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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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Cao H, Zheng T, Jin Z. Validation for the effect of intra-exposure patient motion on the assessment of radiostereometric implant migration in a tibial component phantom study. Orthop Traumatol Surg Res 2024; 110:103776. [PMID: 38016580 DOI: 10.1016/j.otsr.2023.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND An increasing number of radiostereometry (RSA) research studies have long-term follow-up implant migration outcomes, which show ascending curves of implant migration with occasionally decreasing migration. After scrutinizing images and RSA scenes related to the alternating curves, we suppose that intra-exposure patient motion may contribute to that. The main purposes of this in vitro study were 1) to identify whether the patient motion in different directions could result in the inaccurate assessment of implant migration, and 2) to figure out which direction(s) accounted for the alternating curves. HYPOTHESIS It was hypothesized that the assessments of implant migration would be less precise and accurate than they could be when patient motion occurred, and such motion would contribute to the alternating curves of radiostereometric implant migration. MATERIALS AND METHODS A customized phantom, assembled with a tibial component, was designed for simulating intra-exposure patient motion during follow-up RSA examinations. Two different Roentgen tubes were used as the current standard of radiology departments. Radiographs were acquired in a uniplanar technical arrangement. Two defined protocols were conducted: one is to simulate implant migration outcomes at post-op, the early stage (6months), and the later stage (2 to 10years) ; during the later stage, the other is to mimic patient motion by phantom motion in the medial-lateral (x), distal-proximal (y), and anterior-posterior (z) axes. RESULTS Phantom motion could result in the inaccurate assessment of implant migration, and translations along the medial-lateral (x) axis were the most influenced by patient motion. Motion along the medial-lateral (x) axis could account for the curves with decreasing migration. DISCUSSION Our assessments of implant migration may be less precise and accurate than they could be when intra-exposure patient motion occurs. We probably neglect the importance of 100% simultaneous exposures, and the influence of patient motion on RSA accuracy and data reliability, due to the difficulty in detecting patient (micro)motion. Electronically synchronized exposures of two paired Roentgen tubes are 100% simultaneous for image acquisition, and they are thus highly recommended for the assessment of implant migration in RSA. TYPE OF STUDY AND LEVEL OF PROOF not applicable.
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Affiliation(s)
- Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; Department of Orthopaedic Surgery, Taizhou Second People's Hospital, 225599 Taizhou, PR China.
| | - Tiansheng Zheng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Gannan Medical University, 341000 Ganzhou, PR China
| | - Zhengshuai Jin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, PR China; Department of Orthopaedic Surgery, Jiangsu Shengze Hospital, 215228 Suzhou, PR China
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Caravelli S, Bragonzoni L, Zinno R, Vocale E, Pinelli E, Barone G, Vara G, Di Paolo S, Zaffagnini S, Mosca M. In Vivo Total Ankle Arthroplasty Kinematic Evaluation: A Prospective Radiostereometric Analysis. Biomedicines 2024; 12:705. [PMID: 38672061 PMCID: PMC11048208 DOI: 10.3390/biomedicines12040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/04/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Ankle osteoarthritis (OA) represents a significant social burden and is one of the main causes of chronic disability in a rapidly growing part of the world's population. Total ankle arthroplasty (TAA) has become increasingly popular despite the poor results obtained with the first dedicated designs. The purpose of this paper was to evaluate the ankle kinematics, in vivo and under weight-bearing conditions, of a TAA through a dynamic model-based radiostereometric analysis (MB-RSA). The clinical evaluation was performed by administering the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and Short Form-36 questionnaires. The kinematic evaluation was conducted through MB-RSA during the execution of an open kinetic chain and a closed kinetic chain motor task. Double radiographic images of the ankle joint were processed using dedicated software to obtain a 3D reconstruction of the ankle prosthetic components' motion. Eighteen patients (five females) completed the clinical and instrumental preoperative and postoperative evaluations (age 59.1 ± 10.3). All clinical scores showed a marked improvement (p < 0.005). During the closed kinetic chain motor tasks, the ankle showed a total range of motion (ROM) in dorsi-plantarflexion of 19.84°. The parameters in varus-valgus were recorded. Physiological motion can be achieved in TAA, characterized by a wide range of motion and coupling of movements on the three planes. The results of the present work may help to understand the real movement of a widespread TAA model and possibly to improve future designs and instrumentation.
