Comparison of radiographs, tomosynthesis and CT with metal artifact reduction for the detection of hip prosthetic loosening

Gillet, Romain; Teixeira, Pedro Augusto Gondim; Bonarelli, Chloé; Coudane, H.; Sirveaux, François; Louis, M.; Blum, Alain

doi:10.1007/s00330-018-5717-3

Cited by 19 publications

(9 citation statements)

References 47 publications

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“…CT scans offer improved resolution and are useful in the analysis of focal osteolysis, deformities such as rotational abnormalities and improved digital planning capacities [19][20][21]. X-ray still present the first imaging step when loosening of hip prosthesis is suspected and present with a decent sensitivity and specificity but are not as specific/sensitive as MRI and CT [22].…”

Section: Discussionmentioning

confidence: 99%

Femoral defects in revision hip arthroplasty: a therapy-oriented classification

Jaenisch

Kohlhof

Kasapovic

et al. 2021

Arch Orthop Trauma Surg

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Introduction The complex field of femoral defects in revision hip arthroplasty displays a lack of standardized, intuitive pre- and intraoperative assessment. To address this issue, the femoral defect classification (FDC) is introduced to offer a reliable, reproducible and an intuitive classification system with a clear therapeutic guideline. Materials and methods The FDC is based on the integrity of the main femoral segments which determine function and structural support. It focuses on the femoral neck, the metaphysis consisting of the greater and lesser trochanter, and the femoral diaphysis. The four main categories determine the location of the defect while subcategories a, b and c are being used to classify the extent of damage in each location. In total, 218 preoperative radiographs were retrospectively graded according to FDC and compared to intraoperatively encountered bone defects. To account for inter-rater and intra-rater agreement, 5 different observers evaluated 80 randomized cases at different points in time. Results A Cohens kappa of 0.832 ± 0.028 could be evaluated, accounting for excellent agreement between preoperative radiographs and intraoperative findings. To account for inter-rater reliability, 80 patients have been evaluated by 5 different observers. Testing for inter-rater reliability, a Fleiss Kappa of 0.688 could be evaluated falling into the good agreement range. When testing for intra-rater reliability, Cohens Kappa of each of the 5 raters has been analyzed and the mean was evaluated at 0.856 accounting for excellent agreement. Conclusion The FDC is a reliable and reproducible classification system. It combines intuitive use and structured design and allows for consistent preoperative planning and intraoperative guidance. A therapeutic algorithm has been created according to current literature and expert opinion. Due to the combination of the FDC with the recently introduced Acetabular Defect Classification (ADC) a structured approach to the entire field of hip revision arthroplasty is now available.

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Section: Discussionmentioning

confidence: 99%

Femoral defects in revision hip arthroplasty: a therapy-oriented classification

Jaenisch

Kohlhof

Kasapovic

et al. 2021

Arch Orthop Trauma Surg

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“…DTS is superior to radiography for visualizing superimposed anatomical structures because multiple images from various angles are taken while the X-ray tube is swept within a specified range [ 17 22 ]. DTS is also beneficial for evaluating regions of interest that contain metallic implements [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Digital Tomosynthesis versus Conventional Radiography for Evaluating Osteonecrosis of the Femoral Head

et al. 2021

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Objective The aim of this study was to compare the diagnostic performances of digital tomosynthesis (DTS) and conventional radiography in detecting osteonecrosis of the femoral head (ONFH) using computed tomography (CT), as the reference standard and evaluate the diagnostic reproducibility of DTS. Materials and Methods Forty-five patients (24 male and 21 female; age range, 25–77 years) with clinically suspected ONFH underwent anteroposterior radiography, DTS, and CT. Two musculoskeletal radiologists independently evaluated the presence and type of ONFH. The diagnostic performance of radiography and DTS in detecting the presence of ONFH and determining the types of ONFH were evaluated. The interobserver and intraobserver reliabilities of each imaging modality were analyzed using Cohen's kappa. Results DTS had higher sensitivity (89.4%–100% vs. 74.5%–76.6%) and specificity (97.3%–100% vs. 78.4%–83.8%) for ONFH detection than radiography. DTS showed higher performance than radiography in identifying the subtypes of ONFH with statistical significance in one reader (type 1, 100% vs. 30.8%, p = 0.004; type II, 97.1% vs. 73.5%, p = 0.008). The interobserver agreement was excellent for DTS and moderate for radiography (kappa of 0.86 vs. 0.57, respectively). The intraobserver agreement for DTS was higher than that of radiography (kappa of 0.96 vs. 0.69, respectively). Conclusion DTS showed higher diagnostic performance and reproducibility than radiography in detecting ONFH. DTS may be used as a first-line diagnostic modality instead of radiography for patients suspected of having ONFH.

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“…Third, the influence of metal equipment-related artifacts is reduced. 25 Fourth, the associated radiation dose is lower than that of CT; however, the radiation exposure of tomosynthesis is twice that of radiography. Koyama et al 26 stated that the effective dose during a typical tomosynthesis examination of the hip joint was 0.82 mSv; however, the effective dose during routine CT examination in the same location was 10.5 mSv, which is more than 10 times that of tomosynthesis.…”

Section: Discussionmentioning

confidence: 99%

Tomosynthesis Is Equivalent to Computed Tomography for Evaluating Osseous Integration After Anterior Cruciate Ligament Reconstruction

Toyooka

Masuda

Nishihara

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To compare tomosynthesis and computed tomography (CT) for evaluating bone plug integration after anterior cruciate ligament (ACL) reconstruction with a boneepatellar tendonebone (BPTB) graft. Methods: Data of consecutive adult patients who underwent ACL reconstruction with BPTB were analyzed. Bone integration between the bone plug and bone tunnel was evaluated by tomosynthesis and CT, which were both performed 3 months postoperatively. The obtained data for both modalities were reconstructed with slice thickness of 2 mm. Evaluation of bone integration were separately performed using coronal-and sagittal-reconstructed images for the femur and tibia. The ratio of bone integration between the reconstructed slices in which bone grafting was involved, for both tomosynthesis and CT, was investigated by 2 blinded examiners. The equivalence of tomosynthesis to CT was tested by comparing the bone integration ratio for both modalities. The accuracy of diagnosing bone union using tomosynthesis and CT was also investigated. Results: The diagnostic accuracy of tomosynthesis and CT exceeded 80%. Interobserver agreement of bone integration in the sagittal plane on the femoral side was 0.92 (intraclass correlation coefficient) for CT and 0.76 (intraclass correlation coefficient) for tomosynthesis. Conclusions: Although it showed poor reliability, tomosynthesis was equivalent to CT in evaluating bone plug integration after ACL reconstruction with BPTB.

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Comparison of radiographs, tomosynthesis and CT with metal artifact reduction for the detection of hip prosthetic loosening

Cited by 19 publications

References 47 publications

Femoral defects in revision hip arthroplasty: a therapy-oriented classification

Femoral defects in revision hip arthroplasty: a therapy-oriented classification

Digital Tomosynthesis versus Conventional Radiography for Evaluating Osteonecrosis of the Femoral Head

Tomosynthesis Is Equivalent to Computed Tomography for Evaluating Osseous Integration After Anterior Cruciate Ligament Reconstruction

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