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Kaptein BL, Pijls B, Koster L, Kärrholm J, Hull M, Niesen A, Heesterbeek P, Callary S, Teeter M, Gascoyne T, Röhrl SM, Flivik G, Bragonzoni L, Laende E, Sandberg O, Solomon LB, Nelissen R, Stilling M. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95:256-267. [PMID: 38819193 PMCID: PMC11141406 DOI: 10.2340/17453674.2024.40709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024] Open
Abstract
Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and consistent in execution, presentation, reporting, and interpretation. Both authors and reviewers of scientific papers using RSA may use these guidelines, summarized in the Checklist, as a reference. Deviations from these guidelines should have the underlying rationale stated.
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Affiliation(s)
- Bart L Kaptein
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Bart Pijls
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lennard Koster
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Kärrholm
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maury Hull
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Abby Niesen
- Orthopedic Surgery Department, University of California, Davis, United States
| | - Petra Heesterbeek
- Orthopedic Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Stuart Callary
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Matthew Teeter
- Department of Medical Biophysics, Western University, London, Canada
| | | | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gunnar Flivik
- Department of Orthopedics, Skane University Hospital, Lund, Sweden
| | | | - Elise Laende
- Department of Surgery, Dalhousie University, Halifax, Canada
| | | | - L Bogdan Solomon
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia
| | - Rob Nelissen
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maiken Stilling
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Niesen AE, Hull ML. State of the Art in Radiostereometric Analysis for Tibial Baseplate Migration and Future Research Directions. J Biomech Eng 2023; 145:120801. [PMID: 37792485 DOI: 10.1115/1.4063626] [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: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Radiostereometric analysis (RSA) measures movement (migration) of a baseplate relative to the underlying tibia after total knee arthroplasty (TKA) and has been used extensively to evaluate safety of new implant designs and/or surgical techniques regarding baseplate loosening. Because RSA is a complex methodology which involves various choices that researchers make, including whether to use marker-based or model-based methods, which migration metric to report, how to relate short-term migrations to long-term risk, and how these choices impact error, the objectives of this review were to: (1) lay out a comprehensive structure illustrating the multiple components/considerations for RSA and their interrelations, (2) review components of the structure using the latest RSA literature, and (3) use the preceding review as a context for identifying future areas of study. The components to be reviewed were structured using the following topics: type of RSA, migration metrics, sources of error, studies/reports of error, stability limits, and studies of error in stability limits. Based on the current RSA literature and knowledge gaps which exist, the following future research directions were identified: (1) revising the ISO standard to require reporting of clinical measurement error (bias) and recommending use of a local baseplate coordinate system, (2) identifying the migration metric and associated threshold most predictive of baseplate loosening for individual patients, (3) creating a method for data sharing to improve individual patient diagnostics, and (4) determining an appropriate stability limit for model-based RSA for group stability and individual patient diagnostics.
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Affiliation(s)
- Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Mechanical Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817
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Clarke SG, Logishetty K, Halewood C, Cobb JP. Low dose CT-based spatial analysis (CTSA) to measure implant migration after ceramic hip resurfacing arthroplasty (HRA): A phantom study. Proc Inst Mech Eng H 2023; 237:359-367. [PMID: 36772975 PMCID: PMC10052406 DOI: 10.1177/09544119231153905] [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: 02/12/2023]
Abstract
Implant migration is a predictor of arthroplasty survivorship. It is crucial to monitor the migration of novel hip prostheses within premarket clinical investigations. RSA is the gold standard method, but requires calibrated radiographs using specialised equipment. A commercial computed tomography micromotion analysis solution is a promising alternative but is not yet available for use with monobloc ceramic implants. This study aimed to develop and validate a CT-based spatial analysis (CTSA) method for use with ceramic implants. A phantom study was undertaken to assess accuracy and precision. A ceramic hip resurfacing arthroplasty (HRA) and 20 tantalum beads were implanted into a synthetic hip model and mounted onto a 6-degree of freedom motion stage. The hip was repeatedly scanned with a low dose CT protocol, with imposed micromovements. Data were interrogated using a semiautomated technique. The effective radiation dose for each scan was estimated to be 0.25 mSv. For the head implant, precision ranged between 0.11 and 0.28 mm for translations and 0.34°-0.42° for rotations. For the cup implant, precision ranged between 0.08 and 0.11 mm and 0.19° and 0.42°. For the head, accuracy ranged between 0.04 and 0.18 mm for translations and 0.28°-0.46° for rotations. For the cup, accuracy ranged between 0.04 and 0.08 mm and 0.17° and 0.43°. This in vitro study demonstrates that low dose CTSA of a ceramic HRA is similar in accuracy to RSA. CT is ubiquitous, and this method may be an alternative to RSA to measure prosthesis migration.
