Multi-energy spectral photon-counting computed tomography (MARS) for detection of arthroplasty implant failure

AbstractTo determine whether state-of-the-art multi-energy spectral photon-counting computed tomography (MARS) can detect knee arthroplasty implant failure not detected by standard pre-operative imaging techniques. A total knee arthroplasty (TKA) removed from a patient was reviewed. The extracted prosthesis [NexGen Legacy Posterior Stabilized (LPS) TKA] was analyzed as were pre-operative imaging examination and compared with a MARS-CT examination obtained of the extracted TKA prosthesis. Radiographs, fluoroscopy, ultrasound and MRI preoperatively did not reveal the cause of the implant failure. MARS CT images of the extracted prosthesis clearly showed the presence of posteromedial polyethylene and tibial tray wear which is compatible with the clinical appearance of the extracted TKA. MARS can identify polyethylene insert and metallic tibial tray wear as a cause of TKA failure, that could not be identified with on standard pre-operative imaging. Although clinical MARS CT system is still under development, this case does illustrate its potential clinical usefulness. This is the first study to document how MARS CT imaging can detect orthopedic implant failure not detected by standard current imaging techniques. This system has a potential clinical application in orthopedic patients.

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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

BMC Medical Imaging ◽

10.1186/1471-2342-14-29 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Hennie Verburg ◽

Laurens C van de Ridder ◽

Vincent WJ Verhoeven ◽

Peter Pilot

Keyword(s):

Computed Tomography ◽

Total Knee Arthroplasty ◽

Trabecular Bone ◽

Knee Arthroplasty ◽

Measuring Technique ◽

Tibial Tray ◽

Cement Penetration ◽

Total Knee

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Lymphedema: A Significant Risk Factor for Infection and Implant Failure After Total Knee Arthroplasty

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-20-00005 ◽

2020 ◽

Vol 28 (23) ◽

pp. 996-1002 ◽

Cited By ~ 1

Author(s):

Joshua M. Kolz ◽

William G. Rainer ◽

Cody C. Wyles ◽

Matthew T. Houdek ◽

Kevin I. Perry ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Knee Arthroplasty ◽

Significant Risk ◽

Significant Risk Factor ◽

Implant Failure ◽

Total Knee

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Computed tomography analysis of knee pose and geometry before and after total knee arthroplasty

Journal of Biomechanics ◽

10.1016/j.jbiomech.2012.06.004 ◽

2012 ◽

Vol 45 (13) ◽

pp. 2215-2221 ◽

Cited By ~ 15

Author(s):

K.C.T. Ho ◽

S.K. Saevarsson ◽

H. Ramm ◽

R. Lieck ◽

S. Zachow ◽

...

Keyword(s):

Computed Tomography ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Before And After ◽

Total Knee ◽

Tomography Analysis

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Imaging of symptomatic total knee arthroplasty with cone beam computed tomography

Acta Radiologica ◽

10.1177/0284185118762247 ◽

2018 ◽

Vol 59 (12) ◽

pp. 1500-1507 ◽

Cited By ~ 3

Author(s):

Antti Jaroma ◽

Juha-Sampo Suomalainen ◽

Lea Niemitukia ◽

Tarja Soininvaara ◽

Jari Salo ◽

...

Keyword(s):

Computed Tomography ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cone Beam Computed Tomography ◽

Tibial Component ◽

Cone Beam ◽

Component Rotation ◽

Symptomatic Knee ◽

Total Knee ◽

Component Loosening

Background Computed tomography (CT) can be used to assess the rotational alignment of prosthesis components to identify possible underlying causes of symptomatic total knee arthroplasty (TKA). The use of cone beam computed tomography (CBCT) for the imaging of extremities is relatively new, although it has been widely used in dental imaging. Purpose To assess the intra- and inter-observer reproducibility of CBCT, as well as to validate CBCT for TKA component and periprosthetic bone diagnostics. Material and Methods CBCT scans were performed on 18 patients the day before a scheduled revision TKA, from which the intra- and inter-observer reproducibility were assessed. Component rotation and loosening were evaluated. Perioperative bone defects were classified. Results The inter-observer intraclass coefficient correlation (ICC) for femoral component rotation was 0.41 (95% confidence interval [CI] = 0.12–0.69). For the tibial component, the ICC was 0.87 (95% CI = 0.74–0.94). Intra-observer reproducibilities were 0.70 (95% CI = 0.35–0.87) and 0.92 (95% CI = 0.80–0.97), respectively. The sensitivity for tibial component loosening was 97% and the specificity was 85%. The reliability of bone defect classification was only weak to moderate. Conclusion Two-dimensional (2D) CBCT scanning provides reliable and reproducible data for determining the rotation of femoral and tibial components, while showing minor overestimation of tibial component loosening. CBCT is a promising new tool for the evaluation of symptomatic knee arthroplasty patients, with a substantially lower radiation dose compared to conventional 2D multi-slice CT.

