Comparison of the CT-based micromotion analysis method versus marker-based RSA in measuring femoral head translation and evaluation of its intra- and interobserver reliability: a prospective agreement diagnostic study on 27 patients up to 1 year
DOI:
https://doi.org/10.2340/17453674.2024.42705Keywords:
Arthroplasty, CT based Analysis, CT-RSA, CTMA, Hip, Implants, Migration, OsteoarthrosisAbstract
Background and purpose: Computed tomography radiostereometric analysis (CT-RSA) assesses implant micromovements using low-dose CT scans. We aimed to investigate whether CT-RSA is comparable to marker-based radiostereometric analysis (RSA) measuring early femoral head migration in cemented stems. We hypothesized that CT-RSA is comparable to marker-based RSA in evaluating femoral head subsidence.
Methods: We prospectively included 31 patients undergoing cemented total hip arthroplasty (THA), of which 27 were eligible for the analysis. Femoral head migration at 1 year was measured with marker-based RSA and CT-RSA. Comparison was performed using paired analysis and Bland–Altman plots, and the intra- and interobserver reliability of CT-RSA was assessed
Results: The median (interquartile range [IQR]) translation on the Y-axis measured with marker-based RSA was –0.86 mm (–1.10 to –0.37) and –0.83 mm (–1.11 to –0.48) for CT-RSA (i.e. subsidence), with a median difference of –0.03 mm (95% confidence interval [CI] –0.08 to 0.18). The minimal important difference in translation was set to 0.2 mm. This value was excluded from the CI of the differences. No statistical difference was found between marker-based RSA and CT-RSA regarding assessment of subsidence of the femoral head. The Bland–Altman plots showed good agreement between the 2 methods in measuring subsidence of the femoral head. The intra- and interobserver reliability of the CT-RSA method was excellent with intraclass correlation coefficient (ICC) = 1 (0.99–1) and ICC = 0.99 (0.99–1), respectively.
Conclusion: We showed that CT-RSA was comparable to marker-based RSA in measuring femoral head subsidence. Moreover, the intra- and interobserver reliability of the CT-RSA method was excellent, suggesting that the method is assessor independent.
Downloads
References
van der Voort P, Pijls B G, Nieuwenhuijse M J, Jasper J, Fiocco M, Plevier J W M, et al. Early subsidence of shape-closed hip arthroplasty stems is associated with late revision. Acta Orthop 2015: 575-85. doi: 10.3109/17453674.2015.1043832. DOI: https://doi.org/10.3109/17453674.2015.1043832
Klerken T, Mohaddes M, Nemes S, Kärrholm J. High early migration of the revised acetabular component is a predictor of late cup loosening: 312 cup revisions followed with radiostereometric analysis for 2-20 years. Hip Int 2015; 25(5): 471-6. doi: 10.5301/hipint.5000246. DOI: https://doi.org/10.5301/hipint.5000246
Pijls B G, Nieuwenhuijse M J, Fiocco M, Plevier J W M, Middeldorp S, Nelissen R G H H, et al. Early proximal migration of cups is associated with late revision in THA: a systematic review and meta-analysis of 26 RSA studies and 49 survival studies. Acta Orthop 2012; 83(6): 583-91. doi: 10.3109/17453674.2012.745353. DOI: https://doi.org/10.3109/17453674.2012.745353
