%. The failures occurred in cases with an initial bone defect larger than 11 mm. No cases with measurements smaller than this evolved with failure of the revision. The highest incidence of graft failure occurred in cases described as advanced according to the "Paprosky" classification. CONCLUSION Failure of acetabular revision arthroplasty using an impacted graft did not present any statistically significant correlation with the vertical extent of the lesion on simple anteroposterior radiographs, as a predictor of treatment failure.
Collapse
|
14
|
O tamanho da lesão óssea acetabular é fator preditivo para a falha nas revisões de artroplastia total do quadril com enxerto impactado? Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
15
|
Ballegeer EA. Computed Tomography of the Musculoskeletal System. Vet Clin North Am Small Anim Pract 2016; 46:373-420, v. [DOI: 10.1016/j.cvsm.2015.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
16
|
Severe Periprosthetic Metallosis and Polyethylene Liner Failure Complicating Total Hip Replacement: The Cloud Sign. Radiol Case Rep 2015; 2:115. [PMID: 27303496 PMCID: PMC4895867 DOI: 10.2484/rcr.v2i4.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We present a case of an 85-year-old woman with extensive metallosis of the left hip joint secondary to prosthetic polyethelene liner dislocation and wear. Radiographs demonstrated amorphous cloudy radiodensities surrounding the prosthesis, a feature we have called the “cloud sign.” The presence of amorphous cloudy radiodensities as a radiographic sign of metallosis has not been previously described to our knowledge.
Collapse
|
17
|
Fernandez-Valencia JÁ, Gallart X, Tomás X, Piñeros D, García S, Riba J. Radiography versus multidetector computed tomography in assessing graft integration after acetabular reconstruction. J Orthop Surg (Hong Kong) 2015; 23:370-4. [PMID: 26715721 DOI: 10.1177/230949901502300324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To compare radiography with multidetector computed tomography (MDCT) in the evaluation of graft integration following acetabular reconstruction for failed total hip arthroplasty (THA). METHODS Records of 5 men and 6 women aged 60 to 78 (mean, 71.8) years who underwent acetabular reconstruction using structural allografts for severe acetabular deficiency secondary to aseptic loosening (n=9) or septic loosening (n=2) were reviewed. The mean survival time of the THA was 136.4 (range, 12-360) months. Acetabular defects were classified as IIC (n=2), IIIA (n=3), or IIIB (n=6). Structural allografts were fixed with impaction followed by a reinforcement ring (n=10), an antiprotrusio cage (n=2), and/or an oblong cup (n=1) with gentamicineloaded cement. Cup loosening, graft integration, and graft resorption were evaluated using radiography. In addition, graft integration was evaluated using MDCT. RESULTS At a mean follow-up of 4.2 (range, 2-11) years, the survival of the acetabular reconstruction was 90.9%. No patient had any signs of infection. One patient underwent reoperation 22 months later for dislocation secondary to abductor deficiency caused by nonunion of the trochanteric fracture. According to radiography, all patients had graft integration. One patient had definitive and another had possible cup loosening. Four patients had minor graft resorption. According to MDCT, graft integration was complete in only one patient, partial >50% in 3, partial <50% in 4, and absent in 2. CONCLUSION MDCT is more accurate than radiography in evaluating graft integration following acetabular reconstruction.
Collapse
|
18
|
Ahmad AQ, Schwarzkopf R. Clinical evaluation and surgical options in acetabular reconstruction: A literature review. J Orthop 2015; 12:S238-43. [PMID: 27047229 PMCID: PMC4796576 DOI: 10.1016/j.jor.2015.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/07/2015] [Indexed: 01/19/2023] Open
Abstract
The purpose of this paper is to review the clinical indications for acetabular reconstruction in patients with underlying peri-prosthetic segmental and cavitary defects, evaluate steps in pre-operative planning, and present the American Academy of Orthopaedic Surgeons (AAOS) and Paprosky classification systems to categorize acetabular defects. We also present a review of the current surgical techniques to reconstruct the acetabular socket which includes a cementless acetabular component with morselized bone, structural allograft, jumbo and oblong cups, reinforcement rings, bone cages, custom triflange acetabular constructs, and trabecular metal components.
Collapse
Affiliation(s)
- Asim Qamar Ahmad
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital For Joint Diseases, New York, NY, USA
| |
Collapse
|
19
|
Abstract
Primary total knee arthroplasty is a highly effective treatment that relieves pain and improves joint function in a large percentage of patients. Despite an initially satisfactory surgical outcome, pain, dysfunction, and implant failure can occur over time. Identifying the etiology of complications is vital for appropriate management and proper timing of revision. Due to the increasing number of knee arthroplasties performed and decreasing patient age at implantation, there is a demand for accurate diagnosis to determine appropriate treatment of symptomatic joints following knee arthroplasty, and for monitoring of patients at risk. Magnetic resonance (MR) imaging allows for comprehensive imaging evaluation of the tissues surrounding knee arthroplasty implants with metallic components, including the polyethylene components. Optimized conventional and advanced pulse sequences can result in substantial metallic artifact reduction and afford improved visualization of bone, implant-tissue interfaces, and periprosthetic soft tissue for the diagnosis of arthroplasty-related complications. In this review article, we discuss strategies for MR imaging around knee arthroplasty implants and illustrate the imaging appearances of common modes of failure, including aseptic loosening, polyethylene wear-induced synovitis and osteolysis, periprosthetic joint infections, fracture, patellar clunk syndrome, recurrent hemarthrosis, arthrofibrosis, component malalignment, extensor mechanism injury, and instability. A systematic approach is provided for evaluation of MR imaging of knee implants. MR imaging with optimized conventional pulse sequences and advanced metal artifact reduction techniques can contribute important information for diagnosis, prognosis, risk stratification, and surgical planning.
