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Angelomenos V, Mohaddes M, Kärrholm J, Malchau H, Shareghi B, Itayem R. A prospective randomized study of Refobacin Bone Cement R versus Palacos R + G. Bone Joint J 2024; 106-B:435-441. [PMID: 38688480 DOI: 10.1302/0301-620x.106b5.bjj-2023-0999.r1] [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] [Indexed: 05/02/2024]
Abstract
Aims Refobacin Bone Cement R and Palacos R + G bone cement were introduced to replace the original cement Refobacin Palacos R in 2005. Both cements were assumed to behave in a biomechanically similar fashion to the original cement. The primary aim of this study was to compare the migration of a polished triple-tapered femoral stem fixed with either Refobacin Bone Cement R or Palacos R + G bone cement. Repeated radiostereometric analysis was used to measure migration of the femoral head centre. The secondary aims were evaluation of cement mantle, stem positioning, and patient-reported outcome measures. Methods Overall, 75 patients were included in the study and 71 were available at two years postoperatively. Prior to surgery, they were randomized to one of the three combinations studied: Palacos cement with use of the Optivac mixing system, Refobacin with use of the Optivac system, and Refobacin with use of the Optipac system. Cemented MS30 stems and cemented Exceed acetabular components were used in all hips. Postoperative radiographs were used to assess the quality of the cement mantle according to Barrack et al, and the position and migration of the femoral stem. Harris Hip Score, Oxford Hip Score, Forgotten Joint Score, and University of California, Los Angeles Activity Scale were collected. Results Median distal migration (y-axis) at two years for the Refobacin-Optivac system was -0.79 mm (-2.01 to -0.09), for the Refobacin-Optipac system was -0.75 mm (-2.16 to 0.20), and for the Palacos-Optivac system was -1.01 mm (-4.31 to -0.29). No statistically significant differences were found between the groups. Secondary outcomes did not differ statistically between the groups at the two-year follow-up. Conclusion At two years, we found no significant differences in distal migration or clinical outcomes between the three groups. Our data indicate that Refobacin Bone Cement R and Palacos R + G are comparable in terms of stable fixation and early clinical outcomes.
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Affiliation(s)
- Vasileios Angelomenos
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bita Shareghi
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raed Itayem
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Fraser AN, Bøe B, Fjalestad T, Madsen JE, Röhrl SM. Stable glenoid component of reverse total shoulder arthroplasty at 2 years as measured with model-based radiostereometric analysis (RSA). Acta Orthop 2021; 92:644-650. [PMID: 34196600 PMCID: PMC8635662 DOI: 10.1080/17453674.2021.1943932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Reverse total shoulder arthroplasty (TSA) is used for treating cuff arthropathy, displaced proximal humeral fractures (PHF), and in revision shoulder surgery, despite sparse evidence on long-term results. We assessed stability of the glenoid component in reverse TSA, using model-based RSA.Patients and methods - 20 patients (mean age 76 years, 17 female), operated on with reverse TSA at Oslo University Hospital, in 2015-2017 were included. Indications for surgeries were PHFs, malunion, cuff arthropathy, and chronic shoulder dislocation. RSA markers were placed in the scapular neck, the coracoid, and the acromion. RSA radiographs were conducted postoperatively, at 3 months, 1 year, and 2 years. RSA analysis was performed using RSAcore with Reversed Engineering (RE) modality, with clinical precision < 0.25 mm for all translations (x, y, z) and < 0.7° for rotations (x, z). Scapular "notching" was assessed in conventional radiographs.Results - 1 patient was excluded due to revision surgery. More than half of the patients displayed measurable migration at 2 years: 6 patients with linear translations below 1 mm and 8 patients who showed rotational migration. Except for one outlier, the measured rotations were below 2°. The migration pattern suggested implant stability at 2 years. 10 patients showed radiolographic signs of "notching", and the mean Oxford Shoulder Score (OSS) at 2 years was 29 points (15-36 points).Interpretation - Stability analysis of the glenoid component of reversed total shoulder arthroplasty using reversed engineering (RE) model-based RSA indicated component stability at 2 years.