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Affiliation(s)
- Silvio Caravelli
- U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, 40100 Bologna, BO, Italy; (E.V.); (M.M.)
| | - Laura Bragonzoni
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Raffaele Zinno
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Emanuele Vocale
- U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, 40100 Bologna, BO, Italy; (E.V.); (M.M.)
| | - Erika Pinelli
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Giuseppe Barone
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Giulio Vara
- U.O. Radiodiagnostica, Ospedale Umberto I, 48022 Lugo, BO, Italy;
| | - Stefano Di Paolo
- Dipartimento di Scienze della Qualità della Vita, University of Bologna, 40139 Bologna, BO, Italy; (L.B.); (R.Z.); (E.P.); (G.B.); (S.D.P.)
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, BO, Italy;
| | - Massimiliano Mosca
- U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, 40100 Bologna, BO, Italy; (E.V.); (M.M.)
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Niesen AE, Hull ML. State of the Art in Radiostereometric Analysis for Tibial Baseplate Migration and Future Research Directions. J Biomech Eng 2023; 145:120801. [PMID: 37792485 DOI: 10.1115/1.4063626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Radiostereometric analysis (RSA) measures movement (migration) of a baseplate relative to the underlying tibia after total knee arthroplasty (TKA) and has been used extensively to evaluate safety of new implant designs and/or surgical techniques regarding baseplate loosening. Because RSA is a complex methodology which involves various choices that researchers make, including whether to use marker-based or model-based methods, which migration metric to report, how to relate short-term migrations to long-term risk, and how these choices impact error, the objectives of this review were to: (1) lay out a comprehensive structure illustrating the multiple components/considerations for RSA and their interrelations, (2) review components of the structure using the latest RSA literature, and (3) use the preceding review as a context for identifying future areas of study. The components to be reviewed were structured using the following topics: type of RSA, migration metrics, sources of error, studies/reports of error, stability limits, and studies of error in stability limits. Based on the current RSA literature and knowledge gaps which exist, the following future research directions were identified: (1) revising the ISO standard to require reporting of clinical measurement error (bias) and recommending use of a local baseplate coordinate system, (2) identifying the migration metric and associated threshold most predictive of baseplate loosening for individual patients, (3) creating a method for data sharing to improve individual patient diagnostics, and (4) determining an appropriate stability limit for model-based RSA for group stability and individual patient diagnostics.
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Affiliation(s)
- Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Mechanical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817
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Guruprasad H, Singh M, Naik AK, Jain VK. Association of sagittal alignment of tibial and femoral components with clinical outcome in total knee arthroplasty: A prospective cohort study. J Orthop 2023; 44:72-76. [PMID: 37720915 PMCID: PMC10504456 DOI: 10.1016/j.jor.2023.08.010] [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: 07/29/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
Background In total knee replacement component alignment is a very crucial parameter to achieve better clinical outcomes. Only a few studies exist in the literature on the association between sagittal alignment of components and clinical outcomes. The study aimed to measure the functional outcome and association between the sagittal alignment of total knee replacement components and their clinical outcome. Material & methods Prospectively we collected data of 81 knees (cases) following total knee replacement. The sagittal femoral angle, anterior and posterior tibial slopes were assessed on 2nd postoperative week using a lateral radiograph. Based on these measures 2 groups were made. Group A comprises of the femoral component which was further divided into A1 (41 cases) and A2 (40 cases) based on the component's sagittal femoral angle in flexion or extension.Group B comprises of Tibial component subgrouped based on the degree of Tibal angle as the posterior tibial slope or anterior tibial slopes. The B1 subgroup has posterior tibial slope of more than 5° (23 cases), B2 posterior tibial slope within 5° (53 cases), and B3 anterior tibial slope (5 cases). Preoperative and follow-ups at one month, 6 months, and 3 year; the functional assessment was performed using the American Knee Society score and Oxford knee scores. The duration to raise the leg straight (in days) was also measured. Results 52 patients (81 total knee replacement cases) with a mean age of 62.88 ± 8.21 were enrolled. Results showed significant improvement in mean American Knee Society score (preoperative 32.91 ± 2.61 to 86.68 ± 2.52 postoperatively at 3 years; P < 0.001) and mean Oxford knee score (preoperative 34.69 ± 1.06 to 19.20 ± 1.91 postoperatively at 3-years; P < 0.001). The correlation of American Knee Society score between the femoral component angle and tibial component angle suggested that the maximum correlation was between Group A2 (Femoral angle = 91 to 95) and Group B2 (Tibal angle = 86 to 90), with p-value <0.0001. Conclusions There is a positive association between the proper sagittal alignment of femoral component and tibial component in total knee replacement with clinical outcome. The functional outcome (in terms of mean American Knee Society score) is better when the femoral component is positioned in extension and the posterior tibial slope of less than 5° is achieved.