Collapse
Affiliation(s)
- Jan Fritz
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Brett Lurie
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Hollis G Potter
- From the Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| |
Collapse
|
20
|
Cluster hole versus solid cup in total hip arthroplasty: a randomized control trial. J Arthroplasty 2015; 30:223-9. [PMID: 25257236 DOI: 10.1016/j.arth.2014.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 08/03/2014] [Accepted: 08/27/2014] [Indexed: 02/01/2023] Open
Abstract
Acetabular osteolysis has been linked to polyethylene debris that is generated in the hip migrating through screw holes in the acetabular component. Solid-backed acetabular components were designed to decrease this osteolysis. This prospective trial randomized 100 patients undergoing total hip arthroplasty to either a solid-backed or a cluster-hole acetabular component-all without screws. At 5years post-surgery, 34.4% of all patients had osteolytic lesions that were visible on CT. There was no significant difference in either presence or volume of the osteolytic lesions, cup migration or functional outcomes (OHS) between the groups. There may no longer be a detriment to using cluster-hole cups instead of solid cups in all hips. This would then give the surgeon the option to use screws for stability as required.
Collapse
|
21
|
Abstract
A common situation presenting to the orthopaedic surgeon today is a worn acetabular liner with substantial acetabular and pelvic osteolysis. The surgeon has many options for dealing with osteolytic defects. These include allograft, calcium based substitutes, demineralised bone matrix, or combinations of these options with or without addition of platelet rich plasma. To date there are no clinical studies to determine the efficacy of using bone-stimulating materials in osteolytic defects at the time of revision surgery and there are surprisingly few studies demonstrating the clinical efficacy of these treatment options. Even when radiographs appear to demonstrate incorporation of graft material CT studies have shown that incorporation is incomplete. The surgeon, in choosing a graft material for a surgical procedure must take into account the efficacy, safety, cost and convenience of that material. Cite this article: Bone Joint J 2014;96-B (11 Suppl A):70–2.
Collapse
Affiliation(s)
- J. J. Callaghan
- University of Iowa, Department
of Orthopaedics, 200 Hawkins Drive, UIHC, 01029
JPP, Iowa City, Iowa 52242, USA
| | - S. S. Liu
- University of Iowa, Department
of Orthopaedics, 200 Hawkins Drive, UIHC, 01029
JPP, Iowa City, Iowa 52242, USA
| | - O-A. Phruetthiphat
- University of Iowa, Department
of Orthopaedics, 200 Hawkins Drive, UIHC, 01029
JPP, Iowa City, Iowa 52242, USA
| |
Collapse
|
22
|
Influence of clinical and radiological variables on the extent and distribution of periprosthetic osteolysis in total hip arthroplasty with a hydroxyapatite-coated multiple-hole acetabular component: a magnetic resonance imaging study. J Arthroplasty 2014; 29:2043-8. [PMID: 24986509 DOI: 10.1016/j.arth.2014.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/17/2014] [Accepted: 05/22/2014] [Indexed: 02/01/2023] Open
Abstract
Polyethylene wear-induced osteolysis constitutes the most severe long-term complication of total hip arthroplasties (THA). Our aim was to assess through MRI the severity and growth pattern of osteolysis, as well as the influence clinical-radiographic variables exert. We analyzed 75 THA with an average evolution time of 13.67years. The implant was a titanium alloy, non-cemented, multiple-hole model with hydroxyapatite coating. Osteolysis was found with a peripheral pattern in 48 and a central pattern in 6; in 52 cases it was continuous, and in 4, isolated. Out of 118 screws, 20 exhibited lysis. There was a proportional correlation between osteolysis severity and wear rate with age, physical activity and acetabular abduction, as well as an association between said variables and peripheral and continuous patterns.
Collapse
|
23
|
Elevation of serum tumor necrosis factor α in patients with periprosthetic osteolysis: a case-control study. Clin Orthop Relat Res 2014; 472:584-9. [PMID: 24307062 PMCID: PMC3890206 DOI: 10.1007/s11999-013-3235-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Periprosthetic osteolysis is the leading reason for THA revision. The relationship of serum biomarkers with severe radiographic periprosthetic osteolysis has not been defined but may be important to direct future research and clinical therapeutics. QUESTIONS/PURPOSES We determined whether there was an association between measurable inflammatory markers (high-sensitivity C-reactive protein [hsCRP]) or inflammatory mediators (tumor necrosis factor α [TNF-α], IL-1β, IL-6, receptor activator of nuclear factor κB ligand [RANKL], and osteoprotegerin [OPG]) and periprosthetic osteolysis. METHODS We identified 15 patients with THAs scheduled for revision surgery because of severe periprosthetic osteolysis. For each study patient, a nonosteolytic, pain-free control patient with THAs was identified and matched for age, sex, time since initial THA, acetabular and femoral component prosthesis material, and prosthesis wear within 1.0 mm/year using a manual wear analysis technique. Overall, the study and control patients had a mean wear rate of 0.25 mm/year since index THA. There were no differences in baseline characteristics between study and control patients in age, sex, BMI, Charlson Comorbidity Index, time since initial THA, UCLA activity score, and acetabular and femoral component type. Serum hsCRP, IL-1β, IL-6, TNF-α, RANKL, and OPG were measured by ELISA in duplicate assays. Differences in values were assessed using the Wilcoxon rank-sum test. RESULTS Median TNF-α levels were higher in study patients than in controls (7.1 pg/mL [SD, 11.6 pg/mL] versus 1.5 pg/mL [SD, 1.3 pg/mL]) (p < 0.01). Median IL-6 levels tended to be higher in study patients than in controls (8.9 pg/mL [SD, 13.2 pg/mL] versus 3.5 pg/mL [SD, 0.7 pg/mL]) (p = 0.09). The other serum inflammatory proteins and mediators of bone turnover were not different between groups. CONCLUSIONS TNF-α is elevated in patients with osteolysis compared to matched controls. The role of TNF-α and its potential as a target of nonsurgical therapy to prevent osteolysis warrant further investigation in larger, prospective studies.
