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Ziegenhorn J, Kirschberg J, Heinecke M, von Eisenhart-Rothe R, Matziolis G. Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4. Knee Surg Sports Traumatol Arthrosc 2024; 32:1199-1206. [PMID: 38511851 DOI: 10.1002/ksa.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The purpose of this study was to find out whether the torsions of the femur and tibia are dependent on the coronal plane alignment of the knee (CPAK) type. METHODS Five hundred patients (1000 legs) were included, who received a whole leg standing three-dimensional (3D) radiograph using EOS imaging (EOS Imaging, Paris, France). SterEOS software was used for digital reconstruction. Femoral and tibial torsions were determined by analysing 3D reconstructions of each leg. Femoral torsion was defined as the angle between the femoral neck axis (FNA) and the posterior condylar axis (PCA). Tibial torsion was defined as the angle between the axis tangent to the posterior part of the tibia plateau and the transmalleolar axis. Arithmetic hip-knee-ankle angle (aHKA) and joint-line obliquity (JLO) were also determined, allowing each leg to be assigned one of nine possible phenotypes according to CPAK. RESULTS The mean femoral torsion in CPAK type 1 was significantly higher (+ 2.6° ± 0.8°) than in CPAK type 4 (p = 0.02). All other CPAK types did not differ in the degree of femoral torsions. No differences could be demonstrated for the tibial torsion. CONCLUSION There is a correlation between the coronal alignment of the lower limb and femoral torsion. This may provide the basis for extending the CPAK classification beyond the coronal plane. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jonas Ziegenhorn
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - Julia Kirschberg
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Markus Heinecke
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- German Knee Society (DKG), Munich, Germany
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
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Castille J, Remy S, Vermue H, Victor J. The use of virtual reality to assess the bony landmarks at the knee joint - The role of imaging modality and the assessor's experience. Knee 2024; 46:41-51. [PMID: 38061164 DOI: 10.1016/j.knee.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND At present, extended reality technologies such as virtual reality (VR) have gained popularity in orthopedic surgery. The first aim of this study was to assess the precision of VR and other imaging modalities - computed tomography (CT), magnetic resonance imaging (MRI) - to localize bony landmarks near the knee joint. Secondly, the impact of the educational level of the assessor - medical master students, orthopedic residents, and orthopedic surgeons - on the precision with which landmarks near the knee joint could be localized was analyzed. METHODS We included a total of 77 participants: 62 medical master students, 10 orthopedic residents, and 5 orthopedic surgeons to analyze three cadaver legs. Every participant localized a series of sixteen bony landmarks on six different imaging modalities (CT, MRI, 3D-CT, 3D-MRI, VR-CT, VR-MRI). RESULTS Concerning the imaging modality, the inter- and intra-observer variability were lowest for 3D and VR, higher for MRI (respectively 7.6 mm and 6.9 mm), and highest for CT (respectively 9 mm and 8.7 m).Concerning the educational level of the assessor, inter- and intra-observer variability in VR were lowest for surgeons, (respectively 3.2 mm and 3.6 mm), higher for residents (respectively 5.9 mm and 6.5 mm) and medical students (respectively 5.9 mm and 5.8 mm). CONCLUSIONS VR can be considered a reliable imaging technique. Localization of landmarks tends to be more precise in VR and on 3D than on conventional CT and MRI images. Furthermore, orthopedic surgeons localize landmarks more precisely than orthopedic residents and medical students in VR.
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Affiliation(s)
- Jocelyn Castille
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Stijn Remy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Hannes Vermue
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Jan Victor
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Fernandes LR, Arce C, Martinho G, Campos JP, Meneghini RM. Accuracy, Reliability, and Repeatability of a Novel Artificial Intelligence Algorithm Converting Two-Dimensional Radiographs to Three-Dimensional Bone Models for Total Knee Arthroplasty. J Arthroplasty 2023; 38:2032-2036. [PMID: 36503105 DOI: 10.1016/j.arth.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With the emergence of advanced technology, such as robotics, three-dimensional (3D) imaging is necessary to execute preoperative surgical plans accurately. However, 3D imaging adds cost and potential risk to patients. This study determined the measurement accuracy, reliability, and repeatability of a novel artificial intelligence (AI) algorithm which converts two-dimensional (2D) radiographs to 3D bone models. METHODS An AI algorithm was developed to convert 2D radiographs to 3D bone model reconstructions. The accuracy of the AI algorithm was evaluated by comparing mean absolute error in measurements performed on 3D bone reconstructions, 3D computed tomography (CT) scans, and manual measurements on five cadaveric knees. Reliability and repeatability of the AI algorithm were evaluated by assessing the inter-observer and intra-observer agreement between measurements performed on 3D bone reconstructions, respectively. RESULTS Accuracy of the AI algorithm was considered excellent with mean absolute errors <2mm in 9 of 12 anatomical parameters compared with measurements performed on CTs and manual calipers. All inter-observer and intra-observer correlation coefficients were greater than 0.90 representing a high level of measurement reliability and repeatability by independent observers and the same observers. CONCLUSION This particular AI algorithm demonstrated a high degree of accuracy, reliability, and repeatability for converting 2D radiographs to 3D bone reconstructions similar to a CT-scan. Study results suggest this AI algorithm has the potential for use in preoperative surgical planning due to its efficiencies related to cost and time and reduced radiation exposure without the use of 3D imaging.
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Affiliation(s)
| | - Carlos Arce
- Department of Orthopaedic Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Gonçalo Martinho
- Department of Orthopaedic Surgery, Hospital CUF Santarém, Santarém, Portugal
| | - João Pedro Campos
- Department of Orthopaedic Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Maeztu Redin D, Caroux J, Rohan PY, Pillet H, Cermolacce A, Trnka J, Manassero M, Viateau V, Corté L. A wear model to predict damage of reconstructed ACL. J Mech Behav Biomed Mater 2022; 136:105426. [PMID: 36208581 DOI: 10.1016/j.jmbbm.2022.105426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/07/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
Impingement with surrounding tissues is a major cause of failure of anterior cruciate ligament reconstruction. However, the complexity of the knee kinematics and anatomical variations make it difficult to predict the occurrence of contact and the extent of the resulting damage. Here we hypothesise that a description of wear between the reconstructed ligament and adjacent structures captures the in vivo damage produced with physiological loadings. To test this, we performed an in vivo study on a sheep model and investigated the role of different sources of damage: overstretching, excessive twist, excessive compression, and wear. Seven sheep underwent cranial cruciate ligament reconstruction using a tendon autograft. Necropsy observations and pull-out force measurements performed postoperatively at three months showed high variability across specimens of the extent and location of graft damage. Using 3D digital models of each stifle based on X-ray imaging and kinematics measurements, we determined the relative displacements between the graft and the surrounding bones and computed a wear index describing the work of friction forces underwent by the graft during a full flexion-extension movement. While tensile strain, angle of twist and impingement volume showed no correlation with pull-out force (ρ = -0.321, p = 0.498), the wear index showed a strong negative correlation (r = -0.902, p = 0.006). Moreover, contour maps showing the distribution of wear on the graft were consistent with the observations of damage during the necropsy. These results demonstrate that wear is a good proxy of graft damage. The proposed wear index could be used in implant design and surgery planning to minimise the risk of implant failure. Its application to sheep can provide a way to increase preclinical testing efficiency.
