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Hurry JK, Spurway AJ, Laende EK, Rehan S, Astephen Wilson JL, Dunbar MJ, El-Hawary R. A low-dose biplanar X-ray imager has RSA level precision in total knee arthroplasty. Acta Orthop 2023; 94:555-559. [PMID: 38032252 PMCID: PMC10688435 DOI: 10.2340/17453674.2023.19669] [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: 03/02/2023] [Accepted: 08/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND PURPOSE The low radiation biplanar X-ray imager (EOS imaging, Paris, France) scans patients in a weight-bearing position, provides calibrated images, and limits radiation, an asset for serial radiostereometric analysis (RSA) studies. RSA in vivo precision values have not been published for this type of imaging system, thus the goal of this study was to assess the precision of RSA in vivo utilizing a low radiation biplanar imager. PATIENTS AND METHODS At a mean of 5 years post-surgery (range 1.4-7.5 years), 15 total knee arthroplasty (TKA) participants (mean age 67 years at the time of imaging, 12 female, 3 male) with RSA markers implanted during index surgery were scanned twice at the same visit in the EOS imager. Precision of marker-based analysis was calculated by comparing the position of the implant relative to the underlying bone between the 2 examinations. RESULTS The 95% limit of precision was 0.11, 0.04, and 0.15 mm along the x, y, and z axes, respectively and 0.15°, 0.20°, and 0.14° around the same axes. CONCLUSION This precision study has shown an in vivo RSA precision of ≤ 0.15 mm and ≤ 0.20°, well within published uniplanar values for conventional arthroplasty RSA, with the added benefit of weight-bearing imaging, a lower radiation dose, and without the need for a reference object during the scan.
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Affiliation(s)
- Jennifer K Hurry
- Department of Orthopaedic Surgery, IWK Health Centre, Halifax, Nova Scotia.
| | - Alan J Spurway
- Department of Orthopaedic Surgery, IWK Health Centre, Halifax, Nova Scotia
| | - Elise K Laende
- Division of Orthopaedic Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia; Mechanical and Materials Engineering, Queen's University, Kingston, Ontario
| | - Saad Rehan
- Division of Orthopaedic Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia
| | | | - Michael J Dunbar
- Division of Orthopaedic Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia; School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ron El-Hawary
- Department of Orthopaedic Surgery, IWK Health Centre, Halifax, Nova Scotia; School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Weinmayer H, Breen AB, Steen H, Horn J. Angular deformities after percutaneous epiphysiodesis for leg length discrepancy. J Child Orthop 2022; 16:401-408. [PMID: 36238144 PMCID: PMC9550997 DOI: 10.1177/18632521221115059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/06/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of this study was to systematically analyze the presence of secondary angular deformities after percutaneous epiphysiodesis based on long-standing radiographs, and to see if the occurrence and magnitude of angular deformities after percutaneous epiphysiodesis correlated with the amount of remaining growth at the time of surgery. METHODS From a local Health Register consisting of patients investigated using the Moseley Straight-Line Graph, we identified 269 patients who had undergone percutaneous epiphysiodesis from 2002 until 2020. Radiographic analysis included the measurement of mechanical axis and joint orientation angles on long-standing anterior-posterior radiographs. Remaining growth was analyzed based on the Menelaus method. RESULTS One hundred and forty epiphysiodeses (71 femurs and 69 tibiae) in 88 patients (39 girls and 49 boys) could be included in the study. Mean age at surgery was 13.2 (10-16.8) years, and mean skeletal age at surgery was 13.0 (9.8-15.7) years. A change of the MA (Mechanical axis) ≥10 mm was found in eight patients (9%). Secondary frontal plane deformities after percutaneous epiphysiodesis correlated significantly with the remaining growth at the time of surgery (p = 0.003). CONCLUSION We found a high rate of secondary angular deformities after percutaneous epiphysiodesis, and the magnitude of the deformities correlated with the amount of remaining growth at the time of surgery. A modification of the original surgical method for percutaneous epiphysiodesis to also include ablation of central parts of the growth plate might be considered. Patients should be enrolled in a systematic follow-up scheme which allows for the early detection of possible angular deformities. LEVEL OF EVIDENCE level III study.
