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Verifying a C-arm-based roentgen stereophotogrammetric analysis protocol for assessing tibial implant movement in total knee arthroplasty

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Abstract

Roentgen stereophotogrammetric analysis (RSA) is the “gold standard” technique for measuring sub-millimetric relative motion between implant and bone to quantify post-operative implant migration over time. The vast majority of RSA studies addressing implant motion in knee replacements, however, have been conducted using expensive biplanar radiography systems and commercial software that are not readily available at many institutions. In this study, we evaluated the feasibility of performing RSA using ordinary, readily available C-arm fluoroscopes and open-source software to assess tibial component migration.

We developed an assessment protocol using a Siemens Arcadis Orbic C-arm and the open-source XROMM software and evaluated its accuracy and precision through a series of phantom-based verification tests. The results were highly promising: accuracies were in the range of − 39 to 11 μm for translations and − 0.025 to 0.029° for rotations, while system precisions ranged between 16 to 27 μm for translations and 0.041 to 0.059° for rotations. This performance is comparable to specialized RSA systems reported in the literature. The proposed RSA protocol is therefore capable of accurately measuring the relative motion of knee replacement implants in phantom scenarios, which justifies further the development of the protocol towards use in prospective clinical assessments of new implant designs and surgical techniques.

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  • 06 July 2022

    Springer Nature’s version of this paper was updated because page 9 of the PDF version has been relayout.

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Acknowledgements

The authors acknowledge the support from the Engineers in Scrubs program in funding this project through a fellowship award and facilities support from the Centre for Hip Health and Mobility. We would also like to thank researchers at the XROMM Technology Development Project for providing access to open-source RSA software, and Zimmer of Canada Ltd. for providing the total knee arthroplasty components.

Funding

This study was funded by the Natural Sciences and Engineering Research Council of Canada and the Canadian Institutes for Health Research through a Collaborative Health Research Projects grant, Funding Reference Number 134758.

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Authors and Affiliations

  1. School of Biomedical Engineering, University of British Columbia, 251 - 2222 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada

    Vivian W. J. Chung & Robyn Newell

  2. Centre for Hip Health and Mobility, Robert H.N. Ho Research Center, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Vivian W. J. Chung, Bassam A. Masri & Antony J. Hodgson

  3. Department of Bioengineering, Imperial College London, 514B Building E - Sir Michael Uren White City Campus, London, SW7 2AZ, UK

    Angela Kedgley

  4. McCaig Institute for Bone and Joint Health, Calgary, AB, Canada

    Carolyn Anglin

  5. Biomedical Engineering, University of Calgary, Calgary, AB, Canada

    Carolyn Anglin

  6. Department of Orthopaedics, Faculty of Medicine, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Bassam A. Masri

  7. Department of Mechanical Engineering, University of British Columbia, 6250 Applied Science Lane, Vancouver, BC, V6R 2L7, Canada

    Antony J. Hodgson

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  1. Vivian W. J. Chung
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Correspondence to Vivian W. J. Chung.

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Chung, V.W.J., Newell, R., Kedgley, A. et al. Verifying a C-arm-based roentgen stereophotogrammetric analysis protocol for assessing tibial implant movement in total knee arthroplasty. Med Biol Eng Comput 60, 2389–2403 (2022). https://doi.org/10.1007/s11517-022-02594-0

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