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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

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 ...

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Autores principales: Verburg, Hennie, van Zeeland Koobs, Linda, Niesten, Dieu Donné, Pilot, Peter, Mathijssen, Nina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291566/
https://www.ncbi.nlm.nih.gov/pubmed/32532306
http://dx.doi.org/10.1186/s12891-020-03390-3
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author Verburg, Hennie
van Zeeland Koobs, Linda
Niesten, Dieu Donné
Pilot, Peter
Mathijssen, Nina
author_facet Verburg, Hennie
van Zeeland Koobs, Linda
Niesten, Dieu Donné
Pilot, Peter
Mathijssen, Nina
author_sort Verburg, Hennie
collection PubMed
description 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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spelling pubmed-72915662020-06-12 Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty Verburg, Hennie van Zeeland Koobs, Linda Niesten, Dieu Donné Pilot, Peter Mathijssen, Nina BMC Musculoskelet Disord Research Article 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. BioMed Central 2020-06-12 /pmc/articles/PMC7291566/ /pubmed/32532306 http://dx.doi.org/10.1186/s12891-020-03390-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Verburg, Hennie
van Zeeland Koobs, Linda
Niesten, Dieu Donné
Pilot, Peter
Mathijssen, Nina
Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty
title Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty
title_full Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty
title_fullStr Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty
title_full_unstemmed Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty
title_short Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty
title_sort reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291566/
https://www.ncbi.nlm.nih.gov/pubmed/32532306
http://dx.doi.org/10.1186/s12891-020-03390-3
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