1
|
Sears BW, Christensen RG, Kelly JD, Khazzam MS, Mauter LA, Bader JE, Hatzidakis AM. Reliability assessment of new radiographic scales to evaluate radiolucency and bony in-between fin growth of partially cemented all-polyethylene glenoid components. J Shoulder Elbow Surg 2024; 33:872-879. [PMID: 37689103 DOI: 10.1016/j.jse.2023.07.041] [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: 04/04/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Current methods available for assessment of radiolucency and in-between fin (IBF) growth of a glenoid component have not undergone interobserver reliability testing for an all-polyethylene fluted central peg (FCP) glenoid. The purpose of this study was to evaluate anteroposterior radiographs of an FCP glenoid component at ≥48 months comparing commonly used scales to a new method adapted to the FCP. Our hypothesis was that the new method would result in acceptable intra- and interobserver agreement and a more accurate description of radiographic findings. METHODS We reviewed ≥48-month follow-up radiographs of patients treated with a primary aTSA using an FCP glenoid. Eighty-three patients were included in the review. Radiographs were evaluated by 5 reviewers using novel IBF radiodensity and radiolucency assessments and the Wirth and Lazarus methods. To assess intraobserver reliability, a subset of 40 images was reviewed. Kappa statistics were calculated to determine intra- and interobserver reliability; correlations were assessed using Pearson correlation. RESULTS Interobserver agreement (κ score) was as follows: IBF 0.71, radiolucency 0.68, Wirth 0.48, and Lazarus 0.22. Intraobserver agreement ranges were as follows: IBF radiodensity 0.36-0.67, radiolucency 0.55-0.62, Wirth 0.11-0.73, and Lazarus 0.04-0.46. Correlation analysis revealed the following: IBF to Wirth r = 0.93, radiolucency to Lazarus r = 0.92 (P value <.001 for all). CONCLUSION This study introduces a radiographic assessment method developed specifically for an FCP glenoid component. Results show high interobserver and acceptable intraobserver reliability for the method presented in this study. The new scales provide a more accurate description of radiographic findings, helping to identify glenoid components that may be at risk for loosening.
Collapse
Affiliation(s)
| | | | - James D Kelly
- California Pacific Orthopaedics, San Francisco, CA, USA
| | - Michael S Khazzam
- Department of Orthopaedic Surgery; Shoulder Service, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | |
Collapse
|
2
|
Jun BJ, Ricchetti ET, Haladik J, Bey MJ, Patterson TE, Subhas N, Li ZM, Iannotti JP. Validation of a 3D CT imaging method for quantifying implant migration following anatomic total shoulder arthroplasty. J Orthop Res 2022; 40:1270-1280. [PMID: 34436796 DOI: 10.1002/jor.25170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/29/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Glenoid component loosening remains a common complication following anatomic total shoulder arthroplasty (TSA); however, plain radiographs are unable to accurately detect early implant migration. The purpose of this study was to validate the accuracy of a method of postoperative, three-dimensional (3D) computed tomography (CT) imaging with metal artifact reduction (MAR) to detect glenoid component migration following anatomic TSA. Tantalum bead markers were inserted into polyethylene glenoid components for implant detection on 3D CT. In-vitro validation was performed using a glenoid component placed into a scapula sawbone and incrementally translated and rotated, with MAR 3D CT acquired at each test position. Accuracy was evaluated by root mean square error (RMSE). In-vivo validation was performed on six patients who underwent anatomic TSA, with two postoperative CT scans acquired in each patient and marker-based radiostereometric analysis (RSA) performed on the same days. Glenoid component migration was calculated relative to a scapular coordinate system for both MAR 3D CT and RSA. Accuracy was evaluated by RMSE and paired Student's t-tests. The largest RMSE on in-vitro testing was 0.24 mm in translation and 0.11° in rotation, and on in-vivo testing was 0.47 mm in translation and 1.04° in rotation. There were no significant differences between MAR 3D CT and RSA measurement methods. MAR 3D CT imaging is capable of quantifying glenoid component migration with a high level of accuracy. MAR 3D CT imaging is advantageous over RSA because it is readily available clinically and can also be used to evaluate the implant-bone interface.