Collapse
|
24
|
Sandgren B, Crafoord J, Garellick G, Carlsson L, Weidenhielm L, Olivecrona H. Computed tomography vs. digital radiography assessment for detection of osteolysis in asymptomatic patients with uncemented cups: a proposal for a new classification system based on computer tomography. J Arthroplasty 2013; 28:1608-13. [PMID: 23618751 DOI: 10.1016/j.arth.2013.01.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/27/2012] [Accepted: 01/22/2013] [Indexed: 02/01/2023] Open
Abstract
Digital radiographic images in the anterior-posterior and lateral view have been gold standard for evaluation of peri-acetabular osteolysis for patients with an uncemented hip replacement. We compared digital radiographic images and computer tomography in detection of peri-acetabular osteolysis and devised a classification system based on computer tomography. Digital radiographs were compared with computer tomography on 206 hips, with a mean follow up 10 years after surgery. The patients had no clinical signs of osteolysis and none were planned for revision surgery. On digital radiographs, 192 cases had no osteolysis and only 14 cases had osteolysis. When using computer tomography there were 184 cases showing small or large osteolysis and only 22 patients had no osteolysis. A classification system for peri-acetabular osteolysis is proposed based on computer tomography that is easy to use on standard follow up evaluation.
Collapse
Affiliation(s)
- Buster Sandgren
- Division of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | |
Collapse
|
25
|
Poultsides LA, Sioros V, Anderson JA, Bruni D, Beksac B, Sculco TP. Ten- to 15-year clinical and radiographic results for a compression molded monoblock elliptical acetabular component. J Arthroplasty 2012; 27:1850-6. [PMID: 23146368 DOI: 10.1016/j.arth.2012.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 05/14/2012] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to report the long-term results from a previously published midterm follow-up of a titanium monoblock, elliptical acetabular component. A total of 258 primary total hip arthroplasties (212 patients) with a monoblock, acetabular component were followed up for a mean period of 11.1 years (10-15). Average yearly wear rate was 0.08 mm/y (0.0009-0.32). Acetabular radiolucencies were present in 6 hips (2.4%); all were nonprogressive and present in acetabular zone I. Acetabular osteolysis was present in 5 patients (5 hips, 1.9%); all cups were stable. Four acetabular components were revised, 3 because of recurrent instability. No acetabular components were revised for polyethylene wear or dissociation, acetabular osteolysis, loosening, or deep infection. This monoblock design demonstrates excellent long-term survival and low rate of osteolysis.
Collapse
Affiliation(s)
- Lazaros A Poultsides
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | | | | | | | | |
Collapse
|
26
|
Roth TD, Maertz NA, Parr JA, Buckwalter KA, Choplin RH. CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications. Radiographics 2012; 32:1089-107. [DOI: 10.1148/rg.324115183] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
27
|
Zotti MGT, Campbell DG, Woodman R. Detection of periprosthetic osteolysis around total knee arthroplasties an in vitro study. J Arthroplasty 2012; 27:317-22. [PMID: 21641179 DOI: 10.1016/j.arth.2011.03.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 03/24/2011] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic osteolysis is a common cause of revision of total knee arthroplasties (TKAs), with plain anteroposterior and lateral (APL) radiographs being the most common method for screening. The aim of this study was to examine the utility of lesion detection and volume appreciation with APL, paired oblique radiographs, and computed tomography. Defects of different sizes were created in 3 cadaveric knees with a cementless TKA in situ and imaged with APL, oblique, and computed tomography modalities. The resultant images were then shown to 3 arthroplasty surgeons, and the absence or presence of lesions, volume size, and confidence in assessment were recorded. The results suggest that the current practice of APL is inferior for the assessment of periprosthetic osteolysis around TKA.
Collapse
Affiliation(s)
- Mario G T Zotti
- Department of Orthopaedics, Flinders Medical Centre, Bedford Park and Repatriation General Hospital, Daw Park, South Australia
| | | | | |
Collapse
|
28
|
Engh CA, Ho H, Powers CC, Huynh C, Beykirch SE, Hopper RH. Osteolysis propensity among bilateral total hip arthroplasty patients. J Arthroplasty 2011; 26:555-61. [PMID: 21575791 DOI: 10.1016/j.arth.2010.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 05/18/2010] [Indexed: 02/01/2023] Open
Abstract
Because some patients with high wear rates demonstrate extensive osteolysis whereas other patients with similarly high wear rates show little or no evidence of osteolysis, we hypothesized that both polyethylene wear and a patient-specific propensity mediate the development of osteolysis. We evaluated wear and osteolysis using computed tomography and radiographs among 46 patients who had undergone bilateral total hip arthroplasties (THAs). A radiographic patient-specific propensity for osteolysis associated with each THA was quantified by dividing the amount of osteolysis by the volumetric wear. Using a multivariate regression analysis to simultaneously consider the influence of polyethylene wear and patient propensity, we found that both factors are associated with the amount of osteolysis around a THA and that they appear to be of similar importance.
