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Kaptein BL, Pijls B, Koster L, Kärrholm J, Hull M, Niesen A, Heesterbeek P, Callary S, Teeter M, Gascoyne T, Röhrl SM, Flivik G, Bragonzoni L, Laende E, Sandberg O, Solomon LB, Nelissen R, Stilling M. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95:256-267. [PMID: 38819193 PMCID: PMC11141406 DOI: 10.2340/17453674.2024.40709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024] Open
Abstract
Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and consistent in execution, presentation, reporting, and interpretation. Both authors and reviewers of scientific papers using RSA may use these guidelines, summarized in the Checklist, as a reference. Deviations from these guidelines should have the underlying rationale stated.
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Affiliation(s)
- Bart L Kaptein
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bart Pijls
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lennard Koster
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Kärrholm
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maury Hull
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Abby Niesen
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Petra Heesterbeek
- Orthopedic Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Stuart Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Matthew Teeter
- Department of Medical Biophysics, Western University, London, Canada
| | | | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gunnar Flivik
- Department of Orthopedics, Skane University Hospital, Lund, Sweden
| | | | - Elise Laende
- Department of Surgery, Dalhousie University, Halifax, Canada
| | | | - L Bogdan Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Rob Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Broberg JS, Koff MF, Howard JL, Lanting BA, Potter HG, Teeter MG. A multimodal assessment of cementless tibial baseplate fixation using radiography, radiostereometric analysis, and magnetic resonance imaging. J Orthop Res 2024; 42:100-108. [PMID: 37442642 DOI: 10.1002/jor.25662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/22/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Fixation in cementless total knee arthroplasty is provided by osseous integration. Radiography, radiostereometric analysis (RSA), and magnetic resonance imaging (MRI) were used simultaneously to investigate fixation. Relationships between RSA-measured implant micromotions and MRI-evaluated osseous integration at the component-bone interface were assessed in 10 patients up to 6 months postoperation. Supine MRI (using multispectral imaging sequences) and RSA exams were performed to evaluate osseous integration and measure longitudinal migration, respectively. Inducible displacement was measured from standing RSA exams. Radiolucent lines were detected on conventional radiographs. Of 10 patients, 6 had fibrous membranes detected on MRI. No fluid or osteolytic interfaces were found, and no components were scored loose. Of 10 patients, 6 had radiolucent lines detected. Average maximum total point motion (MTPM) for longitudinal migration at 6 months was 0.816 mm (range 0.344-1.462 mm). Average MTPM for inducible displacement at 6 months was 1.083 mm (range 0.553-1.780 mm). Fictive points located in fibrous-classified baseplate quadrants had greater longitudinal migration than fictive points located in baseplate quadrants with normal interfaces at 2 weeks (p = 0.031), 6 weeks (p = 0.046), and 3 months (p = 0.047), and greater inducible displacements at 3 months (p = 0.011) and 6 months (p = 0.045). Greater early micromotion may be associated with the presence of fibrous membranes at the component-bone interface. Clinical significance: This multimodal imaging study contributes knowledge of the fixation of modern cementless TKA, supporting the notion that osseous integration is important for optimal implant fixation.
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Affiliation(s)
- Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Matthew F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
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Ter Wee MA, Dobbe JGG, Buijs GS, Kievit AJ, Schafroth MU, Maas M, Blankevoort L, Streekstra GJ. Load-induced deformation of the tibia and its effect on implant loosening detection. Sci Rep 2023; 13:21769. [PMID: 38066256 PMCID: PMC10709436 DOI: 10.1038/s41598-023-49177-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
CT imaging under external valgus and varus loading conditions and consecutive image analysis can be used to detect tibial implant loosening after total knee arthroplasty. However, the applied load causes the tibia to deform, which could result in an overestimation of implant displacement. This research evaluates the extent of tibia deformation and its effect on measuring implant displacement. Ten cadaver specimen with TKA were CT-scanned under valgus/varus loading (20 Nm), first implanted without bone cement fixation (mimicking a loose implant) and subsequently with bone cement fixation (mimicking a fixed implant). By means of image analysis, three relative displacements were assessed: (1) between the proximal and distal tibia (measure of deformation), (2) between the implant and the whole tibia (including potential deformation effect) and (3) between the implant and the proximal tibia (reduced deformation effect). Relative displacements were quantified in terms of translations along, and rotations about the axes of a local coordinate system. As a measure of deformation, the proximal tibia moved relative to the distal tibia by, on average 1.27 mm (± 0.50 mm) and 0.64° (± 0.25°). Deformation caused an overestimation of implant displacement in the cemented implant. The implant displaced with respect to the whole tibia by 0.45 mm (± 0.22 mm) and 0.79° (± 0.38°). Relative to the proximal tibia, the implant moved by 0.23 mm (± 0.10 mm) and 0.62° (± 0.34°). The differentiation between loose and fixed implants improved when tibia deformation was compensated for by using the proximal tibia rather than the whole tibia.
