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Yang G, Zhang Z, Hou X, Luo D, Cheng H, Xiao K, Liu H, Zhang H. A New Parameter of Hip Instability in Developmental Dysplasia of the Hip (DDH): Teardrop Distance. Front Surg 2022; 9:899960. [PMID: 36034389 PMCID: PMC9411150 DOI: 10.3389/fsurg.2022.899960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hip instability is one of the etiologies of accelerated onset of osteoarthritis in developmental dysplasia of the hip (DDH). There are some radiological parameters for hip instability in hip dysplasia like broken shenton’s line, elevated acetabular index, reduced lateral center edge angle (LCEA), upsloping lateral sourcil. We have discovered a new index of teardrop distance (TD) for assessing instability. Herein, we hypothesized that increased TD could be used as evidence of hip instability in DDH patients, which we verified using TD as an auxiliary diagnostic parameter for DDH, from supine to standing position. Methods Female DDH patients undergoing Bernese periacetabular osteotomy (PAO) were enrolled in the DDH group, and normal female volunteers were in the control group. Anteroposterior radiographs of the pelvis in the supine and standing positions were taken, and LCEA, Tönnis angle (TA), sharp angle (SA), and TD were tested using Stata software to analyze the changes between supine and standing anteroposterior pelvic radiographs. Results There were 26 female volunteers with 52 hips in the control group: supine TD 6.80 ± 0.98 mm, standing TD 6.65 ± 1.3 mm (P > 0.05). A total of 78 patients with 135 hips were included in the DDH group: supine TD 10.51 ± 3.50 mm, standing TD 10.93 ± 4.23 mm (P < 0.05). In either supine or standing position, TD in the DDH group was significantly wider than that in the control group (P < 0.05). In the DDH group, TD was correlated with TA and LCEA (rp 0.494–0.588, P < 0.05); TD was not correlated with SA, weight, or BMI (P > 0.05). There was a weak correlation between TD difference and standing LCEA (rp −0.276, P < 0.05). Conclusion TD > 10 mm was a common imaging feature of DDH. It increased from supine to standing position, thus indicating hip instability in DDH patients. The hip parameters of both positions should be compared, fully considering the factors of hip stability.
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Affiliation(s)
- Guoyue Yang
- Department of Orthopedics, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
- Tianjin Key Laboratory of Artificial Cell, Tianjin, China
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Zhendong Zhang
- Department of Orthopedics, The Fourth Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiaobin Hou
- Department of Orthopedics, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
- Tianjin Key Laboratory of Artificial Cell, Tianjin, China
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Dianzhong Luo
- Department of Orthopedics, The Fourth Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Hui Cheng
- Department of Orthopedics, The Fourth Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Kai Xiao
- Department of Orthopedics, The Fourth Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Hui Liu
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
- Tianjin Key Laboratory of Artificial Cell, Tianjin, China
- Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
- Correspondence: Hong Zhang Hui Liu
| | - Hong Zhang
- Department of Orthopedics, The Fourth Medical Center of the Chinese People’s Liberation Army General Hospital, Beijing, China
- Correspondence: Hong Zhang Hui Liu
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Affiliation(s)
- Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway,
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Can Na 18F PET/CT bone scans help when deciding if early intervention is needed in patients being treated with a TSF attached to the tibia: insights from 41 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:349-364. [PMID: 32889671 PMCID: PMC7875954 DOI: 10.1007/s00590-020-02776-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/11/2020] [Indexed: 11/13/2022]
Abstract
Purpose To demonstrate the usefulness of positron emission tomography (PET)/computed tomography (CT) bone scans for gaining insight into healing bone status earlier than CT or X-ray alone. Methods Forty-one prospective patients being treated with a Taylor Spatial Frame were recruited. We registered data obtained from successive static CT scans for each patient, to align the broken bone. Radionuclide uptake was calculated over a spherical volume of interest (VOI). For all voxels in the VOI, histograms and cumulative distribution functions of the CT and PET data were used to assess the type and progress of new bone growth and radionuclide uptake. The radionuclide uptake difference per day between the PET/CT scans was displayed in a scatter plot. Superimposing CT and PET slice data and observing the spatiotemporal uptake of 18F− in the region of healing bone by a time-sequenced movie allowed qualitative evaluation. Results Numerical evaluation, particularly the shape and distribution of Hounsfield Units and radionuclide uptake in the graphs, combined with visual evaluation and the movies enabled the identification of six patients needing intervention as well as those not requiring intervention. Every revised patient proceeded to a successful treatment conclusion. Conclusion Numerical and visual evaluation based on all the voxels in the VOI may aid the orthopedic surgeon to assess a patient’s progression to recovery. By identifying slow or insufficient progress at an early stage and observing the uptake of 18F− in specific regions of bone, it might be possible to shorten the recovery time and avoid unnecessary late complications. Electronic supplementary material The online version of this article (10.1007/s00590-020-02776-2) contains supplementary material, which is available to authorized users.