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Affiliation(s)
- Susannah G Clarke
- MSk Lab, Imperial College London, London, UK.,Embody Orthopaedic Limited, London
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Knudsen MB, Thillemann JK, Jørgensen PB, Jakobsen SS, Daugaard H, Søballe K, Stilling M. Electrochemically applied hydroxyapatite on the cementless porous surface of Bi-Metric stems reduces early migration and has a lasting effect : an efficacy trial of a randomized five-year follow-up radiostereometric study. Bone Joint J 2022; 104-B:647-656. [PMID: 35638207 DOI: 10.1302/0301-620x.104b6.bjj-2021-1545.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS BoneMaster is a thin electrochemically applied hydroxyapatite (HA) coating for orthopaedic implants that is quickly resorbed during osseointegration. Early stabilization is a surrogacy marker of good survival of femoral stems. The hypothesis of this study was that a BoneMaster coating yields a fast early and lasting fixation of stems. METHODS A total of 53 patients were randomized to be treated using Bi-Metric cementless femoral stems with either only a porous titanium plasma-sprayed coating (P group) or a porous titanium plasma-sprayed coating with an additional BoneMaster coating (PBM group). The patients were examined with radiostereometry until five years after surgery. RESULTS At three months, the mean total translation (TT) was 0.95 mm (95% confidence interval (CI) 0.68 to 1.22) in the P group and 0.57 mm (95% CI 0.31 to 0.83) in the PBM group (p = 0.047). From two to five years, the TT increased by a mean of 0.14 mm (95% CI 0.03 to 0.25) more in the P group than in the PBM group (p = 0.021). In osteopenic patients (n = 20), the mean TT after three months was 1.61 mm (95% CI 1.03 to 2.20) in the P group and 0.73 mm (95% CI 0.25 to 1.21) in the PBM group (p = 0.023). After 60 months, the mean TT in osteopenic patients was 1.87 mm (95% CI 1.24 to 2.50) in the P group and 0.82 mm (95% CI 0.30 to 1.33) in the PBM group (p = 0.011). CONCLUSION There was less early and midterm migration of cementless stems with BoneMaster coating compared with those with only a porous titanium plasma-sprayed coating. Although a BoneMaster coating seems to be important for stem fixation, especially in osteopenic patients, further research is warranted. Cite this article: Bone Joint J 2022;104-B(6):647-656.
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Affiliation(s)
- Martin B Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Janni K Thillemann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning, Denmark
| | - Peter B Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Stig S Jakobsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Daugaard
- Department of Orthopaedics, Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - Kjeld Søballe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Okowinski M, Hjorth MH, Mosegaard SB, Jürgens-Lahnstein JH, Storgaard Jakobsen S, Hedevang Christensen P, Kold S, Stilling M. Ten-year comparison of two different techniques for femoral bone cavity preparation-broaching versus compaction in patients with cementless total hip arthroplasty : a randomized radiostereometric study of 30 total hip arthroplasties in 15 patients operated bilaterally. Bone Jt Open 2021; 2:1035-1042. [PMID: 34865512 PMCID: PMC8711659 DOI: 10.1302/2633-1462.212.bjo-2021-0152.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.
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Affiliation(s)
- Maciej Okowinski
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Holm Hjorth
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Breddam Mosegaard
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan Hugo Jürgens-Lahnstein
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Kold
- Department of Orthopedics, Aalborg University Hospital, Aalborg, Denmark
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Affiliation(s)
- Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway,
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Reorienting the tibial baseplate improves the registration accuracy of model-based radiostereometric analysis. J Biomech 2020; 113:110078. [DOI: 10.1016/j.jbiomech.2020.110078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
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