Purpose The aim of the study was to assess potential endoprosthesis loosening in patients after revision total hip arthroplasty, based on monochromatic dual-energy computed tomography (DECT) images obtained with and without metal artifact reduction software (MARS) and comparison with the clinical examination and hip function. Materials and Methods Twenty-five consecutive patients underwent DECT examinations. Two monochromatic data sets were generated: with MARS (75-keV MARS) and without MARS (140-keV non-MARS) and evaluated for signs of loosening, using a dedicated radiological score. The Harris Hip Score (HHS) was used to evaluate patients' hip function. Results The mean radiological score for loosening in the non-MARS group was 16.2, in the MARS group 17.0 and was significantly higher (P < 0.001). Radiological loosening evaluation in non-MARS images correlated with the HHS score (ρ = 0.43, P = 0.03), whereas there was no correlation between MARS images and HHS (ρ = 0.15, P = 0.47). New MARS-related artifacts, which hinder implant-bone interface evaluation, were found in 75-keV MARS images (“pseudo-loosening” in 33 of 34 prostheses, “ground-glass blurring” in 20 of 32). Conclusions High-energy monochromatic DECT images are superior to low-energy DECT MARS images in assessment of the potential loosening and correlate better with the clinical examination outcomes. For revision total hip arthroplasty evaluation, 2 data sets should be assessed inseparably because of extra artifacts in MARS images.
The study of symmetrical and non-symmetrical effects in physics, mathematics, mechanics, medicine, and numerical methods is a current topic due to the complexity of the experiments, calculations, and virtual simulations. However, there is a limited number of research publications in computational biomechanics focusing on the symmetry of numerical head models. The majority of the models in the researched literature are symmetrical. Thus, we stated a hypothesis wherever the symmetrical models might be more applicable in numerical analysis. We carried out in-depth studies about head symmetry through clinical data, medical images, materials models, and computer analysis. We concluded that the mapping of the entire geometry of the skull and brain is essential due to the significant differences that affect the results of numerical analyses and the possibility of misinterpretation of the tissue deformation under mechanical load results.
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