Validation of a measuring technique with computed tomography for cement penetration into trabecular bone underneath the tibial tray in total knee arthroplasty on a cadaver model

Verburg, Hennie; Ridder, Laurens C. van de; Verhoeven, Vincent Wj; Pilot, Peter

doi:10.1186/1471-2342-14-29

Cited by 9 publications

(9 citation statements)

References 15 publications

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“…Also, the CT reconstructions were assessed with a numerical computing program (MATLAB® Update 2, The MathWorks, Inc.) based on Hounsfield Units (HU) (matlab method, see additional files for the matlab scripts). The HU was set between 400 and 550 HU for trabecular bone, between 550 and 1600 HU for cement or cemented trabecular bone, 1600-2110 for cortical bone and > 2100 HU for prosthesis [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…The distribution of the cement cannot be visualized with conventional radiography, nor is it possible to obtain a three-dimensional image with this technique. By contrast, in a cadaver model, Computer Tomography (CT) proved to be a reliable procedure to assess the cement mantle in the proximal tibia, with the metal prosthesis in situ [14,15]. So far, however, this procedure has not been evaluated in vivo.…”

Section: Introductionmentioning

confidence: 99%

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Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty

Verburg

Koobs

Niesten

et al. 2020

BMC Musculoskelet Disord

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Background: To evaluate the reliability of two different techniques for measuring penetration and distribution of the cement mantle in the proximal tibia after total knee arthroplasty (TKA) with Computer Tomography (CT) in vivo. Methods: Standardized CT scans of the proximal tibia were taken 1 to 2 years after total knee arthroplasties implanted with a surface cementing technique. These prospectively acquired transversal CT images of the surface of the proximal tibia were divided into four quadrants and were assessed once manually and once with a numerical computing program (MATLAB® Update 2, The MathWorks, Inc.) based on Hounsfield Units by one of the researchers. The assessments were repeated by the same and a second researcher. The ratio cement/trabecular bone was calculated 1, 3 and 5 mm distal of the tibia tray per quadrant. Kruskall-Wallis tests with multiple pairwise comparisons (Dunn's test) were used to determine differences between the quadrants. Intra-and inter-rater reliability as well as the inter method reliability were assessed with the Intraclass Correlation Coefficient (ICC) per level of depth and with Bland-Altman plots. Results: A total of 92 CT scans were included. The intra-and inter-rater reliability of the manual method ranged from 0.22 and 0.52. The intra-and inter-rater reliability of the matlab method varied between 0.98 to 0.99. The median percentage cement measured with the matlab method 1 mm underneath the tibial tray varied between 82 and 88%; at 3 mm depth between 38 and 54% and at 5 mm between 15 and 25%. There was significantly (p < 0.05) less cement in the antero-medial quadrant compared to the antero-lateral and postero-lateral quadrant at 3 mm and 5 mm depth. Conclusions: Distribution and penetration of cement in the proximal tibia in a total knee arthroplasty can be measured reliably with CT in combination with the matlab method presented in this manuscript. This method can be used for clinical purposes as well as for scientific research. Trial registration: METC-nr: 06-104 Dossier NL14807.098.06/versie 06.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty

Verburg

Koobs

Niesten

et al. 2020

BMC Musculoskelet Disord

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“…Moreover, radiographs reduce complex 3D-sturctures to simplified 2D-projections and offer only a limited reproducibility [13–15]. Therefore, various authors have used CT scans to assess the cement mantle around total hip [16, 17] and total knee arthroplasty [7, 18–21]. Liu et al(2009) demonstrated that metal artifact reduction algorithms significantly improve CT image quality for large metal implants.…”

Section: Discussionmentioning

confidence: 99%

“…According to Verburg et al (2014), a separation between pure bone cement and bone cement that has penetrated into trabecular bone is not reliably possible based on HU. Furthermore, they already stated that the prosthesis can be defined accurately based on very high HU values [21]. As a result, a threshold value of 550 HU between trabecular tibial bone and PMMA cement and a threshold of 3000 HU between bone cement and the prosthesis was chosen for the subsequent analysis.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of a non-invasive CT-based measuring technique for cement penetration depth in human tibial UKA