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Affiliation(s)
- M A Ter Wee
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - G S Buijs
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A J Kievit
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M U Schafroth
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M Maas
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - L Blankevoort
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Kievit AJ, Buijs GS, Dobbe JGG, Ter Wee A, Kerkhoffs GMMJ, Streekstra GJ, Schafroth MU, Blankevoort L. Promising results of an non-invasive measurement of knee implant loosening using a loading device, CT-scans and 3D image analysis. Clin Biomech (Bristol, Avon) 2023; 104:105930. [PMID: 36906985 DOI: 10.1016/j.clinbiomech.2023.105930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND After total knee arthroplasty up to 13% requires revision surgery to address loosening. No current diagnostic modalities have a sensitivity or specificity higher than 70-80% to detect loosening, leading to 20-30% of patients undergoing unnecessary, risky and expensive revision surgery. A reliable imaging modality is required to diagnose loosening. This study presents a new and non-invasive method and evaluates its reproducibility and reliability in a cadaveric study. METHODS Ten cadaveric specimens were implanted with a loosely fitted tibial components and CT scanned under load towards valgus and varus using a loading device. Advanced three-dimensional imaging software was used to quantify displacement. Subsequently, the implants were fixed to the bone and scanned to determine the differences between the fixed and the loose state. Reproducibility errors were quantified using a frozen specimen in which displacement was absent. FINDINGS Reproducibility errors, expressed as mean target registration error, screw-axis rotation and maximum total point motion were 0.073 mm (SD 0.033), 0.129 degrees (SD 0.039) and 0.116 mm (SD 0.031), respectively. In the loose condition, all displacements and rotation changes were larger than the reported reproducibility errors. Comparing the mean target registration error, screw axis rotation and maximum total point motion in the loose condition to the fixed condition resulted in mean differences of 0.463 mm (SD 0.279; p = 0.001), 1.769 degrees (SD 0.868; p < 0.001) and 1.339 mm (SD 0.712; p < 0.001), respectively. INTERPRETATION The results of this cadaveric study show that this non-invasive method is reproducible and reliable for detection of displacement differences between fixed and loose tibial components.
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Affiliation(s)
- Arthur J Kievit
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - George S Buijs
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Johannes G G Dobbe
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Annemiek Ter Wee
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Geert J Streekstra
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Matthias U Schafroth
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Leendert Blankevoort
- Amsterdam UMC, location University of Amsterdam, Department of Orthopedic Surgery and Sport Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health, Meibergdreef 9, Amsterdam, the Netherlands
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Teeter MG, Broberg JS, Howard JL, Lanting BA. Axial and sagittal rotation of cementless tibial baseplates occurs in bone under joint loading. J Arthroplasty 2023; 38:1166-1171. [PMID: 36893992 DOI: 10.1016/j.arth.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION There has been a recent increase in the use of cementless fixation for primary total knee arthroplasty (TKA). While the early results of contemporary cementless implants are promising, understanding the behavior of cementless tibial baseplates under loading remains an ongoing interest. The objective of this study was to identify the pattern of displacement that occurred under loading for a single cementless tibial baseplate design at one-year post-operation for stable and continuously migrating implants. METHODS There were 28 subjects from a previous trial of a pegged highly porous cementless tibial baseplate evaluated. Subjects underwent supine radiostereometric exams from two weeks through one year after surgery. At one year, subjects also underwent a standing radiostereometric exam. Fictive points on the tibial baseplate model were used to relate translations to anatomical locations. Migration over time was calculated to determine if subjects displayed stable or continuous migration. The magnitude of inducible displacement between the supine and standing exams was calculated. RESULTS Inducible displacement patterns were similar between stable and continuously migrating tibial baseplates. Displacements were greatest in the anterior-posterior axis followed by the lateral-medial axis. Correlation of displacements between adjacent fictive points in these axes indicated an axial rotation of the baseplate occurred under loading (r2 = 0.689-0.977, P< 0.001). Less displacement occurred in the superior-inferior axis and correlations indicated an anterior-posterior tilt of the baseplate occurred under loading (r2 = 0.178-0.226, P = 0.009-0.023). DISCUSSION From supine to standing position the predominant pattern of displacement for this cementless tibial baseplate was axial rotation, with some subjects also displaying an anterior-posterior tilt.