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Affiliation(s)
- Alexander Nilsskog Fraser
- Institute of Clinical Medicine; University of Oslo,Diakonhjemmet Hospital,Norway,Correspondence: Alexander Nilsskog FRASER,
| | - Berte Bøe
- Division of Orthopaedic Surgery, Oslo University Hospital
| | - Tore Fjalestad
- Division of Orthopaedic Surgery, Oslo University Hospital
| | - Jan Erik Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital,Institute of Clinical Medicine; University of Oslo
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Brodén C, Sandberg O, Olivecrona H, Emery R, Sköldenberg O. Precision of CT-based micromotion analysis is comparable to radiostereometry for early migration measurements in cemented acetabular cups. Acta Orthop 2021; 92:419-423. [PMID: 33821746 PMCID: PMC8381926 DOI: 10.1080/17453674.2021.1906082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - CT (computed tomography) based methods have lately been considered an alternative to radiostereometry (RSA) for assessing early implant migration. However, no study has directly compared the 2 methods in a clinical setting. We estimated the precision and effective radiation dose of a CT-based method and compared it with marker-based RSA in 10 patients with hip arthroplasty.Patients and methods - We included 10 patients who underwent total hip replacement with a cemented cup. CT and RSA double examinations were performed postoperatively, and precision and effective dose data were compared. The CT data was analyzed with CT micromotion analysis (CTMA) software both with and without the use of bone markers. The RSA images were analyzed with RSA software with the use of bone markers.Results - The precision of CTMA with bone markers was 0.10-0.16 mm in translation and 0.31°-0.37° in rotation. Without bone markers, the precision of CTMA was 0.10-0.16 mm in translation and 0.21°-0.31° in rotation. In comparison, the precision of RSA was 0.09-0.26 mm and 0.43°-1.69°. The mean CTMA and RSA effective dose was estimated at 0.2 mSv and 0.04 mSv, respectively.Interpretation - CTMA, with and without the use of bone markers, had a comparable precision to RSA. CT radiation doses were slightly higher than RSA doses but still at a considerably low effective dose.
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Affiliation(s)
- Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | | | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Roger Emery
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | - Olof Sköldenberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
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Keller MC, Hurschler C, Schwarze M. Experimental evaluation of precision and accuracy of RSA in the lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:2060-2068. [PMID: 33275168 DOI: 10.1007/s00586-020-06672-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Roentgen stereophotogrammetric analysis is a technique to make accurate assessments of the relative position and orientation of bone structures and implants in vivo. While the precision and accuracy of stereophotogrammetry for hip and knee arthroplasty is well documented, there is insufficient knowledge of the technique's precision and, especially accuracy when applied to rotational movements in the spinal region. METHODS The motion of one cadaver lumbar spine segment (L3/L4) was analyzed in flexion-extension, lateral bending and internal rotation. The specific aim of this study was to examine the precision and accuracy of stereophotogrammetry in a controlled in vitro setting, taking the surrounding soft tissue into account. The second objective of this study was to investigate the effect of different focal spot values of X-ray tubes. RESULTS Overall, the precision of flexion-extension measurements was found to be better when using a 0.6 mm focal spot value rather than 1.2 mm (± 0.056° and ± 0.153°; respectively), and accuracy was also slightly better for the 0.6 mm focal spot value compared to 1.2 mm (- 0.137° and - 0.170°; respectively). The best values for precision and accuracy were obtained in lateral bending for both 0.6 mm and 1.2 mm focal spot values (precision: ± 0.019° and ± 0.015°, respectively; accuracy: - 0.041° and - 0.035°). CONCLUSION In summary, the results suggest stereophotogrammetry to be a highly precise method to analyze motion of the lumbar spine. Since precision and accuracy are better than 0.2° for both focal spot values, the choice between these is of minor clinical relevance.
