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Whittier DE, Walle M, Schenk D, Atkins PR, Collins CJ, Zysset P, Lippuner K, Müller R. A multi-stack registration technique to improve measurement accuracy and precision across longitudinal HR-pQCT scans. Bone 2023; 176:116893. [PMID: 37666441 DOI: 10.1016/j.bone.2023.116893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/14/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Recent applications of high-resolution peripheral quantitative computed tomography (HR-pQCT) have demonstrated that changes in local bone remodelling can be quantified in vivo using longitudinal three-dimensional image registration. However, certain emerging applications, such as fracture healing and joint analysis, require larger multi-stack scan regions that can result in stack shift image artifacts. These artifacts can be detrimental to the accurate alignment of the bone structure across multiple timepoints. The purpose of this study was to establish a multi-stack registration protocol for evaluating longitudinal HR-pQCT images and to assess the accuracy and precision error in comparison with measures obtained using previously established three-dimensional longitudinal registration. METHODS Three same day multi-stack HR-pQCT scans of the radius (2 stacks in length) and tibia (3 stacks in length) were obtained from 39 healthy individuals who participated in a previous reproducibility study. A fully automated multi-stack registration algorithm was developed to re-align stacks within a scan by leveraging slight offsets between longitudinal scans. Stack shift severity before and after registration was quantified using a newly proposed stack-shift severity score. The false discovery rate for bone remodelling events and precision error of bone morphology and micro-finite element analysis parameters were compared between longitudinally registered scans with and without the addition of multi-stack registration. RESULTS Most scans (82 %) improved in stack alignment or maintained the lowest stack shift severity score when multi-stack registration was implemented. The false discovery rate of bone remodelling events significantly decreased after multi-stack registration, resulting in median false detection of bone formation and resorption fractions between 3.2 to 7.5 % at the radius and 3.4 to 5.3 % at the tibia. Further, precision error was significantly reduced or remained unchanged in all standard bone morphology and micro-finite element analysis parameters, except for total and trabecular cross-sectional areas. CONCLUSION Multi-stack registration is an effective strategy for accurately aligning multi-stack HR-pQCT scans without modification of the image acquisition protocol. The algorithm presented here is a viable approach for performing accurate morphological analysis on multi-stack HR-pQCT scans, particularly for advanced application investigating local bone remodelling in vivo.
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Affiliation(s)
- Danielle E Whittier
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Matthias Walle
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Denis Schenk
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Penny R Atkins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Switzerland; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, United States
| | - Caitlyn J Collins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, United States
| | - Philippe Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Kurt Lippuner
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
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Atkins PR, Morris A, Elhabian SY, Anderson AE. A Correspondence-Based Network Approach for Groupwise Analysis of Patient-Specific Spatiotemporal Data. Ann Biomed Eng 2023; 51:2289-2300. [PMID: 37357248 PMCID: PMC11047278 DOI: 10.1007/s10439-023-03270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
Methods for statistically analyzing patient-specific data that vary both spatially and over time are currently either limited to summary statistics or require elaborate surface registration. We propose a new method, called correspondence-based network analysis, which leverages particle-based shape modeling to establish correspondence across a population and preserve patient-specific measurements and predictions through statistical analysis. Herein, we evaluated this method using three published datasets of the hip describing cortical bone thickness of the proximal femur, cartilage contact stress, and dynamic joint space between control and patient cohorts to evaluate activity- and group-based differences, as applicable, using traditional statistical parametric mapping (SPM) and our proposed spatially considerate correspondence-based network analysis approach. The network approach was insensitive to correspondence density, while the traditional application of SPM showed decreasing area of the region of significance with increasing correspondence density. In comparison to SPM, the network approach identified broader and more connected regions of significance for all three datasets. The correspondence-based network analysis approach identified differences between groups and activities without loss of subject and spatial specificity which could improve clinical interpretation of results.
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Affiliation(s)
- Penny R Atkins
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Alan Morris
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Shireen Y Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- School of Computing, University of Utah, Salt Lake City, UT, USA
| | - Andrew E Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
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Walle M, Whittier DE, Schenk D, Atkins PR, Blauth M, Zysset P, Lippuner K, Müller R, Collins CJ. Precision of bone mechanoregulation assessment in humans using longitudinal high-resolution peripheral quantitative computed tomography in vivo. Bone 2023; 172:116780. [PMID: 37137459 DOI: 10.1016/j.bone.2023.116780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
Local mechanical stimuli in the bone microenvironment are essential for the homeostasis and adaptation of the skeleton, with evidence suggesting that disruption of the mechanically-driven bone remodelling process may lead to bone loss. Longitudinal clinical studies have shown the combined use of high-resolution peripheral quantitative computed tomography (HR-pQCT) and micro-finite element analysis can be used to measure load-driven bone remodelling in vivo; however, quantitative markers of bone mechanoregulation and the precision of these analyses methods have not been validated in human subjects. Therefore, this study utilised participants from two cohorts. A same-day cohort (n = 33) was used to develop a filtering strategy to minimise false detections of bone remodelling sites caused by noise and motion artefacts present in HR-pQCT scans. A longitudinal cohort (n = 19) was used to develop bone imaging markers of trabecular bone mechanoregulation and characterise the precision for detecting longitudinal changes in subjects. Specifically, we described local load-driven formation and resorption sites independently using patient-specific odds ratios (OR) and 99 % confidence intervals. Conditional probability curves were computed to link the mechanical environment to the remodelling events detected on the bone surface. To quantify overall mechanoregulation, we calculated a correct classification rate measuring the fraction of remodelling events correctly identified by the mechanical signal. Precision was calculated as root-mean-squared averages of the coefficient of variation (RMS-SD) of repeated measurements using scan-rescan pairs at baseline combined with a one-year follow-up scan. We found no significant mean difference (p < 0.01) between scan-rescan conditional probabilities. RMS-SD was 10.5 % for resorption odds, 6.3 % for formation odds, and 1.3 % for correct classification rates. Bone was most likely to be formed in high-strain and resorbed in low-strain regions for all participants, indicating a consistent, regulated response to mechanical stimuli. For each percent increase in strain, the likelihood of bone resorption decreased by 2.0 ± 0.2 %, and the likelihood of bone formation increased by 1.9 ± 0.2 %, totalling 38.3 ± 1.1 % of strain-driven remodelling events across the entire trabecular compartment. This work provides novel robust bone mechanoregulation markers and their precision for designing future clinical studies.
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Affiliation(s)
- Matthias Walle
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Danielle E Whittier
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Osteoporosis, Bern University Hospital, Bern, Switzerland
| | - Denis Schenk
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Penny R Atkins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Osteoporosis, Bern University Hospital, Bern, Switzerland
| | - Michael Blauth
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Innsbruck, Austria
| | - Philippe Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Kurt Lippuner
- Department of Osteoporosis, Bern University Hospital, Bern, Switzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Caitlyn J Collins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Virginia Tech, Department of Biomedical Engineering and Mechanics, Blacksburg, VA, United States.
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Peiffer M, Duquesne K, Van Oevelen A, Burssens A, De Mits S, Maas SA, Atkins PR, Anderson AE, Audenaert EA. Validation of a personalized ligament-constraining discrete element framework for computing ankle joint contact mechanics. Comput Methods Programs Biomed 2023; 231:107366. [PMID: 36720186 DOI: 10.1016/j.cmpb.2023.107366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/09/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Computer simulations of joint contact mechanics have great merit to improve our current understanding of articular ankle pathology. Owed to its computational simplicity, discrete element analysis (DEA) is an encouraging alternative to finite element analysis (FEA). However, previous DEA models lack subject-specific anatomy and may oversimplify the biomechanics of the ankle. The objective of this study was to develop and validate a personalized DEA framework that permits movement of the fibula and incorporates personalized cartilage thickness as well as ligamentous constraints. METHODS A linear and non-linear DEA framework, representing cartilage as compressive springs, was established, verified, and validated. Three-dimensional (3D) bony ankle models were constructed from cadaveric lower limb CT scans imaged during application of weight (85 kg) and/or torque (10 Nm). These 3D models were used to generate cartilage thickness and ligament insertion sites based on a previously validated statistical shape model. Ligaments were modelled as non-linear tension-only springs. Validation of contact stress prediction was performed using a simple, axially constrained tibiotalar DEA model against an equivalent FEA model. Validation of ligamentous constraints compared the final position of the ankle mortise to that of the cadaver after application of torque and sequential ligament sectioning. Finally, a combined ligamentous-constraining DEA model was validated for predicted contact stress against an equivalent ligament-constraining FEA model. RESULTS The linear and non-linear DEA model reproduced a mean articular contact stress within 0.36 MPa and 0.39 MPa of the FEA calculated stress, respectively. With respect to the ligamentous validation, the DEA ligament-balancing algorithm could reproduce the position of the distal fibula within the ankle mortise to within 0.97 mm of the experimental observed distal fibula. When combining the ligament-constraining and contact stress algorithm, DEA was able to reproduce a mean articular contact stress to within 0.50 MPa of the FEA calculated contact stress. CONCLUSION The DEA framework presented herein offers a computationally efficient alternative to FEA for the prediction of contact stress in the ankle joint, manifesting its potential to enhance the mechanical understanding of articular ankle pathologies on both a patient-specific and population-wide level. The novelty of this model lies in its personalized nature, inclusion of the distal tibiofibular joint and the use of non-linear ligament balancing to maintain the physiological ankle joint articulation.