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Krakow L, Klockow A, Roehner E, Brodt S, Eijer H, Bossert J, Matziolis G. A simple method of measuring the wear of explanted acetabular component inserts. Bone Joint Res 2017; 6:530-534. [PMID: 28899855 PMCID: PMC5630993 DOI: 10.1302/2046-3758.69.bjr-2016-0249.r1] [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: 09/23/2016] [Accepted: 07/06/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives The determination of the volumetric polyethylene wear on explanted material requires complicated equipment, which is not available in many research institutions. Our aim in this study was to present and validate a method that only requires a set of polyetheretherketone balls and a laboratory balance to determine wear. Methods The insert to be measured was placed on a balance, and a ball of the appropriate diameter was inserted. The cavity remaining between the ball and insert caused by wear was filled with contrast medium and the weight of the contrast medium was recorded. The volume was calculated from the known density of the liquid. The precision, inter- and intraobserver reliability, were determined by four investigators on four days using nine inserts with specified wear (0.094 ml to 1.626 ml), and the intra-class correlation coefficient was calculated. The feasibility of using this method in routine clinical practice and the time required for measurement were tested on 84 explanted inserts by one investigator. Results In order to get the mean for all investigators and determinations, the deviation between the measured and specified wear was -0.08 ml (sd 0.12; -0.21 to 0.11). The interobserver reliability was 0.989 ml (95% confidence interval (CI) 0.964 to 0.997) and the intraobserver reliability was 0.941 for observer 1 (95% CI 0.846 to 0.985), 0.983 for observer 2 (95% CI 0.956 to 0.995), 0.939 for observer 3 (95% CI 0.855 to 0.984), and 0.934 for observer 4 (95% CI 0.790 to 0.984). The mean time required to examine the samples was two minutes (sd 2; 1 to 5). Conclusion The method presented here was shown to be sufficiently precise for many settings and is a cost-effective and quick method of determining the volumetric wear of explanted acetabular components. However, the measurement of wear for scientific purposes will probably continue to involve more accurate and dedicated laboratory equipment. Cite this article: L. Krakow, A. Klockow, E. Roehner, S. Brodt, H. Eijer, J. Bossert, G. Matziolis. A simple method of measuring the wear of explanted acetabular component inserts. Bone Joint Res 2017;6:530–534. DOI: 10.1302/2046-3758.69.BJR-2016-0249.R1
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Affiliation(s)
- L Krakow
- Orthopedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - A Klockow
- Development Hip, Mathys AG, Bettlach, Switzerland
| | - E Roehner
- Orthopedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - S Brodt
- Orthopedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - H Eijer
- Orthopedic Department, Spital Emmental, Switzerland
| | - J Bossert
- Friedrich-Schiller-University Jena, Otto-Schott-Institute for Material Science, Germany
| | - G Matziolis
- Orthopedic Department, University Hospital Jena, Campus Eisenberg, Germany
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Affatato S, Zanini F, Carmignato S. Quantification of Wear and Deformation in Different Configurations of Polyethylene Acetabular Cups Using Micro X-ray Computed Tomography. MATERIALS 2017; 10:ma10030259. [PMID: 28772616 PMCID: PMC5503355 DOI: 10.3390/ma10030259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/27/2017] [Indexed: 12/28/2022]
Abstract
Wear is currently quantified as mass loss of the bearing materials measured using gravimetric methods. However, this method does not provide other information, such as volumetric loss or surface deviation. In this work, we validated a technique to quantify polyethylene wear in three different batches of ultrahigh-molecular-polyethylene acetabular cups used for hip implants using nondestructive microcomputed tomography. Three different configurations of polyethylene acetabular cups, previously tested under the ISO 14242 parameters, were tested on a hip simulator for an additional 2 million cycles using a modified ISO 14242 load waveform. In this context, a new approach was proposed in order to simulate, on a hip joint simulator, high-demand activities. In addition, the effects of these activities were analyzed in terms of wear and deformations of those polyethylenes by means of gravimetric method and micro X-ray computed tomography. In particular, while the gravimetric method was used for weight loss assessment, microcomputed tomography allowed for acquisition of additional quantitative information about the evolution of local wear and deformation through three-dimensional surface deviation maps for the entire cups’ surface. Experimental results showed that the wear and deformation behavior of these materials change according to different mechanical simulations.
