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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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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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Affiliation(s)
- Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands,E-mail:
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Muharemovic O, Troelsen A, Thomsen MG, Kallemose T, Gosvig KK. The effect of personalized versus standard patient protocols for radiostereometric analysis (RSA). Radiography (Lond) 2018; 24:e31-e36. [PMID: 29605122 DOI: 10.1016/j.radi.2017.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Increasing pressure in the clinic requires a more standardized approach to radiostereometric analysis (RSA) imaging. The aim of this study was to investigate whether implementation of personalized RSA patient protocols could increase image quality and decrease examination time and the number of exposure repetitions. METHODS Forty patients undergoing primary total hip arthroplasty were equally randomized to either a case or a control group. Radiographers in the case group were assisted by personalized patient protocols containing information about each patient's post-operative RSA imaging. Radiographers in the control group used a standard RSA protocol. RESULTS At three months, radiographers in the case group significantly reduced (p < 0.001) the number of exposures by 1.6, examination time with 19.2 min, and distance between centrum of prosthesis and centrum of calibration field with 34.1 mm when compared to post-operative (baseline) results. At twelve months, the case group significantly reduced (p < 0.001) number of exposures by two, examination time with 22.5 min, and centrum of prosthesis to centrum of calibration field distance with 43.1 mm when compared to baseline results. No significant improvements were found in the control group at any time point. CONCLUSION There is strong evidence that personalized RSA patient protocols have a positive effect on image quality and radiation dose savings. Implementation of personal patient protocols as a RSA standard will contribute to the reduction of examination time, thus ensuring a cost benefit for department and patient safety.
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Affiliation(s)
- O Muharemovic
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark. mailto:
| | - A Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - M G Thomsen
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
| | - T Kallemose
- Department of Orthopaedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Clinical Research Center, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
| | - K K Gosvig
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
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Alm JJ, Moritz N, Aro HT. In vitro osteogenic capacity of bone marrow MSCs from postmenopausal women reflect the osseointegration of their cementless hip stems. Bone Rep 2016; 5:124-135. [PMID: 28326353 PMCID: PMC4926811 DOI: 10.1016/j.bonr.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/25/2016] [Accepted: 05/20/2016] [Indexed: 11/06/2022] Open
Abstract
Age-related dysfunction of mesenchymal stromal cells (MSCs) is suggested as a main cause of altered bone repair with aging. We recently showed that in postmenopausal women undergoing cementless total hip arthroplasty (THA) aging, low bone mineral density (BMD) and age-related geometric changes of the proximal femur are risk factors for increased early migration and delayed osseointegration of the femoral stems. Extending these analyses, we have here explored how the in vitro osteogenic capacity of bone marrow MSCs from these patients reflects implant osseointegration, representing the patient's in vivo bone healing capacity. A total of 19 postmenopausal women with primary hip osteoarthritis (mean age 65 years, range 50–78) and well-defined bone quality underwent successful preoperative in vitro analysis of osteogenic capacity of iliac crest bone marrow MSCs as well as two-year radiostereometric (RSA) follow-up of femoral stem migration after cementless THA. In patients with MSCs of low osteogenic capacity, the magnitude of cumulative stem subsidence after the settling period of three months was greater (p = 0.028) and the time point for translational osseointegration was significantly delayed (p = 0.030) compared to patients with MSCs of high osteogenic capacity. This study suggests that patients with MSCs of low in vitro osteogenic capacity may display increased stem subsidence after the settling period of 3 months and thereby delayed osseointegration. Our study presents a novel approach for studying the biological progress of hip implant osseointegration and to verify the impact of decreased MSCs function, especially in patients with age-related dysfunction of MSCs and bone healing capacity. Age-related dysfunction of MSCs is a main cause of altered bone repair with aging. MSCs play a critical role in osseointegration of cementless hip replacement. We explored if hip implant osseointegration in postmenopausal women is mirrored by in vitro osteogenic ability of their MSCs. Low osteogenic differentiation of MSCs correlated with increased implant migration.
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Affiliation(s)
- Jessica J Alm
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku/Turku University Hospital, Turku, Finland
| | - Niko Moritz
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku/Turku University Hospital, Turku, Finland
| | - Hannu T Aro
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku/Turku University Hospital, Turku, Finland
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Bojan AJ, Bragdon C, Jönsson A, Ekholm C, Kärrholm J. Three-dimensional bone-implant movements in trochanteric hip fractures: Precision and accuracy of radiostereometric analysis in a phantom model. J Orthop Res 2015; 33:705-11. [PMID: 25640537 DOI: 10.1002/jor.22822] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/06/2015] [Indexed: 02/04/2023]
Abstract
The accuracy and precision of RSA were evaluated in the experimental study of screw cut-out complication after fixation of trochanteric fractures. A plastic bone model of a two-part trochanteric fracture was constructed with a Gamma nail implant incorporating RSA markers. The femoral head fragment was attached to a separate rotational table and the femoral shaft was mounted on the micrometer. Three main motions were simulated: Femoral head translation and rotation along the axis of the lag screw and fracture fragment translation along anatomical axes. Accuracy and precision were determined according to ISO 16,087 and ASTM standard F2385-04. Translations along the lag screw axis were measured with a precision within ±0.14 mm and an accuracy within ±0.03 mm. With simultaneous translations along all three anatomical axes, lowest precision was measured for the x-axis (±0.29, 0.07 mm, respectively), but improved when analyzed as a vector (±0.08, 0.03 mm). The precision and accuracy of femoral head rotations were within 0.5° and 0.18°, respectively. The resolution of the RSA method tested in this model was high, though it varied depending on the type of analyzed motion. This information is valuable when selecting and interpreting outcome parameters evaluating implant migration and osteosynthesis stability in future clinical RSA studies.
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Affiliation(s)
- Alicja J Bojan
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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