Computed tomography-based radiostereometric analysis in orthopedic research: practical guidelines
DOI:
https://doi.org/10.2340/17453674.2023.15337Keywords:
Arthroplasty, CT-based radiostereometric analysis, Implants, radiostereometric analysisAbstract
Early implant migration is an indicator of the long-term survival/failure of implants. CT-based radio-stereometric analysis (CT-RSA) is a precise method for measuring and visualizing implant migration in vivo using image processing of CT scans. This makes the method widely applicable to orthopedic researcher.
Since its development in the early 2000s, CT-RSA has benefited from breakthroughs in CT and computing technology. These advancements have allowed for the acquisition of images with higher resolution at a much lower radiation dose. As a result, the measurement precision of CT-RSA is now comparable to that of the current gold standard technology while still compatible with most ethical considerations regarding radiation exposure.
In this review we present bests practices for the successful execution of CT-RSA research projects. These practices are based on experience from projects on the hip, knee, shoulder, lower back, cervical spine, foot, pelvis, and wrist.
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Hasan S, Marang-van de Mheen P J, Kaptein B L, Nelissen R G H H, Pijls B G. RSA-tested TKA implants on average have lower mean 10-year revision rates than non-RSA-tested designs. Clin Orthop Relat Res 2020; 478(6): 1232-41. doi: 10.1097/CORR.0000000000001209. DOI: https://doi.org/10.1097/CORR.0000000000001209
Nelissen R G H H, Pijls B G, Kärrholm J, Malchau H, Nieuwenhuijse M J, Valstar E R. RSA and registries: the quest for phased introduction of new implants. J Bone Joint Surg Am 2011; 93(Suppl. 3): 62-5. doi: 10.2106/JBJS.K.00907. DOI: https://doi.org/10.2106/JBJS.K.00907
Wretenberg P, Carlsson S, Tholen S, Olivecrona H. Implant movement analysis (IMA), a new CT based technique for diagnosis of aseptic loosening of total knee arthroplasty. Orthop Res Online J 2021; 8(3): 868-72. doi: 10.31031/OPROJ.2021.08.000690. DOI: https://doi.org/10.31031/OPROJ.2021.08.000690
Brodén C, Reilly P, Khanna M, Popat R, Olivecrona H, Griffiths D, et al. CT-based micromotion analysis method can assess early implant migration and development of radiolucent lines in cemented glenoid components: a clinical feasibility study. Acta Orthop 2022; 93: 277-83. doi: 10.2340/17453674.2022.1976. DOI: https://doi.org/10.2340/17453674.2022.1976
Berger R, Fletcher F, Donaldson T, Wasielewski R, Peterson M, Rubash H. Dynamic test to diagnose loose uncemented femoral total hip components. Clin Orthop Relat Res 1996; (330): 115-23. doi: 10.1097/00003086-199609000-00014. DOI: https://doi.org/10.1097/00003086-199609000-00014
Sandberg O, Carlsson S, Harbom E, Cappelen V, Tholén S, Olivecrona H, et al. Inducible displacement CT increases the diagnostic accuracy of aseptic loosening in primary total hip arthroplasty. Acta Orthop 2022; 93: 831-6. doi: 10.2340/17453674.2022.5240. DOI: https://doi.org/10.2340/17453674.2022.5240
Stigbrand H, Brown K, Olivecrona H, Ullmark G. Implant migration and bone mineral density measured simultaneously by low-dose CT scans: a 2-year study on 17 acetabular revisions with impaction bone grafting. Acta Orthop 2020; 91(5): 571-5. doi: 10.1080/17453674.2020.1769295. DOI: https://doi.org/10.1080/17453674.2020.1769295
Brouwers M C, Kerkvliet K, Spithoff K; AGREE Next Steps Consortium. The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ 2016;3 52: i1152. doi: 10.1136/bmj.i1152. DOI: https://doi.org/10.1136/bmj.i1152
Valstar E R, Gill R, Ryd L, Flivik G, Börlin N, Kärrholm J. Guidelines for standardization of radiostereometry (RSA) of implants. Acta Orthop 2005; 76(4): 563-72. doi: 10.1080/17453670510041574. DOI: https://doi.org/10.1080/17453670510041574
ISO SIoIS. ISO 16087:2013 Implants for surgery: Roentegen stereophotogrammetric analysis for the assessment of migration of orthopaedic implants. Geneva: ISO.