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Affiliation(s)
- Saverio Affatato
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Filippo Zanini
- Department of Management and Engineering, University of Padova, 36100 Vicenza, Italy.
| | - Simone Carmignato
- Department of Management and Engineering, University of Padova, 36100 Vicenza, Italy.
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Olivecrona H, Maguire GQ, Noz ME, Zeleznik MP, Kesteris U, Weidenhielm L. A CT method for following patients with both prosthetic replacement and implanted tantalum beads: preliminary analysis with a pelvic model and in seven patients. J Orthop Surg Res 2016; 11:27. [PMID: 26911571 PMCID: PMC4766687 DOI: 10.1186/s13018-016-0360-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiostereometric analysis (RSA) is often used for evaluating implanted devices over time. Following patients who have had tantalum beads implanted as markers in conjunction with joint replacements is important for longitudinal evaluation of these patients and for those with similar implants. As doing traditional RSA imaging is exacting and limited to specialized centers, it is important to consider alternative techniques for this ongoing evaluation. This paper studies the use of computed tomography (CT) to evaluate over time tantalum beads which have been implanted as markers. METHODS The project uses both a hip model implanted with tantalum beads, acquired in several orientations, at two different CT energy levels, and a cohort of seven patients. The model was evaluated twice by the same observer with a 1-week interval. All CT volumes were analyzed using a semi-automated 3D volume fusion (spatial registration) tool which provides landmark-based fusion of two volumes, registering a target volume with a reference volume using a rigid body 3D algorithm. The mean registration errors as well as the accuracy and repeatability of the method were evaluated. RESULTS The mean registration error, maximum value of repeatability, and accuracy for the relative movement in the model were 0.16 mm, 0.02° and 0.1 mm, and 0.36° and 0.13 mm for 120 kVp and 0.21 mm, 0.04° and 0.01 mm, and 0.39° and 0.12 mm for 100 kVp. For the patients, the mean registration errors per patient ranged from 0.08 to 0.35 mm. These results are comparable to those in typical clinical RSA trials. This technique successfully evaluated two patients who would have been lost from the cohort if only RSA were used. CONCLUSIONS The proposed technique can be used to evaluate patients with tantalum beads over time without the need for stereoradiographs. Further, the effective dose associated with CT is decreasing.
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Affiliation(s)
- Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden.
| | - Gerald Q Maguire
- School of Information and Communication Technology, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Marilyn E Noz
- Department of Radiology, New York University School of Medicine, 560 First Avenue, New York, NY, 10016, USA.
| | - Michael P Zeleznik
- School of Computing, College of Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Uldis Kesteris
- Department of Orthopedics, Skåne University Hospital, Lund, Sweden.
| | - Lars Weidenhielm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden.
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A New CT Method for Assessing 3D Movements in Lumbar Facet Joints and Vertebrae in Patients before and after TDR. BIOMED RESEARCH INTERNATIONAL 2015; 2015:260703. [PMID: 26587533 PMCID: PMC4637432 DOI: 10.1155/2015/260703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/22/2015] [Accepted: 10/05/2015] [Indexed: 11/26/2022]
Abstract
This study describes a 3D-CT method for analyzing facet joint motion and vertebral rotation in the lumbar spine after TDR. Ten patients were examined before and then three years after surgery, each time with two CT scans: provoked flexion and provoked extension. After 3D registration, the facet joint 3D translation and segmental vertebral 3D rotation were analyzed at the operated level (L5-S1) and adjacent level (L4-L5). Pain was evaluated using VAS. The median (±SD) 3D movement in the operated level for the left facet joint was 3.2 mm (±1.9 mm) before and 3.5 mm (±1.7 mm) after surgery and for the right facet joint was 3.0 mm (±1.0 mm) before and 3.6 mm (±1.4 mm) after surgery. The median vertebral rotation in the sagittal plane at the operated level was 5.4° (±2.3°) before surgery and 6.8° (±1.7°) after surgery and in the adjacent level was 7.7° (±4.0°) before and 9.2° (±2.7°) after surgery. The median VAS was reduced from 6 (range 5–8) to 3 (range 2–8) in extension and from 4 (range 2–6) to 2 (range 1–3) in flexion.