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Affiliation(s)
- Deyo Maeztu Redin
- Centre des Matériaux, Mines Paris, PSL University, Évry, France; Molecular, Macromolecular Chemistry and Materials, ESPCI Paris, PSL University, Paris, France.
| | - Julien Caroux
- Centre des Matériaux, Mines Paris, PSL University, Évry, France; Molecular, Macromolecular Chemistry and Materials, ESPCI Paris, PSL University, Paris, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Alexia Cermolacce
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Sup, France
| | - Julien Trnka
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Sup, France
| | - Mathieu Manassero
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Sup, France; Laboratoire de Biologie, Bioingénierie et Bioimagerie Ostéo-Articulaire, UMR CNRS 7052, INSERM U1271, 75010, Paris, France
| | - Véronique Viateau
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est Sup, France; Laboratoire de Biologie, Bioingénierie et Bioimagerie Ostéo-Articulaire, UMR CNRS 7052, INSERM U1271, 75010, Paris, France
| | - Laurent Corté
- Centre des Matériaux, Mines Paris, PSL University, Évry, France; Molecular, Macromolecular Chemistry and Materials, ESPCI Paris, PSL University, Paris, France
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Kerbrat A, Rivals I, Dupuy P, Dot G, Berg BI, Attali V, Schouman T. Biplanar Low-Dose Radiograph Is Suitable for Cephalometric Analysis in Patients Requiring 3D Evaluation of the Whole Skeleton. J Clin Med 2021; 10:5477. [PMID: 34884179 PMCID: PMC8658104 DOI: 10.3390/jcm10235477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The biplanar 2D/3D X-ray technology (BPXR) is a 2D/3D imaging system allowing simultaneous stereo-corresponding posteroanterior (PA) and lateral 2D views of the whole body. The aim of our study was to assess the feasibility of cephalometric analysis based on the BPXR lateral skull view to accurately characterize facial morphology. METHOD A total of 17 landmarks and 11 angles were placed and/or calculated on lateral BPXR and lateral cephalograms of 13 patients by three investigators. Five methods of angle identification were performed: the direct construction of straight lines on lateral cephalograms (LC-A) and on BPXR (BPXR-A), as well as the calculation of angles based on landmark identification on lateral cephalograms (LA-L) and on BPXR with the PA image (BPXR-LPA) or without (BPXR-L). Intra- and interoperator reliability of landmark identification and angle measurement of each method were calculated. To determine the most reliable method among the BPXR-based methods, their concordance with the reference method, LC-A, was evaluated. RESULTS Both imaging techniques had excellent intra- and interoperator reliability for landmark identification. On lateral BPXR, BPXR-A presented the best concordance with the reference method and a good intra- and interoperator reliability. CONCLUSION BPXR provides a lateral view of the skull suitable for cephalometric analysis with good reliability.
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Affiliation(s)
- Adeline Kerbrat
- Service de Chirurgie Maxillo-Faciale, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, 75013 Paris, France; (P.D.); (T.S.)
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France; (G.D.); (V.A.)
- Sorbonne Université, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France;
| | - Isabelle Rivals
- Sorbonne Université, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France;
- Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, 75231 Paris, France
| | - Pauline Dupuy
- Service de Chirurgie Maxillo-Faciale, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, 75013 Paris, France; (P.D.); (T.S.)
| | - Gauthier Dot
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France; (G.D.); (V.A.)
| | - Britt-Isabelle Berg
- Department of Cranio-Maxillofacial Surgery, University Hospital Basel, CH-4031 Basel, Switzerland;
| | - Valérie Attali
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France; (G.D.); (V.A.)
- Sorbonne Université, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France;
- Service des Pathologies du Sommeil, Département R3S, Hôpital Pitié-Salpêtrière, AP-HP. Sorbonne Université, 75013 Paris, France
| | - Thomas Schouman
- Service de Chirurgie Maxillo-Faciale, Hôpital Pitié-Salpêtrière, AP-HP Sorbonne Université, 75013 Paris, France; (P.D.); (T.S.)
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France; (G.D.); (V.A.)
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Effects of Total Knee Arthroplasty on Coronal and Sagittal Whole-Body Alignments: Serial Assessments Using Whole-Body EOS. J Clin Med 2021; 10:jcm10153242. [PMID: 34362027 PMCID: PMC8348330 DOI: 10.3390/jcm10153242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The aims of this study were to evaluate the effects of correcting lower limb alignment by total knee arthroplasty (TKA) on the spinopelvic alignment and to identify patients with difference in the knee joint between clinically measured passive motion and the actual standing posture. METHODS In this retrospective study, 101 patients who underwent TKA and whose serial whole-body EOS X-ray were available were included. The relationship of the knee and spinopelvic alignment was analyzed by evaluating the parameters of standing anterior-posterior and lateral whole-body EOS X-ray. The differences between postoperative passive motion and weight-bearing posture in the knee joint were assessed in both coronal and sagittal planes. Furthermore, the causes of such differences were analyzed. RESULTS Significant correlations between Δpelvic obliquity and coronal ΔHip-Knee-Ankle (HKA)Rt-Lt angle between the preoperative and 3-month and 1-year postoperative data (p < 0.001 and p < 0.005, respectively) and improved with coronal lower limb alignment close to neutral resulted in decreased pelvic obliquity (p < 0.001, ß = 0.085 and p = 0.005, ß = 0.065, respectively) were observed. The correlations between Δpelvic tilt (PT) and Δsacral slope (SS) and sagittal ΔHKARt-Lt angle were statistically significant (PT: p < 0.001 and p < 0.045; SS: p = 0.002 and p < 0.001, respectively). The improved sagittal alignment close to neutral resulted in decreased PT and increased SS. The difference between postoperative passive motion and the weight-bearing posture of the knee joint was correlated with lumbar lordosis and sagittal C7 plumb line-sacrum distance (p = 0.042 and p < 0.001, respectively). CONCLUSIONS The correction of lower limb alignment with TKA affected pelvic parameters dominantly; however, there was little effect on the spinal alignment. Additionally, patients with anterior stooping or lumbar flat back demonstrated difference in extension between passive knee motion and standing. Therefore, rather than only focusing on changes in the knee alignment correction, knee surgeons should also evaluate the spinopelvic alignment before surgery to consider the prognosis of the standing and predict the possible changes in the whole-body alignment. This preoperative assessment may improve the prognosis of TKA.
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Shetty V, Wagh Y, Karade V, Maurya A, Parihar M, Shekhar S, Tandel J. CT-Based 3D Reconstruction of Lower Limb Versus X-Ray-Based 3D Reconstruction: A Comparative Analysis and Application for a Safe and Cost-Effective Modality in TKA. Indian J Orthop 2021; 55:1150-1157. [PMID: 34824715 PMCID: PMC8586399 DOI: 10.1007/s43465-021-00456-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/05/2021] [Indexed: 02/04/2023]
Abstract
AIM Patient Specific Instrumentation (PSI) with 3D bone models have been used to improve the outcomes of Total Knee Arthroplasty (TKA). The PSI, however, needs a CT (Computed tomography)/MRI scan to reproduce a bone-based model. However, CT is not a routine imaging method in the TKA and has challenges such as high radiation exposure and increased investigation cost. Any technology or software which could accurately recreate 3D bone models using X-ray would be a cheaper and safer tool. This study is based on one such technology (XrayTo3D®) using X-ray to 3D as an alternative to other image-based 3D bone models and PSI available in the market. This study compares the accuracy of XrayTo3D® versus a Conventional CT to 3D, in the reconstruction of lower limb bones (femur and tibia). METHOD In an analysis of 45 lower limbs, 11 anatomical parameters were measured [Medial Proximal Tibial Angle-MPTA, Tibial(T)-torsion, T-slope, T-length, Mechanical Lateral Distal Femoral Angle (mLDFA), F-version, F-length, Distal femoral Medio lateral width (F-ML), Distal Femoral Antero Posterior (F-AP), Proximal Tibia Antero Posterior (T-AP), Proximal Tibia Medio Lateral (T-ML) based on landmarks selected by three orthopaedic surgeons(numbers of the authors superscript), on two groups of 3D models, one reconstructed using XrayTo3D® and the other using CT. Mean and standard-deviation values were measured for all the parameters in both the groups. Statistical association between both the groups was measured by Pearson's correlation coefficient. Two-sided t tests of the mean values were calculated to compare the two measurement methods. The interobserver reproducibility within each group was measured by the intraclass correlation coefficient (ICC). Point-to-surface (P2S) error, in the distal femur and proximal tibia regions of the models reconstructed using XrayTo3D®, were also measured. RESULTS For all the 11 parameters, no statistically significant difference was found between the 2 groups (p > 0.05). Pearson's correlation coefficients for all the parameters were not significant. The interobserver reproducibility was ranging from 0.90 to 1.00 and 0.90 to 1.00 for the XrayTo3D® and CT groups, respectively. The mean P2S distance was 1.0 mm in distal femur and 1.1 mm in proximal tibia which was within the acceptable limits. CONCLUSION The reconstruction accuracy of the XrayTo3D® is an accurate, safe and cost effective as compared to a CT-based method.