Collapse
Affiliation(s)
- Charles A Engh
- Anderson Orthopaedic Research Institute, Alexandria, Virginia 22307, USA
| | | | | | | | | | | |
Collapse
|
29
|
Moen TC, Ghate R, Salaz N, Ghodasra J, Stulberg SD. A monoblock porous tantalum acetabular cup has no osteolysis on CT at 10 years. Clin Orthop Relat Res 2011; 469:382-6. [PMID: 20809172 PMCID: PMC3018208 DOI: 10.1007/s11999-010-1500-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aseptic osteolysis has been the single most important factor limiting the longevity of a THA. A great deal of attention has been focused on the development of implants and materials that minimize the development of osteolysis. The monoblock porous tantalum acetabular cup was designed to minimize osteolysis, but whether it does so is unclear. QUESTIONS/PURPOSES We evaluated the incidence of osteolytic lesions after THA using a monoblock porous tantalum acetabular component. METHODS We retrospectively reviewed 51 patients who had a THA using a monoblock porous tantalum acetabular cup. At a minimum of 9.6 years postoperatively (average, 10.3 years; SD, 0.2 years; range, 9.6-10.8 years), a helical CT scan of the pelvis using a metal suppression protocol was obtained. This scan was evaluated for the presence of osteolysis. RESULTS We found no evidence of osteolysis on CT scan at an average of 10.3 years. CONCLUSIONS Osteolysis appears not to be a major problem at 10 years with this monoblock porous tantalum acetabular component, but longer term followup will be required to determine whether these findings persist. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Todd C. Moen
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 1350, Chicago, IL 60611 USA
| | - Raju Ghate
- Northwestern Orthopaedic Institute, Chicago, IL USA
| | - Noel Salaz
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 1350, Chicago, IL 60611 USA
| | - Jason Ghodasra
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 1350, Chicago, IL 60611 USA
| | | |
Collapse
|
30
|
Mall NA, Nunley RM, Smith KE, Maloney WJ, Clohisy JC, Barrack RL. The fate of grafting acetabular defects during revision total hip arthroplasty. Clin Orthop Relat Res 2010; 468:3286-94. [PMID: 20577842 PMCID: PMC2974866 DOI: 10.1007/s11999-010-1427-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular defects are frequently grafted during revision THA. Previous studies using plain radiographs report high rates of graft incorporation. However, given plain radiographs underestimate osteolysis, it is unclear whether plain radiographs adequately reflect graft fill or incorporation. QUESTIONS/PURPOSES We determined if (1) graft fill; or (2) incorporation (measured as graft-bone contact) differed with complete revision and grafting compared to liner exchange and grafting; (3) defect fill and incorporation could be assessed on plain radiographs; and (4) the cost of bone grafting differed with these two procedures. METHODS We identified 40 patients who underwent revision THA for aseptic loosening or polyethylene wear and osteolysis, either with retention of a well-fixed cup or complete acetabular revision in which bone graft was used. Lesion size, percent fill, and graft healing was quantified from CT scans. A limited cost analysis was performed using the current hospital costs for implants, bone grafts, and bone graft substitutes. The minimum followup was 1 year (mean, 4.8 years; range, 1-11 years). RESULTS The average defect fill was 30% (range, 0%-81%). The average percent of healing to host bone was 24% (range, 0-66%). Complete revisions had a higher percent defect fill compared to head/liner changes (47% versus 17%) as well as a higher degree of graft healing to host bone compared to head/liner changes (36% versus 14%). High resolution CT demonstrated lower percentages of defect fill and graft healing than previous reports based on plain radiographs. Bone grafting costs exceeded implant costs in the head/liner exchange group; however, the overall cost was higher in the complete revision group. CONCLUSIONS Higher degrees of defect fill and healing were seen with complete revisions compared to head/liner exchanges. Compared to CT scans, plain radiograph assessment tended to overestimate defect fill and healing.
Collapse
Affiliation(s)
- Nathan A. Mall
- Department of Orthopaedics, Washington University/Barnes Jewish Hospital, St. Louis, MO USA
| | - Ryan M. Nunley
- Department of Orthopaedics, Washington University/Barnes Jewish Hospital, St. Louis, MO USA
| | - Kirk E. Smith
- Mallinkrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
USA
| | | | - John C. Clohisy
- Department of Orthopaedics, Washington University/Barnes Jewish Hospital, St. Louis, MO USA
| | - Robert L. Barrack
- Department of Orthopaedics, Washington University/Barnes Jewish Hospital, St. Louis, MO USA ,Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO 63110 USA
| |
Collapse
|
31
|