Angelomenos V, Mohaddes M, Itayem R, Shareghi B. Precision of low-dose CT-based micromotion analysis technique for the assessment of early acetabular cup migration compared with gold standard RSA: a prospective study of 30 patients up to 1 year. Acta Orthop 2022; 93: 459-65. doi: 10.2340/17453674.2022.2528. DOI: https://doi.org/10.2340/17453674.2022.2528
Lorenzen ND, Stilling M, Jakobsen S S, Gustafson K, Søballe K, Baad-Hansen T. Marker-based or model-based RSA for evaluation of hip resurfacing arthroplasty? A clinical validation and 5-year follow-up. Arch Orthop Trauma Surg 2013; 133(11): 1613-21. doi: 10.1007/s00402-013-1850-2. DOI: https://doi.org/10.1007/s00402-013-1850-2
Su A W, Hillen T J, Eutsler E P, Bedi A, Ross J R, Larson C M, et al. Low-dose computed tomography reduces radiation exposure by 90% compared with traditional computed tomography among patients undergoing hip-preservation surgery. Arthroscopy 2019; 35(5): 1385-92. doi: 10.1016/j.arthro.2018.11.013. DOI: https://doi.org/10.1016/j.arthro.2018.11.013
Trattner S, Pearson G D N, Chin C, Cody D D, Gupta R, Hess C P, et al. Standardization and optimization of CT protocols to achieve low dose. J Am Coll Radiol 2014; 11(3). doi: 10.1016/j.jacr.2013.10.016. DOI: https://doi.org/10.1016/j.jacr.2013.10.016
Gjesteby L, de Man B, Jin Y, Paganetti H, Verburg J, Giantsoudi D, et al. Metal artifact reduction in CT: where are we after four decades? IEEE Access 2016; 4. doi: 10.1109/ACCESS.2016.2608621. DOI: https://doi.org/10.1109/ACCESS.2016.2608621
Otten V, Maguire G Q, Noz M E, Zeleznik M P, Nilsson K G, Olivecrona H. Are CT scans a satisfactory substitute for the follow-up of RSA migration studies of uncemented cups? A comparison of RSA double examinations and CT dtasets of 46 total hip arthroplasties. BioMed Res Int 2017; 2017. doi: 10.1155/2017/3681458. DOI: https://doi.org/10.1155/2017/3681458
Christensson A, Nemati H M, Flivik G. Comparison between model-based RSA and an AI-based CT-RSA: an accuracy study of 30 patients. Acta Orthop 2024; 95: 39-46. doi: 10.2340/17453674.2024.35749. DOI: https://doi.org/10.2340/17453674.2024.35749
Sandberg O, Tholén S, Carlsson S, Wretenberg P. The anatomical SP-CL stem demonstrates a non-progressing migration pattern in the first year: a low dose CT-based migration study in 20 patients. Acta Orthop 2020; 91(6): 654-59. doi: 10.1080/17453674.2020.1832294 DOI: https://doi.org/10.1080/17453674.2020.1832294
Angelomenos V, Mohaddes M, Kärrholm J, Malchau H, Shareghi B, Itayem R. A prospective randomized study of Refobacin Bone Cement R versus Palacos R + G. Bone Joint J 2024; 106-B(5): 435-41. doi: 10.1302/0301-620X.106B5.BJJ-2023-0999.R1. DOI: https://doi.org/10.1302/0301-620X.106B5.BJJ-2023-0999.R1
Annual reports – The Swedish Arthroplasty Register. Available from: https://sar.registercentrum.se/about-the-register/annual-reports/p/SJW4-ZGyo [accessed April 18, 2023].
Kärrholm J, Herberts P, Hultmark P, Malchau H, Nivbrant B, Thanner J. Radiostereometry of hip prostheses: review of methodology and clinical results. Clinical Orthop Relat Res 1997; (344): 94-110. Pubmed 9372762 DOI: https://doi.org/10.1097/00003086-199711000-00011
ISO 16087:2013(en), Implants for surgery — Roentgen stereophotogrammetric analysis for the assessment of migration of orthopaedic implants. Available from: https://www.iso.org/obp/ui/#iso:std:iso:16087:ed-1:v1:en [accessed April 17, 2023].
