Assessing implant position and bone properties after cementless total knee arthroplasty using weight-bearing computed tomography
Background Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the prese...
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| Vydáno v: | BMC musculoskeletal disorders Ročník 26; číslo 1; s. 477 - 7 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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BioMed Central
15.05.2025
BioMed Central Ltd Springer Nature B.V BMC |
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| ISSN: | 1471-2474, 1471-2474 |
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| Abstract | Background
Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position.
Methods
Forty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT.
Results
Inter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97).
Conclusion
Cementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability. |
|---|---|
| AbstractList | Background Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position. Methods Forty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT. Results Inter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97). Conclusion Cementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability. Keywords: Cementless total knee arthroplasty, Implant fixation, Coronal alignment, Hip-knee-ankle angle, Joint line obliquity, Bone density Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position. Forty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT. Inter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97). Cementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability. Abstract Background Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position. Methods Forty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT. Results Inter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97). Conclusion Cementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability. Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position. Forty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT. Inter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97). Cementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability. Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position.BACKGROUNDWeight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position.Forty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT.METHODSForty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT.Inter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97).RESULTSInter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97).Cementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability.CONCLUSIONCementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability. Background Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position. Methods Forty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT. Results Inter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97). Conclusion Cementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability. BackgroundWeight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be particularly useful in relation to personalized total knee arthroplasty (TKA) with cementless implants. The objective of the present study was to evaluate the utility and inter-observer repeatability of WBCT in assessing patients with cementless TKA in a loaded position.MethodsForty patients who underwent primary TKA approximately 3 years previously and received one of two cementless implant systems were recruited, including two subjects with bilateral TKA, for a total of 42 knees. All subjects underwent examination of their knee with WBCT while standing, thereby loading the indicated knee. Lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA), and joint line obliquity (JLO) were measured on full length radiographs and the WBCT exams by two observers. Femoral and tibial component rotation was measured on WBCT. Greyscale values representing bone density were assessed in five identically sized regions of interests in both the femur and the tibia on WBCT.ResultsInter-observer agreement for alignment was good (95% ICC: 0.87). Inter-observer agreement for femoral component rotation was moderate (95% ICC: 0.67) and for tibial component rotation was good (95% ICC: 0.84). Inter-observer agreement for femoral greyscale values was good (95% ICC: 0.87) and for tibial greyscale values was excellent (95% ICC: 0.97).ConclusionCementless TKA can be assessed postoperatively using WBCT to measure implant position and bone density in a functional, loaded joint position with good inter-observer repeatability. |
| ArticleNumber | 477 |
| Audience | Academic |
| Author | Kalia, Vishal Vasarhelyi, Edward M. Lanting, Brent A. Teeter, Matthew G. Lin, Jane Zamani, Mariam |