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Affiliation(s)
- Vivek Shetty
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Yash Wagh
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Vikas Karade
- Department of Society of Innovation and Entrepreneurship (SINE), Algosurg Inc., Society of Innovation and Entrepreneurship (SINE), IIT-Bombay, Room no. 501, 5th floor, A3, Raunak Park, Thane West, Mumbai, Maharashtra 400606 India
| | - Amit Maurya
- Department of Society of Innovation and Entrepreneurship (SINE), Algosurg Inc., Society of Innovation and Entrepreneurship (SINE), IIT-Bombay, Room no. 501, 5th floor, A3, Raunak Park, Thane West, Mumbai, Maharashtra 400606 India
| | - Mangal Parihar
- Department of Orthopedics, Mangal Anand Hospital, 48, Swastik Park Building, Sion Trombay Road, Chembur East, Mumbai, Maharashtra 400071 India
| | - Sajeev Shekhar
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
| | - Jignesh Tandel
- Department of Orthopedics, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra 400016 India
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Lahkar BK, Rohan PY, Assi A, Pillet H, Bonnet X, Thoreux P, Skalli W. Development and evaluation of a new methodology for Soft Tissue Artifact compensation in the lower limb. J Biomech 2021; 122:110464. [PMID: 33932915 DOI: 10.1016/j.jbiomech.2021.110464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 01/12/2023]
Abstract
Skin Marker (SM) based motion capture is the most widespread technique used for motion analysis. Yet, the accuracy is often hindered by Soft Tissue Artifact (STA). This is a major issue in clinical gait analysis where kinematic results are used for decision-making. It also has a considerable influence on the results of rigid body and Finite Element (FE) musculoskeletal models that rely on SM-based kinematics to estimate muscle, contact and ligament forces. Current techniques devised to compensate for STA, in particular multi-body optimization methods, often consider simplified joint models. Although joint personalization with anatomical constraints has improved kinematic estimation, these models yet don't represent a fully reliable solution to the STA problem, thus allowing us to envisage an alternative approach. In this perspective, we propose to develop a conceptual FE-based model of the lower limb for STA compensation and evaluate it for 66 healthy subjects under level walking motor task. Both hip and knee joint kinematics were analyzed, considering both rotational and translational joint motion. Results showed that STA caused underestimation of the hip joint kinematics (up to 2.2°) for all rotational DoF, and overestimation of knee joint kinematics (up to 12°) except in flexion/extension. Joint kinematics, in particular the knee joint, appeared to be sensitive to soft tissue stiffness parameters (rotational and translational mean difference up to 1.5° and 3.4 mm). Analysis of the results using alternative joint representations highlighted the versatility of the proposed modeling approach. This work paves the way for using personalized models to compensate for STA in healthy subjects and different activities.
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Affiliation(s)
- Bhrigu K Lahkar
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France.
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Ayman Assi
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France; Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Helene Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Xavier Bonnet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Patricia Thoreux
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France; Université Sorbonne Paris Nord, Bobigny, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
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Lahkar BK, Rohan PY, Pillet H, Thoreux P, Skalli W. Development and evaluation of a new procedure for subject-specific tensioning of finite element knee ligaments. Comput Methods Biomech Biomed Engin 2021; 24:1195-1205. [PMID: 33427509 DOI: 10.1080/10255842.2020.1870220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Subject-specific tensioning of ligaments is essential for the stability of the knee joint and represents a challenging aspect in the development of finite element models. We aimed to introduce and evaluate a new procedure for the quantification of ligament prestrains from biplanar X-ray and CT data. Subject-specific model evaluation was performed by comparing predicted femorotibial kinematics with the in vitro response of six cadaveric specimens. The differences obtained using personalized models were comparable to those reported in similar studies in the literature. This study is the first step toward the use of simplified, personalized knee FE models in clinical context such as ligament balancing.
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Affiliation(s)
- Bhrigu K Lahkar
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Helene Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Patricia Thoreux
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France.,Université Sorbonne Paris Nord, Bobigny, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
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Fischer MCM, Grothues SAGA, Habor J, de la Fuente M, Radermacher K. A robust method for automatic identification of femoral landmarks, axes, planes and bone coordinate systems using surface models. Sci Rep 2020; 10:20859. [PMID: 33257714 PMCID: PMC7704624 DOI: 10.1038/s41598-020-77479-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/11/2020] [Indexed: 01/16/2023] Open
Abstract
The identification of femoral landmarks is a common procedure in multiple academic fields. Femoral bone coordinate systems are used particularly in orthopedics and biomechanics, and are defined by landmarks, axes and planes. A fully automatic detection overcomes the drawbacks of a labor-intensive manual identification. In this paper, a new automatic atlas- and a priori knowledge-based approach that processes femoral surface models, called the A&A method, was evaluated. The A&A method is divided in two stages. Firstly, a single atlas-based registration maps landmarks and areas from a template surface to the subject. In the second stage, landmarks, axes and planes that are used to construct several femoral bone coordinate systems are refined using a priori knowledge. Three common femoral coordinate systems are defined by the landmarks detected. The A&A method proved to be very robust against a variation of the spatial alignment of the surface models. The results of the A&A method and a manual identification were compared. No significant rotational differences existed for the bone coordinate system recommended by the International Society of Biomechanics. Minor significant differences of maximally 0.5° were observed for the two other coordinate systems. This might be clinically irrelevant, depending on the context of use and should, therefore, be evaluated by the potential user regarding the specific application. The entire source code of the A&A method and the data used in the study is open source and can be accessed via https://github.com/RWTHmediTEC/FemoralCoordinateSystem .
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Affiliation(s)
- Maximilian C M Fischer
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany.
| | - Sonja A G A Grothues
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Juliana Habor
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Matías de la Fuente
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - Klaus Radermacher
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
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Yoo HJ, Kim JE, Kim SC, Kim JS, Yang HJ, Kim TW, Lee YS. Pitfalls in assessing limb alignment affected by rotation and flexion of the knee after total knee arthroplasty: Analysis using sagittal and coronal whole-body EOS radiography. Knee 2020; 27:1551-1559. [PMID: 33010773 DOI: 10.1016/j.knee.2020.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/22/2020] [Accepted: 08/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inappropriate posture during radiographic assessment may lead to misunderstanding of postoperative alignment after total knee arthroplasty (TKA). The EOS system assesses coronal and sagittal alignment simultaneously. This study aimed to evaluate the effect of flexion and/or rotation on alignment, and identify the patterns of knee posture with serial follow-up using the EOS system. METHODS One-hundred and fifteen patients of TKA and serial whole-body EOS were included. The hip-knee-ankle (HKA) angle in the coronal and sagittal planes, femoral component rotation ratio (FCR), tibial component rotation ratio (TCR), and fibular overlap ratio (FO) were measured immediately and at six months and one year postoperatively. Total and partial correlation, using flexion and rotation as a control variable was performed. RESULTS The mean HKA values and flexion immediately post-operation were different compared with the values noted at six months and one year postoperatively (for all, P < 0.05). The FCR and FO were correlated with the HKA angle during all periods (for both, P < 0.05). The Pearson correlation coefficients of the HKA angle with rotation parameters decreased when flexion was controlled. CONCLUSIONS Combined rotation and flexion of the knee joint has a greater effect on coronal alignment compared with isolated flexion or rotation and was more frequently observed during the early postoperative period. Therefore, surgeons should be made aware of the potential knee rotation and flexion errors after TKA.