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Affiliation(s)
- Marie Christina Keller
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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Brodén C, Sandberg O, Sköldenberg O, Stigbrand H, Hänni M, Giles JW, Emery R, Lazarinis S, Nyström A, Olivecrona H. Low-dose CT-based implant motion analysis is a precise tool for early migration measurements of hip cups: a clinical study of 24 patients. Acta Orthop 2020; 91:260-265. [PMID: 32056507 PMCID: PMC8023951 DOI: 10.1080/17453674.2020.1725345] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Early implant migration is known to be a predictive factor of clinical loosening in total hip arthroplasty (THA). Radiostereometric analysis (RSA) is the gold standard used to measure early migration in patients. However, RSA requires costly, specialized imaging equipment and the image process is complex. We determined the precision of an alternative, commercially available, CT method in 3 ongoing clinical THA studies, comprising 3 different cups.Materials and methods - 24 CT double examinations of 24 hip cups were selected consecutively from 3 ongoing prospective studies: 2 primary THA (1 cemented and 1 uncemented) and 1 THA (cemented) revision study. Precision of the CT-based implant motion analysis (CTMA) system was calculated separately for each study, using both the surface anatomy of the pelvis and metal beads placed in the pelvis.Results - For the CTMA analysis using the surface anatomy of the pelvis, the precision ranged between 0.07 and 0.31 mm in translation and 0.20° and 0.39° for rotation, respectively. For the CTMA analysis using beads the precision ranged between 0.08 and 0.20 mm in translation and between 0.20° and 0.43° for rotations. The radiation dose ranged between 0.2 and 2.3 mSv.Interpretation - CTMA achieved a clinically relevant and consistent precision between the 3 different hip cups studied. The use of different hip cup types, different CT scanners, or registration method (beads or surface anatomy) had no discernible effect on precision. Therefore, CTMA without the use of bone markers could potentially be an alternative to RSA to measure early migration.
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Affiliation(s)
- Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, London, UK; ,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; ,Correspondence:
| | | | - Olof Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden;
| | - Hampus Stigbrand
- Department of Orthopedic Surgery, Länssjukhuset, Gävle, Sweden; Center for Research and Development, Uppsala University/County Council of Gävleborg, Sweden;
| | - Mari Hänni
- Department of Surgical Sciences, Section of Radiology, Uppsala University Hospital, Uppsala, Sweden;
| | - Joshua W Giles
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada;
| | - Roger Emery
- Department of Orthopaedic Surgery, St Mary’s Hospital, London, UK;
| | - Stergios Lazarinis
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden;
| | - Andreas Nyström
- Department of Orthopedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden;
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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6
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Brodén C, Giles JW, Popat R, Fetherston S, Olivecrona H, Sandberg O, Maguire GQ, Noz ME, Sköldenberg O, Emery R. Accuracy and precision of a CT method for assessing migration in shoulder arthroplasty: an experimental study. Acta Radiol 2020; 61:776-782. [PMID: 31684750 DOI: 10.1177/0284185119882659] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiostereometric analysis (RSA) is the gold standard to measure early implant migration which is a predictive factor for implant survival. PURPOSE To validate an alternative computed tomography (CT) technique to measure implant migration in shoulder arthroplasty. MATERIAL AND METHODS A cadaver proximal humerus and a scapula, which had tantalum beads incorporated within them, were prepared to accept a short-stemmed humeral component and a two-pegged glenoid component of a commercial total shoulder arthroplasty (TSA) system. A five degree of freedom micrometer and goniometer equipped rig was used to translate and rotate the implant components relative to the respective bone to predetermined positions. Double CT examinations were performed for each position and CT motion analysis software (CTMA) was used to assess these movements. The accuracy and precision of the software was estimated using the rig's micrometers and goniometers as the gold standard. The technique's effective dose was also assessed. RESULTS The accuracy was in the range of 0.07-0.23 mm in translation and 0.22-0.71° in rotation. The precision was in the range of 0.08-0.15 mm in translation and 0.23-0.54° in rotation. The mean effective dose for the CT scans was calculated to be 0.27 mSv. CONCLUSION In this experimental setting, accuracy, precision, and effective dose of the CTMA technique were found to be comparable to that of RSA. Therefore, we believe clinical studies are warranted to determine if CTMA is a suitable alternative to traditional RSA for migration measurements in TSA.