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Affiliation(s)
| | - Anne B Breen
- Section of Children’s Orthopaedics and
Reconstructive Surgery, Division of Orthopaedic Surgery, Oslo University Hospital,
Oslo, Norway
| | - Harald Steen
- Biomechanics Lab, Oslo University
Hospital, Oslo, Norway
| | - Joachim Horn
- Section of Children’s Orthopaedics and
Reconstructive Surgery, Division of Orthopaedic Surgery, Oslo University Hospital,
Oslo, Norway,Institute of Clinical Medicine,
University of Oslo, Oslo, Norway,Joachim Horn, Section of Children’s
Orthopaedics and Reconstructive Surgery, Division of Orthopaedic Surgery, Oslo
University Hospital, Postbox 4950 Nydalen, Oslo 0424, Norway.
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Wingstrand M, Elfving M, Hägglund G, Lauge-Pedersen H. Postoperative growth rate affects time to growth arrest after percutaneous physiodesis: A radiostereometric analysis. J Child Orthop 2022; 16:174-182. [PMID: 35800652 PMCID: PMC9254027 DOI: 10.1177/18632521221105781] [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: 09/03/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study was to determine the time at which physeal arrest is achieved after percutaneous physiodesis, and whether immediate postoperative growth rate affects the time to reach physeal arrest. METHODS Radiostereometric analysis, with implantation of tantalum balls as radiographic markers on each side of the physes, was used to measure residual longitudinal growth in 21 children (10 boys and 11 girls) after percutaneous physiodesis for leg length discrepancy or extreme tall stature. In total, 25 femoral and 20 tibial physes were operated on. Median age at surgery was 13.9 years (range = 11.4-16.1). Radiostereometric analysis was performed postoperatively and after 3, 6, 9, 12, 26, and 52 weeks. Longitudinal growth rate <50 µm per week was defined as physeal arrest. Descriptive statistics were used for evaluation. RESULTS Physeal arrest was obtained in 19 of the 21 children (40 physes) within 12 weeks postoperatively. One child was reoperated on in three out of four physes because of continued growth, and in one child, delayed physeal arrest was present at 26 weeks postoperatively. Time to physeal arrest was longer in physes with a higher immediate postoperative growth rate. CONCLUSION Postoperative follow-up with radiostereometric analysis at 12 and 15 weeks can determine whether physeal arrest has been achieved. The immediate postoperative growth rate after physiodesis seems to affect the time to physeal arrest. This implies that the risk for complications is greater for children during an accelerated growth period, for example, in boys, younger children and in distal femoral physes. LEVEL OF EVIDENCE level III.
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Affiliation(s)
- Maria Wingstrand
- Orthopaedics, Department of Clinical
Sciences Lund, Lund University, Lund, Sweden,Maria Wingstrand, Orthopaedics, Department
of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden.
| | - Maria Elfving
- Paediatrics, Department of Clinical
Sciences Lund, Lund University, Lund, Sweden
| | - Gunnar Hägglund
- Orthopaedics, Department of Clinical
Sciences Lund, Lund University, Lund, Sweden
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The reliability of radiostereometric analysis in determining physeal motion in slipped capital femoral epiphysis in standard uniplanar and low-dose EOS biplanar radiography: a phantom model study. J Pediatr Orthop B 2018; 27:496-502. [PMID: 29762188 DOI: 10.1097/bpb.0000000000000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Physeal closure after slipped capital femoral epiphysis fixation can be difficult to assess on two-dimensional conventional radiographs. Radiostereometric analysis offers improved motion detection over conventional radiography, whereas the EOS biplanar imager provides a means for low radiation weight-bearing images. This phantom study assessed the reliability of measuring motion using radiostereometric analysis in the EOS using a slipped capital femoral epiphysis model. The accuracy and precision were better than 0.09±0.05 mm and 0.20°±0.36° when centered in the imaging space, were within the limits of clinical significance, and were not different from a standard uniplanar radiostereometric system.
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Buxbom P, Sonne-Holm S, Ellitsgaard N, Wong C. Stability and migration across femoral varus derotation osteotomies in children with neuromuscular disorders. Acta Orthop 2017; 88:198-204. [PMID: 27892801 PMCID: PMC5385116 DOI: 10.1080/17453674.2016.1263110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 - Studies have indicated that one-third of children with cerebral palsy (CP) develop dislocation of the hip that needs surgical intervention. When hip dislocation occurs during childhood surgical treatment consists of tenotomies, femoral varus derotation osteotomy (VDRO), and acetabuloplasty. Relapse is observed in one-fifth of cases during adolescence. In this prospective cohort study, we performed a descriptive evaluation of translation and rotation across VDROs in children with neuromuscular disorders and syndromes by radiostereometric analysis (RSA). We assessed "RSA stability" and migration across the VDROs. Patients and methods - Children with a neuromuscular disorder were set up for skeletal corrective surgery of the hip. RSA follow-ups were performed postoperatively, at 5 weeks, and 3, 6, and 12 months after surgery. Results - 27 femoral VDROs were included; 2 patients were excluded during the study period. RSA data showed stability across the VDRO in the majority of cases within the first 5 weeks. At the 1-year follow-up, the mean translations (SD) of the femoral shaft distal to the VDRO were 0.51 (1.12) mm medial, 0.69 (1.61) mm superior, and 0.21 (1.28) mm posterior. The mean rotations were 0.39° (2.90) anterior tilt, 0.02° (3.07) internal rotation, and 2.17° (2.29) varus angulation. Interpretation - The migration stagnates within the first 5 weeks, indicating stability across the VDRO in most patients.