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Affiliation(s)
- M Peiffer
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
| | - K Duquesne
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - A Van Oevelen
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - A Burssens
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - S De Mits
- Department of Reumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Smart Space, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - S A Maas
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - P R Atkins
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - A E Anderson
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - E A Audenaert
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium; Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; Department of Electromechanics, Op3Mech research group, University of Antwerp, Antwerp, Belgium
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Lewis CL, Uemura K, Atkins PR, Lenz AL, Fiorentino NM, Aoki SK, Anderson AE. Patients with cam-type femoroacetabular impingement demonstrate increased change in bone-to-bone distance during walking: A dual fluoroscopy study. J Orthop Res 2023; 41:161-169. [PMID: 35325481 PMCID: PMC9508282 DOI: 10.1002/jor.25332] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023]
Abstract
Cam-type femoroacetabular impingement (FAI) syndrome is a painful, structural hip disorder. Herein, we investigated hip joint mechanics through in vivo, dynamic measurement of the bone-to-bone distance between the femoral head and acetabulum in patients with cam FAI syndrome and morphologically screened controls. We hypothesized that individuals with cam FAI syndrome would have larger changes in bone-to-bone distance compared to the control group, which we would interpret as altered joint mechanics as signified by greater movement of the femoral head as it articulates within the acetabulum. Seven patients with cam FAI syndrome and 11 asymptomatic individuals with typical morphology underwent dual fluoroscopy imaging during level and inclined walking (upward slope). The change in bone-to-bone distance between femoral and acetabular bone surfaces was evaluated for five anatomical regions of the acetabulum at each timepoint of gait. Linear regression analysis of the bone-to-bone distance considered two within-subject factors (activity and region) and one between-subjects factor (group). Across activities, the change in minimum bone-to-bone distance was 1.38-2.54 mm for the cam FAI group and 1.16-1.84 mm for controls. In all regions except the anterior-superior region, the change in bone-to-bone distance was larger in the cam group than the control group (p ≤ 0.024). An effect of activity was detected only in the posterior-superior region where larger changes were noted during level walking than incline walking. Statement of clinical significance: Patients with cam FAI syndrome exhibit altered hip joint mechanics during the low-demand activity of walking; these alterations could affect load transmission, and contribute to pain, tissue damage, and osteoarthritis.
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Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Niccolo M Fiorentino
- Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, USA
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6
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Schuring LL, Mozingo JD, Lenz AL, Uemura K, Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Anderson AE. Acetabular labrum and cartilage contact mechanics during pivoting and walking tasks in individuals with cam femoroacetabular impingement syndrome. J Biomech 2023; 146:111424. [PMID: 36603366 PMCID: PMC9869780 DOI: 10.1016/j.jbiomech.2022.111424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
Femoroacetabular impingement syndrome (FAIS) is a motion-related pathology of the hip characterized by pain, morphological abnormalities of the proximal femur, and an elevated risk of joint deterioration and hip osteoarthritis. Activities that require deep flexion are understood to induce impingement in cam FAIS patients, however, less demanding activities such as walking and pivoting may induce pain as well as alterations in kinematics and joint stability. Still, the paucity of quantitative descriptions of cam FAIS has hindered understanding underlying hip joint mechanics during such activities. Previous in silico studies have employed generalized model geometry or kinematics to simulate impingement between the femur and acetabulum, which may not accurately capture the interplay between morphology and motion. In this study, we utilized models with participant-specific bone and articular soft tissue anatomy and kinematics measured by dual-fluoroscopy to compare hip contact mechanics of cam FAIS patients to controls during four activities of daily living (internal/external pivoting and level/incline walking). Averaged across the gait cycle during incline walking, patients displayed increased strain in the anterior joint (labrum strain: p-value = 0.038, patients: 11.7 ± 6.7 %, controls: 5.0 ± 3.6 %; cartilage strain: p-value = 0.029, patients: 9.1 ± 3.3 %, controls: 4.2 ± 2.3). Patients also exhibited increased average anterior cartilage strains during external pivoting (p-value = 0.039; patients: 13.0 ± 9.2 %, controls: 3.9 ± 3.2 %]). No significant differences between patient and control contact area and strain were found for level walking and internal pivoting. Our study provides new insights into the biomechanics of cam FAIS, including spatiotemporal hip joint contact mechanics during activities of daily living.
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Affiliation(s)
- Lindsay L Schuring
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Joseph D Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Amy L Lenz
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA
| | - Niccolo M Fiorentino
- Mechanical Engineering Department, University of Vermont, Burlington, VT 05405, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | | | - Andrew E Anderson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA; Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA; Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA.
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7
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Khan N, Peterson AC, Aubert B, Morris A, Atkins PR, Lenz AL, Anderson AE, Elhabian SY. Statistical multi-level shape models for scalable modeling of multi-organ anatomies. Front Bioeng Biotechnol 2023; 11:1089113. [PMID: 36873362 PMCID: PMC9978224 DOI: 10.3389/fbioe.2023.1089113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Statistical shape modeling is an indispensable tool in the quantitative analysis of anatomies. Particle-based shape modeling (PSM) is a state-of-the-art approach that enables the learning of population-level shape representation from medical imaging data (e.g., CT, MRI) and the associated 3D models of anatomy generated from them. PSM optimizes the placement of a dense set of landmarks (i.e., correspondence points) on a given shape cohort. PSM supports multi-organ modeling as a particular case of the conventional single-organ framework via a global statistical model, where multi-structure anatomy is considered as a single structure. However, global multi-organ models are not scalable for many organs, induce anatomical inconsistencies, and result in entangled shape statistics where modes of shape variation reflect both within- and between-organ variations. Hence, there is a need for an efficient modeling approach that can capture the inter-organ relations (i.e., pose variations) of the complex anatomy while simultaneously optimizing the morphological changes of each organ and capturing the population-level statistics. This paper leverages the PSM approach and proposes a new approach for correspondence-point optimization of multiple organs that overcomes these limitations. The central idea of multilevel component analysis, is that the shape statistics consists of two mutually orthogonal subspaces: the within-organ subspace and the between-organ subspace. We formulate the correspondence optimization objective using this generative model. We evaluate the proposed method using synthetic shape data and clinical data for articulated joint structures of the spine, foot and ankle, and hip joint.
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Affiliation(s)
- Nawazish Khan
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- School of Computing, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Nawazish Khan ,
| | - Andrew C. Peterson
- Department of Orthopaedics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Alan Morris
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Penny R. Atkins
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Orthopaedics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Amy L. Lenz
- Department of Orthopaedics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Andrew E. Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- Department of Orthopaedics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Shireen Y. Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
- School of Computing, University of Utah, Salt Lake City, UT, United States
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8
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Walle M, Eggemann D, Atkins PR, Kendall JJ, Stock K, Müller R, Collins CJ. Motion grading of high-resolution quantitative computed tomography supported by deep convolutional neural networks. Bone 2023; 166:116607. [PMID: 36368464 DOI: 10.1016/j.bone.2022.116607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
Image quality degradation due to subject motion confounds the precision and reproducibility of measurements of bone density, morphology and mechanical properties from high-resolution peripheral quantitative computed tomography (HR-pQCT). Time-consuming operator-based scoring of motion artefacts remains the gold standard to determine the degree of acceptable motion. However, due to the subjectiveness of manual grading, HR-pQCT scans of poor quality, which cannot be used for analysis, may be accepted upon initial review, leaving patients with incomplete or inaccurate imaging results. Convolutional Neural Networks (CNNs) enable fast image analysis with relatively few pre-processing requirements in an operator-independent and fully automated way for image classification tasks. This study aimed to develop a CNN that can predict motion scores from HR-pQCT images, while also being aware of uncertain predictions that require manual confirmation. The CNN calculated motion scores within seconds and achieved a high F1-score (86.8 ± 2.8 %), with good precision (87.5 ± 2.7 %), recall (86.7 ± 2.9 %) and a substantial agreement with the ground truth measured by Cohen's kappa (κ = 68.6 ± 6.2 %); motion scores of the test dataset were predicted by the algorithm with comparable accuracy, precision, sensitivity and agreement as by the operators (p > 0.05). This post-processing approach may be used to assess the effect of motion scores on microstructural analysis and can be immediately implemented into clinical protocols, significantly reducing the time for quality assessment and control of HR-pQCT scans.
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Affiliation(s)
- Matthias Walle
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Penny R Atkins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jack J Kendall
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Kerstin Stock
- University Hospital for Orthopedics and Traumatology, Innsbruck, Austria
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Caitlyn J Collins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Virginia Tech, Department of Biomedical Engineering and Mechanics, Blacksburg, United States.