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Affiliation(s)
- Cyrus Brodén
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Joshua W Giles
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, Canada
- Mechatronics in Medicine Laboratory, Mechanical Engineering, Imperial College London, London, UK
| | - Ravi Popat
- Department of Bioengineering, Imperial College London, London, UK
| | - Shirley Fetherston
- Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Henrik Olivecrona
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Gerald Q Maguire
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Marilyn E Noz
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden
| | - Roger Emery
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
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7
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Fraser AN, Tsukanaka M, Fjalestad T, Madsen JE, Röhrl SM. Model-based RSA is suitable for clinical trials on the glenoid component of reverse total shoulder arthroplasty. J Orthop Res 2018; 36:3299-3307. [PMID: 30035319 DOI: 10.1002/jor.24111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/13/2018] [Indexed: 02/04/2023]
Abstract
This study aims to validate model-based radiostereometric analysis (RSA) on the glenoid component of reversed total shoulder arthroplasty. We compared two different modalities of model-based RSA, elementary geometrical shapes and reversed engineering. We also explored two different ways to position the patient to obtain different projections of the implant, the hip-position (transversal) and shoulder-position (sagittal). Phantom accuracy was determined by performing nine translations (x, y, z) and five rotations (x, y, z), and expressed as the mean difference between RSA measurements and micrometer values. Precision was measured using 12 double examinations of the phantom and 19 in patients, and expressed as1.96 × standard deviations of the paired differences between double examinations. The accuracy was high for both modalities, but rotation around the symmetrical axis of the implant could not be measured using reversed engineering. Clinical precision ranged from 0.13 to 0.25 mm for translations, and 0.4° to 0.7° for rotations, using reversed engineering. For elementary geometrical shapes, the precision ranged from 0.18 to 0.34 mm for translations, and 0.8° to 1.8° for rotations. The hip-position was abandoned due to poor implant visualization. Model-based RSA on the glenoid component of reversed total shoulder arthroplasty has a high precision and accuracy, comparable to RSA results on hips and knees. Patient positioning is vital for obtaining adequate results. We found that reversed engineering was the more reliable method, and recommend reversed engineering as the method of choice for further clinical RSA investigation of the glenoid component of reversed total shoulder arthroplasty. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3299-3307, 2018.