A three-dimensional method for evaluating changes in acetabular osteolytic lesions in response to treatment. Clin Orthop Relat Res 2010; 468:480-90. [PMID: 19701674 PMCID: PMC2806972 DOI: 10.1007/s11999-009-1050-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 08/03/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED The treatment of asymptomatic osteolysis among well-fixed cementless cups remains controversial. To compare the effectiveness of different treatment strategies, an objective technique for evaluating bone remodeling would be useful. By matching and comparing serial CT images with the aid of a computer-assisted imaging program, we developed a method to evaluate three-dimensional mineralization changes within osteolytic defects. Preoperative, immediate postoperative, and followup CT images were normalized based on a phantom with known densities and matched using image registration so that the same region could be analyzed on each image. New bone mineralization within the preoperative osteolytic lesion volume was quantified based on a patient-specific trabecular bone density threshold. As a pilot study, we applied this technique in 10 patients treated by polyethylene liner exchange with débridement and grafting of periacetabular osteolytic lesions using a calcium sulfate bone graft substitute. Relative to the preoperative osteolytic lesion volume, an average of 43% (range, 8%-72%) of each defect was filled with graft at revision. After resorption of the graft, an average of 24% (range, 9%-44%) of the original defect volume demonstrated evidence of new mineralization at 1-year followup. The amount of new mineralization was directly proportional (r(2) = 0.70) to the defect filling achieved at revision. CT-based image analysis offers an objective method for quantifying three-dimensional bone remodeling and can be used to evaluate the effectiveness of osteolysis treatment strategies. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
32
|
Cook SD, Patron LP, Salkeld SL, Smith KE, Whiting B, Barrack RL. Correlation of computed tomography with histology in the assessment of periprosthetic defect healing. Clin Orthop Relat Res 2009; 467:3213-20. [PMID: 19756903 PMCID: PMC2772920 DOI: 10.1007/s11999-009-1087-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Computed tomography (CT) may more accurately assess the healing of grafted osteolytic lesions around acetabular components compared with plain radiographs, although clinical validation is lacking. To determine whether clinical or micro-CT imaging could assess accurately the grafted lesion compared with histology, we therefore quantified bone healing and ingrowth to determine an effective rhBMP-2 dose and ratio to allograft bone when grafted adjacent to a cementless porous-coated component. We grafted surgically created acetabular defects in canines (n = 20) before uncemented total hip arthroplasty. At 6 weeks, embedded acetabula were imaged and the CT slice images matched to histology section images. The percentage of bone in the defect and growth into the porous surface was assessed quantitatively. Low-dose rhBMP-2 with allograft (1:5 ratio) resulted in a higher percentage of defect healing (43.8%) than rhBMP-2 alone (29.2%) and a higher percentage of bone ingrowth (15.7%) than allograft bone alone (1.1%) as measured by histology. Micro-CT measurements were similar to histologic measurements of defect healing, whereas clinical CT overestimated periprosthetic bone by 38%. Neither clinical CT nor micro-CT techniques are adequate for assessing ingrowth or the bone-implant interface with metal artifacts.
Collapse
Affiliation(s)
| | | | | | - Kirk E. Smith
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO USA
| | - Bruce Whiting
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO USA
| | - Robert L. Barrack
- Charles F. and Joanne Knight Distinguished Professor of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO 63110 USA
| |
Collapse
|
33
|
Sheikh A, Schweitzer M. Pre- and postoperative assessment in joint preserving and replacing surgery. Rheum Dis Clin North Am 2009; 35:651-73. [PMID: 19931807 DOI: 10.1016/j.rdc.2009.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Advances in imaging technology have increased its suitability for diagnosing musculoskeletal disease. Modification of imaging techniques and improved image quality have led to increased use of computed tomography and magnetic resonance imaging in the assessment of postoperative complications. This article discusses the indications, pre- and postoperative imaging findings, and postoperative complications of knee and hip arthroplasty, articular cartilage repair, and high tibial osteotomy.
Collapse
Affiliation(s)
- Adnan Sheikh
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Road, Ottawa, KIH 8L6, Canada.
| | | |
Collapse
|
34
|
Shon WY, Gupta S, Biswal S, Han SH, Hong SJ, Moon JG. Pelvic osteolysis relationship to radiographs and polyethylene wear. J Arthroplasty 2009; 24:743-50. [PMID: 18555652 DOI: 10.1016/j.arth.2008.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2007] [Accepted: 02/13/2008] [Indexed: 02/01/2023] Open
Abstract
The relationship of radiographic pelvic osteolysis to computed tomographic (CT) volume and polyethylene wear remains controversial. We evaluated the sensitivity and specificity of radiographs in detecting osteolysis considering CT scan as the true value, in 118 hips with cementless cups. Correlation between osteolysis volume in CT, area of osteolysis in radiograph, and linear wear of polyethylene was assessed. The sensitivity and specificity of anteroposterior radiographs for detection of osteolysis was 57.6% and 92.9%, respectively. Addition of oblique radiographs increased the sensitivity to 64.4% without changing the specificity. The sensitivity increased to 92.8% for lesion more than 1000 mm(3). There was good correlation between 2-dimensional (2D) osteolytic area in radiograph and 3-dimensional (3D) volume (r = 0.74) in CT scan and linear wear of polyethylene showed good correlation with 3D CT volume (r = 0.62) and 2D area in radiograph (r = 0.60). Thus radiographs are useful to screen clinically significant osteolysis.
Collapse
Affiliation(s)
- Won Yong Shon
- Department of Orthopedics, Korea University Guro Hospital, Seoul, Korea.