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Affiliation(s)
- Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Eui Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Sung Chan Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Joo Sung Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hee Jin Yang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
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12
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Cerquiglini A, Henckel J, Hothi HS, Dall'Ava L, Shearing P, Hirschmann MT, Hart AJ. Computed Tomography Techniques Help Understand Wear Patterns in Retrieved Total Knee Arthroplasty. J Arthroplasty 2018; 33:3030-3037. [PMID: 29754982 DOI: 10.1016/j.arth.2018.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/23/2018] [Accepted: 04/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Suboptimal total knee arthroplasty (TKA) position of both femoral and tibial components is thought to be linked with poor clinical outcomes, polyethylene wear and the "unexplained" painful knee arthroplasty. The aim of this study was to better understand the effect of implant orientation on knee implant performance. METHODS We analyzed 30 retrieved contemporary TKA implants. Implant positioning measurements in the coronal plane were made prior to revision using a diagnostic algorithm, based on 3D computed tomography (CT) images. Each retrieved polyethylene component was imaged using a micro-CT scanner and a high resolution computational 3D model of each component was digitally reconstructed. The difference in thickness between medial and lateral components was calculated. Statistical analysis was performed to investigate the association between component positioning and damage patterns. RESULTS We found a significant correlation between both the tibiofemoral and femoral angles and difference in thickness between polyethylene compartments: varus angulations were strongly associated with thinner medial compartments, whilst valgus angulations were associated with thinner lateral compartments. Moreover, suboptimal tibiofemoral orientations and tibial component angulations were associated to greater differences in thickness between polyethylene compartments. CONCLUSION Our study is the first to compare accurate 3D CT measurements of prerevision TKA positioning in the coronal plane with postrevision retrieval analysis from innovative, accurate and highly reliable micro-CT-based method. Our results demonstrate the impact of component positioning on polyethylene damage and helps understanding of the in vivo performance of these implants. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Arianna Cerquiglini
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry S Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Lorenzo Dall'Ava
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Paul Shearing
- Department of Chemical Engineering, Electrochemical Innovation Lab, University College London, London, UK
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, UK
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13
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Articular-surface-based automatic anatomical coordinate systems for the knee bones. J Biomech 2018; 80:171-178. [PMID: 30213649 DOI: 10.1016/j.jbiomech.2018.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/10/2018] [Accepted: 08/22/2018] [Indexed: 11/23/2022]
Abstract
Increasing use of patient-specific surgical procedures in orthopaedics means that patient-specific anatomical coordinate systems (ACSs) need to be determined. For knee bones, automatic algorithms constructing ACSs exist and are assumed to be more reliable than manual methods, although both approaches are based on non-unique numerical reconstructions of true bone geometries. Furthermore, determining the best algorithms is difficult, as algorithms are evaluated on different datasets. Thus, in this study, we developed 3 algorithms, each with 3 variants, and compared them with 5 from the literature on a dataset comprising 24 lower-limb CT-scans. To evaluate algorithms' sensitivity to the operator-dependent reconstruction procedure, the tibia, patella and femur of each CT-scan were each reconstructed once by three different operators. Our algorithms use principal inertia axis (PIA), cross-sectional area, surface normal orientations and curvature data to identify the bone region underneath articular surfaces (ASs). Then geometric primitives are fitted to ASs, and the ACSs are constructed from the geometric primitive points and/or axes. For each bone type, the algorithm displaying the least inter-operator variability is identified. The best femur algorithm fits a cylinder to posterior condyle ASs and a sphere to the femoral head, average axis deviations: 0.12°, position differences: 0.20 mm. The best patella algorithm identifies the AS PIAs, average axis deviations: 0.91°, position differences: 0.19 mm. The best tibia algorithm finds the ankle AS center and the 1st PIA of a layer around a plane fitted to condyle ASs, average axis deviations: 0.38°, position differences: 0.27 mm.
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14
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3D Sequential Kinematics of the Femoro-Tibial Joint of Normal Knee from Multiple Bi-planar X-rays: Accuracy and Repeatability. Ing Rech Biomed 2018. [DOI: 10.1016/j.irbm.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Zheng G, Hommel H, Akcoltekin A, Thelen B, Stifter J, Peersman G. A novel technology for 3D knee prosthesis planning and treatment evaluation using 2D X-ray radiographs: a clinical evaluation. Int J Comput Assist Radiol Surg 2018; 13:1151-1158. [PMID: 29785589 DOI: 10.1007/s11548-018-1789-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To present a clinical validation of a novel technology called "3X" which allows for 3D prosthesis planning and treatment evaluation in total knee arthroplasty (TKA) using only 2D X-ray radiographs. MATERIALS AND METHODS After local institution review board approvals, 3X was evaluated on 43 cases (23 for preoperative planning and 20 for postoperative treatment evaluation). All the patients underwent CT scans according to a standard protocol. The results measured on the CT data were regarded as the ground truth. Additionally, two X-ray images were acquired for each affected leg and were used by 3X technology to derive patient-specific measurements of the leg. In total, we compared seven parameters for planning TKA and five parameters for postoperative prosthesis alignment. RESULTS Our experimental results demonstrated that the mean distances between the surface models reconstructed from 2D X-rays and the associated surface models obtained from 3D CT data were smaller than 1.5 mm. The average differences for all angular parameters were smaller than [Formula: see text]. In over 78% cases 3X technology derived the same femoral component size as the CT-based ground truth and this value went down to 70% when 3X technology was used to predict the size of tibial component. CONCLUSION 3X is a technology that allows for true 3D preoperative planning and postoperative treatment evaluation based on 2D X-ray radiographs.
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Affiliation(s)
- Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland.
| | - Hagen Hommel
- Clinic for Orthopedic, Sports Medicine and Rehabilitation, Krankenhaus Mrkisch Oderland GmbH, Wriezen, Germany
| | - Alper Akcoltekin
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - Benedikt Thelen
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | | | - Geert Peersman
- Institute for Orthopaedic Research and Training, KU Leuven, Campus Pellenberg, Louvain, Belgium
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Aubry S, Padoin P, Petegnief Y, Vidal C, Riethmuller D, Delabrousse E. Can three-dimensional pelvimetry using low-dose stereoradiography replace low-dose CT pelvimetry? Diagn Interv Imaging 2018; 99:569-576. [PMID: 29567122 DOI: 10.1016/j.diii.2018.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/31/2018] [Accepted: 02/20/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the reliability of pelvimetric measurements performed using stereoradiographic imaging (SRI), and to assess maternal and fetal radiation doses compared to low-dose computer tomography (CT) pelvimetry. MATERIALS AND METHODS Thirty-five pregnant women (mean age, 29.6±5.5 [SD] years; range: 20-41 years) were prospectively included. All women underwent simultaneous frontal and lateral low-dose SRI and low-dose CT examination of the pelvis. Pelvimetry measurements were obtained from both examinations and radiation doses obtained with the two techniques were compared. RESULTS SRI-CT correlation (Pearson coefficient correlation [r]; mean bias [mb]) was strong for transverse inlet diameter (r=0.92; mb=-0.09cm), anteroposterior diameter of the pelvic inlet (r=0.92; mb = 0.47cm), maximal transverse diameter (r=0.9; mb=0.21cm), sacrum length (r=0.9; mb=0.09cm). Correlation was good. Correlation was good for the sacrum depth (r=0.75; mb=0.06cm) and Magnin's index (r=0.7; mb=0.5cm). Correlation was moderate for anteroposterior diameter of pelvic outlet (r=0.6; mb=0.52cm). The fetal dose was 13.1 times lower using SRI (87±26μGy) than CT (1140±220μGy, P<0.0001). The effective maternal dose was 3.1 times lower using SRI (97±21μSv) than CT (310±60μSv; P<0.0001). CONCLUSION Pelvic inlet measurements using SRI are reliable. Compared to CT pelvimetry, SRI leads to a significant decrease in fetal and maternal radiation doses. These findings should prompt physicians to use SRI as the first-line approach for pelvimetry.
