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Engseth LHW, Schulz A, Pripp AH, Röhrl SMH, Øhrn FD. CT-based migration analysis is more precise than radiostereometric analysis for tibial implants: a phantom study on a porcine cadaver. Acta Orthop 2023; 94:207-214. [PMID: 37114404 PMCID: PMC10141323 DOI: 10.2340/17453674.2023.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiostereometric analysis (RSA) is the gold standard for migration analysis, but computed tomography analysis methods (CTRSA) have shown comparable results in other joints. We attempted to validate precision for CT compared with RSA for a tibial implant. MATERIAL AND METHODS RSA and CT were performed on a porcine knee with a tibial implant. Marker-based RSA, model-based RSA (MBRSA), and CT scans from 2 different manufacturers were compared. CT analysis was performed by 2 raters for reliability evaluation. RESULTS 21 double examinations for precision measurements for RSA and CT-based Micromotion Analysis (CTMA) were analysed. Mean (95% confidence interval) precision data for maximum total point motion (MTPM) using marker-based RSA was 0.45 (0.19-0.70) and 0.58 (0.20-0.96) using MBRSA (F-statistic 0.44 [95% CI 0.18-1.1], p = 0.07). Precision data for total translation (TT) for CTMA was 0.08 (0.03-0.12) for the GE scanner and 0.11 (0.04-0.19) for the Siemens scanner (F-statistic 0.37 [0.15-0.91], p = 0.03). When comparing the aforementioned precision for both RSA methods with both CTMA analyses, CTMA was more precise (p < 0.001). The same pattern was seen for other translations and migrations. Mean effective radiation doses were 0.005 mSv (RSA) (0.0048-0.0050) and 0.08 mSv (CT) (0.078-0.080) (p < 0.001). Intra- and interrater reliability were 0.79 (0.75-0.82) and 0.77 (0.72-0.82), respectively. CONCLUSION CTMA is more precise than RSA for migration analysis of a tibial implant, has overall good intra- and interrater reliability but higher effective radiation doses in a porcine cadaver.
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Affiliation(s)
- Lars H W Engseth
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo.
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo
| | - Are H Pripp
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo
| | - Stephan M H Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital Ullevål, Oslo; Faculty of Medicine, University of Oslo, Oslo
| | - Frank-David Øhrn
- Orthopaedic Department, Kristiansund Hospital, Møre and Romsdal Hospital Trust, Kristiansund; Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science (INB), NTNU Norwegian University of Science and Technology, Norway
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Medial congruent polyethylene design show different tibiofemoral kinematics and enhanced congruency compared to a standard symmetrical cruciate retaining design for total knee arthroplasty-an in vivo randomized controlled study of gait using dynamic radiostereometry. Knee Surg Sports Traumatol Arthrosc 2023; 31:933-945. [PMID: 35809105 DOI: 10.1007/s00167-022-07036-w] [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: 01/04/2022] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE New total knee arthroplasty implant designs attempt to normalize kinematics patterns that may improve functional performance and patient satisfaction. It was hypothesized that a more medial congruent (MC) anatomic bearing design (1) influences the tibiofemoral kinematics and (2) enhances articular congruency compared to a standard symmetrical cruciate retaining (CR) bearing design. METHODS In this double-blinded randomized study, 66 patients with knee osteoarthritis were randomly included in two groups: MC (n = 31) and CR (n = 33). Clinical characteristics such as knee ligament lesions and knee osteoarthritis scores were graded on preoperative magnetic resonance imaging and radiography. At the 1-year follow-up, dynamic radiostereometric analysis was used to assess tibiofemoral joint kinematics and articulation congruency. Patient-reported outcome measures, Oxford Knee Score, the Forgotten Joint Score, and the Knee Osteoarthritis Outcome Score, were assessed preoperatively and at the 1-year follow-up. RESULTS Compared to the CR bearing, the MC bearing displayed an offset with approximately 3 mm greater anterior tibial drawer (p < 0.001) during the entire motion, and up to approximately 3.5 degrees more tibial external rotation (p = 0.004) from mid-swing to the end of the gait cycle at the 1-year follow-up. Furthermore, the congruency area in the joint articulation was larger during approximately 80% of the gait cycle for the MC bearing compared to the CR. The patient-reported outcome measures improved (p < 0.001), but there were no differences between groups. In addition, there were no differences in clinical characteristics and there were no knee revisions or recognized deep infections during follow-up. CONCLUSION The study demonstrates that the MC-bearing design changes tibiofemoral kinematics and increases the area of congruency towards more native knee kinematics than the CR bearing. In perspective this may contribute to a more stabilized knee motion, restoring the patient's confidence in knee function during daily activities.
