Low-dose CT-based implant motion analysis is a precise tool for early migration measurements of hip cups: a clinical study of 24 patients

Cyrus Brodén, Olof Sandberg, Olof Sköldenberg, Hampus Stigbrand, Mari Hänni, Joshua W Giles, Roger Emery, Stergios Lazarinis, Andreas Nyström, Henrik Olivecrona, Cyrus Brodén, Olof Sandberg, Olof Sköldenberg, Hampus Stigbrand, Mari Hänni, Joshua W Giles, Roger Emery, Stergios Lazarinis, Andreas Nyström, Henrik Olivecrona

Abstract

Background and purpose - Early implant migration is known to be a predictive factor of clinical loosening in total hip arthroplasty (THA). Radiostereometric analysis (RSA) is the gold standard used to measure early migration in patients. However, RSA requires costly, specialized imaging equipment and the image process is complex. We determined the precision of an alternative, commercially available, CT method in 3 ongoing clinical THA studies, comprising 3 different cups.Materials and methods - 24 CT double examinations of 24 hip cups were selected consecutively from 3 ongoing prospective studies: 2 primary THA (1 cemented and 1 uncemented) and 1 THA (cemented) revision study. Precision of the CT-based implant motion analysis (CTMA) system was calculated separately for each study, using both the surface anatomy of the pelvis and metal beads placed in the pelvis.Results - For the CTMA analysis using the surface anatomy of the pelvis, the precision ranged between 0.07 and 0.31 mm in translation and 0.20° and 0.39° for rotation, respectively. For the CTMA analysis using beads the precision ranged between 0.08 and 0.20 mm in translation and between 0.20° and 0.43° for rotations. The radiation dose ranged between 0.2 and 2.3 mSv.Interpretation - CTMA achieved a clinically relevant and consistent precision between the 3 different hip cups studied. The use of different hip cup types, different CT scanners, or registration method (beads or surface anatomy) had no discernible effect on precision. Therefore, CTMA without the use of bone markers could potentially be an alternative to RSA to measure early migration.

Figures

Figure 1.
Figure 1.
Implant types used in the studies: (a) the uncemented TOP cup used in the Uppsala study, (b) a cemented Muller Exceed ABT polyethylene cup from the Danderyd study, (c) the graft-compressing titanium shell and a cemented Lubinus cross-linked UHMWP polyethylene cup used in the Gävle study.
Figure 2.
Figure 2.
Processing schematic for CTMA. (Step 1) First an optimization of bone thresholding is performed manually. (Step 2) Thereafter the pelvic bone is defined here by the surface of the pelvic anatomy; a first registration is subsequently performed. (Step 3) A manual thresholding of metal is performed. (Step 4) The implant rigid body (the cup) is defined. The user indicates the region of interest for the second registration in the 2 datasets, i.e., the implant. Next the second registration occurs. Green color indicates a successful registration.

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