TY - JOUR
T1 - Promising results of an non-invasive measurement of knee implant loosening using a loading device, CT-scans and 3D image analysis
AU - Kievit, Arthur J.
AU - Buijs, George S.
AU - Dobbe, Johannes G. G.
AU - ter Wee, Annemiek
AU - Streekstra, Geert J.
AU - Schafroth, Matthias U.
AU - Blankevoort, Leendert
AU - Kerkhoffs, Gino M. M. J.
N1 - Funding Information: This study has been conducted following the recommendations of Committee of Ministers as stated in The Recommendation Rec (2006)4 ( Ministers Co, 2006 ; Pierannunzii, 2015 ). This study was funded by an internal pre-seed grand from the Amsterdam University Medical Centers. Publisher Copyright: © 2023
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Background: After total knee arthroplasty up to 13% requires revision surgery to address loosening. No current diagnostic modalities have a sensitivity or specificity higher than 70–80% to detect loosening, leading to 20–30% of patients undergoing unnecessary, risky and expensive revision surgery. A reliable imaging modality is required to diagnose loosening. This study presents a new and non-invasive method and evaluates its reproducibility and reliability in a cadaveric study. Methods: Ten cadaveric specimens were implanted with a loosely fitted tibial components and CT scanned under load towards valgus and varus using a loading device. Advanced three-dimensional imaging software was used to quantify displacement. Subsequently, the implants were fixed to the bone and scanned to determine the differences between the fixed and the loose state. Reproducibility errors were quantified using a frozen specimen in which displacement was absent. Findings: Reproducibility errors, expressed as mean target registration error, screw-axis rotation and maximum total point motion were 0.073 mm (SD 0.033), 0.129 degrees (SD 0.039) and 0.116 mm (SD 0.031), respectively. In the loose condition, all displacements and rotation changes were larger than the reported reproducibility errors. Comparing the mean target registration error, screw axis rotation and maximum total point motion in the loose condition to the fixed condition resulted in mean differences of 0.463 mm (SD 0.279; p = 0.001), 1.769 degrees (SD 0.868; p < 0.001) and 1.339 mm (SD 0.712; p < 0.001), respectively. Interpretation: The results of this cadaveric study show that this non-invasive method is reproducible and reliable for detection of displacement differences between fixed and loose tibial components.
AB - Background: After total knee arthroplasty up to 13% requires revision surgery to address loosening. No current diagnostic modalities have a sensitivity or specificity higher than 70–80% to detect loosening, leading to 20–30% of patients undergoing unnecessary, risky and expensive revision surgery. A reliable imaging modality is required to diagnose loosening. This study presents a new and non-invasive method and evaluates its reproducibility and reliability in a cadaveric study. Methods: Ten cadaveric specimens were implanted with a loosely fitted tibial components and CT scanned under load towards valgus and varus using a loading device. Advanced three-dimensional imaging software was used to quantify displacement. Subsequently, the implants were fixed to the bone and scanned to determine the differences between the fixed and the loose state. Reproducibility errors were quantified using a frozen specimen in which displacement was absent. Findings: Reproducibility errors, expressed as mean target registration error, screw-axis rotation and maximum total point motion were 0.073 mm (SD 0.033), 0.129 degrees (SD 0.039) and 0.116 mm (SD 0.031), respectively. In the loose condition, all displacements and rotation changes were larger than the reported reproducibility errors. Comparing the mean target registration error, screw axis rotation and maximum total point motion in the loose condition to the fixed condition resulted in mean differences of 0.463 mm (SD 0.279; p = 0.001), 1.769 degrees (SD 0.868; p < 0.001) and 1.339 mm (SD 0.712; p < 0.001), respectively. Interpretation: The results of this cadaveric study show that this non-invasive method is reproducible and reliable for detection of displacement differences between fixed and loose tibial components.
KW - Aseptic loosening
KW - Diagnostic 3D imaging
KW - Total knee arthroplasty
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85150391529&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36906985
UR - http://www.scopus.com/inward/record.url?scp=85150391529&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.clinbiomech.2023.105930
DO - https://doi.org/10.1016/j.clinbiomech.2023.105930
M3 - Article
C2 - 36906985
SN - 0268-0033
VL - 104
JO - Clinical Biomechanics
JF - Clinical Biomechanics
M1 - 105930
ER -