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Langlois J, Zaoui A, Scemama C, Martell J, Bragdon C, Hamadouche M. Validation of a computer-assisted method for measurement of radiographic wear in total hip arthroplasty using all polyethylene cemented acetabular components. J Orthop Res 2015; 33:417-20. [PMID: 25564735 DOI: 10.1002/jor.22777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/26/2014] [Indexed: 02/04/2023]
Abstract
Although cemented all polyethylene (PE) cups have been routinely used in total hip arthroplasty for decades, no computer-assisted method for measurement of radiographic wear has ever been specifically validated for these implants. Using a validated hip phantom model, AP plain hip radiographs were obtained consecutively for eight simulated wear positions. A version of Martell's Hip Analysis Suite software dedicated to all polyethylene sockets was used by three different examiners of varied experience. Bias (mean, standard deviation and 95% confidence interval limit), repeatability (standard deviation and 95% limit) and reproducibility (standard deviation and 95% limit) for two-dimensional wear measurements were assessed, as recommended by the current ASTM guidelines. Using this protocol, the dedicated software showed an overall mean bias of 0.089 ± 0.060 mm (mean ± SD), and 0.118 mm for 95% CI limit. Repeatability (intra examiner) standard deviation and 95% limit were respectively 0.106 mm and 0.292 mm. Reproducibility (inter examiner) standard deviation and 95% limit were respectively 0.112 mm and 0.308 mm. Martell Hip Analysis for all PE cemented cups is a reliable and low-cost instrument in the assessment of wear, despite being less precise than its original version dedicated to cementless components.
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Affiliation(s)
- Jean Langlois
- Service de chirurgie orthopédique et traumatologique, Hôpital Cochin, APHP, Université René Descartes, 27 rue du Faubourg Saint-Jacques, 75679, Paris CEDEX 14, France
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Risk factors for periacetabular osteolysis and wear in asymptomatic patients with uncemented total hip arthroplasties. ScientificWorldJournal 2014; 2014:905818. [PMID: 25478600 PMCID: PMC4248425 DOI: 10.1155/2014/905818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/29/2014] [Indexed: 11/17/2022] Open
Abstract
Osteolysis is a silent disease leading to aseptic loosening. This has not been studied in a cohort of asymptomatic patients. The aim of this study was to detect factors that might be associated with the development of periacetabular osteolysis and wear around an uncemented cup. We assessed 206 patients with an uncemented cup, measuring wear and periacetabular osteolysis using computed tomography with a median follow-up of 10 years after surgery (range 7–14 years). EQ5D, pain from the hip, and satisfaction were assessed. The association between periacetabular osteolysis and wear, age, gender, activity, BMI, cup type, cup age, positioning of the cup, and surface coating was investigated with a proportional odds model. Wear and male gender were associated with an increased risk for periacetabular osteolysis. There was no association with periacetabular osteolysis for time from operation, patient age, UCLA Activity Score, liner thickness at time of operation, BMI, cup positioning, and type of implant. A thin liner at time of operation is correlated to increased wear. Linear wear rate was 0.18 mm/year and 46 of 206 patients had large periacetabular osteolysis. Asymptomatic patients with these implants should be followed up on a regular basis with a sensitive method such as CT in order to detect complications early.