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Petersen ET, Vind TD, Jürgens-Lahnstein JH, Christensen R, de Raedt S, Brüel A, Rytter S, Andersen MS, Stilling M. Evaluation of automated radiostereometric image registration in total knee arthroplasty utilizing a synthetic-based and a CT-based volumetric model. J Orthop Res 2023; 41:436-446. [PMID: 35532010 PMCID: PMC10084430 DOI: 10.1002/jor.25359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/28/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
Radiostereometic analysis (RSA) is an accurate method for rigid body pose (position and orientation) in three-dimensional space. Traditionally, RSA is based on insertion of periprosthetic tantalum markers and manual implant contour selection which limit clinically application. We propose an automated image registration technique utilizing digitally reconstructed radiographs (DRR) of computed tomography (CT) volumetric bone models (autorsa-bone) as a substitute for tantalum markers. Furthermore, an automated synthetic volumetric representation of total knee arthroplasty implant models (autorsa-volume) to improve previous silhouette-projection methods (autorsa-surface). As reference, we investigated the accuracy of implanted tantalum markers (marker) or a conventional manually contour-based method (mbrsa) for the femur and tibia. The data are presented as mean (standard deviation). The autorsa-bone method displayed similar accuracy of -0.013 (0.075) mm compared to the gold standard method (marker) of -0.013 (0.085). The autorsa-volume with 0.034 (0.106) mm did not markedly improve the autorsa-surface with 0.002 (0.129) mm, and none of these reached the mbrsa method of -0.009 (0.094) mm. In conclusion, marker-free RSA is feasible with similar accuracy as gold standard utilizing DRR and CT obtained volumetric bone models. Furthermore, utilizing synthetic generated volumetric implant models could not improve the silhouette-based method. However, with a slight loss of accuracy the autorsa methods provide a feasible automated alternative to the semi-automated method.
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Affiliation(s)
- Emil Toft Petersen
- University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Dahl Vind
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan Hugo Jürgens-Lahnstein
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Rasmus Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sepp de Raedt
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Søren Rytter
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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4
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Thillemann JK, De Raedt S, Petersen ET, Puhakka KB, Hansen TB, Stilling M. Normal Values of Distal Radioulnar Joint Kinematics during a Dynamic Press Test. J Wrist Surg 2022; 11:406-415. [PMID: 36339081 PMCID: PMC9633146 DOI: 10.1055/s-0041-1740486] [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: 06/02/2021] [Accepted: 11/09/2021] [Indexed: 12/30/2022]
Abstract
Background Measurement of in vivo distal radioulnar joint (DRUJ) pathomechanics during simple activities can represent the disability experienced by patients and may be useful in diagnostics of DRUJ instability. A first step is to describe the physiological normal limits for DRUJ kinematics in a reproducible and precise test setup, which was the aim of this study. Methods DRUJ kinematics were evaluated in 33 participants with dynamic radiostereometry (RSA) while performing a standardized press test examination. AutoRSA software was used for image analyses. Computed tomography (CT) forearm bone models were generated, and standardized anatomical axes were applied to estimate kinematic outcomes including, DRUJ translation, DRUJ position ratio, and changes in ulnar variance. Repeatability of dynamic RSA press test double examinations was evaluated to estimate the precision and intraclass correlation coefficient (ICC) test-retest agreement. Results The maximum force during the press test was 6.0 kg (95% confidence interval [CI]: 5.1-6.9), which resulted in 4.7 mm (95% CI: 4.2-5.1) DRUJ translation, DRUJ position ratio of 0.40 (95% CI: 0.33-0.44), and increase in ulnar variance of 1.1 mm (95% CI: 1.0-1.2). The mean maximum DRUJ translation leveled off after a 5 kg force application. The DRUJ translation ICC coefficient was 0.93 within a prediction interval of ± 0.53mm. Conclusions This clinical study demonstrates the normal values of DRUJ kinematics and reports excellent agreement and high precision of the press tests examination using an automated noninvasive dynamic RSA imaging method based on patient-specific CT bone models. The next step is the application of the method in patients with arthroscopic verified triangular fibrocartilage complex injuries. Level of Evidence This is a Level IV, case series study.