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9
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Collins CJ, Atkins PR, Ohs N, Blauth M, Lippuner K, Müller R. Clinical observation of diminished bone quality and quantity through longitudinal HR-pQCT-derived remodeling and mechanoregulation. Sci Rep 2022; 12:17960. [PMID: 36289391 PMCID: PMC9606273 DOI: 10.1038/s41598-022-22678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023] Open
Abstract
High resolution peripheral quantitative computed tomography (HR-pQCT) provides methods for quantifying volumetric bone mineral density and microarchitecture necessary for early diagnosis of bone disease. When combined with a longitudinal imaging protocol and finite element analysis, HR-pQCT can be used to assess bone formation and resorption (i.e., remodeling) and the relationship between this remodeling and mechanical loading (i.e., mechanoregulation) at the tissue level. Herein, 25 patients with a contralateral distal radius fracture were imaged with HR-pQCT at baseline and 9-12 months follow-up: 16 patients were prescribed vitamin D3 with/without calcium supplement based on a blood biomarker measures of bone metabolism and dual-energy X-ray absorptiometry image-based measures of normative bone quantity which indicated diminishing (n = 9) or poor (n = 7) bone quantity and 9 were not. To evaluate the sensitivity of this imaging protocol to microstructural changes, HR-pQCT images were registered for quantification of bone remodeling and image-based micro-finite element analysis was then used to predict local bone strains and derive rules for mechanoregulation. Remodeling volume fractions were predicted by both average values of trabecular and cortical thickness and bone mineral density (R2 > 0.8), whereas mechanoregulation was affected by dominance of the arm and group classification (p < 0.05). Overall, longitudinal, extended HR-pQCT analysis enabled the identification of changes in bone quantity and quality too subtle for traditional measures.
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Affiliation(s)
- Caitlyn J. Collins
- grid.5801.c0000 0001 2156 2780Institute for Biomechanics, ETH Zurich, Zurich, Switzerland ,grid.438526.e0000 0001 0694 4940Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA USA
| | - Penny R. Atkins
- grid.5801.c0000 0001 2156 2780Institute for Biomechanics, ETH Zurich, Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.223827.e0000 0001 2193 0096Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT USA
| | - Nicholas Ohs
- grid.5801.c0000 0001 2156 2780Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Michael Blauth
- grid.5361.10000 0000 8853 2677Department of Orthopedics and Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria ,Clinical Medical Department DePuy Synthes, Zuchwil, Switzerland
| | - Kurt Lippuner
- grid.5734.50000 0001 0726 5157Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ralph Müller
- grid.5801.c0000 0001 2156 2780Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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10
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Atkins PR, Agrawal P, Mozingo JD, Uemura K, Tokunaga K, Peters CL, Elhabian SY, Whitaker RT, Anderson AE. Prediction of femoral head coverage from articulated statistical shape models of patients with developmental dysplasia of the hip. J Orthop Res 2022; 40:2113-2126. [PMID: 34812545 PMCID: PMC9124729 DOI: 10.1002/jor.25227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/04/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is commonly described as reduced femoral head coverage due to anterolateral acetabular deficiency. Although reduced coverage is the defining trait of DDH, more subtle and localized anatomic features of the joint are also thought to contribute to symptom development and degeneration. These features are challenging to identify using conventional approaches. Herein, we assessed the morphology of the full femur and hemi-pelvis using an articulated statistical shape model (SSM). The model determined the morphological and pose-based variations associated with DDH in a population of Japanese females and established which of these variations predict coverage. Computed tomography (CT) images of 83 hips from 47 patients were segmented for input into a correspondence-based SSM. The dominant modes of variation in the model initially represented scale and pose. After removal of these factors through individual bone alignment, femoral version and neck-shaft angle, pelvic curvature, and acetabular version dominated the observed variation. Femoral head oblateness and prominence of the acetabular rim and various muscle attachment sites of the femur and hemi-pelvis were found to predict 3D CT-based coverage measurements (R2 = 0.5-0.7 for the full bones, R2 = 0.9 for the joint). Statement of Clinical Significance: Currently, clinical measurements of DDH only consider the morphology of the acetabulum. However, the results of this study demonstrated that variability in femoral head shape and several muscle attachment sites were predictive of femoral head coverage. These morphological differences may provide insight into improved clinical diagnosis and surgical planning based on functional adaptations of patients with DDH.
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Affiliation(s)
- Penny R. Atkins
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Praful Agrawal
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
| | - Joseph D. Mozingo
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Japan
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | | | - Shireen Y. Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- School of Computing, University of Utah, Salt Lake City, Utah
| | - Ross T. Whitaker
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- School of Computing, University of Utah, Salt Lake City, Utah
| | - Andrew E. Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
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11
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Atkins PR, Fiorentino NM, Anderson AE. In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy. J Vis Exp 2021. [PMID: 34279514 DOI: 10.3791/62792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Several hip pathologies have been attributed to abnormal morphology with an underlying assumption of aberrant biomechanics. However, structure-function relationships at the joint level remain challenging to quantify due to difficulties in accurately measuring dynamic joint motion. The soft tissue artifact errors inherent in optical skin marker motion capture are exacerbated by the depth of the hip joint within the body and the large mass of soft tissue surrounding the joint. Thus, the complex relationship between bone shape and hip joint kinematics is more difficult to study accurately than in other joints. Herein, a protocol incorporating computed tomography (CT) arthrography, three-dimensional (3D) reconstruction of volumetric images, dual fluoroscopy, and optical motion capture to accurately measure the dynamic motion of the hip joint is presented. The technical and clinical studies that have applied dual fluoroscopy to study form-function relationships of the hip using this protocol are summarized, and the specific steps and future considerations for data acquisition, processing, and analysis are described.
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Affiliation(s)
- Penny R Atkins
- Department of Orthopaedics, University of Utah; Scientific Computing and Imaging Institute, University of Utah
| | - Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah; Department of Mechanical Engineering, University of Vermont
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah; Scientific Computing and Imaging Institute, University of Utah; Department of Biomedical Engineering, University of Utah; Department of Physical Therapy, University of Utah;
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12
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Ohs N, Collins CJ, Tourolle DC, Atkins PR, Schroeder BJ, Blauth M, Christen P, Müller R. Automated segmentation of fractured distal radii by 3D geodesic active contouring of in vivo HR-pQCT images. Bone 2021; 147:115930. [PMID: 33753277 DOI: 10.1016/j.bone.2021.115930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022]
Abstract
Radius fractures are among the most common fracture types; however, there is limited consensus on the standard of care. A better understanding of the fracture healing process could help to shape future treatment protocols and thus improve functional outcomes of patients. High-resolution peripheral quantitative computed tomography (HR-pQCT) allows monitoring and evaluation of the radius on the micro-structural level, which is crucial to our understanding of fracture healing. However, current radius fracture studies using HR-pQCT are limited by the lack of automated contouring routines, hence only including small number of patients due to the prohibitively time-consuming task of manually contouring HR-pQCT images. In the present study, a new method to automatically contour images of distal radius fractures based on 3D morphological geodesic active contours (3D-GAC) is presented. Contours of 60 HR-pQCT images of fractured and conservatively treated radii spanning the healing process up to one year post-fracture are compared to the current gold standard, hand-drawn 2D contours, to assess the accuracy of the algorithm. Furthermore, robustness was established by applying the algorithm to HR-pQCT images of intact radii of 73 patients and comparing the resulting morphometric indices to the gold standard patient evaluation including a threshold- and dilation-based contouring approach. Reproducibility was evaluated using repeat scans of intact radii of 19 patients. The new 3D-GAC approach offers contours within inter-operator variability for images of fractured distal radii (mean Dice score of 0.992 ± 0.005 versus median operator Dice score of 0.992 ± 0.006). The generated contours for images of intact radii yielded morphometric indices within the in vivo reproducibility limits compared to the current gold standard. Additionally, the 3D-GAC approach shows an improved robustness against failure (n = 5) when dealing with cortical interruptions, fracture fragments, etc. compared with the automatic, default manufacturer pipeline (n = 40). Using the 3D-GAC approach assures consistent results, while reducing the need for time-consuming hand-contouring.