| Author_xml | – sequence: 1 givenname: Jane surname: Lin fullname: Lin, Jane organization: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University – sequence: 2 givenname: Mariam surname: Zamani fullname: Zamani, Mariam organization: Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University – sequence: 3 givenname: Vishal surname: Kalia fullname: Kalia, Vishal organization: Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University – sequence: 4 givenname: Edward M. surname: Vasarhelyi fullname: Vasarhelyi, Edward M. organization: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University – sequence: 5 givenname: Brent A. surname: Lanting fullname: Lanting, Brent A. organization: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University – sequence: 6 givenname: Matthew G. surname: Teeter fullname: Teeter, Matthew G. email: matthew.teeter@lhsc.on.ca organization: Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University |
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| Keywords | Coronal alignment Bone density Cementless total knee arthroplasty Hip-knee-ankle angle Joint line obliquity Implant fixation |
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| References_xml | – volume: 31 start-page: 878 issue: 4 year: 2016 ident: 8718_CR3 publication-title: J Arthroplasty doi: 10.1016/j.arth.2015.08.015 – ident: 8718_CR5 doi: 10.2106/JBJS.23.01092 – volume: 8 start-page: 874 issue: 12 year: 2023 ident: 8718_CR13 publication-title: EFORT Open Rev doi: 10.1530/EOR-22-0096 – volume: 2 start-page: 100083 issue: 3–4 year: 2022 ident: 8718_CR7 publication-title: Osteoarthr Imaging doi: 10.1016/j.ostima.2022.100083 – volume: 32 start-page: 473 issue: 2 year: 2024 ident: 8718_CR2 publication-title: Knee Surg Sports Traumatol Arthrosc doi: 10.1002/ksa.12066 – volume: 19 start-page: 793 issue: 6 year: 2012 ident: 8718_CR17 publication-title: Knee doi: 10.1016/j.knee.2012.02.011 – volume: 39 start-page: 2014 issue: 8 year: 2024 ident: 8718_CR14 publication-title: J Arthroplasty doi: 10.1016/j.arth.2024.02.068 – volume: 32 start-page: 515 issue: 3 year: 2024 ident: 8718_CR1 publication-title: Knee Surg Sports Traumatol Arthrosc doi: 10.1002/ksa.12107 – volume: 27 start-page: 101504 issue: 3 year: 2024 ident: 8718_CR19 publication-title: J Clin Densitom doi: 10.1016/j.jocd.2024.101504 – ident: 8718_CR11 doi: 10.1259/bjr.20160925 – volume: 74 start-page: 676 issue: 4 year: 2023 ident: 8718_CR18 publication-title: Can Assoc Radiol J doi: 10.1177/08465371231164743 – volume: 103–B start-page: 329 issue: 2 year: 2021 ident: 8718_CR15 publication-title: Bone Joint J doi: 10.1302/0301-620X.103B2.BJJ-2020-1050.R1 – ident: 8718_CR20 doi: 10.1177/24730114231164143 – year: 2024 ident: 8718_CR9 publication-title: Skeletal Radiol Published Online doi: 10.1007/s00256-024-04562-1 – volume: 59 start-page: 1500 issue: 12 year: 2018 ident: 8718_CR12 publication-title: Acta Radiol doi: 10.1177/0284185118762247 – volume: 27 start-page: e516 issue: 11 year: 2019 ident: 8718_CR4 publication-title: J Am Acad Orthop Surg doi: 10.5435/JAAOS-D-18-00272 – volume: 25 start-page: 319 issue: 3 year: 2022 ident: 8718_CR16 publication-title: J Clin Densitom doi: 10.1016/j.jocd.2022.01.004 – volume: 30 start-page: 671 issue: 5 year: 2022 ident: 8718_CR10 publication-title: Osteoarthritis Cartilage doi: 10.1016/j.joca.2021.11.019 – ident: 8718_CR8 doi: 10.1016/j.otsr.2021.102874 – volume: 127 start-page: 729 issue: 8 year: 2007 ident: 8718_CR6 publication-title: Arch Orthop Trauma Surg doi: 10.1007/s00402-007-0351-6 |
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Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load.... Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load. This may be... Background Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load.... BackgroundWeight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is under load.... Abstract Background Weight-bearing CT (WBCT) scanners are growing in availability and provide the capability of three-dimensional imaging while a joint is... |
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| SubjectTerms | Aged Aged, 80 and over Ankle Arthroplasty (knee) Arthroplasty, Replacement, Knee - instrumentation Arthroplasty, Replacement, Knee - methods Artificial hip joints Bone Density Bones Cementless total knee arthroplasty Computed tomography Coronal alignment CT imaging Density Epidemiology Female Femur Femur - diagnostic imaging Femur - surgery Hip-knee-ankle angle Humans Implant fixation Implants, Artificial Internal Medicine Joint line obliquity Joint replacement surgery Knee Knee Joint - diagnostic imaging Knee Joint - surgery Knee Prosthesis Male Mechanical properties Medical imaging Medical research Medicine Medicine & Public Health Medicine, Experimental Middle Aged Observer Variation Orthopedics Patients Physiological aspects Prosthesis Rehabilitation Reproducibility of Results Rheumatology Sports Medicine Surgery, Experimental Surgical research Tibia Tibia - diagnostic imaging Tibia - surgery Tomography Tomography, X-Ray Computed - methods Transplants & implants Triathlon Weight-Bearing - physiology |
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| Title | Assessing implant position and bone properties after cementless total knee arthroplasty using weight-bearing computed tomography |
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