Söderkvist I, Wedin P Å. On condition numbers and algorithms for determining a rigid body movement. BIT Numer Math 1994; 34(3): 424-36. doi: 10.1007/BF01935651. DOI: https://doi.org/10.1007/BF01935651
Ranstam J. Methodological note: accuracy, precision, and validity. Acta Radiol 2008; 49(1): 105-6. doi: 10.1080/02841850701772706. DOI: https://doi.org/10.1080/02841850701772706
Koo T K, Li M Y. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15(2): 155. doi: 10.1016/J.JCM.2016.02.012. DOI: https://doi.org/10.1016/j.jcm.2016.02.012
Bland J M, Altman D G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 327(8476): 307-10. PMID: 2868172 DOI: https://doi.org/10.1016/S0140-6736(86)90837-8
Bland J M, Altman D G. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8(2): 135-60. doi: 10.1177/096228029900800204. DOI: https://doi.org/10.1191/096228099673819272
Scheerlinck T, Polfliet M, Deklerck R, Van Gompel G, Buls N, Vandemeulebroucke J. Development and validation of an automated and marker-free CT-based spatial analysis method (CTSA) for assessment of femoral hip implant migration: in vitro accuracy and precision comparable to that of radiostereometric analysis (RSA). Acta Orthop 2016; 87(2): 139-45. doi: 10.3109/17453674.2015.1123569. DOI: https://doi.org/10.3109/17453674.2015.1123569
Brodén C, Olivecrona H, Maguire G Q, Noz M E, Zeleznik M P, Sköldenberg O. Accuracy and precision of three-dimensional low dose CT compared to standard RSA in acetabular cups: an experimental study. BioMed Res Int 2016; 2016: 5909741. doi: 10.1155/2016/5909741. DOI: https://doi.org/10.1155/2016/5909741
Brodén C, Giles J W, Popat R, Fetherston S, Olivecrona H, Sandberg O, et al. Accuracy and precision of a CT method for assessing migration in shoulder arthroplasty: an experimental study. Acta Radiol 2019; 284185119882659. doi: 10.1177/0284185119882659. DOI: https://doi.org/10.1177/0284185119882659
Brodén C, Sandberg O, Sköldenberg O, Stigbrand H, Hänni M, Giles J W, et al. Low-dose CT-based implant motion analysis is a precise tool for early migration measurements of hip cups: a clinical study of 24 patients. Acta Orthop 2020; 1-6. doi: 10.1080/17453674.2020.1725345. DOI: https://doi.org/10.1080/17453674.2020.1725345
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
Sandgren B, Skorpil M, Nowik P, Olivecrona H, Crafoord J, Weidenhielm L, et al. Assessment of wear and periacetabular osteolysis using dual energy computed tomography on a pig cadaver to identify the lowest acceptable radiation dose. Bone Joint Res 2016; 5(7): 307-13. doi: 10.1302/2046-3758.57.2000566. DOI: https://doi.org/10.1302/2046-3758.57.2000566
Øhrn F D, Engseth L H W, Pripp A H, Röhrl S M H, Schulz A. Dose reduction does not impact the precision of CT-based RSA in tibial implants: a diagnostic accuracy study on precision in a porcine cadaver. Acta Orthop 2023; 94: 550-4. doi: 10.2340/17453674.2023.24022. DOI: https://doi.org/10.2340/17453674.2023.24022
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): 1-395. doi: 10.1080/17453674.2020.1767443 DOI: https://doi.org/10.1080/17453674.2020.1767443
Poulsen M, Stødle A H, Nordsletten L, Röhrl S M. CT-based radiostereometric analysis for assessing midfoot kinematics: precision compared with marker-based radiostereometry. Acta Orthop 2023; 94: 366-72. doi: 10.2340/17453674.2023.16905. DOI: https://doi.org/10.2340/17453674.2023.16905
Weber E, Olsson C, Kesteris U, Flivik G. Is a hollow centralizer necessary when using a polished, tapered, cemented femoral stem? Acta Orthop 2017; 88(4): 377-82. doi: 10.1080/17453674.2017.1315553. DOI: https://doi.org/10.1080/17453674.2017.1315553
Murray D W, Gulati A, Gill H S. Ten-year RSA-measured migration of the Exeter femoral stem. Bone Joint J 2013; 95-B(5): 605-8. doi: 10.1302/0301-620X.95B5.31330. DOI: https://doi.org/10.1302/0301-620X.95B5.31330
Sandberg O H, Kärrholm J, Olivecrona H, Röhrl S M, Sköldenberg O G, Brodén C. Computed tomography-based radiostereometric analysis in orthopedic research: practical guidelines. Acta Orthop 2023; 94: 373-8. doi: 10.2340/17453674.2023.15337. DOI: https://doi.org/10.2340/17453674.2023.15337
Additional Files
Published
How to Cite
License
Copyright (c) 2025 Vasileios Angelomenos, Bita Shareghi, Raed Itayem, Maziar Mohaddes
This work is licensed under a Creative Commons Attribution 4.0 International License.