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Affiliation(s)
- Nicholas Ohs
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | | | - Penny R Atkins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Michael Blauth
- Department for Trauma Surgery, Innsbruck University Hospital, Innsbruck, Austria
| | - Patrik Christen
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Institute for Information Systems, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
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13
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Atkins PR, Stock K, Ohs N, Collins CJ, Horling L, Benedikt S, Degenhart G, Lippuner K, Blauth M, Christen P, Müller R. Formation Dominates Resorption With Increasing Mineralized Density and Time Postfracture in Cortical but Not Trabecular Bone: A Longitudinal HRpQCT Imaging Study in the Distal Radius. JBMR Plus 2021; 5:e10493. [PMID: 34189382 PMCID: PMC8216136 DOI: 10.1002/jbm4.10493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 01/07/2023] Open
Abstract
Clinical evaluation of fracture healing is often limited to an assessment of fracture bridging from radiographic images, without consideration for other aspects of bone quality. However, recent advances in HRpQCT offer methods to accurately monitor microstructural bone remodeling throughout the healing process. In this study, local bone formation and resorption were investigated during the first year post fracture in both the fractured (n = 22) and contralateral (n = 19) radii of 34 conservatively treated patients (24 female, 10 male) who presented with a unilateral radius fracture at the Innsbruck University Hospital, Austria. HRpQCT images and clinical metrics were acquired at six time points for each patient. The standard HRpQCT image acquisition was captured for all radii, with additional distal and proximal image acquisitions for the fractured radii. Measured radial bone densities were isolated with a voxel‐based mask and images were rigidly registered to images from the previous imaging session using a pyramid‐based approach. From the registered images, bone formation and resorption volume fractions were quantified for multiple density‐based thresholds and compared between the fractured and contralateral radius and relative to demographics, bone morphometrics, and fracture metrics using regression. Compared with the contralateral radius, both bone formation and resorption were significantly increased in the fractured radius throughout the study for nearly all evaluated thresholds. Higher density cortical bone formation continually increased throughout the duration of the study and was significantly greater than resorption during late‐stage healing in both the fractured and intact regions of the radius. With the small and diverse study population, only weak relationships between fracture remodeling and patient‐specific parameters were unveiled. However this study provides methods for the analysis of local bone remodeling during fracture healing and highlights relevant considerations for future studies, specifically that remodeling postfracture is likely to continue beyond 12‐months postfracture. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Penny R Atkins
- Institute for Biomechanics, ETH ZurichZurichSwitzerland
- Department of OsteoporosisBern University Hospital, University of BernBernSwitzerland
| | - Kerstin Stock
- Department of Orthopedics and Trauma SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Nicholas Ohs
- Institute for Biomechanics, ETH ZurichZurichSwitzerland
| | | | - Lukas Horling
- Department of Orthopedics and Trauma SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Stefan Benedikt
- Department of Orthopedics and Trauma SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Gerald Degenhart
- Department of RadiologyMedical University InnsbruckInnsbruckAustria
| | - Kurt Lippuner
- Department of OsteoporosisBern University Hospital, University of BernBernSwitzerland
| | - Michael Blauth
- Department of Orthopedics and Trauma SurgeryMedical University of InnsbruckInnsbruckAustria
- Clinical Medical DepartmentDePuy SynthesZuchwilSwitzerland
| | - Patrik Christen
- Institute for Biomechanics, ETH ZurichZurichSwitzerland
- Institute for Information SystemsFHNW University of Applied Sciences and Arts Northwestern SwitzerlandOltenSwitzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH ZurichZurichSwitzerland
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14
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Atkins PR, Hananouchi T, Anderson AE, Aoki SK. Inclusion of the Acetabular Labrum Reduces Simulated Range of Motion of the Hip Compared With Bone Contact Models. Arthrosc Sports Med Rehabil 2020; 2:e779-e787. [PMID: 33376992 PMCID: PMC7754612 DOI: 10.1016/j.asmr.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To determine whether inclusion of the acetabular labrum affects the maximum range of motion (ROM) during simulation of the flexion–adduction–internal rotation impingement examination. Methods Three-dimensional surface reconstructions of the femur, hemi-pelvis, and labrum from computed tomography arthrography images of 19 participants were used to simulate maximum ROM during the flexion–adduction–internal rotation examination. Simulations were conducted for positions between 70° and 110° flexion and 0° and 20° adduction at 10° increments to measure maximum internal rotation and the position of contact between the femur and acetabular rim (bone-to-bone) or the femur and labrum (bone-to-labrum). Internal rotation angles and clock-face position values were compared between the 2 contact scenarios for each position. Results The ROM in the bone-to-labrum contact model was significantly less than that of the bone-to-bone contact model for all evaluated positions (P ≤ .001, except at 110° flexion and 20° adduction, P = .114). The inclusion of the labrum reduced internal rotation by a median [interquartile range] of 18 [15, 25]° while altering the position of contact on the acetabular clock-face by –0:01 [–0:27, 0:16]. The variability in contact location for the bone-to-labrum contact scenario was nearly double that of the bone-to-bone contact scenario, as indicated by the interquartile range. Conclusions Inclusion of the anatomy of the acetabular labrum in collision models used to simulate impingement examinations reduced the internal rotation ROM by approximately 20° and increased variability in the location of contact relative to the acetabular rim. Clinical Relevance While standard bone-to-bone contact ROM simulations may be informative with respect to the relative change in ROM based on a surgical intervention (e.g., pre- and post-osteochondroplasty for cam-type femoroacetabular impingement), they may not accurately represent the clinical ROM of the joint or the kinematic position at which damage may occur due to shape mismatch between the femur and acetabulum.
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Affiliation(s)
- Penny R. Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A
| | - Takehito Hananouchi
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
- Medical Engineering Laboratory, Department of Mechanical Engineering, Osaka Sangyo University, Daito, Osaka, Japan
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
- Address correspondence to Stephen K. Aoki, University of Utah Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108.
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15
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Ohs N, Collins CJ, Atkins PR. Validation of HR-pQCT against micro-CT for morphometric and biomechanical analyses: A review. Bone Rep 2020; 13:100711. [PMID: 33392364 PMCID: PMC7772687 DOI: 10.1016/j.bonr.2020.100711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 12/26/2022] Open
Abstract
High-resolution peripheral quantitative computed-tomography (HR-pQCT) has the potential to become a powerful clinical assessment and diagnostic tool. Given the recent improvements in image resolution, from 82 to 61 μm, this technology may be used to accurately quantify in vivo bone microarchitecture, a key biomarker of degenerative bone diseases. However, computational methods to assess bone microarchitecture were developed for micro computed tomography (micro-CT), a higher-resolution technology only available for ex vivo studies, and validation of these computational analysis techniques against the gold-standard micro-CT has been inconsistent and incomplete. Herein, we review methods for segmentation of bone compartments and microstructure, quantification of bone morphology, and estimation of mechanical strength using finite-element analysis, highlighting the need throughout for improved standardization across the field. Studies have relied on homogenous datasets for validation, which does not allow for robust comparisons between methods. Consequently, the adaptation and validation of novel segmentation approaches has been slow to non-existent, with most studies still using the manufacturer's segmentation for morphometric analysis despite the existence of better performing alternative approaches. The promising accuracy of HR-pQCT for capturing morphometric indices is overshadowed by considerable variability in outcomes between studies. For finite element analysis (FEA) methods, the use of disparate material models and FEA tools has led to a fragmented ability to assess mechanical bone strength with HR-pQCT. Further, the scarcity of studies comparing 62 μm HR-pQCT to the gold standard micro-CT leaves the validation of this imaging modality incomplete. This review revealed that without standardization, the capabilities of HR-pQCT cannot be adequately assessed. The need for a public, extendable, heterogeneous dataset of HR-pQCT and corresponding gold-standard micro-CT images, which would allow HR-pQCT users to benchmark existing and novel methods and select optimal methods depending on the scientific question and data at hand, is now evident. With more recent advancements in HR-pQCT, the community must learn from its past and provide properly validated technologies to ensure that HR-pQCT can truly provide value in patient diagnosis and care.
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Affiliation(s)
- Nicholas Ohs
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Penny R. Atkins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Osteoporosis, Inselspital, Bern, Switzerland
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16
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Krahenbuhl N, Lenz AL, Lisonbee R, Peterson AC, Atkins PR, Hintermann B, Saltzman CL, Anderson AE, Barg A. Morphologic analysis of the subtalar joint using statistical shape modeling. J Orthop Res 2020; 38:2625-2633. [PMID: 32816337 PMCID: PMC8713294 DOI: 10.1002/jor.24831] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
Weightbearing computed tomography (WBCT) enables visualization of the foot and ankle as patients stand under load. Clinical measurements of WBCT images are generally limited to two-dimensions, which reduces the ability to quantify complex morphology of individual osseous structures as well as the alignment between two or more bones. The shape and orientation of the healthy/normal subtalar joint, in particular, is not well-understood, which makes it very difficult to diagnose subtalar pathoanatomy. Herein, we employed statistical shape modeling to evaluate three-dimensional (3D) shape variation, coverage, space, and congruency of the subtalar joint using WBCT data of 27 asymptomatic healthy individuals. The four most relevant findings were: (A) talar and calcaneal anatomical differences were found regarding the presence of (a) the talar posterior process, (b) calcaneal pitch, and (c) curvature of the calcaneal posterior facet; (B) the talar posterior facet articular surface area was significantly greater than the calcaneal posterior facet articular surface area; (C) the posterior facet varied in joint space distance, whereas the anteromedial facet was even; and (D) the posterior and anteromedial facet of the subtalar joint was consistently congruent. Despite considerable shape variation across the population, the posterior and anteromedial articular facets of the subtalar joint were consistently congruent. Results provide a detailed 3D analysis of the subtalar joint under a weightbearing condition in a healthy population which can be used for comparisons to pathological patient populations. The described SSM approach also shows promise for clinical evaluation of the subtalar joint from 3D surface reconstructions of WBCT images.