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Affiliation(s)
- S Aubry
- Department of Musculoskeletal Imaging, CHRU Besançon, 25000 Besançon, France; Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000 Besançon, France.
| | - P Padoin
- Department of Musculoskeletal Imaging, CHRU Besançon, 25000 Besançon, France
| | - Y Petegnief
- Department of Nuclear Medicine, CHRU Besançon, 25000 Besançon, France
| | - C Vidal
- Clinical Investigation Center, Inserm CIT808, CHRU Besançon, 25000 Besançon, France
| | - D Riethmuller
- Department of Obstetrics and Gynecology, CHRU Besançon, 25000 Besançon, France
| | - E Delabrousse
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000 Besançon, France; Department of Abdominal Imaging, CHRU Besançon, 25000 Besançon, France
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17
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Chiron P, Demoulin L, Wytrykowski K, Cavaignac E, Reina N, Murgier J. Radiation dose and magnification in pelvic X-ray: EOS™ imaging system versus plain radiographs. Orthop Traumatol Surg Res 2017; 103:1155-1159. [PMID: 28942025 DOI: 10.1016/j.otsr.2017.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/29/2017] [Accepted: 07/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND In plain pelvic X-ray, magnification makes measurement unreliable. The EOS™ (EOS Imaging, Paris France) imaging system is reputed to reproduce patient anatomy exactly, with a lower radiation dose. This, however, has not been assessed according to patient weight, although both magnification and irradiation are known to vary with weight. We therefore conducted a prospective comparative study, to compare: (1) image magnification and (2) radiation dose between the EOS imaging system and plain X-ray. HYPOTHESIS The EOS imaging system reproduces patient anatomy exactly, regardless of weight, unlike plain X-ray. MATERIAL AND METHOD A single-center comparative study of plain pelvic X-ray and 2D EOS radiography was performed in 183 patients: 186 arthroplasties; 104 male, 81 female; mean age 61.3±13.7years (range, 24-87years). Magnification and radiation dose (dose-area product [DAP]) were compared between the two systems in 186 hips in patients with a mean body-mass index (BMI) of 27.1±5.3kg/m2 (range, 17.6-42.3kg/m2), including 7 with morbid obesity. RESULTS Mean magnification was zero using the EOS system, regardless of patient weight, compared to 1.15±0.05 (range, 1-1.32) on plain X-ray (P<10-5). In patients with BMI<25, mean magnification on plain X-ray was 1.15±0.05 (range, 1-1.25) and, in patients with morbid obesity, 1.22±0.06 (range, 1.18-1.32). The mean radiation dose was 8.19±2.63dGy/cm2 (range, 1.77-14.24) with the EOS system, versus 19.38±12.37dGy/cm2 (range, 4.77-81.75) with plain X-ray (P<10-4). For BMI >40, mean radiation dose was 9.36±2.57dGy/cm2 (range, 7.4-14.2) with the EOS system, versus 44.76±22.21 (range, 25.2-81.7) with plain X-ray. Radiation dose increased by 0.20dGy with each extra BMI point for the EOS system, versus 0.74dGy for plain X-ray. CONCLUSION Magnification did not vary with patient weight using the EOS system, unlike plain X-ray, and radiation dose was 2.5-fold lower. LEVEL OF EVIDENCE 3, prospective case-control study.
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Affiliation(s)
- P Chiron
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - L Demoulin
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - K Wytrykowski
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - E Cavaignac
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - N Reina
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - J Murgier
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
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Liow MHL, Tsai TY, Dimitriou D, Li G, Kwon YM. Does 3-Dimensional In Vivo Component Rotation Affect Clinical Outcomes in Unicompartmental Knee Arthroplasty? J Arthroplasty 2016; 31:2167-72. [PMID: 27067168 DOI: 10.1016/j.arth.2016.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/11/2016] [Accepted: 03/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is an effective treatment for single-compartment osteoarthritis. Limited studies have examined the relationship between component rotation and functional outcomes, with no existing consensus to guide "optimal" UKA component rotation. Our study aims to study the effect of 3-dimensional (3D) in vivo UKA component axial rotation on functional outcomes by determining (1) how much component axial rotation variability exists in UKA? and (2) does 3D in vivo UKA component axial rotation affect functional outcomes? METHODS Sixty-six UKAs from 58 consecutive patients (36 male [62.1%], age 63.7 ± 9.2 years, body mass index 28.2 ± 4.9 kg/m(2), and mean follow-up time 49.2 months) were imaged in weight-bearing standing position using biplanar radiography. We performed multiple comparisons to analyze the relationship between 3D UKA component alignment and European Quality of Life - 5 Dimensions (EQ-5D), UCLA activity score, and Knee Injury and Osteoarthritis Outcome Scores. RESULTS Significant improvements in EQ-5D, EQ-5D (United States adjusted), and Knee Injury and Osteoarthritis Outcome Scores (Sport/Rec) scores were noted postoperatively. However, high variability in 3D UKA femoral (6.2° ± 6.5°) and tibial (4.6° ± 6.4°) component positioning was observed. A trend toward better outcome scores in lower angles of femoral (<2.7° external rotation [ER]) and tibial (2.7° ER to 2.4° internal rotation [IR]) component rotation was noted, with better functional scores observed at mean femoral and tibial rotation angles of 3° ER to 3° IR. CONCLUSION Patients with UKA femoral and/or tibial component rotation angles within 3° ER to 3° IR of neutral component alignment reported better functional outcomes. Surgeons should be cognizant of the high variability noted in UKA component axial rotation and its potential correlation with functional scores.
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Affiliation(s)
- Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dimitris Dimitriou
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Guoan Li
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Pillet H, Bergamini E, Rochcongar G, Camomilla V, Thoreux P, Rouch P, Cappozzo A, Skalli W. Femur, tibia and fibula bone templates to estimate subject-specific knee ligament attachment site locations. J Biomech 2016; 49:3523-3528. [DOI: 10.1016/j.jbiomech.2016.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/04/2016] [Accepted: 09/19/2016] [Indexed: 12/01/2022]
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20
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Rochcongar G, Pillet H, Bergamini E, Moreau S, Thoreux P, Skalli W, Rouch P. A new method for the evaluation of the end-to-end distance of the knee ligaments and popliteal complex during passive knee flexion. Knee 2016; 23:420-5. [PMID: 26971234 DOI: 10.1016/j.knee.2016.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accurate knowledge about the length variation of the knee ligaments (ACL, PCL, MCL and LCL) and the popliteal complex during knee flexion/extension is essential for modelling and clinical applications. The aim of the present study is to provide this information by using an original technique able to faithfully reproduce the continuous passive knee flexion-extension kinematics and to reliably identify each ligament/tendon attachment site. METHODS Twelve lower limbs (femur, tibia, fibula, patella) were tested and set in motion (0-120°) using an ad hoc rig. Tibio-femoral kinematics was obtained using an optoelectronic system. A 3D digital model of each bone was obtained using low-dosage stereoradiography. Knee specimens were dissected and the insertion of each ligament and popliteal complex were marked with radio opaque paint. ACL, PCL and MCL were separated into two bundles. Bone epiphyses were CT-scanned to obtain a digital model of each ligament insertion. Bones and attachment site models were registered and the end-to-end distance variation of each ligament/tendon was computed over knee flexion. RESULTS A tibial internal rotation of 18°±4° with respect to the femur was observed. The different bundles of the ACL, MCL and LCL shortened, whereas all bundles of the PCL lengthened. The popliteal complex was found to shorten until 30° of knee flexion and then to lengthen. CONCLUSION The end-to-end distance variation of the knee ligaments and popliteal complex can be estimated during knee flexion using a robust and reliable method based on marking the ligaments/tendon insertions with radiopaque paint. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- G Rochcongar
- Département d'Orthopédie et Traumatologie, INSERM U1075 COMETE "Mobilité: Attention, Orientation & Chronobiologie", Université de Caen, France; Arts et Metiers ParisTech, LBM\Institut de Biomécanique Humaine Georges Charpak, Paris, France.