Collapse
Affiliation(s)
- Bong-Jae Jun
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeffrey Haladik
- Department of Orthopaedic Surgery, Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Michael J Bey
- Department of Orthopaedic Surgery, Bone & Joint Center, Henry Ford Health System, Detroit, Michigan, USA
| | - Thomas E Patterson
- Department of Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Naveen Subhas
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zong-Ming Li
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Van de Kleut ML, Yuan X, Teeter MG, Athwal GS. Bony increased-offset reverse shoulder arthroplasty vs. metal augments in reverse shoulder arthroplasty: a prospective, randomized clinical trial with 2-year follow-up. J Shoulder Elbow Surg 2022; 31:591-600. [PMID: 34968693 DOI: 10.1016/j.jse.2021.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) is rapidly being adopted as the standard procedure for a growing number of shoulder pathologies. Lateralization of the glenoid component is known to reduce the incidence of scapular notching and possibly improve postoperative range of motion. A number of methods are used for glenoid component lateralization, including bony increased-offset reverse shoulder arthroplasty (BIO-RSA) and porous metal-augmented baseplates. Presently, there exists little comparative literature on bone vs. metal lateralization. Therefore, the purpose of this study was to compare BIO-RSA to metal-augmented glenoid baseplates by assessing clinical outcomes and baseplate migration using model-based radiostereometric analysis. METHODS A power analysis indicated 40 patients would be required for this radiostereometric study. Therefore, 41 shoulders were prospectively randomized to receive either glenoid bone grafting (BIO-RSA) or a porous metal-augmented wedge-shaped titanium baseplate for primary reverse shoulder arthroplasty. At the time of primary surgery, all patients also underwent implantation of 8 tantalum marker beads in the glenoid and coracoid. Following surgery, participants were imaged using a calibrated, stereo radiographic technique. Radiographs were acquired at 6 weeks (baseline), 3 months, 6 months, 1 year, and 2 years postoperatively. Migration of the prosthesis was compared between bone and metal lateralization groups at each time point using a mixed effects model with Bonferroni test for multiple comparisons. Outcome measures were acquired preoperatively and 2 years postoperatively. RESULTS No significant differences were observed along any translation or rotation axis at any time point for either glenoid fixation group (P ≥ .175). Mean total glenoid component translation (± standard deviation) 2 years postoperatively was 0.4 ± 0.2 mm and 0.5 ± 0.3 mm for BIO-RSA and metal-augmented baseplates, respectively (P = .784). No significant differences were observed between groups in active range of motion; pain; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score; Simple Shoulder Test score; Disabilities of the Arm, Shoulder, and Hand score; Constant Shoulder score; or Subjective Shoulder Value (P ≥ .117), with the exception of increased active external rotation in the BIO-RSA cohort (P = .036). CONCLUSION This randomized clinical trial assessed reverse shoulder arthroplasty glenoid component migration using model-based radiostereometric analysis. At 2-year follow-up, our results indicate both BIO-RSA and porous metal wedge augmented baseplates provide stable initial fixation, which is maintained at 2 years' follow-up, with no substantial differences in clinical outcomes.