et al. 2019

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BackgroundAseptic loosening of the tibial component remains a major cause of failure in unicompartmental knee arthroplasty (UKA) and may be related to micro-motion at the cement-bone interface due to insufficient cement penetration depth. Cement penetration is therefore taken as an indicator of solid fixation strength and primary stability. However, its non-invasive clinical assessment remains difficult in vivo as conventional x-ray is prone to distortion and CT-scans (computed tomography) are difficult to assess due to metal artifacts. The purpose of this study was to develop and validate a reliable in vivo measuring technique of cement penetration depth in human tibial UKA.MethodsIn an experimental setting, twelve UKA were implanted in fresh-frozen human cadaver knees using a minimal-invasive medial approach. Cement penetration depth was then measured via 1) virtual 3D-models based on metal artifact reduced CT-scans and 2) histological evaluation of nine serial cross-section cuts through the implant-cement-bone-interface. Subsequently, a concordance analysis between the two measuring techniques was conducted.ResultsThe average cement penetration depth was 1) 2.20 mm (SD 0.30 mm) measured on metal artifact reduced CT-scans and 2) 2.21 mm (SD = 0.42) measured on serial cuts (p = 0.956). The mean difference between both techniques was 0.01 mm (SD 0.31 mm) and the Person correlation coefficient was r = 0.686 (p = 0.014). All differences were within the upper and lower limit of agreement. There was no evidence of any significant proportional bias between both techniques (p = 0.182).ConclusionsCT-based non-invasive measurement of cement penetration depth delivers reliable results in measuring the penetration depth in tibial UKA. Thereby, it enables clinicians and researchers to assess the cement penetration for in vivo diagnostics in the clinical setting as well as in vitro biomechanical research with subsequent application of load to failure on the implant-cement-bone-interface.

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“…этому спо-собствуют очевидные преимущества, которые он позволяет получить: уменьшение продолжитель-ности оперативного вмешательства, снижение объема интраоперационной кровопотери, отлич-ная визуализация во время оперативного вмеша-тельства, обеспечение оптимальных условий для цементной фиксации имплантата [7][8][9].…”

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Efficiency and Safety of Tourniquet During Total Knee Arthroplasty: When to Perform Release?

Чугаев¹,

Корнилов²,

Kogan³

2017

Traumatology and Orthopedics of Russia

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Use of a pneumatic tourniquet during total knee arthroplasty is an effective option allowing reduction of the time of surgery and intraoperative blood loss. At the same time, there are a lot of researchers who advocate differing tactical approaches to the duration of the tourniquet application — the so-called “early” and “late” releases.Purpose of the study. To assess the effectiveness and safety of various methods of tourniquet use during primary total knee arthroplasty.Material and methods. 72 patients with end-stage knee osteoarthritis were randomly divided into two equal prospective groups: 1) keeping the tourniquet throughout the surgery, including wound closure (late release); 2) performing knee arthroplasty using the tourniquet until after implantation of the prosthesis component and implementation of hemostasis after the release of the tourniquet (early release). Such aspects as perioperative blood loss and changes in blood counts, blood transfusion volume, and severity of pain on the VAS scale, the rate of recovery of the knee joint function and number of postoperative complications were assessed during hospital stay of patients.Results. The duration of procedures was 70±15,4 min for the Group I with tourniquet throughout surgery (late release) and 95±27,5 for the Group II with early release (p = 0,001). On the 7th day after the arthroplasty the authors observed statistically significant differences (p0,05) in the dynamics of reducing the level of hemoglobin, red blood cells and hematocrit in patients of compared groups — in patients who underwent late release of the tourniquet, these indicators were higher. When assessing the rate of recovery of knee joint function according to the KSS -and the intensity of the pain syndrome no significant statistical differences were found in the patients of both groups.Conclusion. Application of the tourniquet throughout the surgery to release after closure of the surgical wound does not lead to a sharp increase in the number of ischemic and thromboembolic complications, while at the same time, the application of this methodology to a large extent maintains hemoglobin indicators, red blood cells and hematocrit at a high level without a critical decrease.

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Validation of a measuring technique with computed tomography for cement penetration into trabecular bone underneath the tibial tray in total knee arthroplasty on a cadaver model

Cited by 9 publications

References 15 publications

Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty

Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty

Accuracy of a non-invasive CT-based measuring technique for cement penetration depth in human tibial UKA

Efficiency and Safety of Tourniquet During Total Knee Arthroplasty: When to Perform Release?

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