| | | | | | | | | | | |
Collapse
|
35
|
Sheikh A, Schweitzer M. Imaging in Pre- and Post-operative Assessment in Joint Preserving and Replacing Surgery. Radiol Clin North Am 2009; 47:761-75. [DOI: 10.1016/j.rcl.2009.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Ohashi K, El-Khoury GY. Musculoskeletal CT: Recent Advances and Current Clinical Applications. Radiol Clin North Am 2009; 47:387-409. [DOI: 10.1016/j.rcl.2008.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
37
|
Engh CA. Newer Radiographic Methods for Detection and Treatment Planning for Patients with Pelvic Osteolysis. ACTA ACUST UNITED AC 2009. [DOI: 10.1053/j.sart.2008.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
38
|
Kurmis TP, Kurmis AP, Campbell DG, Slavotinek JP. Pre-surgical radiologic identification of peri-prosthetic osteolytic lesions around TKRs: a pre-clinical investigation of diagnostic accuracy. J Orthop Surg Res 2008; 3:47. [PMID: 18834525 PMCID: PMC2570664 DOI: 10.1186/1749-799x-3-47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 10/03/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emerging longitudinal data appear to demonstrate an alarming trend towards an increasing prevalence of osteolysis-induced mechanical failure, following total knee replacement (TKR). Even with high-quality multi-plane X-rays, accurate pre-surgical evaluation of osteolytic lesions is often difficult. This is likely to have an impact on surgical management and provides reasonable indication for the development of a model allowing more reliable lesion assessment. The aim of this study, using a simulated cadaver model, was to explore the accuracy of rapid spiral computed tomography (CT) examination in the non-invasive evaluation of peri-prosthetic osteolytic lesions, secondary to TKR, and to compare this to conventional X-ray standards. METHODS A series of nine volume-occupying defects, simulating osteolytic lesions, were introduced into three human cadaveric knees, adjacent to the TKR implant components. With implants in situ, each knee was imaged using a two-stage conventional plain X-ray series and rapid-acquisition spiral CT. A beam-hardening artefact removal algorithm was employed to improve CT image quality.After random image sorting, 12 radiologists were independently shown the series of plain X-ray images and asked to note the presence, anatomic location and 'size' of osteolytic lesions observed. The same process was repeated separately for review of the CT images. The corresponding X-ray and CT responses were directly compared to elicit any difference in the ability to demonstrate the presence and size of osteolytic lesions. RESULTS Access to CT images significantly improved the accuracy of recognition of peri-prosthetic osteolytic lesions when compared to AP and lateral projections alone (P = 0.008) and with the addition of bi-planar oblique X-rays (P = 0.03). No advantage was obtained in accuracy of identification of such lesions through the introduction of the oblique images when compared with the AP and lateral projections alone (P = 0.13) CONCLUSION The findings of this study suggest that peri-prosthetic osteolytic lesions can be reliably described non-invasively using a simple, rapid-acquisition CT-based imaging approach. The low sensitivity of conventional X-ray, even with provision of supplementary bi-planar 45 degrees oblique views, suggests a limited role for use in situ for TKR implant screening where peri-prosthetic osteolytic lesions are clinically suspected. In contrast, the accuracy of CT evaluation, linked to its procedural ease and widespread availability, may provide a more accurate way of evaluating osteolysis around TKRs, at routine orthopaedic follow up. These findings have direct clinical relevance, as accurate early recognition and classification of such lesions influences the timing and aggressiveness of surgical and non-operative management strategies, and also the nature and appropriateness of planned implant revision or joint-salvaging osteotomy procedures.
Collapse
Affiliation(s)
- Timothy P Kurmis
- Department of Orthopaedic Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.
| | | | | | | |
Collapse
|
39
|
Abstract
During the past two decades, most total hip arthroplasties were performed with metal or ceramic heads on conventional polyethylene, an articulation associated with wear and limited life expectancy. Wear is associated with acetabular osteolysis. Isolated liner exchange has become a common surgical intervention when the acetabular component remains well-fixed. The purpose of isolated liner exchange is to prevent loosening of the components secondary to osteolysis and catastrophic mechanical failure caused by bearing wear-through. Treatment options for polyethylene wear include observation (in the asymptomatic hip), liner exchange, and more extensive revision procedures. Patients frequently present with asymptomatic but substantial polyethylene wear with or without associated osteolysis, the treatment of which is controversial. Other areas of debate include complete acetabular component removal to allow bone grafting and placement of an improved bearing surface, reuse of modular mechanisms, cementation into well-fixed shells, and whether to use periacetabular bone grafting.
Collapse
|
40
|
Wilkie JR, Giger ML, Chinander MR, Engh CA, Hopper RH, Martell JM. Temporal radiographic texture analysis in the detection of periprosthetic osteolysis. Med Phys 2008; 35:377-87. [PMID: 18293592 DOI: 10.1118/1.2820900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Periprosthetic osteolysis is one of the most serious long-term problems in total hip arthroplasty. It has been primarily attributed to the body's inflammatory response to submicron polyethylene particles worn from the hip implant, and it leads to bone loss and structural deterioration in the surrounding bone. It was previously demonstrated that radiographic texture analysis (RTA) has the ability to distinguish between osteolysis and normal cases at the time of clinical detection of the disease; however, that analysis did not take into account the changes in texture over time. The goal of this preliminary analysis, however, is to assess the ability of temporal radiographic texture analysis (tRTA) to distinguish between patients who develop osteolysis and normal cases. Two tRTA methods were used in the study: the RTA feature change from baseline at various follow-up intervals and the slope of the best-fit line to the RTA data series. These tRTA methods included Fourier-based and fractal-based features calculated from digitized images of 202 total hip replacement cases, including 70 that developed osteolysis. Results show that separation between the osteolysis and normal groups increased over time for the feature difference method, as the disease progressed, with area under the curve (AUC) values from receiver operating characteristic analysis of 0.65 to 0.72 at 15 years postsurgery. Separation for the slope method was also evident, with AUC values ranging from 0.65 to 0.76 for the task of distinguishing between osteolysis and normal cases. The results suggest that tRTA methods have the ability to measure changes in trabecular structure, and may be useful in the early detection of periprosthetic osteolysis.
Collapse
Affiliation(s)
- Joel R Wilkie
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637, USA.
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
Prospective, randomized clinical wear studies have shown significant wear reduction when highly cross-linked, e-beamed, melted polyethylene was compared with conventional polyethylene sterilized by gamma irradiation in air. More complete assessment of wear-induced osteolysis in the general total hip arthroplasty patient population must rely on registries with follow-up of large populations of patients through radiographic evaluation of wear-related factors, such as suboptimal placement of the implant components, osteolytic defects, and aseptic loosening. Follow-up radiographs should be obtained in the early postoperative period and at 1, 5, and 10 years postoperatively, and then every 1 to 5 years, thereafter depending on radiographic findings of osteolysis and its progression. When pathologic findings are present, further examinations, such as oblique Judet views and magnetic resonance imaging (MRI) with artifact minimization should be considered to provide a better determination of the extent of the osteolysis. Because conventional radiographs underestimate the prevalence and extent of osteolysis in many instances, diagnosis and surveillance should be performed with radiographic edge detection, spiral computed tomography (CT), MRI, radiostereometric analysis, and quantitation of wear and osteolysis, including bone and soft-tissue lesions. Helical CT has demonstrated excellent specificity in identifying and quantifying the extent of osteolysis. MRI can more accurately localize both osseous and soft-tissue particulate disease, and detect granuloma and compression on adjacent nerves and vessels.
