CT-based migration analysis of a tibial component compared to radiostereometric analysis : one-year results of a prospective single-group implant safety study.
Lars H W Engseth, Frank-David Øhrn, Anselm Schulz, Stephan M Röhrl
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引用次数: 0
Abstract
Aims: Radiostereometric analysis (RSA) is considered the gold standard for in vivo migration analysis, but CT-based alternatives show comparable results in the shoulder and hip. We have previously validated a CT-based migration analysis method (CTMA) in a knee phantom compared to RSA. In this study, we validated the method in patients undergoing total knee arthroplasty (TKA). Our primary outcome measure was the difference in maximum total point motion (MTPM) between the differing methods.
Methods: A total of 31 patients were prospectively studied having undergone an uncemented medial pivot knee TKA. Migrations were measured up to 12 months with marker-based and model-based RSA, and CT-RSA.
Results: Mean precision data for MTPM were 0.27 mm (SD 0.09) for marker-based RSA, 0.37 mm (SD 0.26) for model-based RSA, and 0.25 mm (SD 0.11) for CTMA. CTMA was as precise as both RSA methods (p = 0.845 and p = 0.156). At three months, MTPM showed a mean of 0.66 mm (95% CI 0.52 to 0.81) for marker-based RSA, 0.79 (95% CI 0.64 to 0.94) for model-based RSA, and 0.59 (95% CI 0.47 to 0.72) for CTMA. There was no difference between CTMA and marker-based RSA (p = 0.400), but CTMA showed lower migration than model-based RSA (p = 0.019). At 12 months, MTPM was 1.03 (95% CI 0.79 to 1.26) for marker-based RSA, 1.02 (95% CI 0.79 to 1.25) for model-based RSA, and 0.71 (95% CI 0.48 to 0.94) for CTMA. MTPM for CTMA was lower than both RSA methods (p < 0.001). Differences between migration increased between the methods from three to 12 months. Mean effective radiation doses per examination were 0.016 mSv (RSA) and 0.069 mSv (CT). Imaging time for performing RSA radiographs was 17 minutes 26 seconds (SD 7 mins 9 sec) and 4 minutes 24 seconds (SD 2 mins 3 sec) for CT.
Conclusion: No difference in precision was found between CTMA and marker- or model-based RSA, but CTMA shows lower migration values of the tibial component at 12 months. CTMA can be used with low effective radiation doses, and CT image acquisition is faster to perform than RSA methods and may be suitable for use in ordinary clinical settings.
目的：放射立体分析（RSA）被认为是体内迁移分析的金标准，但基于ct的替代方法在肩部和髋关节显示出可比的结果。我们之前已经验证了基于ct的移动分析方法（CTMA）与RSA在膝关节幻影中的对比。在本研究中，我们在全膝关节置换术（TKA）患者中验证了该方法。我们的主要结果测量是不同方法之间最大总点运动（MTPM）的差异。方法：对31例行非骨水泥内侧枢轴膝关节全膝关节置换术的患者进行前瞻性研究。使用基于标记和基于模型的RSA以及CT-RSA测量迁移长达12个月。结果：基于标记的RSA的MTPM平均精度数据为0.27 mm (SD 0.09)，基于模型的RSA为0.37 mm (SD 0.26)， CTMA为0.25 mm （SD 0.11）。CTMA的准确度与RSA方法相同（p = 0.845和p = 0.156）。在三个月时，MTPM显示基于标记的RSA平均为0.66 mm (95% CI 0.52至0.81)，基于模型的RSA为0.79 (95% CI 0.64至0.94)，CTMA为0.59 （95% CI 0.47至0.72）。CTMA与基于标记的RSA之间没有差异（p = 0.400），但CTMA的迁移率低于基于模型的RSA （p = 0.019）。12个月时，基于标记的RSA的MTPM为1.03 (95% CI 0.79至1.26)，基于模型的RSA的MTPM为1.02 (95% CI 0.79至1.25)，CTMA的MTPM为0.71 （95% CI 0.48至0.94）。CTMA的MTPM低于两种RSA方法（p < 0.001）。从3个月到12个月，两种方法之间的迁移差异有所增加。每次检查的平均有效辐射剂量分别为0.016 mSv （RSA）和0.069 mSv （CT）。RSA x线片成像时间为17分26秒（SD 7分9秒），CT成像时间为4分24秒（SD 2分3秒）。结论：CTMA与基于标记物或模型的RSA在精度上没有差异，但CTMA在12个月时显示出更低的胫骨假体迁移值。CTMA可以在低有效辐射剂量下使用，CT图像采集比RSA方法更快，可能适合在普通临床环境中使用。
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