Advanced quantitative 3D imaging improves the reliability of the classification of acetabular defects

Meynen, Alexander; Vles, Georges; Roussot, Mark; Eemeren, Anthony Van; Wafa, Hazem; Mulier, Michiel; Scheys, Lennart

doi:10.1007/s00402-022-04372-x

Cited by 6 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Different authors, highlighted the importance of using CT scans images for the preoperative planning and suggested to adapt originally X-rays based classification on CT images ( 19 , 22 , 29 ). CT scans, in fact, provide superior image clarity, more information into the 3 main plain (coronal, sagittal and axial view) and can be processed to obtain a 3-dimensional reconstruction, which are essential for preoperative planning and implant selection ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…The utility of CT scan or 3D imaging technologies for the analysis and the classification of bone defects has been widely proven on the acetabular side ( 19 - 22 ). Nowadays, 3D modeling software, segmentation and metal artifacts reduction tools, in fact, allow using CT scan images and even magnetic resonance imaging (MRI) in the setting of three-dimensional (3D) bone defect assessment ( 23 , 24 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Proximal femoral defect classifications in revision total hip arthroplasty from X-rays imaging to advanced 3D imaging: a narrative review

Marongiu,

Leinardi,

Antuofermo

et al. 2024

Ann Joint

View full text Add to dashboard Cite

Background and Objective Femoral bone defect in hip arthroplasty revision surgery represents a complex problem, and the treatment is a challenge for orthopedic surgeons called to assess the residual bone stock in an altered anatomy and obtain stability for the new implant. Classification systems available are mostly based on X-rays two-dimensional images and lack of accuracy and reproducibility and comprehensive therapeutic algorithms. However, there is no record of any classification based on computed tomography (CT)-scan images or three-dimensional (3D) modeling modern techniques. We aimed to review the current literature around femoral defect classifications (FDCs) analyzing their different rationale basis, reliability and accuracy, and their benefit in clinical practice. Moreover, we highlighted the role of CT scan-based 3D modeling techniques in the setting of femoral bone defects and revision hip arthroplasty. Methods A narrative review was conducted. The articles were selected from the PubMed and Scopus medical database updated to March 2023. All Level-I to IV studies in the English language were considered for inclusion. The research was performed using relevant search term items: “femoral defects”, “classification”, “radiographic”, “revision hip arthroplasty”, “CT scan” and “3D” and we included only articles that evaluated the accuracy or reliability (or both) of the different femoral bone defects classification system. Key Content and Findings Our search yielded 408 results, of which 17 were deemed highly relevant. We found seven X-ray-based classification systems which have been attempted to quantify the degree of bone loss with low to good reproducibility. The most used classification system for femoral bone defects were the AAOS and Paprosky classification, which also offers a clinical therapeutic algorithm. In 2021, the FDC interestingly showed a new simple classification system with sub-optimal reproducibility and a practical therapeutic algorithm. Despite the numerous classification system of femoral defects, none of them comprehends the use of CT scan and 3D imaging technologies. Conclusions Traditional X-rays-based classification system are still widely used event if their intra-observer and inter-observer reliability is sub-optimal. 3D modeling techniques represent an important diagnostic tool that could improve the understanding of bone defects and residual bone supportive structures, allowing to elaborate new, more precise, classification systems.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proximal femoral defect classifications in revision total hip arthroplasty from X-rays imaging to advanced 3D imaging: a narrative review

Marongiu,

Leinardi,

Antuofermo

et al. 2024

Ann Joint

View full text Add to dashboard Cite

show abstract

“…As for the other most used acetabular defect classification systems, they relies on 2D radiographs, with poor results in terms of reliability and accuracy between preoperative planning and intraoperative findings [13][14][15]. The development of modern diagnostic and tridimensional reconstruction techniques inspired different authors to use 3D models to anticipate the intraoperative reality and consequently develop new quantitative and reproducible classification methods [19,20,23,26]. Significant efforts were made to switch from a qualitative evaluation to a quantitative estimation of the bone defects.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Meynen et al used 3D models to analyze the accuracy of the Acetabular Defect Classification (ADC), a qualitative classification originally elaborated by Wirtz et al [21,22]. On 3D-CT imaging with statistical shape models, bone loss volume was quantified, and this analytical defect information was used by the raters to classify defects, resulting in doubling the intra-and inter-rater reliability and in upscaling the acetabular defect classification when compared to standard radiographs [23].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Assessment of Acetabular Defects in Revision Hip Arthroplasty Based on 3D Modeling: The Area Increase Ratio (AIR) Method