Collapse
|
42
|
Engh CA, Egawa H, Beykirch SE, Hopper RH, Engh CA. The quality of osteolysis grafting with cementless acetabular component retention. Clin Orthop Relat Res 2007; 465:150-4. [PMID: 17876287 DOI: 10.1097/blo.0b013e3181576097] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Periprosthetic osteolysis is a common cause for revision of total hip arthroplasty. When modular cementless acetabular components are stable, curettage and grafting of the osteo-lytic lesion while retaining the component are a good surgical option. Although the midterm outcome of this procedure is known, the quality of the surgical technique is not. We used preoperative and postoperative computed tomography to determine the percentage of periacetabular lesions that was grafted and the percentage of the lesion volume filled with an injectable bone graft substitute. We discovered, even with preoperative computed tomography reconstructions and surgical planning, four of 22 lesions were neglected at the time of surgery. In the 18 lesions that were treated, we were able to fill an average of 49% (range, 0-83%) of the lesion volume. These inconsistent results illustrate a need to further refine surgical techniques and instrumentation to treat one of the most common complications in total hip arthroplasty. Longer followup with repeat computed tomography scans or other imaging techniques would determine if the percentage of lesion fill has an effect on clinical outcome.
Collapse
Affiliation(s)
- C Anderson Engh
- Anderson Orthopaedic Research Institute, Alexandria, VA 22307, USA
| | | | | | | | | |
Collapse
|
43
|
Sofka CM. Current applications of advanced cross-sectional imaging techniques in evaluating the painful arthroplasty. Skeletal Radiol 2007; 36:183-93. [PMID: 17151850 DOI: 10.1007/s00256-006-0226-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 09/10/2006] [Accepted: 09/13/2006] [Indexed: 02/02/2023]
Abstract
Patients with a painful arthroplasty can present a clinical diagnostic dilemma. Aspirates are often negative for infection and alignment of the prosthesis on conventional radiographs is usually satisfactory. These patients can have a myriad of soft tissue as well as osseous pathologies, which may be clinically unsuspected or radiographically occult. The ability of advanced cross-sectional imaging to diagnose osseous and soft tissue injuries has been well documented, but applications to arthroplasty imaging are often limited by regional metallic artifacts. Adjustment of standard imaging parameters can make CT and MR imaging useful adjuncts in imaging the painful arthroplasty, especially in the setting of normal radiographs. Ultrasound can be used to evaluate the periprosthetic soft tissues and provide a real-time method of evaluating the dynamic relationship of the periprosthetic soft tissues to the arthroplasty components, and it also can be used as a guide for diagnostic and therapeutic interventions.
Collapse
Affiliation(s)
- Carolyn M Sofka
- Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
| |
Collapse
|
44
|
Kitamura N, Pappedemos PC, Duffy PR, Stepniewski AS, Hopper RH, Engh CA, Engh CA. The value of anteroposterior pelvic radiographs for evaluating pelvic osteolysis. Clin Orthop Relat Res 2006; 453:239-45. [PMID: 17290152 DOI: 10.1097/01.blo.0000246554.41058.8d] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We investigated the role of conventional radiographs and computed tomography scans for the routine followup of total hip arthroplasty patients. Among 92 total hip arthroplasties with a mean followup of 8.5 years, 94 acetabular lesions were detected among 63 hips using computed tomography and 42 of these hips had osteolysis diagnosed on radiograph. Using computed tomography as a gold standard, the sensitivity of anteroposterior pelvic radiographs for the detection of acetabular osteolysis was 67% and the specificity was 72%. Although smaller lesions were more frequently missed, osteolysis was diagnosed on radiograph in 20 of 22 total hip arthroplasties with lesion volumes of at least 10 mL. Because larger osteolytic lesions were generally detected on radiograph, two-dimensional and three-dimensional lesion sizes correlated. However, the limits of agreement for the volume estimates based on the radiograph area were -14.6 to 18.7 mL. Although radiographs can be useful to screen for clinically important pelvic osteolysis, computed tomography images are necessary to accurately measure lesion volumes.
Collapse
Affiliation(s)
- Nobuto Kitamura
- Anderson Orthopaedic Research Institute, Alexandria, VA 22307, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Puri L, Lapinski B, Wixson RL, Lynch J, Hendrix R, Stulberg SD. Computed tomographic follow-up evaluation of operative intervention for periacetabular lysis. J Arthroplasty 2006; 21:78-82. [PMID: 16950066 DOI: 10.1016/j.arth.2006.05.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 05/16/2006] [Indexed: 02/01/2023] Open
Abstract
Computed tomography (CT) accurately evaluates periacetabular lytic lesions. The purpose of this study is to determine the fate of osteolytic lesions after treatment with liner exchange and bone grafting. Fifteen patients who had undergone liner exchange with grafting for progressive lytic lesions, as demonstrated by preoperative CT scans, were identified. Postoperative CT scans were performed at a minimum of 2 years post revision. The largest cross sectional lytic area was compared with the postoperative scan to determine the fate of the lesion. The mean size of the measured lytic lesions preoperatively was 6.38 cm(2). Postoperatively, lesions decreased to 2.94 cm(2) (P = .000). Modular liner exchange with grafting is effective in treating osteolytic lesions in the pelvis, as demonstrated by CT.