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Radzi S, Cowin G, Robinson M, Pratap J, Volp A, Schuetz MA, Schmutz B. Metal artifacts from titanium and steel screws in CT, 1.5T and 3T MR images of the tibial Pilon: a quantitative assessment in 3D. Quant Imaging Med Surg 2014; 4:163-72. [PMID: 24914417 PMCID: PMC4032923 DOI: 10.3978/j.issn.2223-4292.2014.03.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/14/2014] [Indexed: 11/14/2022]
Abstract
Radiographs are commonly used to assess articular reduction of the distal tibia (pilon) fractures postoperatively, but may reveal malreductions inaccurately. While magnetic resonance imaging (MRI) and computed tomography (CT) are potential three-dimensional (3D) alternatives they generate metal-related artifacts. This study aims to quantify the artifact size from orthopaedic screws using CT, 1.5T and 3T MRI data. Three screws were inserted into one intact human cadaver ankle specimen proximal to and along the distal articular surface, then CT, 1.5T and 3T MRI scanned. Four types of screws were investigated: titanium alloy (TA), stainless steel (SS) (Ø =3.5 mm), cannulated TA (CTA) and cannulated SS (CSS) (Ø =4.0 mm, Ø empty core =2.6 mm). 3D artifact models were reconstructed using adaptive thresholding. The artifact size was measured by calculating the perpendicular distance from the central screw axis to the boundary of the artifact in four anatomical directions with respect to the distal tibia. The artifact sizes (in the order of TA, SS, CTA and CSS) from CT were 2.0, 2.6, 1.6 and 2.0 mm; from 1.5T MRI they were 3.7, 10.9, 2.9, and 9 mm; and 3T MRI they were 4.4, 15.3, 3.8, and 11.6 mm respectively. Therefore, CT can be used as long as the screws are at a safe distance of about 2 mm from the articular surface. MRI can be used if the screws are at least 3 mm away from the articular surface except for SS and CSS. Artifacts from steel screws were too large thus obstructed the pilon from being visualised in MRI. Significant differences (P<0.05) were found in the size of artifacts between all imaging modalities, screw types and material types, except 1.5T versus 3T MRI for the SS screws (P=0.063). CTA screws near the joint surface can improve postoperative assessment in CT and MRI. MRI presents a favourable non-ionising alternative when using titanium hardware. Since these factors may influence the quality of postoperative assessment, potential improvements in operative techniques should be considered.
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Can Na18F PET/CT be used to study bone remodeling in the tibia when patients are being treated with a Taylor Spatial Frame? ScientificWorldJournal 2014; 2014:249326. [PMID: 24778581 PMCID: PMC3977467 DOI: 10.1155/2014/249326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/16/2014] [Indexed: 11/30/2022] Open
Abstract
Monitoring and quantifying bone remodeling are of interest, for example, in correction osteotomies, delayed fracture healing pseudarthrosis, bone lengthening, and other instances. Seven patients who had operations to attach an Ilizarov-derived Taylor Spatial Frame to the tibia gave informed consent. Each patient was examined by Na18F PET/CT twice, at approximately six weeks and three months after the operation. A validated software tool was used for the following processing steps. The first and second CT volumes were aligned in 3D and the respective PET volumes were aligned accordingly. In the first PET volume spherical volumes of interest (VOIs) were delineated for the crural fracture and normal bone and transferred to the second PET volume for SUVmax evaluation. This method potentially provides clinical insight into questions such as, when has the bone remodeling progressed well enough to safely remove the TSF? and when is intervention required, in a timelier manner than current methods? For example, in two patients who completed treatment, the SUVmax between the first and second PET/CT examination decreased by 42% and 13%, respectively. Further studies in a larger patient population are needed to verify these preliminary results by correlating regional Na18F PET measurements to clinical and radiological findings.
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A new automated way to measure polyethylene wear in THA using a high resolution CT scanner: method and analysis. ScientificWorldJournal 2014; 2014:528407. [PMID: 24587727 PMCID: PMC3920851 DOI: 10.1155/2014/528407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/07/2013] [Indexed: 11/17/2022] Open
Abstract
As the most advantageous total hip arthroplasty (THA) operation is the first, timely replacement of only the liner is socially and economically important because the utilization of THA is increasing as younger and more active patients are receiving implants and they are living longer. Automatic algorithms were developed to infer liner wear by estimating the separation between the acetabular cup and femoral component head given a computed tomography (CT) volume. Two series of CT volumes of a hip phantom were acquired with the femoral component head placed at 14 different positions relative to the acetabular cup. The mean and standard deviation (SD) of the diameter of the acetabular cup and femoral component head, in addition to the range of error in the expected wear values and the repeatability of all the measurements, were calculated. The algorithms resulted in a mean (± SD) for the diameter of the acetabular cup of 54.21 (± 0.011) mm and for the femoral component head of 22.09 (± 0.02) mm. The wear error was ± 0.1 mm and the repeatability was 0.077 mm. This approach is applicable clinically as it utilizes readily available computed tomography imaging systems and requires only five minutes of human interaction.