Marongiu,

Campacci,

Capone

2024

Bioengineering

View full text Add to dashboard Cite

The most common classifications for acetabular bone defects are based on radiographic two-dimensional imaging, with low reliability and reproducibility. With the rise of modern processing techniques based on 3D modelling, methodologies for the volumetric quantification of acetabular bone loss are available. Our study aims to describe a new methodology for the quantitative assessment of acetabular defects based on 3D modelling, focused on surface analysis of the integrity of the main anatomical structures of the acetabulum represented by four corresponding sectors (posterior, superior, anterior, and medial). The defect entity is measured as the area increase ratio (AIR) detected in all the sectors analyzed on three planes of view (frontal, sagittal, and axial) compared to healthy hemipelvises. The analysis was performed on 3D models from the CT-scan of six exemplary specimens with a unilateral pathological hemipelvis. The AIR between the native and the pathological hemipelvis was calculated for each sector, for a total of 48 analyses (range, +0.93–+171.35%). An AIR of >50% were found in 22/48 (45.8%) sectors and affected mostly the posterior, medial, and superior sectors (20/22, 90.9%). Qualitative analysis showed consistency between the data and the morphological features of the defects. Further studies with larger samples are needed to validate the methodology and potentially develop a new classification scheme.

show abstract

“…They can be particularly useful in analysing anatomical features, allowing the mean shape and shape variance within a cohort to be visualised [9]. In orthopaedics, SSM has been implemented to describe populations of pelvises, in order to classify large acetabular defects and reconstruct their original centre of rotation, informing the placement and design of restorative implants [10][11][12][13]. Its application to the surfaces of retrieved acetabular hip components would allow wear patterns across their entire surface, from a wide cohort of patients, to be visualised collectively in single map.…”

Section: Introductionmentioning

confidence: 99%

Statistical Shape Modelling the In Vivo Location of Acetabular Wear in Retrieved Hip Implants

et al. 2022

View full text Add to dashboard Cite

Edge-wear in acetabular cups is known to be correlated with greater volumes of material loss; the location of this wear pattern in vivo is less understood. Statistical shape modelling (SSM) may provide further insight into this. This study aimed to identify the most common locations of wear in vivo, by combining CT imaging, retrieval analysis and SMM. Shape variance was described in 20 retrieved metal-on-metal acetabular surfaces. These were revised after a mean of 90 months, from 13 female and seven male patients. They were positioned with a mean inclination and anteversion of 53° and 30°, respectively. Their orientation, in vivo, was established using their stabilising fins, visible in pre-revision CT imaging. The impact of wear volume, positioning, time, gender and size on the in vivo location of wear was investigated. These surfaces had a mean wear volume of 49.63 mm3. The mean acetabular surface displayed superior edge-wear centred 7° within the posterosuperior quadrant, while more of the volumetric wear occurred in the anterosuperior quadrant. Components with higher inclination had greater superior edge-wear scars, while a relationship was observed between greater anteversion angles and more posterosuperior edge-wear. This SSM method can further our understanding of hip implant function, informing future design and may help to refine the safe zone for implant positioning.

show abstract

Advanced quantitative 3D imaging improves the reliability of the classification of acetabular defects

Cited by 6 publications

References 31 publications

Proximal femoral defect classifications in revision total hip arthroplasty from X-rays imaging to advanced 3D imaging: a narrative review

Proximal femoral defect classifications in revision total hip arthroplasty from X-rays imaging to advanced 3D imaging: a narrative review

Quantitative Assessment of Acetabular Defects in Revision Hip Arthroplasty Based on 3D Modeling: The Area Increase Ratio (AIR) Method

Statistical Shape Modelling the In Vivo Location of Acetabular Wear in Retrieved Hip Implants

Contact Info

Product

Resources

About