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Affiliation(s)
- Alexander Nilsskog Fraser
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Masako Tsukanaka
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tore Fjalestad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jan E Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Ten Brinke B, Beumer A, Koenraadt KLM, Eygendaal D, Kraan GA, Mathijssen NMC. The accuracy and precision of radiostereometric analysis in upper limb arthroplasty. Acta Orthop 2017; 88:320-325. [PMID: 28464752 PMCID: PMC5434603 DOI: 10.1080/17453674.2017.1291872] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Radiostereometric analysis (RSA) is an accurate method for measurement of early migration of implants. Since a relation has been shown between early migration and future loosening of total knee and hip prostheses, RSA plays an important role in the development and evaluation of prostheses. However, there have been few RSA studies of the upper limb, and the value of RSA of the upper limb is not yet clear. We therefore performed a systematic review to investigate the accuracy and precision of RSA of the upper limb. Patients and methods - PRISMA guidelines were followed and the protocol for this review was published online at PROSPERO under registration number CRD42016042014. A systematic search of the literature was performed in the databases Embase, Medline, Cochrane, Web of Science, Scopus, Cinahl, and Google Scholar on April 25, 2015 based on the keywords radiostereometric analysis, shoulder prosthesis, elbow prosthesis, wrist prosthesis, trapeziometacarpal joint prosthesis, humerus, ulna, radius, carpus. Articles concerning RSA for the analysis of early migration of prostheses of the upper limb were included. Quality assessment was performed using the MINORS score, Downs and Black checklist, and the ISO RSA Results - 23 studies were included. Precision values were in the 0.06-0.88 mm and 0.05-10.7° range for the shoulder, the 0.05-0.34 mm and 0.16-0.76° range for the elbow, and the 0.16-1.83 mm and 11-124° range for the TMC joint. Accuracy data from marker- and model-based RSA were not reported in the studies included. Interpretation - RSA is a highly precise method for measurement of early migration of orthopedic implants in the upper limb. However, the precision of rotation measurement is poor in some components. Challenges with RSA in the upper limb include the symmetrical shape of prostheses and the limited size of surrounding bone, leading to over-projection of the markers by the prosthesis. We recommend higher adherence to RSA guidelines and encourage investigators to publish long-term follow-up RSA studies.
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Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda;,Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft;,Correspondence:
| | | | - Koen L M Koenraadt
- FORCE Foundation, Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Ziekenhuis, Breda;,Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft
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Evaluation of periprosthetic bone mineral density and postoperative migration of humeral head resurfacing implants: two-year results of a randomized controlled clinical trial. J Shoulder Elbow Surg 2014; 23:1427-36. [PMID: 25220196 DOI: 10.1016/j.jse.2014.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/05/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Implant migration, bone mineral density (BMD), length of glenohumeral offset (LGHO), and clinical results were compared for the Copeland (Biomet Inc, Warsaw, IN, USA) and the Global C.A.P. (DePuy Int, Warsaw, IN, USA) humeral head resurfacing implants (HHRIs). METHODS The study randomly allocated 32 patients (13 women), mean age 63 years (range, 39-82 years), with shoulder osteoarthritis to a Copeland (n = 14) or Global C.A.P. (n = 18) HHRI. Patients were monitored for 2 years with radiostereometry, dual-energy X-ray absorptiometry, Constant Shoulder Score (CSS), and the Western Ontario Osteoarthritis of the Shoulder Index (WOOS). LGHO was measured preoperatively and 6 months postoperatively. RESULTS At 2 years, total translation (TT) was 0.48 mm (standard deviation [SD], 0.21 mm) for the Copeland and 0.82 mm (SD, 0.46 mm) for the Global C.A.P. (P = .06). Five HHRI were revised, and in the interval before the last follow-up (revision or 2 years), TT of 0.58 mm (SD, 0.61 mm) for revised HHRI was higher (P = .02) than TT of 0.22 mm (SD, 0.17 mm) in nonrevised HHRI. A comparison of TT at the last follow-up (revision or 2 years) found no difference between the HHRIs (P = .12). Periprosthetic BMD decreased initially but increased continuously after 6 months for both HHRIs. At 2 years, BMD was 48% higher around the Copeland HHRI (P = .005). The mean difference in LGHO was significantly higher for the Copeland than for the Global C.A.P. HHRI (P = .02). Clinical results evaluated with CSS and WOOS improved over time for both implant groups (P < .01), with no differences between the groups. CONCLUSION Both implants had only little migration and good clinical results. Periprosthetic BMD and LGHO both increased for the Copeland HHRI more than for the Global C.A.P HHRI.