Collapse
Affiliation(s)
- Madeleine L Van de Kleut
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada; School of Biomedical Engineering, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada
| | - Xunhua Yuan
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Matthew G Teeter
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - George S Athwal
- Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON, Canada.
| |
Collapse
|
4
|
Ten Brinke B, Hesseling B, Eygendaal D, Hoelen MA, Mathijssen NMC. Early fixation of the humeral component in stemless total shoulder arthroplasty : a radiostereometric and clinical study with 24-month follow-up. Bone Joint J 2022; 104-B:76-82. [PMID: 34969283 DOI: 10.1302/0301-620x.104b1.bjj-2021-0945.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Stemless humeral implants have been developed to overcome stem-related complications in total shoulder arthroplasty (TSA). However, stemless implant designs may hypothetically result in less stable initial fixation, potentially affecting long-term survival. The aim of this study is to investigate early fixation and migration patterns of the stemless humeral component of the Simpliciti Shoulder System and to evaluate clinical outcomes. METHODS In this prospective cohort study, radiostereometric analysis (RSA) radiographs were obtained in 24 patients at one day, six weeks, six months, one year, and two years postoperatively. Migration was calculated using model-based RSA. Clinical outcomes were evaluated using the visual analogue scale (VAS), the Oxford Shoulder Score (OSS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS At two years, median translation along the x-, y-, and z-axis was -0.12 mm (interquartile range (IQR) -0.18 to 0.02), -0.17 mm (IQR -0.27 to -0.09), and 0.09 mm (IQR 0.02 to 0.31). Median rotation around the x-, y-, and z-axis was 0.12° (IQR -0.50 to 0.57), -0.98° (IQR -1.83 to 1.23), and 0.09° (IQR -0.76 to 0.30). Overall, 20 prostheses stabilized within 12 months postoperatively. Four prostheses showed continuous migration between 12 and 24 months. At two-year follow-up, with the exception of one revised prosthesis, all clinical scores improved significantly (median VAS difference at rest: -3.0 (IQR -1.5 to -6.0); OSS 22.0 (IQR 15.0 to 25.0); CMS 29.5 (IQR 15.0 to 35.75); and DASH -30.0 (IQR -20.6 to -41.67) (all p < 0.001)) with the exception of one revised prosthesis. CONCLUSION In conclusion, we found that 20 out of 24 implants stabilized within 12 months postoperatively. The significance of continuous migration in four implants is unclear and future research on the predictive value of early migration for future loosening in TSA is required. Clinical results revealed a clinically relevant improvement. Cite this article: Bone Joint J 2022;104-B(1):76-82.
Collapse
Affiliation(s)
- Bart Ten Brinke
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Brechtje Hesseling
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Erasmus Medical Center, Delft, Netherlands
| | - Max A Hoelen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| |
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Durchholz H, Salomonsson B, Moroder P, Lambert S, Page R, Audigé L, Sperling J, Schwyzer HK. Core Set of Radiographic Parameters for Shoulder Arthroplasty Monitoring: Criteria Defined by an International Delphi Consensus Process. JB JS Open Access 2019; 4:e0025. [PMID: 32043057 PMCID: PMC6959915 DOI: 10.2106/jbjs.oa.19.00025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Some unfavorable local events following shoulder arthroplasty occur without the patient experiencing symptoms and yet may be detected on diagnostic imaging, thereby serving as indicators of complications that may require revision. Our aim was to create a standardized protocol for an image-based monitoring process for assessing patients who are asymptomatic following shoulder arthroplasty. Methods A Delphi exercise was implemented with the participation of an international panel of experienced shoulder surgeons. On the basis of expert opinion from a core steering group, an initial list of imaging parameters for shoulder arthroplasty monitoring of asymptomatic patients was developed and reviewed by panel members. The most appropriate imaging modality was identified. Between each survey, all feedback was considered in order to revise the proposed core set with its definitions and specifications. Consensus was reached upon a two-thirds agreement. Results Three online surveys were administered, with 98 surgeons responding to the first and/or the second survey. The response rate for the final survey was 74%. Final parameter definitions were organized in 7 categories (implant migration, radiolucency around implant and implant loosening, signs of shoulder displacement, bone resorption and formation, wear of implant articular surfaces, fractures around the implant, and implant breakage and disassembly) and approved with 85% to 100% agreement. Seventy-eight percent of the panel members agreed on a minimum radiographic imaging schedule: standard anteroposterior and axial (alternatively, Y) views made within 6 weeks after implantation and between 3 and 6 months as well as at 12 months post-surgery. Conclusions Our work presents a monitoring tool developed with international consensus for the assessment of asymptomatic patients after shoulder arthroplasty and including a structured core set of radiographic parameters. Clinical application and scientific evaluation of the monitoring process are needed. Clinical Relevance This represents a major step toward the standardization of shoulder arthroplasty radiographic monitoring for routine quality controls and research investigations.