Collapse
Affiliation(s)
- Lalit Puri
- Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Knowledge of imaging principles and parameter modifications of advanced imaging techniques--nuclear medicine, ultrasound, CT, and MR--aid musculoskeletal radiologists in selecting the appropriate examination for clinical questions; tailoring imaging parameters results in better image quality, thus more confident diagnoses. CT can evaluate for subtle fractures often better than conventional radiographs. Adjusting the area of interest, increasing the peak kilovoltage (kVp), and viewing images with postprocessing software allow better CT image quality. Proper modification of MR imaging parameters also provides useful information including visualizing the extent of osteolysis better than conventional radiographs. Fast spin echo imaging should be used, gradient echo avoided, and fast inversion recovery used instead of frequency-selective fat suppression.
Collapse
Affiliation(s)
- Carolyn M Sofka
- Weill Medical College of Cornell University, New York, NY, USA.
| |
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW Inflammation-induced osteolysis is a problem in both inflammatory arthritis and total joint arthroplasty. New drug therapies have been shown to slow, halt, or even reverse the osteolysis associated with inflammatory arthritis. Unfortunately, similar advances in the medical treatment of periprosthetic osteolysis have not occurred. This review will update the state of periprosthetic osteolysis. RECENT FINDINGS Preliminary results with phase I and II clinical trials with AMG-162, a human IgG2 that binds receptor activator of nuclear factor kappaB (RANK) ligand, have been reported. Based on these results AMG-162 appears to be safe and to have a potent effect on osteoclast function. Based on animal studies, it is expected that regents such as AMG-162 that block RANK-ligand/RANK interaction will have activity in inflammation-induced osteolysis. Volumetric three-dimensional and magnetic resonance imaging scans for detecting and quantifying periprosthetic osteolysis have been validated in cadaver studies. Lymphocytic infiltrates and positive skin tests to cobalt have been found in patients with periprosthetic osteolysis after second generation metal-on-metal prostheses. These findings again raise the question of whether metal allergy may contribute to implant failure in these patients. A new subset of T helper cells that are neither Th1 nor Th2, but secrete a unique pattern of cytokines including IL-17, has recently been discovered. The importance of these cells in modifying particle-induced osteolysis remains to be determined. SUMMARY There have been significant advances in our understanding of periprosthetic osteolysis, imaging technology to quantify osteolysis, and drug development. The time now seems ripe to translate these advances in clinical trials.
Collapse
Affiliation(s)
- R John Looney
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, NY 1442, USA.
| | | | | | | |
Collapse
|
48
|
Musculoskeletal imaging update: current applications of advanced imaging techniques to evaluate the early and long-term complications of patients with orthopedic implants. HSS J 2006; 2:73-7. [PMID: 18751851 PMCID: PMC2504118 DOI: 10.1007/s11420-005-0131-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Technical advances in imaging have increased their applicability to diagnosing conditions of the musculoskeletal system, especially in the postoperative setting, where traditionally metallic artifacts have hindered evaluation. Advances in computed tomography (CT), magnetic resonance (MR) imaging, ultrasound, and nuclear medicine have resulted in improved overall image quality. Specific modifications of imaging parameters, especially in CT and MRI, have improved the radiologist's ability to diagnose potential hardware complications such as loosening and osteolysis. Sonography can evaluate the periprosthetic soft tissues and enables both diagnostic information and therapeutic treatment at the same sitting. Lastly, diagnostic scintigraphic applications such as positron emission tomography (PET) have increased specificity in diagnosing potential infection in the arthroplasty setting. This review discusses some of the current applications of CT, MRI, ultrasound, and nuclear medicine in evaluating the postoperative orthopedic patient, concentrating on the appropriate imaging evaluation for the painful arthroplasty patient.
Collapse
|
49
|
Walde TA, Weiland DE, Leung SB, Kitamura N, Sychterz CJ, Engh CA, Claus AM, Potter HG, Engh CA. Comparison of CT, MRI, and radiographs in assessing pelvic osteolysis: a cadaveric study. Clin Orthop Relat Res 2005:138-44. [PMID: 16056041 DOI: 10.1097/01.blo.0000164028.14504.46] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In this study, we compared the accuracy of radiography, computed tomography, and magnetic resonance imaging in assessing periacetabular osteolytic lesions. Using a previously published cadaver model, we created 87 lesions in pelves implanted with total hip replacement components. The sensitivity for detecting lesions was 51.7% for radiography, 74.7% for computed tomography, and 95.4% for magnetic resonance imaging. For all three techniques, sensitivity increased as lesion size increased. Magnetic resonance imaging emerged as the most effective tool for detecting small periacetabular osteolytic lesions (< or = 3 cm). For lesions larger than 3 cm, which are of more concern clinically, computed tomography and magnetic resonance imaging were effective in identifying lesions with detection rates greater than 80%. For radiography and computed tomography, lesion detection was dependent on lesion location, whereas magnetic resonance imaging had consistently good sensitivity in all lesion locations. Although the mean volumetric errors for computed tomography and magnetic resonance imaging (0.3 cm and 0.8 cm) were small compared with mean lesion volume (6.1 cm), computed tomography was more accurate than magnetic resonance imaging at measuring lesion volume, with a lower mean absolute error. This study verifies the problems associated with radiographic detection of osteolysis while showing the effectiveness of computed tomography and magnetic resonance imaging in determining the presence of lesions and assessing their three-dimensional volume.
Collapse
Affiliation(s)
- Tim A Walde
- Department of Traumatology, Plastic and Reconstructive Surgery, University of Göttingen, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
|