Metal Artifact Reduction Dual-Energy CT as an Accurate and Reliable Method for Measuring Total Knee Arthroplasty Femoral Component Rotation Compared to Conventional CT

Abstract

This article determines the accuracy and reliability of dual-energy computed tomography (DECT) with metal artifact reduction (MAR) in the evaluation of femoral component rotation after total knee arthroplasty (TKA), in comparison with conventional CT images. A total of 49 patients (mean age, 69 years; 42 women) who underwent TKA between January 2019 and March 2020 were retrospectively enrolled. Femoral component rotation, including the anatomic and surgical transepicondylar axes, was evaluated with preoperative conventional CT and postoperative conventional CT and DECT with MAR. Surgical femoral component rotation was also assessed as a reference standard. Accuracy was assessed using paired t-test, and inter- and intraobserver reliability using intraclass correlation coefficients (ICCs) based on postoperative conventional CT and DECT with MAR. Clinical outcomes were evaluated using the Knee Society objective and functional scores. Accuracy of femoral component rotation was not significantly different from that of surgical rotation with both conventional CT and DECT with MAR. However, inter- and intraobserver reliability were better for DECT with MAR (ICC: 0.953–0.966) than for conventional CT (ICC: 0.641–0.749). The Knee Society objective and functional scores improved 1 year postoperatively. Conclusion DECT with MAR showed accurate and more reliable results than did conventional CT in the evaluation of femoral component rotation after TKA.

Radiological and clinical outcomes after Attune primary total knee arthroplasty using Stemmable Tibia: a two-year follow-up prospective bi-center study

“…All orthopedic surgeons (X.X., X.X., and X.X.) participating in the surgical procedures received training on the Depuy Attune Knee Implant system and had prior experience with the system before this study commenced [12].…”

Advances in Bone Joint Imaging-Metal Artifact Reduction

“…Previous studies reported that DECT reduced metal artifacts on spine implants, implants for fractures, and hip and knee prostheses [ 40 , 41 , 42 , 50 , 51 , 52 ]. However, there is no generalized optimal kV for metal implants, which may be attributed to differences in metal alloys, the size, shape, and geometry of the implant, the body region, and the acquisition parameters used [ 31 ].…”