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Affiliation(s)
| | | | - Rich Lisonbee
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew C. Peterson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R. Atkins
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
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17
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Uemura K, Atkins PR, Okamoto M, Tokunaga K, Anderson AE. Can measurements from an anteroposterior radiograph predict pelvic sagittal inclination? J Orthop Res 2020; 38:1477-1485. [PMID: 32320097 PMCID: PMC7335595 DOI: 10.1002/jor.24701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/12/2020] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
Pelvic sagittal inclination (PSI) is often evaluated in patients with hip pathology using lateral radiographs. However, it would be useful if PSI could be predicted from an anteroposterior radiograph since this film is ubiquitous in the evaluation of hip pathology. Herein, computer-modeling was applied to predict PSI from radiographic measurements assessed in the anteroposterior plane. Three-dimensional surface models of the pelvis, femur, and sacrum were reconstructed from computed tomography images of 50 women with hip dysplasia. This study cohort was selected as changes in PSI alter femoral head coverage, which is relevant to the diagnosis and treatment of hip dysplasia, a known cause of hip osteoarthritis. Five radiographic parameters commonly used to independently estimate PSI were evaluated after bone surfaces were projected to an anteroposterior plane, including the symphysis to sacrococcygeal joint distance (S-S distance), the pelvic foramen aspect ratio (PF ratio), the distance between the symphysis and a line connecting the femoral head centers (S-H distance), the sacro-femoral-pubic angle (SFP angle), and the pelvic vertical ratio (PVR). Regression models determined the ability of these parameters to predict PSI from -20° to 20° at 1° increment. All five parameters showed a strong correlation with the PSI (all r > 0.9). From the regression models, PSI was estimated with a median (maximum) absolute error of 3.6° (18.4°), 3.8° (17.7°), 5.2° (17.9°), 5.8° (28.8°), and 3.2° (23.5°) for the S-S distance, PF ratio, S-H distance, SFP angle, and PVR, respectively. The regression model for S-S distance had a mean slope of 2.18 that ranged from 1.98 to 2.41 when the sacrococcygeal joint was located superior to the symphysis. Results indicated that substantial errors occur when estimating the actual value of PSI from an anteroposterior radiograph. However, the change in PSI could be estimated from the S-S distance, which may aid surgeons to successfully increase head coverage through periacetabular osteotomy and to locate the acetabular cup in a functional position for total hip arthroplasty.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USA
| | - Penny R. Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USA,Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Niigata, 9500165, Japan
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USA,Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, 84112, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT, 84108, USA
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18
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Fiorentino NM, Atkins PR, Kutschke MJ, Bo Foreman K, Anderson AE. Soft tissue artifact causes underestimation of hip joint kinematics and kinetics in a rigid-body musculoskeletal model. J Biomech 2020; 108:109890. [PMID: 32636003 DOI: 10.1016/j.jbiomech.2020.109890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Rigid body musculoskeletal models have been applied to study kinematics, moments, muscle forces, and joint reaction forces in the hip. Most often, models are driven with segment motions calculated through optical tracking of markers adhered to the skin. One limitation of optical tracking is soft tissue artifact (STA), which occurs due to motion of the skin surface relative to the underlying skeleton. The purpose of this study was to quantify differences in musculoskeletal model outputs when tracking body segment positions with skin markers as compared to bony landmarks measured by direct imaging of bone motion with dual fluoroscopy (DF). Eleven asymptomatic participants with normally developed hip anatomy were imaged with DF during level treadmill walking at a self-selected speed. Hip joint kinematics and kinetics were generated using inverse kinematics, inverse dynamics, static optimization and joint reaction force analysis. The effect of STA was assessed by comparing the difference in estimates from simulations based on skin marker positions (SM) versus virtual markers on bony landmarks from DF. While patterns were similar, STA caused underestimation of kinematics, range of motion (ROM), moments, and reaction forces at the hip, including flexion-extension ROM, maximum internal rotation joint moment and peak joint reaction force magnitude. Still, kinetic differences were relatively small, and thus they may not be relevant nor clinically meaningful.
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Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Vermont, 33 Colchester Ave, Burlington, VT 05403, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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Van Houcke J, Audenaert EA, Atkins PR, Anderson AE. A Combined Geometric Morphometric and Discrete Element Modeling Approach for Hip Cartilage Contact Mechanics. Front Bioeng Biotechnol 2020; 8:318. [PMID: 32373602 PMCID: PMC7186355 DOI: 10.3389/fbioe.2020.00318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/24/2020] [Indexed: 11/17/2022] Open
Abstract
Finite element analysis (FEA) provides the current reference standard for numerical simulation of hip cartilage contact mechanics. Unfortunately, the development of subject-specific FEA models is a laborious process. Owed to its simplicity, Discrete Element Analysis (DEA) provides an attractive alternative to FEA. Advancements in computational morphometrics, specifically statistical shape modeling (SSM), provide the opportunity to predict cartilage anatomy without image segmentation, which could be integrated with DEA to provide an efficient platform to predict cartilage contact stresses in large populations. The objective of this study was, first, to validate linear and non-linear DEA against a previously validated FEA model and, second, to present and evaluate the applicability of a novel population-averaged cartilage geometry prediction method against previously used methods to estimate cartilage anatomy. The population-averaged method is based on average cartilage thickness maps and therefore allows for a more accurate and individualized cartilage geometry estimation when combined with SSM. The root mean squared error of the population-averaged cartilage geometry predicted by SSM as compared to the manually segmented cartilage geometry was 0.31 ± 0.08 mm. Identical boundary and loading conditions were applied to the DEA and FEA models. Predicted DEA stress distribution patterns and magnitude of peak stresses were in better agreement with FEA for the novel cartilage anatomy prediction method as compared to commonly used parametric methods based on the estimation of acetabular and femoral head radius. Still, contact stress was overestimated and contact area was underestimated for all cartilage anatomy prediction methods. Linear and non-linear DEA methods differed mainly in peak stress results with the non-linear definition being more sensitive to detection of high peak stresses. In conclusion, DEA in combination with the novel population-averaged cartilage anatomy prediction method provided accurate predictions while offering an efficient platform to conduct population-wide analyses of hip contact mechanics.
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Affiliation(s)
- Jan Van Houcke
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Emmanuel A Audenaert
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerp, Belgium
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, United States.,Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
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20
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Atkins PR, Fiorentino NM, Hartle JA, Aoki SK, Peters CL, Foreman KB, Anderson AE. In Vivo Pelvic and Hip Joint Kinematics in Patients With Cam Femoroacetabular Impingement Syndrome: A Dual Fluoroscopy Study. J Orthop Res 2020; 38:823-833. [PMID: 31693209 PMCID: PMC7301904 DOI: 10.1002/jor.24509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
Femoroacetabular impingement syndrome (FAIS) may alter the kinematic function of the hip, resulting in pain and tissue damage. Previous motion analysis studies of FAIS have employed skin markers, which are prone to soft tissue artifact and inaccurate calculation of the hip joint center. This may explain why the evidence linking FAIS with deleterious kinematics is contradictory. The purpose of this study was to employ dual fluoroscopy (DF) to quantify in vivo kinematics of patients with cam FAIS relative to asymptomatic, morphologically normal control participants during various activities. Eleven asymptomatic, morphologically normal controls and seven patients with cam FAIS were imaged with DF during standing, level walking, incline walking, and functional range of motion activities. Model-based tracking calculated the kinematic position of the hip by registering projections of three-dimensional computed tomography models with DF images. Patients with FAIS stood with their hip extended (mean [95% confidence interval], -2.2 [-7.4, 3.1]°, flexion positive), whereas controls were flexed (5.3 [2.6, 8.0]°; p = 0.013). Male patients with cam FAIS had less peak internal rotation than the male control participants during self-selected speed level-walking (-0.2 [-6.5, 6.1]° vs. -9.8 [-12.2, -7.3]°; p = 0.007) and less anterior pelvic tilt at heel-strike of incline (5°) walking (3.4 [-1.0, -7.9]° vs. 9.8 [6.4, 13.2]°; p = 0.032). Even during submaximal range of motion activities, such as incline walking, patients may alter pelvic motion to avoid positions that approximate the cam lesion and the acetabular labrum. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:823-833, 2020.