Collapse
Affiliation(s)
- Holger Durchholz
- Research and Development (H.D. and L.A.) and Shoulder and Elbow Surgery (L.A.), Schulthess Klinik, Zurich, Switzerland.,Klinik Gut, St. Moritz, Switzerland
| | | | | | - Simon Lambert
- University College London Hospital, London, United Kingdom
| | - Richard Page
- Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin, University, Geelong, Victoria, Australia
| | - Laurent Audigé
- Research and Development (H.D. and L.A.) and Shoulder and Elbow Surgery (L.A.), Schulthess Klinik, Zurich, Switzerland
| | | | | |
Collapse
|
7
|
Sabesan VJ, Lima DJL, Whaley JD, Pathak V, Zhang L. The effect of glenohumeral radial mismatch on different augmented total shoulder arthroplasty glenoid designs: a finite element analysis. J Shoulder Elbow Surg 2019; 28:1146-1153. [PMID: 30770315 DOI: 10.1016/j.jse.2018.11.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/10/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Augmented glenoid implants to correct bone loss can possibly reconcile current prosthetic failures and improve long-term performance for total shoulder arthroplasty. Biomechanical implant studies have suggested benefits from augmented glenoid components, but limited evidence exists on optimal design. METHODS An integrated kinematic finite element analysis (FEA) model was used to evaluate optimal augmented glenoid design based on biomechanical performance in translation in the anteroposterior plane similar to clinical loading and failure mechanisms with osteoarthritis. Computer-aided design software models of 2 different commercially available augmented glenoid designs-wedge (Equinox; Exactech, Inc., Gainesville, FL, USA) and step (STEPTECH; DePuy Synthes, Warsaw, IN, USA) were created according to precise manufacturer's dimensions of the implants. Using FEA, they were virtually implanted to correct 20° of retroversion. Two glenohumeral radial mismatches, 3.5/4 mm and 10 mm, were evaluated for joint stability and implant fixation simulating high-risk conditions for failure. RESULTS The wedged and step designs showed similar glenohumeral joint stability under both radial mismatches. Surrogate for micromotion was a combination of distraction, translation, and compression. With similar behavior and measurements for distraction and translation, compression dictated micromotion (wedge: 3.5 mm = 0.18 mm and 10 mm = 0.10 mm; step: 3.5 mm = 0.19 mm and 10 mm = 0.25 mm). Stress levels on the backside of the implant and on the cement mantle were higher using a step design. DISCUSSION Greater radial mismatch has the advantage of providing higher glenohumeral stability with tradeoffs, such as higher implant and cement mantle stress levels, and micromotion worse when using a step design.
