The accuracy and precision of CT-RSA in arthroplasty: a systematic review and meta-analysis
DOI:
https://doi.org/10.2340/17453674.2025.43334Keywords:
Arthroplasty, Hip, Knee, Radiological imaging, Shoulder, SpineAbstract
Background and purpose: Computed tomography-based radiostereometric analysis (CT-RSA) is an alternative to conventional radiostereometric analysis (RSA) in measuring implant migration, circumventing the need for operative insertion of tantalum markers. The accuracy and precision of different CT-RSA techniques in various joints are still unclear, and the effective radiation dose (ED) of CT-RSA is usually higher than RSA. In this systematic literature review, we aimed to provide an overview of the accuracy, precision, clinical precision, and ED of CT-RSA techniques.
Methods: We performed a systematic search in PubMed, Cochrane, and Embase databases. Main search items were “arthroplasty” AND “migration” AND “computed tomography.” We included full-text English papers, using CT for migration analysis (CT-RSA) in human, animal, or synthetic models with arthroplasties, reporting accuracy and/or precision. Eligible studies were screened and reviewed by 2 authors independently. Main outcomes were accuracy, precision, and clinical precision of CT-RSA in 6 degrees of freedom. Secondary outcome was the mean ED. A meta-analysis on (clinical) precision of CT-RSA was performed.
Results: 23 studies were included involving 163 patients, 20 human cadaveric, 3 porcine cadaveric, and 7 synthetic models. 6 different CT-RSA techniques were used to study 6 different joint components in cervical disc replacement and shoulder, hip, and knee arthroplasty. CT-RSA accuracy ranged between 0.02 and 0.71 mm and 0.03° and 1.00°. CT-RSA precision ranged between 0.00 and 0.47 mm and 0.00° and 1.09°. Mean precision was 0.15 mm (95% confidence interval [CI] 0.05–0.25) in the acetabulum, 0.13 mm (CI 0.00–0.28) and 0.24° (CI 0.00–0.51) in the proximal femur, and 0.04 mm (CI 0.00–0.08) and 0.07° (CI 0.00–0.15) in the proximal tibia. CT-RSA clinical precision ranged between 0.03 and 1.36 mm and 0.06° and 2.25°. Mean clinical precision was 0.13 mm (CI 0.11–0.16) and 0.26° (CI 0.20–0.32) in the acetabulum. The mean ED of CT-RSA ranged between 0.02 and 5.80 mSv.
Conclusion: CT-RSA shows comparable accuracy and precision to standard RSA. CT-RSA seems to be a promising alternative to RSA.
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