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Affiliation(s)
- Janni Kjærgaard Thillemann
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Sepp De Raedt
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- NRT X-RAY A/S, Hasselager, Denmark
| | - Emil Toft Petersen
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Katriina Bøcker Puhakka
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Radiology, Regional Hospital Horsens, Horsens, Denmark
| | - Torben Bæk Hansen
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- Department of Orthopaedic Surgery, Aarhus University, Aarhus N, Denmark
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Mobile-Bearing Total Ankle Replacement In Vivo Kinematic Assessment: A Prospective Study Protocol. J Clin Med 2022; 11:jcm11185328. [PMID: 36142975 PMCID: PMC9503301 DOI: 10.3390/jcm11185328] [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: 07/03/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Total ankle prosthesis as a surgical solution in the case of end-stage osteoarthritis has seen a considerable increase in the last two decades. This study protocol arises from the need to understand the in vivo kinematics of mobile-bearing, flat tibial component total ankle replacement, evaluating the real range of motion and the reciprocal relationships between the components during normal motor tasks through the use of model-based radio-stereometric analysis (MB-RSA). In addition, pre- and post-operative evaluation of walking kinematics with inertial motion sensors, proprioception through a dedicated workstation, and clinical outcomes are discussed. We expect that based on our study protocol researchers will be able to improve future prosthetic designs and validate the setup of MB-RSA, as well as to understand "how an ankle prosthesis moves" once implanted in the patient.
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6
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Fontalis A, Haddad FS. Roentgen stereophotogrammetric analysis: still a very valuable tool in the orthopaedic research armamentarium. Bone Joint Res 2022; 11:210-213. [PMID: 35369732 PMCID: PMC9057520 DOI: 10.1302/2046-3758.114.bjr-2021-0593.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andreas Fontalis
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares S Haddad
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Sport, Exercise and Health, London, UK.,The Bone & Joint Journal , The British Editorial Society of Bone & Joint Surgery, London, UK
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7
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Patients with knee osteoarthritis can be divided into subgroups based on tibiofemoral joint kinematics of gait - an exploratory and dynamic radiostereometric study. Osteoarthritis Cartilage 2022; 30:249-259. [PMID: 34757027 DOI: 10.1016/j.joca.2021.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/29/2021] [Accepted: 10/23/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients with advanced knee osteoarthritis (KOA) frequently alter their gait patterns in an attempt to alleviate symptoms. Understanding the underlying pathomechanics and identifying KOA phenotypes are essential to improve treatments. We investigated kinematics in patients with KOA to identify subgroups of homogeneous knee joint kinematics. METHOD A total of 66 patients with symptomatic KOA scheduled for total knee arthroplasty and 15 age-matched healthy volunteers with asymptomatic, non-arthritic knees were included. We used k-means clustering to divide patients into subgroups based on dynamic radiostereometry-assessed tibiofemoral joint kinematics. Clinical characteristics such as knee ligament lesions and KOA scores were graded by magnetic resonance imaging and radiographs, respectively. RESULTS We identified four clusters that were supported by clinical characteristics. The flexion group (n = 20) consisted primarily of patients with medial KOA. The abduction group (n = 17) consisted primarily of patients with lateral KOA. The anterior draw group (n = 10) was composed of patients with medial KOA, some degree of anterior cruciate ligament lesion and the highest KOA score. The external rotation group (n = 19) primarily included patients with medial collateral and posterior cruciate ligament lesions. CONCLUSION Based on tibiofemoral gait patterns, patients with advanced KOA can be divided into four subgroups with specific clinical characteristics and different KOA-affected compartments. The findings add to our understanding of how knee kinematics may affect the patient's development of different types of KOA. This may inspire improved and more patient-specific treatment strategies in the future.