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Affiliation(s)
- Penny R. Atkins
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Mechanical Engineering Department, University of Vermont, 33 Colchester Ave, Votey Hall 201A, Burlington, VT 05405, USA
| | - Joseph A. Hartle
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Christopher L. Peters
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA
| | - Andrew. E. Anderson
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA,Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, Salt Lake City, UT 84112, USA
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21
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Uemura K, Atkins PR, Peters CL, Anderson AE. The effect of pelvic tilt on three-dimensional coverage of the femoral head: A computational simulation study using patient-specific anatomy. Anat Rec (Hoboken) 2019; 304:258-265. [PMID: 31755243 DOI: 10.1002/ar.24320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 01/23/2023]
Abstract
Improved understanding of how three-dimensional (3D) femoral head coverage changes as the pelvic sagittal inclination (PSI) is altered would advance clinical diagnosis of hip pathoanatomy. Herein, we applied computer modeling of 3D computed tomography reconstructions of the pelvis and proximal femur to quantify relationships between the PSI and regional 3D femoral head coverage. Eleven healthy, young adult participants with typically developed hip anatomy were analyzed. The orientation of the pelvis was altered to define a PSI of -30° to 30° at 1° increments. Hip adduction and rotation were fixed in a standing position, which was measured by direct in vivo imaging of the pelvis and femur bones using dual fluoroscopy. Femoral head coverage was quantified in the anterior, superior, posterior, and inferior regions for each PSI position. Change in coverage was largest in the anterior region (29.8%) and smallest in the superior region (6.5%). Coverage increased linearly in the anterior region as the PSI increased, while a linear decrease was found in the posterior region and the inferior region (all p < .001). The slopes of the regression line for these regions were 0.513, -0.316, and -0.255, respectively. For the superior region, coverage increased when the PSI was altered from -30° to 5° and decreased when the PSI was larger than 5°. Overall, a 1° increase in PSI resulted in an increase of 0.5% in anterior coverage and a decrease of 0.3% in posterior coverage. Our findings provide baseline data that improve understanding of the effect of PSI on femoral coverage.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah.,Department of Bioengineering, University of Utah, Salt Lake City, Utah
| | | | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah.,Department of Bioengineering, University of Utah, Salt Lake City, Utah.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah.,Department of Physical Therapy, University of Utah, Salt Lake City, Utah
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22
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Murphy MM, Atkins PR, Kobayashi EF, Anderson AE, Maak TG, Nechyporenko AV, Aoki SK. Assessment of Acetabular Morphology Using the Acetabular Anterior Center-Edge Angle on Modified False-Profile Radiographs. Arthroscopy 2019; 35:3060-3066. [PMID: 31699257 DOI: 10.1016/j.arthro.2019.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare radiographic parameters of acetabular morphology between standard and modified false-profile (FP) radiographs. METHODS Standard and modified FP radiographs were obtained in 225 hips in 200 consecutive patients evaluated for hip pain and suspected femoroacetabular impingement. Radiographs were retrospectively reviewed by 2 readers to determine the anterior center-edge angle (ACEA), as assessed to the sourcil and to the bone edge. Inter-rater reliability of radiographic measurements was assessed using the intraclass correlation coefficient. Measurements were evaluated for normality with the Shapiro-Wilk test, averaged between the 2 readers, and compared between views using the paired Wilcoxon test. RESULTS The intraclass correlation coefficient values for standard and modified FP views were 0.923 and 0.932, respectively, measuring to the sourcil and 0.867 and 0.896, respectively, measuring to the lateral bone edge. The median difference in ACEA measurements to the sourcil was 1° between the standard and modified FP view (45° vs 44°, P < .001). The median difference in ACEA measurements to the bone edge was 2° (34° vs 32°, P < .001). CONCLUSIONS Thirty-five degrees of femoral internal rotation for a modified FP hip radiographic view provides similar clinical information regarding acetabular morphology to that of the standard FP view. Given that the modified FP view also provides better visualization of the anterosuperior head-neck junction cam lesion, the modified FP view may be preferred over the standard FP view in evaluation of hip pain in the young patient. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Michael M Murphy
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.; Department of Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A.; Department of Bioengineering, University of Utah, Salt Lake City, Utah, U.S.A.; Department of Physical Therapy, University of Utah, Salt Lake City, Utah, U.S.A.; Scientific Computing and Imaging Institute, Salt Lake City, Utah, U.S.A
| | - Travis G Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Anatoliy V Nechyporenko
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A..
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23
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Killian ML, Locke RC, James MG, Atkins PR, Anderson AE, Clohisy JC. Novel model for the induction of postnatal murine hip deformity. J Orthop Res 2019; 37:151-160. [PMID: 30259572 PMCID: PMC6393179 DOI: 10.1002/jor.24146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/12/2018] [Indexed: 02/04/2023]
Abstract
Acetabular dysplasia is a common, multi-etiological, pre-osteoarthritic (OA) feature that can lead to pain and instability of the young adult hip. Despite the clinical significance of acetabular dysplasia, there is a paucity of small animal models to investigate structural and functional changes that mediate morphology of the dysplastic hip and drive the subsequent OA cascade. Utilizing a novel murine model developed in our laboratory, this study investigated the role of surgically induced unilateral instability of the postnatal hip on the initiation and progression of acetabular dysplasia and impingement up to 8-weeks post-injury. C57BL6 mice were used to develop titrated levels of hip instability (i.e., mild, moderate, and severe instabillity or femoral head resection) at weaning. Joint shape, acetabular coverage, histomorphology, and statistical shape modeling were used to assess quality of the hip following 8 weeks of destabilization. Acetabular coverage was reduced following severe, but not moderate, instability. Moderate instability induced lateralization of the femur without dislocation, whereas severe instability led to complete dislocation and pseudoacetabulae formation. Mild instability did not result in morphological changes to the hip. Removal of the femoral head led to reduced hip joint space volume. These data support the notion that hip instability, driven by mechanical loss-of-function of soft connective tissue, can induce morphometric changes in the growing mouse hip. This work developed a new mouse model to study hip health in the murine adolescent hip and is a useful tool for investigating the mechanical and structural adaptations to hip instability during growth. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Megan L. Killian
- Department of Biomedical Engineering, University of Delaware, 5 Innovation Way, Suite 200, Newark, Delaware 19716,,Department of Orthopaedic Surgery, Washington University School of Medicine, 425 S. Euclid Avenue, Saint Louis, Missouri 63110
| | - Ryan C. Locke
- Department of Biomedical Engineering, University of Delaware, 5 Innovation Way, Suite 200, Newark, Delaware 19716
| | - Michael G. James
- Department of Orthopaedic Surgery, Washington University School of Medicine, 425 S. Euclid Avenue, Saint Louis, Missouri 63110
| | - Penny R. Atkins
- Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah 84112,,Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108
| | - Andrew E. Anderson
- Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah 84112,,Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, Utah 84108
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, 425 S. Euclid Avenue, Saint Louis, Missouri 63110
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Uemura K, Atkins PR, Maas SA, Peters CL, Anderson AE. Three-dimensional femoral head coverage in the standing position represents that measured in vivo during gait. Clin Anat 2018; 31:1177-1183. [PMID: 30117200 DOI: 10.1002/ca.23262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
Individuals with over- or under-covered hips may develop hip osteoarthritis. Femoral head coverage is typically evaluated using radiographs, and/or computed tomography (CT) or magnetic resonance images obtained supine. Yet, these static assessments of coverage may not provide accurate information regarding the dynamic, three-dimensional (3-D) relationship between the femoral head and acetabulum. The objectives of this study were to: (1) quantify total and regional 3-D femoral head coverage in a standing position and during gait, and (2) quantify the relationship between 3-D femoral head coverage in standing to that measured during gait. The kinematic position of the hip during standing and gait was measured in vivo for 11 asymptomatic morphologically normal subjects using dual fluoroscopy and model-based tracking of 3-D CT models. Percent coverage in the standing position and during gait was measured overall and on a regional basis (anterior, superior, posterior, inferior). Coverage in standing was correlated with that measured during gait. For total coverage, very little change in coverage occurred during gait (range: 35.0-36.7%; mean: 36.2%). Coverage at each time point of gait strongly correlated with coverage during standing (r = 0.929-0.989). The regions thought to play an important role in weight bearing (i.e. anterior, superior, posterior) were significantly correlated with coverage in standing during the stance phase. Our results suggest that coverage measured in a standing position is a good surrogate for coverage measured during gait. Clin. Anat. 31:1177-1183, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA
| | - Steve A Maas
- Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA.,Scientific Computing and Imaging Institute, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA.,Musculoskeletal Research Laboratories, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA
| | - Christopher L Peters
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA
| | - Andrew E Anderson
- Department of Orthopaedics, Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, 590 Wakara Way, Salt Lake City, Utah, 84108, USA.,Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, Utah, 84112, USA.,Scientific Computing and Imaging Institute, University of Utah, Warnock Engineering Building, 72 S Central Campus Drive, Room 3750, Salt Lake City, Utah, 84112, USA.,Department of Physical Therapy, University of Utah, Dumke Health Professions Building, 520 Wakara Way, Suite 240, Salt Lake City, Utah, 84108, USA
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25
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Uemura K, Atkins PR, Fiorentino NM, Anderson AE. Hip rotation during standing and dynamic activities and the compensatory effect of femoral anteversion: An in-vivo analysis of asymptomatic young adults using three-dimensional computed tomography models and dual fluoroscopy. Gait Posture 2018; 61:276-281. [PMID: 29413797 PMCID: PMC6599491 DOI: 10.1016/j.gaitpost.2018.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/18/2018] [Accepted: 01/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals are thought to compensate for femoral anteversion by altering hip rotation. However, the relationship between hip rotation in a neutral position (i.e. static rotation) and dynamic hip rotation is poorly understood, as is the relationship between anteversion and hip rotation. RESEARCH OBJECTIVE Herein, anteversion and in-vivo hip rotation during standing, walking, and pivoting were measured in eleven asymptomatic, morphologically normal, young adults using three-dimensional computed tomography models and dual fluoroscopy. METHODS Using correlation analyses, we: 1) determined the relationship between hip rotation in the static position to that measured during dynamic activities, and 2) evaluated the association between femoral anteversion and hip rotation during dynamic activities. Hip rotation was calculated while standing (static-rotation), throughout gait, as a mean during gait (mean gait rotation), and as a mean (mid-pivot rotation), maximum (max-rotation) and minimum (min-rotation) during pivoting. RESULTS Static-rotation (mean ± standard deviation; 11.3° ± 7.3°) and mean gait rotation (7.8° ± 4.7°) were positively correlated (r = 0.679, p = 0.022). Likewise, static-rotation was strongly correlated with mid-pivot rotation (r = 0.837, p = 0.001), max-rotation (r = 0.754, p = 0.007), and min-rotation (r = 0.835, p = 0.001). Strong positive correlations were found between anteversion and hip internal rotation during all of the stance phase (0-60% gait) and during mid- and terminal-swing (86-100% gait) (all r > 0.607, p < 0.05). CONCLUSIONS Our results suggest that the static position may be used cautiously to express the neutral rotational position of the femur for dynamic movements. Further, our results indicate that femoral anteversion is compensated for by altering hip rotation. As such, both anteversion and hip rotation may be important to consider when diagnosing hip pathology and planning for surgical procedures.