| | - H Pillet
- Arts et Metiers ParisTech, LBM\Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - E Bergamini
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", P.zza Lauro de Bosis 15, 00135 Rome, Italy
| | - S Moreau
- Laboratoire d'Anatomie, Université de Caen, France
| | - P Thoreux
- Arts et Metiers ParisTech, LBM\Institut de Biomécanique Humaine Georges Charpak, Paris, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Avicenne - Université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - W Skalli
- Arts et Metiers ParisTech, LBM\Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - P Rouch
- Arts et Metiers ParisTech, LBM\Institut de Biomécanique Humaine Georges Charpak, Paris, France
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Tsai TY, Dimitriou D, Liow MHL, Rubash HE, Li G, Kwon YM. Three-Dimensional Imaging Analysis of Unicompartmental Knee Arthroplasty Evaluated in Standing Position: Component Alignment and In Vivo Articular Contact. J Arthroplasty 2016; 31:1096-101. [PMID: 26730450 DOI: 10.1016/j.arth.2015.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/24/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Component malalignment in unicompartmental knee arthroplasty (UKA) has been associated with contact stress concentration and poor clinical outcomes. However, there is a paucity of data regarding UKA component alignment and in vivo articular contact in weight-bearing position. This study aims to (1) quantify three-dimensional UKA component alignment and (2) evaluate the association between the component alignment and in vivo articular contact in standing position. METHODS Seventy-seven UKAs in 68 consecutive patients were imaged in standing position using a biplanar X-ray imaging acquisition system. The UKA models were imported into a virtual imaging environment and registered with component silhouette on X-ray image for determination of component position and contact location. Anatomic bony landmarks of the lower limb were digitized for quantification of the bone alignment. RESULTS The femoral component (FC) showed 1.6° ± 3.3° valgus, 6.5° ± 6.4° external rotation, and 2.4° ± 4.6° flexion. The tibial component (TC) showed 3.9° ± 4.5° varus, 4.4° ± 6.7° internal rotation, and 10.1° ± 4.6° tibial slope. The average contact point was located medially and posteriorly by 7.8 ± 7.6% and 0.7 ± 7.7% of TC dimensions to its center. Multiple regression analysis identified FC flexion as a significant variable affecting UKA anterior and/or posterior contact position (R = 0.549, P < .001). CONCLUSION This study demonstrated the highest variability of UKA component positioning in axial plane rotation for FC and TC. The association between FC flexion and anterior contact position suggests accurate implant positioning may be important in optimizing in vivo UKA contact behavior. Further studies are required to gain understanding of the influence of axial rotation variability on in vivo UKA contact kinematics during functional activities.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dimitris Dimitriou
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Harry E Rubash
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Guoan Li
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Tsai TY, Dimitriou D, Hosseini A, Liow MHL, Torriani M, Li G, Kwon YM. Assessment of accuracy and precision of 3D reconstruction of unicompartmental knee arthroplasty in upright position using biplanar radiography. Med Eng Phys 2016; 38:633-638. [PMID: 27117422 DOI: 10.1016/j.medengphy.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 02/07/2016] [Accepted: 04/02/2016] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate the precision and accuracy of 3D reconstruction of UKA component position, contact location and lower limb alignment in standing position using biplanar radiograph. Two human specimens with 4 medial UKAs were implanted with beads for radiostereometric analysis (RSA). The specimens were frozen in standing position and CT-scanned to obtain relative positions between the beads, bones and UKA components. The specimens were then imaged using biplanar radiograph (EOS). The positions of the femur, tibia, UKA components and UKA contact locations were obtained using RSA- and EOS-based techniques. Intraclass correlation coefficient (ICC) was calculated for inter-observer reliability of the EOS technique. The average (standard deviation) of the differences between two techniques in translations and rotations were less than 0.18 (0.29) mm and 0.39° (0.66°) for UKA components. The root-mean-square-errors (RMSE) of contact location along the anterior/posterior and medial/lateral directions were 0.84mm and 0.30mm. The RMSEs of the knee rotations were less than 1.70°. The ICCs for the EOS-based segmental orientations between two raters were larger than 0.98. The results suggest the EOS-based 3D reconstruction technique can precisely determine component position, contact location and lower limb alignment for UKA patients in weight-bearing standing position.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dimitris Dimitriou
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ali Hosseini
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Martin Torriani
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Guoan Li
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 2016; 10:1-14. [PMID: 26883033 PMCID: PMC4763151 DOI: 10.1007/s11832-016-0713-0] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/22/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS(®) 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS(®) imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations. METHODS The review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS(®) system. RESULTS While EOS(®) imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan. CONCLUSIONS The major advantages of EOS(®) are the relatively low dose of radiation (50-80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS(®) imaging technique has proven itself to be a very useful research and diagnostic tool.
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Affiliation(s)
- Elias Melhem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
| | - Rami El Rachkidi
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon ,Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
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Bergamini E, Pillet H, Rochcongar G, Thoreux P, Skalli W, Cappozzo A, Rouch P. Estimation of subject-specific ligament length variation during knee flexion. Comput Methods Biomech Biomed Engin 2015. [DOI: 10.1080/10255842.2015.1069556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- E. Bergamini
- BOHNES, University of Rome “Foro Italico”, Rome, Italy
| | - H. Pillet
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - G. Rochcongar
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
- Département d’Orthopédie et Traumatologie, INSERM U1075 COMETE “Mobilité: Attention, Orientation & Chronobiologie”, Université de Caen, Caen, France
| | - P. Thoreux
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Avicenne, Université Paris 13, Bobigny, France
| | - W. Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
| | - A. Cappozzo
- BOHNES, University of Rome “Foro Italico”, Rome, Italy
| | - P. Rouch
- Arts et Metiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, Paris, France
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Schlatterer B, Linares JM, Cazal J, Merloz P, Plaweski S. Posterior tibial slope accuracy with patient-specific cutting guides during total knee arthroplasty: A preliminary study of 50 cases. Orthop Traumatol Surg Res 2015; 101:S233-40. [PMID: 26249539 DOI: 10.1016/j.otsr.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/25/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patient-specific cutting guides were recently introduced to facilitate total knee arthroplasty (TKA). Their accuracy in achieving optimal implant alignment remains controversial. The objective of this study was to evaluate postoperative radiographic outcomes of 50 TKA procedures with special attention to posterior tibial slope (PTS), which is difficult to control intraoperatively. We hypothesized that patient-specific cutting guides failed to consistently produce the planned PTS. MATERIAL AND METHODS The Signature™ patient-specific cutting guides (Biomet) developed from magnetic resonance imaging data were used in a prospective case-series of 50 TKAs. The target PTS was 2°. Standardised digitised radiographs were obtained postoperatively and evaluated by an independent reader. Reproducibility of the radiographic measurements was assessed on 20 cases. The posterior cortical line of the proximal tibia was chosen as the reference for PTS measurement. Inaccuracy was defined as an at least 2° difference in either direction compared to the target. RESULTS The implant PTS was within 2° of the target in 72% of knees. In the remaining 28%, PTS was either excessive (n=10; maximum, 9°) or reversed (n=4; maximum, -6°). The postoperative hip-knee-ankle angle was 0° ± 3° in 88% of knees, and the greatest deviation was 9° of varus. CONCLUSION These findings support our hypothesis that patient-specific instrumentation decreases PTS accuracy. They are consistent with recently published data. In contrast, patient-specific instrumentation provided accurate alignment in the coronal plane.
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Affiliation(s)
- B Schlatterer
- Institut monégasque de médecine et chirurgie du sport, 98000 Monaco.
| | - J-M Linares
- Aix-Marseille université, CNRS, ISM UMR 7287, 13288 Marseille, France
| | - J Cazal
- Institut monégasque de médecine et chirurgie du sport, 98000 Monaco
| | - P Merloz
- Service de chirurgie orthopédique et traumatologie, hôpital A.-Michallon, CHU de Grenoble, 38043 Grenoble, France
| | - S Plaweski
- Service de chirurgie orthopédique et traumatologie du sport, hôpital sud, CHU de Grenoble, avenue de Kimberley, 38034 Échirolles, France
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Planned Bone Resections Using an MRI-Based Custom Cutting Guide System Versus 3-Dimensional, Weight-Bearing Images in Total Knee Arthroplasty. J Arthroplasty 2015; 30:567-72. [PMID: 25533640 DOI: 10.1016/j.arth.2014.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/23/2014] [Accepted: 11/06/2014] [Indexed: 02/01/2023] Open
Abstract
Potential sources of alignment variability not yet investigated with the use of custom cutting guides (CCG) in total knee arthroplasty (TKA) are weight-bearing and lower extremity rotation. This study compared the preoperative planned bone resections created using an MRI-based CCG system to those from 3-dimensional, weight-bearing, full-length lower extremity images in 53 patients undergoing TKA. The angular difference between the proposed resections of the two systems was greater than 2° in 30.2% of patients for the distal femur, and 52.8% for the proximal tibia. An increased preoperative varus alignment had a slight association with an increased angular difference for the tibial resection (r=0.4). This study demonstrates weight-bearing and lower extremity rotation to be potential sources of alignment variability when using MRI-based CCGs.