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8
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Hansen L, de Raedt S, Jørgensen PB, Mygind-Klavsen B, Rømer L, Kaptein B, Søballe K, Stilling M. Hip joint motion does not change one year after arthroscopic osteochondroplasty in patients with femoroacetabular impingement evaluated with dynamic radiostereometry. J Exp Orthop 2022; 9:4. [PMID: 34985680 PMCID: PMC8733129 DOI: 10.1186/s40634-021-00427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/10/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose Dynamic radiostereometric analysis (dRSA) enables precise non-invasive three-dimensional motion-tracking of bones for assessment of joint kinematics. Hereby, the biomechanical effects of arthroscopic osteochondroplasty of the hip (ACH) can be evaluated in patients with femoroacetabular impingement (FAI). The aim was to investigate the pre- and postoperative range of motion (ROM) and the CT bone volume removed (BV) after ACH. We hypothesize increase in ROM 1 year after surgery. Methods Thirteen patients (6 female) with symptomatic FAI were included prospectively. The patient’s hips were CT-scanned and CT-bone models were created. Preoperative dRSA recordings were acquired during passive flexion to 90°, adduction, and internal rotation (FADIR). ACH was performed, CT and dRSA were repeated 3 months and 1 year postoperatively. Hip joint kinematics before, and 3 months and 1 year after ACH were compared pairwise. The bone volume removal was quantified and compared to change in ROM. Results Mean hip internal rotation, adduction and flexion were all unchanged after ACH at 1-year follow-up (p > 0.84). HAGOS scores revealed improvement of quality of life (QOL) from 32 to 60 (p = 0.02). The BV was between 406 and 1783 mm3 and did not correlate to post-operative ROM. Conclusions ACH surgery in FAI patients had no impact of ROM at 1-year follow-up. QOL improved significantly. This indicates that the positive clinical effects reported after ACH might be a result of reduced labral stress and cartilage pressure during end-range motion rather than increased ROM. Level of evidence Therapeutic prospective cohort study, level II.
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Affiliation(s)
- Lars Hansen
- Aarhus University Hospital, Aarhus, Denmark.
| | | | | | | | - Lone Rømer
- Aarhus University Hospital, Aarhus, Denmark
| | - Bart Kaptein
- Aarhus University Hospital, Aarhus, Denmark.,Leiden University Medical Center, Leiden, Netherlands
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9
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Jørgensen PB, Kaptein BL, Søballe K, Jakobsen SS, Stilling M. Combined and hybrid marker models for radiostereometry assessment of polyethylene liner motion in dual mobility hip prosthesis: a proof-of-concept study. Eur Radiol Exp 2021; 5:55. [PMID: 34907467 PMCID: PMC8671599 DOI: 10.1186/s41747-021-00253-x] [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: 06/22/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Investigation of polyethylene liner movement in total hip arthroplasty requires bead-marking for radiographic visibility of the liner. However, occlusion of markers poses a challenge for marker registration in radiographs. Methods The polyethylene of a dual mobility acetabular system was marked with twelve 1-mm tantalum markers (four groups of three markers) using a custom-made drill guide. Liner motion in a phantom and a patient was investigated with dynamic radiostereometry analysis (dRSA) at 1-year follow-up and static radiostereometry analysis (sRSA) postoperatively and at 1- and 2-year follow-up. A combined marker configuration (CMC) model was calculated from the registered positions of the liner markers and the femoral head in several images. Furthermore, the CMC model and the theoretic marker positions from computer-assisted models of the drill guide were combined in a hybrid model. Results The CMC model included eleven markers in the phantom and nine markers in the patient, which was sufficient for dRSA. Liner movement in the phantom followed liner contact with the femoral neck, while liner movement in the patient was independent. The hybrid model was necessary to determine liner orientation in sRSA recordings, which clearly changed from postoperative to 1- and 2-year follow-up even though the patient was positioned similarly. Conclusion Polyethylene liner motion in dual mobility hip prosthesis can be assessed with CMC models in dRSA recordings. In sRSA, the liner position between follow-ups is unpredictable and analysis requires inclusion of all markers in the model, accomplished with a hybrid marker model. Trial registration ClinicalTrials.gov [NCT02301182], 25 October 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-021-00253-x.
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Affiliation(s)
- Peter Bo Jørgensen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J118-119, 8200, Aarhus, Denmark.