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Iannotti JP, Ricchetti ET, Rodriguez EJ, Bryan JA. Development and validation of a new method of 3-dimensional assessment of glenoid and humeral component position after total shoulder arthroplasty. J Shoulder Elbow Surg 2013; 22:1413-22. [PMID: 23473609 DOI: 10.1016/j.jse.2013.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/24/2012] [Accepted: 01/07/2013] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS This study evaluates the intrarater and inter-rater reliability of 3-dimensional (3D) computed tomography (CT) measurements of component position and alignment after total shoulder arthroplasty (TSA). MATERIALS AND METHODS Two patients and one whole-body cadaver with anatomic TSA implants underwent CT scans of the shoulder with a 0.6-mm slice thickness in two different arm positions (supine arm down or lateral decubitus arm up) on the same day. Test-retest reliability of component measurements within and between 5 observers was determined, as were any differences in measurements based on arm position. Precision and 95% confidence intervals were determined for the following measurements: glenoid component position (anterior-posterior, superior-inferior, and medial-lateral), glenoid component orientation (version, inclination, and roll), and humeral-glenoid alignment (HGA). HGA was defined in the anterior-posterior and superior-inferior dimensions. RESULTS The range of precision for measurement of the position of the glenoid implant across observers was between 0.2 and 0.5 mm, and for orientation, it was between 1.2° and 1.5°. The range of precision for measurement of HGA across observers was between 0.7 and 1.2 mm. There was no significant difference in the precision of measurements between the two imaged arm positions. DISCUSSION AND CONCLUSION The described method of 3-dimensional CT imaging can provide very precise and reproducible assessment of component position after TSA. Ultimately, correlation of these measurements with clinical outcome, anatomic factors, prosthetic design, and surgical factors will allow for better understanding of the causes of implant failure.
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Affiliation(s)
- Joseph P Iannotti
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA; Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
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Lin H, Wang S, Tsai TY, Li G, Kwon YM. In-vitro validation of a non-invasive dual fluoroscopic imaging technique for measurement of the hip kinematics. Med Eng Phys 2013; 35:411-6. [DOI: 10.1016/j.medengphy.2012.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 09/17/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
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Goldvasser D, Noz ME, Maguire GQ, Olivecrona H, Bragdon CR, Malchau H. A new technique for measuring wear in total hip arthroplasty using computed tomography. J Arthroplasty 2012; 27:1636-1640.e1. [PMID: 22658429 DOI: 10.1016/j.arth.2012.03.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 03/28/2012] [Indexed: 02/01/2023] Open
Abstract
Accurately estimating polyethylene wear in 3 dimensions, without the need for additional procedures or equipment, is of significant interest. We investigated the use of a high-resolution clinical computed tomographic (CT) scanner to estimate femoral head displacement relative to the cup as an indirect method of estimating polyethylene wear. A hip phantom was used to simulate the 3-dimensional displacement of a femoral head. The phantom was imaged in a high-resolution CT scanner. The mean difference between the true phantom displacement as positioned by micrometers and the calculated displacement based on the CT images was as follows: for the x-axis, 0 mm (SD, 0.213; SE, 0.058); y-axis, 0.039 mm (SD, 0.035; SE, 0.026); and z-axis, 0.039 mm (SD, 0.051; SE, 0.020).
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Affiliation(s)
- Dov Goldvasser
- Massachusetts General Hospital, Boston, Massachusetts, USA
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Yun HH, Shon WY, Yoon JR, Yang JH, Lim DS. Reliability of a PowerPoint method for wear measurement after total hip arthroplasty: a retrieval study using 3-dimensional laser scanning. J Arthroplasty 2012; 27:1530-7. [PMID: 22503331 DOI: 10.1016/j.arth.2011.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 12/23/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the reliability of the PowerPoint (PP) (2007 Version; Microsoft, Redmond, Wash) method for measuring polyethylene liner wear after total hip arthroplasty. Seventeen retrieved polyethylene liners were included in this study. Wear volumes were calculated using the PP, the Dorr and Wan, and 3-dimensional (3D) laser scanning methods. Spearman correlation coefficients for wear volume results indicated strong correlations between the PP and 3D laser scanning methods (range, 0.89-0.93). On the other hand, Spearman correlation analysis revealed only moderate correlations between the Dorr and Wan and 3D laser scanning methods (range, 0.67-0.77). The PP method can be used to monitor linear wear after total hip arthroplasty and could serve as an alternative method when computerized methods are not available.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, Korea
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