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Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA.
| | - Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Mechanical Engineering Department, University of Vermont, 33 Colchester Ave, Votey Hall 201A, Burlington, VT 05405, USA.
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA; Department of Bioengineering, University of Utah, James LeVoy Sorenson Molecular Biotechnology Building, 36 S. Wasatch Drive, Rm. 3100, Salt Lake City, UT 84112 USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Maak TG, Anderson AE. In Vivo Measurements of the Ischiofemoral Space in Recreationally Active Participants During Dynamic Activities: A High-Speed Dual Fluoroscopy Study. Am J Sports Med 2017; 45:2901-2910. [PMID: 28682639 PMCID: PMC6599761 DOI: 10.1177/0363546517712990] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ischiofemoral impingement (IFI) is a dynamic process, but its diagnosis is often based on static, supine images. PURPOSE To couple 3-dimensional (3D) computed tomography (CT) models with dual fluoroscopy (DF) images to quantify in vivo hip motion and the ischiofemoral space (IFS) in asymptomatic participants during weightbearing activities and evaluate the relationship of dynamic measurements with sex, hip kinematics, and the IFS measured from axial magnetic resonance imaging (MRI). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Eleven young, asymptomatic adults (5 female) were recruited. 3D reconstructions of the femur and pelvis were generated from MRI and CT. The axial and 3D IFS were measured from supine MRI. In vivo hip motion during weightbearing activities was quantified using DF. The bone-to-bone distance between the lesser trochanter and ischium was measured dynamically. The minimum and maximum IFS were determined and evaluated against hip joint angles using a linear mixed-effects model. RESULTS The minimum IFS occurred during external rotation for 10 of 11 participants. The IFS measured from axial MRI (mean, 23.7 mm [95% CI, 19.9-27.9]) was significantly greater than the minimum IFS observed during external rotation (mean, 10.8 mm [95% CI, 8.3-13.7]; P < .001), level walking (mean, 15.5 mm [95% CI, 11.4-19.7]; P = .007), and incline walking (mean, 15.8 mm [95% CI, 11.6-20.1]; P = .004) but not for standing. The IFS was reduced with extension (β = 0.66), adduction (β = 0.22), and external rotation (β = 0.21) ( P < .001 for all) during the dynamic activities observed. The IFS was smaller in female than male participants for standing (mean, 20.9 mm [95% CI, 19.3-22.3] vs 30.4 mm [95% CI, 27.2-33.8], respectively; P = .034), level walking (mean, 8.8 mm [95% CI, 7.5-9.9] vs 21.1 mm [95% CI, 18.7-23.6], respectively; P = .001), and incline walking (mean, 9.1 mm [95% CI, 7.4-10.8] vs 21.3 mm [95% CI, 18.8-24.1], respectively; P = .003). Joint angles between the sexes were not significantly different for any of the dynamic positions of interest. CONCLUSION The minimum IFS during dynamic activities was smaller than axial MRI measurements. Compared with male participants, the IFS in female participants was reduced during standing and walking, despite a lack of kinematic differences between the sexes. The relationship between the IFS and hip joint angles suggests that the hip should be placed into greater extension, adduction, and external rotation in clinical examinations and imaging, as the IFS measured from static images, especially in a neutral orientation, may not accurately represent the minimum IFS during dynamic motion. Nevertheless, this statement must be interpreted with caution, as only asymptomatic participants were analyzed herein.
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Affiliation(s)
- Penny R. Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA
| | - Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Christopher L. Peters
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA
| | - Travis G. Maak
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive Rm 3100, Salt Lake City, UT 84112, USA,Scientific Computing and Imaging Institute, University of Utah, 72 S Central Campus Drive Rm 3750, Salt Lake City, UT 84112, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way Suite 240, Salt Lake City, UT 84108, USA
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Atkins PR, Elhabian SY, Agrawal P, Harris MD, Whitaker RT, Weiss JA, Peters CL, Anderson AE. Quantitative comparison of cortical bone thickness using correspondence-based shape modeling in patients with cam femoroacetabular impingement. J Orthop Res 2017; 35:1743-1753. [PMID: 27787917 PMCID: PMC5407942 DOI: 10.1002/jor.23468] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/23/2016] [Indexed: 02/04/2023]
Abstract
UNLABELLED The proximal femur is abnormally shaped in patients with cam-type femoroacetabular impingement (FAI). Impingement may elicit bone remodeling at the proximal femur, causing increases in cortical bone thickness. We used correspondence-based shape modeling to quantify and compare cortical thickness between cam patients and controls for the location of the cam lesion and the proximal femur. Computed tomography images were segmented for 45 controls and 28 cam-type FAI patients. The segmentations were input to a correspondence-based shape model to identify the region of the cam lesion. Median cortical thickness data over the region of the cam lesion and the proximal femur were compared between mixed-gender and gender-specific groups. Median [interquartile range] thickness was significantly greater in FAI patients than controls in the cam lesion (1.47 [0.64] vs. 1.13 [0.22] mm, respectively; p < 0.001) and proximal femur (1.28 [0.30] vs. 0.97 [0.22] mm, respectively; p < 0.001). Maximum thickness in the region of the cam lesion was more anterior and less lateral (p < 0.001) in FAI patients. Male FAI patients had increased thickness compared to male controls in the cam lesion (1.47 [0.72] vs. 1.10 [0.19] mm, respectively; p < 0.001) and proximal femur (1.25 [0.29] vs. 0.94 [0.17] mm, respectively; p < 0.001). Thickness was not significantly different between male and female controls. CLINICAL SIGNIFICANCE Studies of non-pathologic cadavers have provided guidelines regarding safe surgical resection depth for FAI patients. However, our results suggest impingement induces cortical thickening in cam patients, which may strengthen the proximal femur. Thus, these previously established guidelines may be too conservative. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1743-1753, 2017.