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Sigmann MH, Delabrousse E, Riethmuller D, Runge M, Peyron C, Aubry S. An evaluation of the EOS X-ray imaging system in pelvimetry. Diagn Interv Imaging 2014; 95:833-8. [PMID: 24906809 DOI: 10.1016/j.diii.2014.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To demonstrate the reliability of the EOS imaging system in measuring the internal diameters of the bony pelvis. MATERIALS AND METHODS A prospective study comparing the results of the pelvimetry of 18 dry pelvises carried out on the EOS imaging system to measurements taken manually and using the two current gold standard CT methods. Pelvimetric measurements of each pelvic bone were obtained using four methods and compared: direct manual measurements, spiral and sequential CT pelvimetry, and 2D-3D low-dose biplanar X-rays. The various obstetric diameters were measured to the millimetre and compared. RESULTS There was no significant difference in the different diameters assessed, with the exception of the interspinous diameter. There was a highly significant correlation (P < 0.001) between the values measured manually and by EOS for the Magnin index (Pearson = 0.98), the obstetric conjugate diameter (Pearson = 0.99), and the median transverse diameter (Pearson = 0.87). CONCLUSION The EOS imaging system allows for an ex vivo determination of the obstetrical diameters that is reliable enough to estimate obstetric prognosis, producing comparable measurements to CT. In view of concerns about protection from radiation, this low-dose imaging technique could become, after in vivo prospective validation, the new gold standard for pelvimetry and therefore a good alternative to CT.
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Affiliation(s)
- M-H Sigmann
- Department of Osteoarticular Imaging, Jean Minjoz Regional University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - E Delabrousse
- Department of Gastrointestinal and Genitourinary Imaging, Jean Minjoz Regional University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Laboratory of nanomedicine EA4662, University of Franche-Comté, Besançon, France
| | - D Riethmuller
- Department of Obstetrics and Gynaecology, Jean Minjoz Regional University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - M Runge
- Department of Osteoarticular Imaging, Jean Minjoz Regional University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - C Peyron
- Department of Osteoarticular Imaging, Jean Minjoz Regional University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - S Aubry
- Department of Osteoarticular Imaging, Jean Minjoz Regional University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Laboratory I4S. EA4268 IFR133, University of Franche-Comté, Besançon, France
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Reliability of overcoverage parameters with varying morphologic pincer features: comparison of EOS® and radiography. Clin Orthop Relat Res 2013; 471:2578-85. [PMID: 23657877 PMCID: PMC3705041 DOI: 10.1007/s11999-013-3001-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 04/12/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multiple radiographic parameters used for diagnosis and quantification of morphologic pincer features have emerged, but the degree to which pelvic tilt or rotation affects conventional radiography and EOS(®) is unknown. QUESTION/PURPOSES We asked: (1) What is the reliability of EOS(®) and conventional radiography at increasing sizes of morphologic pincer features with varying degrees of tilt and rotation? (2) What is the effect of tilt and rotation on acetabular overcoverage measurements? METHODS Using a dry cadaveric pelvis, AP conventional radiographs and EOS(®) images were taken at intervals of increasing modeled pincer size with 0° to 15° varying tilt and rotation. Lateral center-edge angle, Sharp angle, Tönnis angle, crossover sign, and retroversion index were measured on all images. Statistical analysis was conducted. RESULTS The intermodality intraclass correlation coefficients for conventional radiography and EOS(®) radiography across all pincer sizes, rotations, and tilts were excellent (0.93-0.98). Crossover sign was in perfect agreement in conventional radiography and EOS(®). Rotation of the hip away from the beam source and/or increased anterior tilt falsely increased all overcoverage parameters except for Tönnis angle. Rotation away from the beam of 10° or greater or anterior tilt of 5° or greater produced a false-positive crossover sign. CONCLUSIONS EOS(®) radiography maintained excellent reliability in comparison to conventional radiography but both were equally vulnerable to the effects of tilt and rotation for quantification of hip parameters used in acetabular overcoverage assessment. A standardized pelvic radiograph ensuring that the pelvis is not excessively tilted or rotated should be used for assessing acetabular overcoverage parameters.
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Comparison of radiation dose, workflow, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose X-ray system for upright full-length lower limb and whole spine radiography. Skeletal Radiol 2013; 42:959-67. [PMID: 23536038 DOI: 10.1007/s00256-013-1600-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/01/2013] [Accepted: 03/04/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the radiation dose, workflow, patient comfort, and financial break-even of a standard digital radiography and a biplanar low-dose X-ray system. MATERIALS AND METHODS A standard digital radiography system (Ysio, Siemens Healthcare, Erlangen, Germany) was compared with a biplanar X-ray unit (EOS, EOS imaging, Paris, France) consisting of two X-ray tubes and slot-scanning detectors, arranged at an angle of 90° allowing simultaneous vertical biplanar linear scanning in the upright patient position. We compared data of standing full-length lower limb radiographs and whole spine radiographs of both X-ray systems. RESULTS Dose-area product was significantly lower for radiographs of the biplanar X-ray system than for the standard digital radiography system (e.g. whole spine radiographs; standard digital radiography system: 392.2 ± 231.7 cGy*cm(2) versus biplanar X-ray system: 158.4 ± 103.8 cGy*cm(2)). The mean examination time was significantly shorter for biplanar radiographs compared with standard digital radiographs (e.g. whole spine radiographs: 449 s vs 248 s). Patients' comfort regarding noise was significantly higher for the standard digital radiography system. The financial break-even point was 2,602 radiographs/year for the standard digital radiography system compared with 4,077 radiographs/year for the biplanar X-ray unit. CONCLUSION The biplanar X-ray unit reduces radiation exposure and increases subjective noise exposure to patients. The biplanar X-ray unit demands a higher number of examinations per year for the financial break-even point, despite the lower labour cost per examination due to the shorter examination time.
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Sutter R, Pfirrmann CWA, Espinosa N, Buck FM. Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements. Skeletal Radiol 2013. [PMID: 23179737 DOI: 10.1007/s00256-012-1543-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To establish a hindfoot alignment measurement technique based on low-dose biplanar radiographs and compare with hindfoot alignment measurements on long axial view radiographs, which is the current reference standard. MATERIALS AND METHODS Long axial view radiographs and low-dose biplanar radiographs of a phantom consisting of a human foot skeleton embedded in acrylic glass (phantom A) and a plastic model of a human foot in three different hindfoot positions (phantoms B1-B3) were imaged in different foot positions (20° internal to 20° external rotation). Two independent readers measured hindfoot alignment on long axial view radiographs and performed 3D hindfoot alignment measurements based on biplanar radiographs on two different occasions. Time for three-dimensional (3D) measurements was determined. Intraclass correlation coefficients (ICC) were calculated. RESULTS Hindfoot alignment measurements on long axial view radiographs were characterized by a large positional variation, with a range of 14°/13° valgus to 22°/27° varus (reader 1/2 for phantom A), whereas the range of 3D hindfoot alignment measurements was 7.3°/6.0° to 9.0°/10.5° varus (reader 1/2 for phantom A), with a mean and standard deviation of 8.1° ± 0.6/8.7° ± 1.4 respectively. Interobserver agreement was high (ICC = 0.926 for phantom A, and ICC = 0.886 for phantoms B1-B3), and agreement between different readouts was high (ICC = 0.895-0.995 for reader 1, and ICC = 0.987-0.994 for reader 2) for 3D measurements. Mean duration of 3D measurements was 84 ± 15/113 ± 15 s for reader 1/2. CONCLUSION Three-dimensional hindfoot alignment measurements based on biplanar radiographs were independent of foot positioning during image acquisition and reader independent. In this phantom study, the 3D measurements were substantially more precise than the standard radiographic measurements.