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden University Medical Center, 2333, Leiden, ZA, The Netherlands
| | - Kjeld Søballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J118-119, 8200, Aarhus, Denmark
| | - Stig S Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J118-119, 8200, Aarhus, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, J118-119, 8200, Aarhus, Denmark
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Christensen R, Petersen ET, Jürgens-Lahnstein J, Rytter S, Lindgren L, De Raedt S, Brüel A, Stilling M. Assessment of knee kinematics with dynamic radiostereometry: Validation of an automated model-based method of analysis using bone models. J Orthop Res 2021; 39:597-608. [PMID: 33030797 DOI: 10.1002/jor.24875] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/26/2020] [Accepted: 10/06/2020] [Indexed: 02/04/2023]
Abstract
Radiostereometic analysis (RSA) is a precise method for the functional assessment of joint kinematics. Traditionally, the method is based on tracking of surgically implanted bone markers and analysis is user intensive. We propose an automated method of analysis based on models generated from computed tomography (CT) scans and digitally reconstructed radiographs. The study investigates method agreement between marker-based RSA and the CT bone model-based RSA method for assessment of knee joint kinematics in an experimental setup. Eight cadaveric specimens were prepared with bone markers and bone volume models were generated from CT-scans. Using a mobile fixture setup, dynamic RSA recordings were obtained during a knee flexion exercise in two unique radiographic setups, uniplanar and biplanar. The method agreement between marker-based and CT bone model-based RSA methods was compared using bias and LoA. Results obtained from uniplanar and biplanar recordings were compared and the influence of radiographic setup was considered for clinical relevance. The automated method had a bias of -0.19 mm and 0.11° and LoA within ±0.42 mm and ±0.33° for knee joint translations and rotations, respectively. The model pose estimation of the tibial bone was more precise than the femoral bone. The radiographic setup had no clinically relevant effect on results. In conclusion, the automated CT bone model-based RSA method had a clinical precision comparable to that of marker-based RSA. The automated method is non-invasive, fast, and clinically applicable for functional assessment of knee kinematics and pathomechanics in patients.
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Affiliation(s)
- Rasmus Christensen
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Emil Toft Petersen
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,University Clinic for Hand, Hip and Knee Surgery, Holstebro Central Hospital, Holstebro, Denmark
| | - Jonathan Jürgens-Lahnstein
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Søren Rytter
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars Lindgren
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Sepp De Raedt
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,NRT X-RAY, Hasselager, Denmark
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaeadic Research Unit, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus N, Denmark
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Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry. J Exp Orthop 2021; 8:10. [PMID: 33543376 PMCID: PMC7862458 DOI: 10.1186/s40634-021-00329-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA). Methods In a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5). The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair. Results The DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17). Conclusion In conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions.
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12
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Martinkevich P, Rahbek O, Møller-Madsen B, Stilling M. Calcaneal cuboid joint motion and osteotomy stability in children one year after calcaneal lengthening osteotomy. J Orthop 2020; 22:565-570. [PMID: 33239853 DOI: 10.1016/j.jor.2020.11.001] [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: 07/27/2020] [Revised: 09/13/2020] [Accepted: 11/01/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Flexible pes planovalgus in children may be corrected with a calcaneal lengthening osteotomy (CLO).However, CLO surgery may displace the distal calcaneal fragment dorsally and affect the motion in the calcaneal-cuboid joint (CCJ). We used radiostereometric analysis (RSA) to evaluate CCJ motion and CLO stability in children one year after CLO. Methods Ten patients (10 feet) with symptomatic flexible pes planovalgus were investigated one year after CLO. Mean age was 11.5 years (range 8.2-14.2). Standardised RSA measurements of the foot were obtained one year after surgery without and with weight-bearing (single leg stance). Tantalum markers inserted during surgery, were used to described the CCJ motion as cuboid bone motion with respect to the distal calcaneus, and the CLO stability as distal calcaneal migration with respect to the proximal calcaneus. Results One year after surgery the CLO was stable. The motion in the CCJ upon full weight-bearing was mean -1.04 mm (CI95% -1.40; -0.67) joint distraction, mean 2.27 mm (CI95% 1.57; 2.96) cuboid dorsal translation, mean -1.94 mm (CI 95% -2.68; -1.20) cuboid medial translation, and mean 7.43° (CI 95% 3.97; 10.88) adduction. Conclusion The motion in the CCJ of children with CLO corrections for pes planovalgus is similar to that of adults during stance load with a normal foot posture and the patients were asymptomatic. Marker-based RSA may be used to evaluate causalities of foot symptoms after CLO surgery.