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Affiliation(s)
- H.B. Guruprasad
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Mohit Singh
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Anant kumar Naik
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Vijay Kumar Jain
- Department of Orthopaedic Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
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Koster LA, Rassir R, Kaptein BL, Sierevelt IN, Schager M, Nelissen RGHH, Nolte PA. A randomized controlled trial comparing two-year postoperative femoral and tibial migration of a new and an established cementless rotating platform total knee arthroplasty. Bone Joint J 2023; 105-B:148-157. [PMID: 36722052 DOI: 10.1302/0301-620x.105b2.bjj-2022-0414.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS The primary aim of this study was to compare the migration of the femoral and tibial components of the cementless rotating platform Attune and Low Contact Stress (LCS) total knee arthroplasty (TKA) designs, two years postoperatively, using radiostereometric analysis (RSA) in order to assess the risk of the development of aseptic loosening. A secondary aim was to compare clinical and patient-reported outcome measures (PROMs) between the designs. METHODS A total of 61 TKAs were analyzed in this randomized clinical RSA trial. RSA examinations were performed one day and three, six, 12, and 24 months postoperatively. The maximal total point motion (MPTM), translations, and rotations of the components were analyzed. PROMs and clinical data were collected preoperatively and at six weeks and three, six, 12, and 24 months postoperatively. Linear mixed effect modelling was used for statistical analyses. RESULTS The mean MTPM two years postoperatively (95% confidence interval (CI)) of the Attune femoral component (0.92 mm (0.75 to 1.11)) differed significantly from that of the LCS TKA (1.72 mm (1.47 to 2.00), p < 0.001). The Attune femoral component subsided, tilted (anteroposteriorly), and rotated (internal-external) significantly less. The mean tibial MTPM two years postoperatively did not differ significantly, being 1.11 mm (0.94 to 1.30) and 1.17 mm (0.99 to 1.36, p = 0.447) for the Attune and LCS components, respectively. The rate of migration in the second postoperative year was negligible for the femoral and tibial components of both designs. The mean pain-at-rest (numerical rating scale (NRS)-rest) in the Attune group was significantly less compared with that in the LCS group during the entire follow-up period. At three months postoperatively, the Knee injury and Osteoarthritis Outcome Physical Function Shortform score, the Oxford Knee Score, and the NRS-activity scores were significantly better in the Attune group. CONCLUSION The mean MTPM of the femoral components of the cementless rotating platform Attune was significantly less compared with that of the LCS design. This was reflected mainly in significantly less subsidence, posterior tilting, and internal rotation. The mean tibial MTPMs were not significantly different. During the second postoperative year, the components of both designs stabilized and low risks for the development of aseptic loosening are expected.Cite this article: Bone Joint J 2023;105-B(2):148-157.
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Affiliation(s)
- Lennard A Koster
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Rachid Rassir
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | - Bart L Kaptein
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Inger N Sierevelt
- SCORE, Specialized Centre of Orthopedic Research and Education, Xpert Orthopedie Amsterdam, Amsterdam, Netherlands
| | - Marjolein Schager
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis Hoofddorp, Hoofddorp, Netherlands
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Cao H. Accuracy of radiostereometric analysis using a motorized Roentgen system in a pilot study for clinical simulation. Med Eng Phys 2023; 111:103929. [PMID: 36792244 DOI: 10.1016/j.medengphy.2022.103929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
Radiostereometric analysis (RSA) is routinely implemented with two paired Roentgen tubes for three-dimensional (3D) implant migration measurements. A conventional set-up of one stationary tube and one mobile could be time-consuming. Utilizing two customized ceiling-mounted tubes is normally associated with investment costs. Thus, a pilot set-up of a motorized system (single Roentgen source) for radiostereometric image acquisition may be a time-saving and space-efficient alternative. RSA using the motorized system is feasible in this study as a non-synchronized image acquisition technique, however, patient motion may occur and influence the assessment of implant migration. The phantom study aimed to assess accuracy of RSA using the motorized Roentgen system in this in vitro study. Accuracy values of translations and rotations were ±0.29 mm and ±0.48° for the single Roentgen source RSA set-up and ±0.26 mm and ±0.48° for the conventional RSA set-up. This study was also performed to simulate potential patient motion during exposure intervals between paired image acquisition. RSA using the motorized system is able to implement RSA with acceptable accuracy. In general, RSA with synchronized image acquisition is the gold standard to access in vivo implant migration with the highest accuracy. Patient motion exists in non-synchronized image acquisition techniques and results in RSA-related motion artifacts. Then we introduced what RSA-related motion artifacts are. The uniplanar calibration cage applied in the study has a few fiducial and control markers, and some of the markers were occluded in radiographs. Whereas, the number of markers in the calibration cage is correlated with accuracy of 3D implant reconstruction.
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Affiliation(s)
- Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; Department of Orthopaedic Surgery, Taizhou Second People's Hospital, 225599 Taizhou, China.
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