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10
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Sköldenberg O, Eisler T, Stark A, Muren O, Martinez-Carranza N, Ryd L. Measurement of the migration of a focal knee resurfacing implant with radiostereometry. Acta Orthop 2014; 85:79-83. [PMID: 24286562 PMCID: PMC3940996 DOI: 10.3109/17453674.2013.869654] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Articular resurfacing metal implants have been developed to treat full-thickness localized articular cartilage defects. Evaluation of the fixation of these devices is mandatory. Standard radiostereometry (RSA) is a validated method for evaluation of prosthetic migration, but it requires that tantalum beads are inserted into the implant. For technical reasons, this is not possible for focal articular resurfacing components. In this study, we therefore modified the tip of an articular knee implant and used it as a marker for RSA, and then validated the method. MATERIAL AND METHODS We modified the tip of a resurfacing component into a hemisphere with a radius of 3 mm, marked it with a 1.0-mm tantalum marker, and implanted it into a sawbone marked with 6 tantalum beads. Point-motion RSA of the "hemisphere bead" using standard automated RSA as the gold standard was compared to manual measurement of the tip hemisphere. 20 repeated stereograms with gradual shifts of position of the specimen between each double exposure were used for the analysis. The tip motion was compared to the point motion of the hemisphere bead to determine the accuracy and precision. RESULTS The accuracy of the manual tip hemisphere method was 0.08-0.19 mm and the precision ranged from 0.12 mm to 0.33 mm. INTERPRETATION The accuracy and precision for translations is acceptable when using a small hemisphere at the tip of a focal articular knee resurfacing implant instead of tantalum marker beads. Rotations of the implant cannot be evaluated. The method is accurate and precise enough to allow detection of relevant migration, and it will be used for future clinical trials with the new implant.
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Affiliation(s)
- Olof Sköldenberg
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Thomas Eisler
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - André Stark
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Olle Muren
- Department of Orthopaedics at Danderyd Hospital and Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm
| | - Nicolas Martinez-Carranza
- Department of Orthopaedics, Karolinska University Hospital, Stockholm and Karolinska Institutet, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Stockholm
| | - Leif Ryd
- Episurf Medical AB, Stockholm, Sweden
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11
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Stilling M, Mechlenburg I, Amstrup A, Soballe K, Klebe T. Precision of novel radiological methods in relation to resurfacing humeral head implants: assessment by radiostereometric analysis, DXA, and geometrical analysis. Arch Orthop Trauma Surg 2012; 132:1521-30. [PMID: 22773108 DOI: 10.1007/s00402-012-1580-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Resurfacing humeral head implants (RHHI) are used to preserve bone stock and restore normal anatomy in the osteoarthritic shoulder joint. The purpose of this study was: (1) to describe the use of novel radiological methods in relation to evaluation of RHHI; (2) to estimate the precision of these methods; and (3) to present preliminary clinical and radiological results at 6 months follow-up after Copeland and Global Cap RHHI. METHODS Twenty-one patients (10 females) at a mean age of 64 (39-82) years and with shoulder osteoarthritis were randomized to a Copeland (n = 11) or Global C.A.P (n = 10) RHHI. Migration of the RHHI was analyzed with radiostereometric analysis (RSA), and bone mineral density (BMD) was measured with dual energy X-ray absorptiometry (DXA). The length of gleno-humeral offset (LGHO) was measured on radiographs. The patients were followed clinically with questionnaires. RESULTS Precision of the radiological methods was high for the LGHO and acceptable for RSA and for DXA. At 6 months, shoulder function had improved significantly for both RHHI groups. LGHO increased significantly for the Copeland RHHI and was slightly reduced for the Global C.A.P. RHHI. The implant migration and BMD change around the implant from baseline until 6 months follow-up was comparable for both RHHI. CONCLUSION Radiostereometric analysis and DXA can be used for evaluation of RHHI, but expectedly with a lower precision as compared to standards of TKA or THA. Geometric analysis of the prosthetic shoulder is precise. We interpret that the early radiological and clinical results of the two RHHI are comparable.
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Affiliation(s)
- Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Tage-Hansens Gade 2, Building 10 A, Office 13, 8000, Aarhus, Denmark
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