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Affiliation(s)
| | - Ole Rahbek
- Dept. of Children's Orthopaedics, Aarhus University Hospital, Denmark
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Thillemann JK, De Raedt S, Jørgensen PB, Rømer L, Hansen TB, Stilling M. Distal radioulnar joint stability measured with radiostereometry during the piano key test. J Hand Surg Eur Vol 2020; 45:923-930. [PMID: 32594823 DOI: 10.1177/1753193420934689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distal radioulnar joint instability is difficult to grade by clinical examination and interobserver reliability is low. This study used a new and precise radiostereometry method for measurement of distal radioulnar joint translation. Eight human donor arms were positioned in a custom-made fixture and a standardized piano key test was done with pressure on the ulnar head. Examination was done before and after dividing the styloid and foveal insertions of the triangular fibrocartilage complex. In the intact wrists, the piano key test induced a mean 1.36 mm translation of the ulnar head, which increased statistically significantly to 1.96 mm after a lesion of the styloid ligament insertion and to 2.3 mm after combined lesions of the styloid and foveal ligament insertions. This experimental cadaver study demonstrates a radiological method for precise quantification of distal radioulnar joint stability after different grades of triangular fibrocartilage complex injury.
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Affiliation(s)
- Janni Kjærgaard Thillemann
- Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Holstebro, Denmark.,Department of Orthopaedic Surgery, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Denmark
| | | | - Peter Bo Jørgensen
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Bæk Hansen
- Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Denmark
| | - Maiken Stilling
- Department of Orthopaedic Surgery, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba Skejby, Denmark
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Parashin S, Gascoyne T, Zarrabian M. A phantom and cadaveric study of radiostereometric analysis in posterior cervical and lumbar spinal fusion. Spine J 2020; 20:1333-1343. [PMID: 32272254 DOI: 10.1016/j.spinee.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Detecting pseudarthrosis following spinal fusion is important for accurate diagnosis and treatment. Current diagnostic measures hold certain drawbacks. Radiostereometric analysis (RSA) is a radiographic technique with the capability to measure intervertebral segment changes and may be a novel way of assessing fusion. PURPOSE The purpose of this work was to measure the accuracy and precision of RSA in instrumented posterior cervical and lumbar spinal fusion for measuring intervertebral movement. Further, to gain surgical practice with RSA in spine and determine optimal bead placements. STUDY DESIGN Artificial bone and cadaveric spine models were used to simulate a 3-level cervical (C3-C6) and a 2-level (L4-S1) lumbosacral posterior spinal fusion to analyze bead placements and to measure RSA accuracy and precision. METHODS Preliminary RSA bead placements were planned and measured in the artificial model. Secondary bead placements were adjusted slightly in the cadaveric model to consider additional fusion scenarios. Bead spread, detectability, and stability were measured to determine optimal placements. Translational and rotational precision of both models were measured. Accuracy was measured in the artificial spine model. Model-based RSA software was used for analysis. RESULTS Optimal bead placements were found to be throughout the lateral mass of C3-C6 and in the spinous process, transverse process, and within the screw canal of L4-S1. Detectability was high among all segments. Spread was greater in L4-S1 than C3-C6 due to bead collinearity along the transverse axis of the cervical vertebrae. Translational and rotational RSA accuracy in cervical and lumbosacral regions ranged between 0.005 to 0.014 mm and 0.058 to 0.208°. Translational and rotational precision measured in the phantom models ranged 0.017 to 0.131 mm and 0.058 to 0.394° in C3-C6, and 0.086 to 0.191 mm and 0.200 to 0.369° in L4-S1. Translational and rotational precision measured in the cadaveric models ranged 0.054 to 0.548 mm and 0.148 to 1.386° in C3-C6, and 0.068 to 0.164 mm and 0.100 to 0.270° in L4-S1. CONCLUSIONS RSA was found to be a feasible radiographic technique in C3-C6 and L4-S1 spinal fusion when measured in artificial and cadaveric models. Optimal bead placements were determined. Bead spread was shown to be better throughout the lumbar region than the cervical region due to anatomical size variations. RSA accuracy and precision were within acceptable RSA criteria. CLINICAL SIGNIFICANCE The results from this work contribute to the accuracy, precision, and bead placements for studying RSA in cervical and lumbar spinal fusions. This work may further support the development of clinical studies to assess spinal fusion by evaluating postoperative intervertebral movement using RSA.