European Commission. Radiation Protection 99. Guidance on medical exposures in medical and biomedical research; 1998. Available from: https://energy.ec.europa.eu/system/files/2014-11/099_en_1.pdf.
Geijer M, Rundgren G, Weber L, Flivik G. Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty. Acta Radiol 2017; 58(10): 1276-82. doi: 10.1177/0284185117693462. DOI: https://doi.org/10.1177/0284185117693462
Valstar E R, De Jong F W, Vrooman H A, Rozing P M, Reiber J H C. Model-based Roentgen stereophotogrammetry of orthopaedic implants. J Biomech 2001; 34(6): 715-22. doi: 10.1016/s0021-9290(01)00028-8. DOI: https://doi.org/10.1016/S0021-9290(01)00028-8
Blom I F, Koster L A, Brinke B Ten, Mathijssen N M C. Effective radiation dose in radiostereometric analysis of the hip. Acta Orthop 2020; 91(4): 390-5. doi: 10.1080/17453674.2020.1767443. DOI: https://doi.org/10.1080/17453674.2020.1767443
Brodén C, Sandberg O, Olivecrona H, Emery R, Sköldenberg O. Precision of CT-based micromotion analysis is comparable to radiostereometry for early migration measurements in cemented acetabular cups. Acta Orthop 2021; 92(4): 419-23. doi: 10.1080/17453674.2021.1906082. DOI: https://doi.org/10.1080/17453674.2021.1906082
Pijls B G, Nieuwenhuijse M J, Fiocco M, Plevier J W, Middeldorp S, Nelissen R G, et al. Early proximal migration of cups is associated with late revision in THA. Acta Orthop 2012; 83(6): 583-91. doi: 10.3109/17453674.2012.745353. DOI: https://doi.org/10.3109/17453674.2012.745353
Kärrholm J, Borssén B, Löwenhielm G, Snorrason F. Does early micromotion of femoral stem prostheses matter? 4–7-year stereoradiographic follow-up of 84 cemented prostheses. J Bone Joint Surg Br 1994;76(6): 912-17. DOI: https://doi.org/10.1302/0301-620X.76B6.7983118
Ryd L, Albrektsson B E, Carlsson L, Dansgard F, Herberts P, Lindstrand A, et al. Roentgen stereophotogrammetric analysis as a predictor of mechanical loosening of knee prostheses. J Bone Joint Surg Br 1995; 77(3): 377-83. DOI: https://doi.org/10.1302/0301-620X.77B3.7744919
Gudnason A, Adalberth G, Nilsson K-G, Hailer N P. Tibial component rotation around the transverse axis measured by radiostereometry predicts aseptic loosening better than maximal total point motion. Acta Orthop 2017; 88(3): 282-7. doi: 10.1080/17453674.2017.1297001. DOI: https://doi.org/10.1080/17453674.2017.1297001
Dyreborg K, Andersen M R, Winther N, Solgaard S, Flivik G, Petersen M M. Migration of the uncemented Echo Bi-Metric and Bi-Metric THA stems: a randomized controlled RSA study involving 62 patients with 24-month follow-up. Acta Orthop 2020; 91(6): 693-8. doi: 10.1080/17453674.2020.1802682. DOI: https://doi.org/10.1080/17453674.2020.1802682
Eriksson T, Maguire G Q, Noz M E, Zeleznik M P, Olivecrona H, Shalabi A, et al. Are low-dose CT scans a satisfactory substitute for stereoradiographs for migration studies? A preclinical test of low-dose CT scanning protocols and their application in a pilot patient. Acta Radiol 2019; 60(12): 1643-52. doi: 10.1177/0284185119844166. DOI: https://doi.org/10.1177/0284185119844166
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Copyright (c) 2023 Olof H Sandberg, Johan Kärrholm, Henrik Olivecrona, Stephan M Röhrl, Olof G Sköldenberg, Cyrus Brodén
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