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Affiliation(s)
- Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - James L Howard
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Broberg JS, Vasarhelyi EM, Lanting BA, Howard JL, Teeter MG, Naudie DDR. Migration and Inducible Displacement of the Bicruciate-Stabilized Total Knee Arthroplasty: A Randomized Controlled Trial of Gap Balancing and Measured Resection Techniques. J Arthroplasty 2022; 37:252-258. [PMID: 34710566 DOI: 10.1016/j.arth.2021.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The goal of this study is to investigate the migration and inducible displacement of a bicruciate-stabilized (BCS) total knee arthroplasty implanted using gap balancing (GB) or measured resection (MR) surgical techniques. We hypothesized equal migration and displacement between the techniques. METHODS The study is a single-blinded, prospective, randomized controlled trial, with allocation of 71 patients to either GB or MR groups. Fifteen patients were withdrawn, resulting in 31 patients in the GB group and 25 in the MR group. Patients received the JOURNEY II™ BCS implant. Migration and inducible displacement were evaluated using radiostereometric analysis and patient examinations were performed at a 2-week baseline, and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperation. RESULTS No differences (P > .05) existed between GB and MR groups for any measurement of tibial or femoral migration. Both groups had tibial migrations below 0.5 mm from baseline to 6 months, and below 0.2 mm from both 6 months to 1 year and 1-2 years postoperation. No differences (P > .05) were found between GB and MR groups for inducible displacement. CONCLUSION No differences were found in implant migration or inducible displacement between GB and MR groups. The BCS implant can be expected to have migration risks on par with industry standards and both surgical techniques are safe and effective options for implantation of this implant design.
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Affiliation(s)
- Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | - Edward M Vasarhelyi
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
| | - Douglas D R Naudie
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, ON, Canada
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Affiliation(s)
- Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway,
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Laende EK, Richardson CG, Dunbar MJ. Predictive value of short-term migration in determining long-term stable fixation in cemented and cementless total knee arthroplasties. Bone Joint J 2019; 101-B:55-60. [DOI: 10.1302/0301-620x.101b7.bjj-2018-1493.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Early implant migration measured with radiostereometric analysis (RSA) has been proposed as a useful predictor of long-term fixation of tibial components in total knee arthroplasty. Evaluation of actual long-term fixation is of interest for cemented components, as well as for cementless fixation, which may offer long-term advantages once osseointegration has occurred. The objective of this study was to compare the long-term migration with one- and two-year migration to evaluate the predictive ability of short-term migration data and to compare migration and inducible displacement between cemented and cementless (porous metal monoblock) components at least ten years postoperatively. Patients and Methods Patients who had participated in RSA migration studies with two-year follow-up were recruited to return for a long-term follow-up, at least ten years from surgery. Two cemented tibial designs from two manufacturers and one porous metal monoblock cementless tibial design were studied. At the long-term follow-up, patients had supine RSA examinations to determine migration and loaded examinations (single leg stance) to determine inducible displacement. In total, 79 patients (54 female) returned, with mean time since surgery of 12 years (10 to 14). There were 58 cemented and 21 cementless tibial components. Results Migration at one year and two years was significantly correlated with long-term migration (p < 0.001). Median migration at the long-term follow-up was 0.6 mm (maximum total point motion; interquartile range (IQR) 0.4 to 0.9) for the cemented group and 0.6 mm (IQR 0.3 to 1.1) for the cementless group with no difference between groups (p = 0.99). Inducible displacement was significantly lower for the cementless components (p < 0.001). Conclusion Long-term migration was strongly correlated with two-year migration. Although long-term migration was not different for cemented or cementless tibial components, inducible displacement at the long-term visit was significantly lower for these cementless components, suggesting superior fixation. These findings support the predictive value of short-term migration in determining long-term fixation. Cite this article: Bone Joint J 2019;101-B(7 Supple C):55–60
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Affiliation(s)
- E. K. Laende
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
| | - C. G. Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
| | - M. J. Dunbar
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada; Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Canada
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