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Affiliation(s)
- Sara Parashin
- The Orthopaedic Innovation Centre, Suite 320-1155 Concordia Avenue, Winnipeg, Manitoba, Canada, R2K 2M9.
| | - Trevor Gascoyne
- The Orthopaedic Innovation Centre, Suite 320-1155 Concordia Avenue, Winnipeg, Manitoba, Canada, R2K 2M9
| | - Mohammad Zarrabian
- Department of Surgery, Faculty of Medicine, AE 101-820 Sherbrook Street, University of Manitoba, Winnipeg, Manitoba, Canada, R3A 1R9
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Kawahara S, Hara T, Sato T, Kitade K, Shimoto T, Nakamura T, Mawatari T, Higaki H, Nakashima Y. Digitalized analyses of intraoperative acetabular component position using image-matching technique in total hip arthroplasty. Bone Joint Res 2020; 9:360-367. [PMID: 32728432 PMCID: PMC7376306 DOI: 10.1302/2046-3758.97.bjr-2019-0260.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims Appropriate acetabular component placement has been proposed for prevention of postoperative dislocation in total hip arthroplasty (THA). Manual placements often cause outliers in spite of attempts to insert the component within the intended safe zone; therefore, some surgeons routinely evaluate intraoperative pelvic radiographs to exclude excessive acetabular component malposition. However, their evaluation is often ambiguous in case of the tilted or rotated pelvic position. The purpose of this study was to develop the computational analysis to digitalize the acetabular component orientation regardless of the pelvic tilt or rotation. Methods Intraoperative pelvic radiographs of 50 patients who underwent THA were collected retrospectively. The 3D pelvic bone model and the acetabular component were image-matched to the intraoperative pelvic radiograph. The radiological anteversion (RA) and radiological inclination (RI) of the acetabular component were calculated and those measurement errors from the postoperative CT data were compared relative to those of the 2D measurements. In addition, the intra- and interobserver differences of the image-matching analysis were evaluated. Results Mean measurement errors of the image-matching analyses were significantly small (2.5° (SD 1.4°) and 0.1° (SD 0.9°) in the RA and RI, respectively) relative to those of the 2D measurements. Intra- and interobserver differences were similarly small from the clinical perspective. Conclusion We have developed a computational analysis of acetabular component orientation using an image-matching technique with small measurement errors compared to visual evaluations regardless of the pelvic tilt or rotation.Cite this article: Bone Joint Res 2020;9(7):360-367.
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Affiliation(s)
- Shinya Kawahara
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Kazuki Kitade
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Shimoto
- Faculty of Information Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Tetsuro Nakamura
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abstract
PURPOSE OF REVIEW This review discusses imaging modalities for fracture repair assessment, with an emphasis on pragmatic clinical and translational use, best practices for implementation, and challenges and opportunities for continuing research. RECENT FINDINGS Semiquantitative radiographic union scoring remains the clinical gold standard, but has questionable reliability as a surrogate indicator of structural bone healing, particularly in early-stage, complex, or compromised healing scenarios. Alternatively, computed tomography (CT) scanning enables quantitative assessment of callus morphometry and mechanics through the use of patient-specific finite-element models. Dual-energy X-ray absorptiometry (DXA) scanning and radiostereometric analysis (RSA) are also quantitative, but technically challenging. Nonionizing magnetic resonance (MR) and ultrasound imaging are of high interest, but require development to enable quantification of 3D mineralized structures. Emerging image-based methods for quantitative assessment of bone healing may transform clinical research design by displacing binary outcomes classification (union/nonunion) and ultimately enhance clinical care by enabling early nonunion detection.
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Affiliation(s)
- Peter Schwarzenberg
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
- Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zürich, Zürich, Switzerland
| | - Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Hannah L Dailey
- Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, PA, USA.
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