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Abstract
BACKGROUND Low-dose biplanar radiography (EOS) is an appealing imaging modality for use in children given its low radiation and ease of use. The goal of this study was to determine the accuracy and reliability of EOS compared with CT scanogram for measurement of leg length and to assess interrater and intrarater reliability of measured interbead distances for EOS and CT scanogram after insertion of tantalum beads into lamb femurs. METHODS Tantalum beads (0.8 mm) were inserted into the cortex on both the medial and lateral sides of 10 skeletally immature lamb femurs. CT scanogram and EOS imaging were obtained. Measurements of total length and distance between bead pairs were recorded on anteroposterior and lateral views by 2 orthopaedic surgeons on 2 separate occasions. Pearson correlations were performed for statistical comparisons. RESULTS EOS measurements showed near-perfect correlation to those of CT scanogram (r>0.96, P<0.001). Intrarater reliability was excellent for all measurements with EOS (r>0.98, P<0.001) and CT scanogram (r>0.99, P<0.001) as was interrater reliability for EOS (r>0.98, P<0.001) and CT scanogram (r>0.99, P<0.001). CONCLUSIONS EOS is comparable with CT scanogram in the assessment of limb length and the distance between 2 radiopaque markers. Reliability was excellent for all measurements. The combination of EOS imaging and tantalum bead implantation may be an effective way to evaluate physeal growth following procedures such as epiphysiodesis and physeal bar resection. LEVEL OF EVIDENCE Level II—diagnostic
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Shiguetomi-Medina JM, Rahbek O, Abood AAH, Stødkilde-Jørgensen H, Møller-Madsen B. Thermal epiphysiodesis performed with radio frequency in a porcine model. Acta Orthop 2014; 85:538-42. [PMID: 25036720 PMCID: PMC4164874 DOI: 10.3109/17453674.2014.939014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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 Current techniques for epiphysiodesis involve opening of cortical windows; use of staples, screws, and tension devices; and fusion with curettes or drills. Complications may have serious consequences. There is a need for a more reliable, precise, and less traumatic procedure that overcomes the known complications from existing techniques. We analyzed a new epiphysiodesis technique using radio-frequency ablation (RFA) in a porcine model. METHODS Six 35-kg and two 25-kg immature pigs were used. 1 hind leg of each animal was randomly selected and the proximal tibia growth plate was ablated laterally and medially. The contralateral leg was used as a control. MR images were obtained immediately after the ablation and 12 weeks later for 6 animals, and 24 weeks later for the other 2 animals. CT was done for the 2 animals that were followed for 24 weeks for proof of bone bridges. RESULTS Both tibias were equal in length initially. At the 12-week follow-up, there was an average leg length discrepancy of 3.9 mm (95% CI: 3.0-4.8), and at 24 weeks the difference was 8.4 mm and 7.5 mm. No damage to the adjacent tissue was found. Bone bridges and physeal closure were found after 24 weeks. The pigs showed no discomfort after the intervention. INTERPRETATION We found RFA to be feasible for epiphysiodesis in a pig model. The method is minimally invasive and recovery may be quick compared to conventional methods. We recommend that the method should be tested in larger-scale safety studies before clinical application.
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Affiliation(s)
| | - Ole Rahbek
- Aarhus University, Orthopaedic Research Laboratory,Department of Children’s Orthopaedics, Aarhus University Hospital
| | | | | | - Bjarne Møller-Madsen
- Aarhus University, Orthopaedic Research Laboratory,Department of Children’s Orthopaedics, Aarhus University Hospital
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Sabharwal S, Louie KW, Reid JS. What's new in limb-lengthening and deformity correction. J Bone Joint Surg Am 2014; 96:1399-406. [PMID: 25143503 DOI: 10.2106/jbjs.n.00369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - Kevin W Louie
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - J Spence Reid
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
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