Collapse
Affiliation(s)
- Vani J Sabesan
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
| | - Diego J L Lima
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - James D Whaley
- Department of Orthopedic Surgery, Beaumont Health System, Royal Oak, MI, USA
| | - Varun Pathak
- Department of Biomedical Engineering, Wayne State University School of Medicine, Detroit, MI, USA
| | - Liying Zhang
- Department of Biomedical Engineering, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Yuan X, Broberg JS, Naudie DD, Holdsworth DW, Teeter MG. Radiostereometric analysis using clinical radiographic views: Validation with model-based radiostereometric analysis for the knee. Proc Inst Mech Eng H 2018; 232:759-767. [PMID: 29974802 DOI: 10.1177/0954411918785662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radiostereometric analysis is a sophisticated radiographic technique with high measurement accuracy. In order to improve the accessibility of radiostereometric analysis for clinical use, a modified radiostereometric analysis procedure has been previously proposed that enables clinical radiographic views to be used for radiostereometric analysis. It has been successfully validated for its application to the hip wear study with the conventional bead-based radiostereometric analysis environment using computed radiography. In this study, we describe the implementation and validation of this technique for the knee study with the model-based radiostereometric analysis environment using digital radiography. A knee-joint phantom with 6 degrees of freedom was examined, and the bias and repeatability/reproducibility of the modified radiostereometric analysis approach were investigated following the newly updated ASTM recommendations. The bias parameters (mean ± 95% confidence interval) ranged from 0.008 ± 0.003 mm to 0.027 ± 0.006 mm for translation and from 0.014° ± 0.007° to 0.040° ± 0.020° for rotation. The repeatability standard deviation ranged from 0.004 to 0.020 mm for translation and from 0.005° to 0.015° for rotation. The 95% repeatability limit ranged from 0.011 to 0.055 mm for translation and from 0.014° to 0.041° for rotation. The reproducibility standard deviation ranged from 0.004 to 0.023 mm for translation and from 0.006° to 0.040° for rotation. The 95% reproducibility limit ranged from 0.012 to 0.063 mm for translation and from 0.016° to 0.112° for rotation. The modified procedure allows routine clinical radiographs to be used for radiostereometric analysis, which provides the possibility of adding quantitative measurements to current patient registries.
Collapse
Affiliation(s)
- Xunhua Yuan
- 1 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jordan S Broberg
- 2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Douglas Dr Naudie
- 1 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 3 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - David W Holdsworth
- 1 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 4 Western's Bone and Joint Institute, Western University, London, ON, Canada
| | - Matthew G Teeter
- 1 Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 2 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 3 Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- 5 Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| |
Collapse
|
10
|
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.
Collapse
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
| | | |
Collapse
|
11
|
Clinical and radiologic outcomes of the second-generation Trabecular Metal™ glenoid for total shoulder replacements after 2-6 years follow-up. Arch Orthop Trauma Surg 2016; 136:1637-1645. [PMID: 27566616 DOI: 10.1007/s00402-016-2562-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND A porous tantalum glenoid component for total shoulder replacements was introduced in 2003 to promote biologic ingrowth. However, reports of component failure prompted design modifications. The purpose of this study is to present the largest series to date, of TSR with the second-generation Trabecular Metal™ glenoid component. METHOD A radiologic and clinical evaluation of the second-generation TM glenoid was conducted in consecutive cases of 76 shoulders (66 patients) with a mean follow-up of 43.2 months (range 24-72 months). Pre-operative VAS score, patient self-assessed ASES score, active shoulder range of motion, and radiologic assessment were recorded. Patients were recalled for latest follow-up clinical and radiologic evaluation. RESULTS On latest follow-up, the mean VAS scores (pre-op: 6.4-latest: 0.9) and ASES scores (pre-op: 36.9-latest: 88.5) improved. Active range of motion improved in all planes. There was no report of glenoid component migration, loosening, or humeral stem subsidence. The incidence of non-progressive radiolucency in the glenoid was 6.6 % (Franklin 1: 3 cases, Franklin 2: 2 cases). Post-operative complications involved dislocation (n = 2) which were reduced in ED, post-operative stiffness (n = 1), transient axillary nerve neuropraxia (n = 1), and supraspinatus tear which underwent arthroscopic repair at 16 months post-op. There were no revision surgeries for implant loosening nor glenoid component fracture at the peg-base plate junction. CONCLUSIONS The modifications established in the second-generation TM glenoid resulted to improve early to mid-term survivorship and clinical outcomes in TSR, with promise of long-term implant stability through bony ingrowth. LEVEL OF EVIDENCE Level IV, case series, treatment study.
Collapse
|