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Affiliation(s)
- Penny R. Atkins
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
| | - Shireen Y. Elhabian
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Praful Agrawal
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Michael D. Harris
- Program of Physical Therapy, Washington University School of Medicine, Saint Louis, Missouri 63110
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri 63110
| | - Ross T. Whitaker
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Jeffrey A. Weiss
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Christopher L. Peters
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
| | - Andrew E. Anderson
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah 84108
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Atkins PR, Aoki SK, Whitaker RT, Weiss JA, Peters CL, Anderson AE. Does Removal of Subchondral Cortical Bone Provide Sufficient Resection Depth for Treatment of Cam Femoroacetabular Impingement? Clin Orthop Relat Res 2017; 475:1977-1986. [PMID: 28342138 PMCID: PMC5498381 DOI: 10.1007/s11999-017-5326-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/16/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Residual impingement resulting from insufficient resection of bone during the index femoroplasty is the most-common reason for revision surgery in patients with cam-type femoroacetabular impingement (FAI). Development of surgical resection guidelines therefore could reduce the number of patients with persistent pain and reduced ROM after femoroplasty. QUESTIONS/PURPOSES We asked whether removal of subchondral cortical bone in the region of the lesion in patients with cam FAI could restore femoral anatomy to that of screened control subjects. To evaluate this, we analyzed shape models between: (1) native cam and screened control femurs to observe the location of the cam lesion and establish baseline shape differences between groups, and (2) cam femurs with simulated resections and screened control femurs to evaluate the sufficiency of subchondral cortical bone thickness to guide resection depth. METHODS Three-dimensional (3-D) reconstructions of the inner and outer cortical bone boundaries of the proximal femur were generated by segmenting CT images from 45 control subjects (29 males; 15 living subjects, 30 cadavers) with normal radiographic findings and 28 nonconsecutive patients (26 males) with a diagnosis of cam FAI based on radiographic measurements and clinical examinations. Correspondence particles were placed on each femur and statistical shape modeling (SSM) was used to create mean shapes for each cohort. The geometric difference between the mean shape of the patients with cam FAI and that of the screened controls was used to define a consistent region representing the cam lesion. Subchondral cortical bone in this region was removed from the 3-D reconstructions of each cam femur to create a simulated resection. SSM was repeated to determine if the resection produced femoral anatomy that better resembled that of control subjects. Correspondence particle locations were used to generate mean femur shapes and evaluate shape differences using principal component analysis. RESULTS In the region of the cam lesion, the median distance between the mean native cam and control femurs was 1.8 mm (range, 1.0-2.7 mm). This difference was reduced to 0.2 mm (range, -0.2 to 0.9 mm) after resection, with some areas of overresection anteriorly and underresection superiorly. In the region of resection for each subject, the distance from each correspondence particle to the mean control shape was greater for the cam femurs than the screened control femurs (1.8 mm, [range, 1.1-2.9 mm] and 0.0 mm [range, -0.2-0.1 mm], respectively; p < 0.031). After resection, the distance was not different between the resected cam and control femurs (0.3 mm; range, -0.2-1.0; p > 0.473). CONCLUSIONS Removal of subchondral cortical bone in the region of resection reduced the deviation between the mean resected cam and control femurs to within a millimeter, which resulted in no difference in shape between patients with cam FAI and control subjects. Collectively, our results support the use of the subchondral cortical-cancellous bone margin as a visual intraoperative guide to limit resection depth in the correction of cam FAI. CLINICAL RELEVANCE Use of the subchondral cortical-cancellous bone boundary may provide a method to guide the depth of resection during arthroscopic surgery, which can be observed intraoperatively without advanced tooling, or imaging.
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Affiliation(s)
- Penny R. Atkins
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA ,0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA
| | - Stephen K. Aoki
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA
| | - Ross T. Whitaker
- 0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eScientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eSchool of Computing, University of Utah, Salt Lake City, UT USA
| | - Jeffrey A. Weiss
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA ,0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eScientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eSchool of Computing, University of Utah, Salt Lake City, UT USA
| | - Christopher L. Peters
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA ,0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA
| | - Andrew E. Anderson
- 0000 0001 2193 0096grid.223827.eDepartment of Orthopaedics, University of Utah, 590 Wakara Way, Room A100, Salt Lake City, UT 84108 USA ,0000 0001 2193 0096grid.223827.eDepartment of Bioengineering, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eScientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT USA ,0000 0001 2193 0096grid.223827.eDepartment of Physical Therapy, University of Utah, Salt Lake City, UT USA
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Fiorentino NM, Atkins PR, Kutschke MJ, Goebel JM, Foreman KB, Anderson AE. Soft tissue artifact causes significant errors in the calculation of joint angles and range of motion at the hip. Gait Posture 2017; 55:184-190. [PMID: 28475981 PMCID: PMC9840870 DOI: 10.1016/j.gaitpost.2017.03.033] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
Soft tissue movement between reflective skin markers and underlying bone induces errors in gait analysis. These errors are known as soft tissue artifact (STA). Prior studies have not examined how STA affects hip joint angles and range of motion (ROM) during dynamic activities. Herein, we: 1) measured STA of skin markers on the pelvis and thigh during walking, hip abduction and hip rotation, 2) quantified errors in tracking the thigh, pelvis and hip joint angles/ROM, and 3) determined whether model constraints on hip joint degrees of freedom mitigated errors. Eleven asymptomatic young adults were imaged simultaneously with retroreflective skin markers (SM) and dual fluoroscopy (DF), an X-ray technique with sub-millimeter and sub-degree accuracy. STA, defined as the range of SM positions in the DF-measured bone anatomical frame, varied based on marker location, activity and subject. Considering all skin markers and activities, mean STA ranged from 0.3cm to 5.4cm. STA caused the hip joint angle tracked with SM to be 1.9° more extended, 0.6° more adducted, and 5.8° more internally rotated than the hip tracked with DF. ROM was reduced for SM measurements relative to DF, with the largest difference of 21.8° about the internal-external axis during hip rotation. Constraining the model did not consistently reduce angle errors. Our results indicate STA causes substantial errors, particularly for markers tracking the femur and during hip internal-external rotation. This study establishes the need for future research to develop methods minimizing STA of markers on the thigh and pelvis.
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Affiliation(s)
- Niccolo M. Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R. Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J. Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Justine M. Goebel
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA,Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA,Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA,Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA,Corresponding author at: University of Utah Orthopaedics, 590 Wakara Way, RM A-100, Salt Lake City, UT, 84108, USA., (A.E. Anderson)
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Fiorentino NM, Atkins PR, Kutschke MJ, Foreman KB, Anderson AE. In-vivo quantification of dynamic hip joint center errors and soft tissue artifact. Gait Posture 2016; 50:246-251. [PMID: 27693944 PMCID: PMC5119549 DOI: 10.1016/j.gaitpost.2016.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 02/02/2023]
Abstract
Hip joint center (HJC) measurement error can adversely affect predictions from biomechanical models. Soft tissue artifact (STA) may exacerbate HJC errors during dynamic motions. We quantified HJC error and the effect of STA in 11 young, asymptomatic adults during six activities. Subjects were imaged simultaneously with reflective skin markers (SM) and dual fluoroscopy (DF), an x-ray based technique with submillimeter accuracy that does not suffer from STA. Five HJCs were defined from locations of SM using three predictive (i.e., based on regression) and two functional methods; these calculations were repeated using the DF solutions. Hip joint center motion was analyzed during six degrees-of-freedom (default) and three degrees-of-freedom hip joint kinematics. The position of the DF-measured femoral head center (FHC), served as the reference to calculate HJC error. The effect of STA was quantified with mean absolute deviation. HJC errors were (mean±SD) 16.6±8.4mm and 11.7±11.0mm using SM and DF solutions, respectively. HJC errors from SM measurements were all significantly different from the FHC in at least one anatomical direction during multiple activities. The mean absolute deviation of SM-based HJCs was 2.8±0.7mm, which was greater than that for the FHC (0.6±0.1mm), suggesting that STA caused approximately 2.2mm of spurious HJC motion. Constraining the hip joint to three degrees-of-freedom led to approximately 3.1mm of spurious HJC motion. Our results indicate that STA-induced motion of the HJC contributes to the overall error, but inaccuracies inherent with predictive and functional methods appear to be a larger source of error.
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Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA; Scientific Computing and Imaging Institute, 72 S Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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Abstract
BACKGROUND Recent evidence suggests that the frequency response requirements for peak expiratory flow (PEF) meters are higher than was first thought and that the American Thoracic Society (ATS) waveforms to test PEF meters may not be adequate for the purpose. METHODS The dynamic response of mini-Wright (MW), Vitalograph (V), TruZone (TZ), MultiSpiro (MS) and pneumotachograph (PT) flow meters was tested by delivering two differently shaped flow-time profiles from a computer controlled explosive decompression device fitted with a fast response solenoid valve. These profiles matched population 5th and 95th centiles for rise time from 10% to 90% of PEF and dwell time of flow above 90% PEF. Profiles were delivered five times with identical chamber pressure and solenoid aperture at PEF. Any difference in recorded PEF for the two profiles indicates a poor dynamic response. RESULTS The absolute (% of mean) flow differences in l/min for the V, MW, and PT PEF meters were 25 (4.7), 20 (3.9), and 2 (0.3), respectively, at PEF approximately 500 l/min, and 25 (10.5), 20 (8.7) and 6 (3.0) at approximately 200 l/min. For TZ and MS meters at approximately 500 l/min the differences were 228 (36.1) and 257 (39.2), respectively, and at approximately 200 l/min they were 51 (23.9) and 1 (0.5). All the meters met ATS accuracy requirements when tested with their waveforms. CONCLUSIONS An improved method for testing the dynamic response of flow meters detects marked overshoot (underdamping) of TZ and MS responses not identified by the 26 ATS waveforms. This error could cause patient misclassification when using such meters with asthma guidelines.
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Affiliation(s)
- M R Miller
- Department of Medicine, University of Birmingham, Selly Oak Hospital, Birmingham, UK.
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Sawicki E, Atkins PR, Belsky T, Friedel RA, Hyde DL, Monkman JL, Rasmussen RA, Ripperton LA, Sigsby JE, White LD. Addendum to "tentative method for the continuous analysis of total hydrocarbons in the atmosphere (flame ionization method)": flame ionization detector. Health Lab Sci 1973; 10:108-14. [PMID: 4701508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Sawicki E, Atkins PR, Belsky TA, Friedel RA, Hyde DL, Monkman JL, Ripperton LA, Sigsby JE, White LD. Tentative method of analysis for carbonate and non-carbonate carbon in atmospheric particulate matter. Health Lab Sci 1973; 10:119-27. [PMID: 4701510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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