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Affiliation(s)
- Reto Sutter
- Department of Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.
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Sarmah SS, Patel S, Hossain FS, Haddad FS. The radiological assessment of total and unicompartmental knee replacements. ACTA ACUST UNITED AC 2012; 94:1321-9. [PMID: 23015555 DOI: 10.1302/0301-620x.94b10.29411] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Radiological assessment of total and unicompartmental knee replacement remains an essential part of routine care and follow-up. Appreciation of the various measurements that can be identified radiologically is important. It is likely that routine plain radiographs will continue to be used, although there has been a trend towards using newer technologies such as CT, especially in a failing knee, where it provides more detailed information, albeit with a higher radiation exposure. The purpose of this paper is to outline the radiological parameters used to evaluate knee replacements, describe how these are measured or classified, and review the current literature to determine their efficacy where possible.
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Affiliation(s)
- S S Sarmah
- University College London Hospital, 235 Euston Road, London NW1 2BU, UK.
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Guenoun B, Zadegan F, Aim F, Hannouche D, Nizard R. Reliability of a new method for lower-extremity measurements based on stereoradiographic three-dimensional reconstruction. Orthop Traumatol Surg Res 2012; 98:506-13. [PMID: 22858107 DOI: 10.1016/j.otsr.2012.03.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Several clinical and radiological techniques have been described to assess lower limb length and angle measurements. None of them has yet met the ideal criteria for a reliable, reproducible, safe, and inexpensive system. In this context, a new biplanar X-ray system (EOS™, EOS imaging, Paris, France) makes it possible to obtain a 3D reconstruction of the lower extremities from two 2D orthogonal radiographic images, with associated calculation of 3D measurements. The reliability of this technique has never been documented on adults. HYPOTHESIS Lower limb measurements produced by the 3D EOS™ reconstruction system are reproducible regarding inter- and intraobserver assessment and more reliable with this 3D technique than when they are obtained from 2D measurements. MATERIALS AND METHODS This study included 25 patients awaiting total hip arthroplasty (50 lower limbs). Two independent observers made all measurements twice, both on the 2D frontal radiograph and using 3D reconstructions (femoral measurements of length, offset, neck shaft angle, neck length, and head diameter, as well as the tibia length, limb length, HKA and HKS). Reproducibility was estimated by intraclass correlation coefficients. RESULTS Both the inter- and intraobserver reproducibility of the EOS™ measurements was excellent; more specifically inter- and intraobserver reproducibility was 0.997 and 0.997 for femoral length, 0.996 and 0.995 for tibial length, 0.999 and 0.999 for limb length, 0.894 and 0.891 for HKS, 0.993 and 0.994 for HKA, 0.870 and 0.845 for femoral offset, and 0.765 and 0.851 for neck shaft angle. For most of the variables, the interobserver correlations were statistically better with the EOS™ 3D reconstruction. DISCUSSION Our results show that the EOS™ systems allow reproducible lower limb measurements. Furthermore, 3D EOS™ reconstructions offer better reproducible measures for most of the parameters than radiographic 2D projection. Its use before deciding on surgery and during planning for lower limb arthroplasty appears essential to us. LEVEL OF EVIDENCE Level III: diagnostic prospective study on consecutive patients.
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Affiliation(s)
- B Guenoun
- Department of Orthopedic and traumatology Surgery A, Cochin, Port-Royal Hospital Group (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75679 Paris, France.
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Three-dimensional measurements of the lower extremity in children and adolescents using a low-dose biplanar X-ray device. Eur Radiol 2011; 22:765-71. [DOI: 10.1007/s00330-011-2308-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/23/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
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Bergamini E, Pillet H, Hausselle J, Thoreux P, Guerard S, Camomilla V, Cappozzo A, Skalli W. Tibio-femoral joint constraints for bone pose estimation during movement using multi-body optimization. Gait Posture 2011; 33:706-11. [PMID: 21458992 DOI: 10.1016/j.gaitpost.2011.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/18/2011] [Accepted: 03/07/2011] [Indexed: 02/02/2023]
Abstract
When using skin markers and stereophotogrammetry for movement analysis, bone pose estimation may be performed using multi-body optimization with the intent of reducing the effect of soft tissue artefacts. When the joint of interest is the knee, improvement of this approach requires defining subject-specific relevant kinematic constraints. The aim of this work was to provide these constraints in the form of plausible values for the distances between origin and insertion of the main ligaments (ligament lengths), during loaded healthy knee flexion, taking into account the indeterminacies associated with landmark identification during anatomical calibration. Ligament attachment sites were identified through virtual palpation on digital bone templates. Attachments sites were estimated for six knee specimens by matching the femur and tibia templates to low-dose stereoradiography images. Movement data were obtained using stereophotogrammetry and pin markers. Relevant ligament lengths for the anterior and posterior cruciate, lateral collateral, and deep and superficial bundles of the medial collateral ligaments (ACL, PCL, LCL, MCLdeep, MCLsup) were calculated. The effect of landmark identification variability was evaluated performing a Monte Carlo simulation on the coordinates of the origin-insertion centroids. The ACL and LCL lengths were found to decrease, and the MCLdeep length to increase significantly during flexion, while variations in PCL and MCLsup length was concealed by the experimental indeterminacy. An analytical model is given that provides subject-specific plausible ligament length variations as functions of the knee flexion angle and that can be incorporated in a multi-body optimization procedure.
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Affiliation(s)
- E Bergamini
- Locomotor Apparatus Bioengineering Laboratory, Department of Human Movement and Sport Sciences, University of Rome Foro Italico, piazza Lauro De Bosis 15, 00135 Rome, Italy
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Azmy C, Guérard S, Bonnet X, Gabrielli F, Skalli W. EOS orthopaedic imaging system to study patellofemoral kinematics: assessment of uncertainty. ORTHOPAEDICS & TRAUMATOLOGY, SURGERY & RESEARCH : OTSR 2010; 96:28-36. [PMID: 20170853 DOI: 10.1016/j.rcot.2009.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 09/24/2009] [Accepted: 10/19/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accurate knowledge of knee joint kinematics, especially patellofemoral joint kinematics,is essential for prosthetic evaluation so as to further improve total knee arthroplasty performances. Improving the evaluation of the functioning of the extensor apparatus appears,in this respect, particularly important in this optimization effort. OBJECTIVES The aim of this study was to propose a new experimental setup for the analysis of knee joint kinematics and to validate its relevance in terms of accuracy and uncertainty.The technique developed herein combines 3D reconstruction imaging with the use of a motion capture system. MATERIAL AND METHODS Eight pairs of fresh-frozen cadaver specimens with no evidence of previous knee surgery were studied using a new test rig where the femur remains fixed and the tibia is free to rotate. The flexion-extension cycles were executed using computer-controlled traction of the quadriceps tendon combined with an antagonist force applied to the distal part of the tibia. Knee joint kinematics were tracked using an optoelectronic motion capture system after a preliminary stage of data acquisition of bone geometry and markers position. This stage was carried out using a new digital stereophotogrammetric system, EOS, combined with specific 3D reconstruction software that also determined the coordinate system used in the kinematic analysis. The resulting uncertainty was assessed as was its impact on the estimated kinematics. RESULTS Test results on eight knees validated the setup designed for the analysis of knee joint kinematics during the flexion-extension cycle. More specifically, the statistical results show that measurement uncertainty for rotations and translations remains below 0.4 and 1.8 mm,respectively, for the tibia and 0.4 and 1.2 mm for the patella (+/- 2 S.D. for all four measurements). DISCUSSION The combination of 3D imaging and motion capture enables the proposed method to track the real-time motion of any bone segment during knee flexion-extension cycle. In particular,the new test rig introduced in this paper allows in vitro measurements of the patello femoral and tibiofemoral kinematics with a good level of accuracy. Moreover, this personalized experimental analysis can provide a more objective approach to the evaluation of knee implants as well as the validation of the finite-elements-based models of the patellofemoral joint.
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Affiliation(s)
- C Azmy
- Centre hospitalier intercommunal de Villeneuve-Saint-Georges, 40, allée de la source, 94195 Villeneuve-Saint-Georges cedex, France.
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