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Computed tomography evaluation of total knee arthroplasty implants position after two different surgical methods of implantation

International Orthopaedics ◽

10.1007/s00264-018-4180-8 ◽

2018 ◽

Vol 43 (1) ◽

pp. 139-149 ◽

Cited By ~ 5

Author(s):

Francesco Benazzo ◽

Stefano Marco Paolo Rossi ◽

Gianmarco Danesino ◽

Catherine Klersy ◽

Simone Perelli ◽

...

Keyword(s):

Computed Tomography ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Surgical Methods ◽

Total Knee

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Recurrent hemarthrosis after total knee arthroplasty in rheumatoid arthritis successfully treated with selective embolization: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20964116 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2096411

Author(s):

Takeo Mammoto ◽

Toshiyuki Irie ◽

Nobuyuki Takahashi ◽

Shun Nakajima ◽

Atsushi Hirano

Keyword(s):

Rheumatoid Arthritis ◽

Computed Tomography ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rare Complication ◽

Selective Embolization ◽

Acute Complications ◽

Genicular Artery ◽

Suprapatellar Pouch ◽

Total Knee

Recurrent hemarthrosis after total knee arthroplasty is a rare complication. This usually occurs in osteoarthritis, but is relatively rare in rheumatoid arthritis. This is a report of recurrent hemarthrosis after total knee arthroplasty in a rheumatoid arthritis patient. An 85-year-old woman with rheumatoid arthritis had received total knee arthroplasty without acute complications. At 6 months after surgery, the first hemarthrosis occurred and an initial conservative treatment failed. Contrast computed tomography showed prominent synovial enhancement in the superior lateral suprapatellar pouch. Selective catheterization revealed an abnormal hyperemic blush supplied from the branches of the superior lateral genicular artery. After embolization with N-butyl-2-cyanoacrylate, abnormal staining of the synovium diminished and knee swelling and pain disappeared without complications. Selective embolization is favorable for successful treatment of recurrent hemarthrosis after total knee arthroplasty in patients with rheumatoid arthritis.

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The Posterolateral Corner-Locked Technique Is Applicable in a Chinese Population Regarding the Tibial Component Rotation Alignment in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1678536 ◽

2019 ◽

Vol 33 (05) ◽

pp. 466-473

Author(s):

Chao-Hua Fang ◽

Cheng-Kung Cheng ◽

Tie-Bing Qu ◽

Jun-Hui Zhang ◽

Bo Zhang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Chinese Population ◽

Posterolateral Corner ◽

Tibial Tubercle ◽

Tibial Osteotomy ◽

Tibial Tray ◽

Total Knee ◽

Asymmetrical Design

AbstractRotational malalignment between the femoral and tibial components in total knee arthroplasty (TKA) can affect clinical outcomes, but there is no consensus on how to best determine tibia tray orientation. The posterolateral corner-locked (PLCL) technique may be a new method. This study aims to assess the applicability of this technique in a Chinese population. Forty normal Chinese volunteers were recruited and underwent computed tomography (CT) of the lower limbs. Knee model reconstructions and simulated standard tibial osteotomy were conducted digitally. The transepicondylar axis (TEA), the Akagi line, and the line connecting the medial third of the tibial tubercle with the midpoint of the posterior cruciate ligament (PCL) were projected to the tibial cross-section and marked. The PLCL technique was applied using either symmetrical or asymmetrical tibial tray templates, and the anteroposterior (AP) axis of the tibial tray was marked. The angles between the TEA and these lines were calculated, and the statistical differences were analyzed. The angle between the TEA and the Akagi line and between the TEA and the line connecting the medial third of the tibial tubercle with the midpoint of the PCL were 96.90 ± 5.57 and 107.31 ± 5.95 degrees, respectively. The angles between the TEA and the AP axis of the symmetrical and the asymmetrical design tibial trays were 94.01 ± 4.21 and 96.65 ± 4.70 degrees, respectively. Except for the Akagi line and AP axis of the asymmetrical tibial tray, statistical differences were found between all lines (p < 0.05). The PLCL technique is principally suitable for Chinese patients requiring TKA when using the tibial component referred to in this study, although it may result in slight external rotation.

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