Aims. Although CT is considered the benchmark to measure femoral version, 3D biplanar
Abstract. Background. Post operative radiographs following total joint arthroplasty are requested as part of routine follow up in many institutions. These studies have a significant cost to the local departments, in terms of financial and clinic resources, however, previous research has suggested they may not alter the course of the patients treatment. The purpose of this study was to assess the significance of elective post operative radiographs on changes in management of patients who underwent total joint arthroplasty. Method. All patients who underwent total knee arthroplasty and total hip arthroplasty at a District General Hospital from 2019 to 2020 were included. Data was collected retrospectively from medical records and radiograph requests. Alterations to clinical management based on
Malalignment is often postulated as the main reason for the high failure rate of total ankle replacements (TARs). Only a few studies have been performed to correlate
Knee joint distraction (KJD) has been associated with clinical and structural improvement and synovial fluid (SF) marker changes. However, structural changes have not yet been shown satisfactorily in regular care, since
Introduction. Routine radiographs in the follow-up of circular frames is commonplace, however the effect on clinical decision making is unclear. Previous work locally has suggested that >95% of radiographs, particularly at early time points, do not affect clinical management. This study was conducted to assess the impact of a transition to early remote follow-up on circular frame patients with limited
Aims. Distraction osteogenesis (DO) is a useful orthopaedic procedure employed to lengthen and reshape bones by stimulating bone formation through controlled slow stretching force. Despite its promising applications, difficulties are still encountered. Our previous study demonstrated that pulsed electromagnetic field (PEMF) treatment significantly enhances bone mineralization and neovascularization, suggesting its potential application. The current study compared a new, high slew rate (HSR) PEMF signal, with different treatment durations, with the standard Food and Drug Administration (FDA)-approved signal, to determine if HSR PEMF is a better alternative for bone formation augmentation. Methods. The effects of a HSR PEMF signal with three daily treatment durations (0.5, one, and three hours/day) were investigated in an established rat DO model with comparison of an FDA-approved classic signal (three hrs/day). PEMF treatments were applied to the rats daily for 35 days, starting from the distraction phase until termination.
Polyethylene wear represents a significant risk factor for the long-term success of knee arthroplasty [1]. This work aimed to develop and in vivo validate an automated algorithm for accurate and precise AI based wear measurement in knee arthroplasty using clinical AP radiographs for scientifically meaningful multi-centre studies. Twenty postoperative radiographs (knee joint AP in standing position) after knee arthroplasty were analysed using the novel algorithm. A convolutional neural network-based segmentation is used to localize the implant components on the X-Ray, and a 2D-3D registration of the CAD implant models precisely calculates the three-dimensional position and orientation of the implants in the joint at the time of acquisition. From this, the minimal distance between the involved implant components is determined, and its postoperative change over time enables the determination of wear in the radiographs. The measured minimum inlay height of 335 unloaded inlays excluding the weight-induced deformation, served as ground truth for validation and was compared to the algorithmically calculated component distances from 20 radiographs. With an average weight of 94 kg in the studied TKA patient cohort, it was determined that an average inlay height of 6.160 mm is expected in the patient. Based on the radiographs, the algorithm calculated a minimum component distance of 6.158 mm (SD = 81 µm), which deviated by 2 µm in comparison to the expected inlay height. An automated method was presented that allows accurate and precise determination of the inlay height and subsequently the wear in knee arthroplasty based on a clinical radiograph and the CAD models. Precision and accuracy are comparable to the current gold standard RSA [2], but without relying on special
Introduction and Objective. Up to 30% of thoracolumbar (TL) fractures are missed in the emergency room. Failure to identify these fractures can result in neurological injuries up to 51% of the casesthis article aimed to clarify the incidence and risk factors of traumatic fractures in China. The China National Fracture Study (CNFS. Obtaining sagittal and anteroposterior radiographs of the TL spine are the first diagnostic step when suspecting a traumatic injury. In most cases, CT and/or MRI are needed to confirm the diagnosis. These are time and resource consuming. Thus, reliably detecting vertebral fractures in simple
Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes.Aims
Methods
Objectives. Researchers continue to seek easier ways to evaluate the quality of bone and screen for osteoporosis and osteopenia. Until recently,
It has been well documented in the arthroplasty literature that lumbar degenerative disc disease (DDD) contributes to abnormal spinopelvic motion. However, the relationship between the severity or pattern of hip osteoarthritis (OA) as measured on an anteroposterior (AP) pelvic view and spinopelvic biomechanics has not been well investigated. Therefore, the aim of the study is to examine the association between the severity and pattern of hip OA and spinopelvic motion. A retrospective chart review was conducted to identify patients undergoing primary total hip arthroplasty (THA). Plain AP pelvic radiographs were reviewed to document the morphological characteristic of osteoarthritic hips. Lateral spine-pelvis-hip sitting and standing plain radiographs were used to measure sacral slope (SS) and pelvic femoral angle (PFA) in each position. Lumbar disc spaces were measured to determine the presence of DDD. The difference between sitting and standing SS and PFA were calculated to quantify spinopelvic motion (ΔSS) and hip motion (ΔPFA), respectively. Univariate analysis and Pearson correlation were used to identify morphological hip characteristics associated with changes in spinopelvic motion.Aims
Methods
Objectives. The
Assessment of bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) is a well-established clinical technique, but it is not available in the acute trauma setting. Thus, it cannot provide a preoperative estimation of BMD to help guide the technique of fracture fixation. Alternative methods that have been suggested for assessing BMD include: 1) cortical measures, such as cortical ratios and combined cortical scores; and 2) aluminium grading systems from preoperative digital radiographs. However, limited research has been performed in this area to validate the different methods. The aim of this study was to investigate the evaluation of BMD from digital radiographs by comparing various methods against DXA scanning. A total of 54 patients with distal radial fractures were included in the study. Each underwent posteroanterior (PA) and lateral radiographs of the injured wrist with an aluminium step wedge. Overall 27 patients underwent routine DXA scanning of the hip and lumbar spine, with 13 undergoing additional DXA scanning of the uninjured forearm. Analysis of radiographs was performed on ImageJ and Matlab with calculations of cortical measures, cortical indices, combined cortical scores, and aluminium equivalent grading.Aims
Methods
Introduction. Cross table lateral (CTL) radiographs are commonly used to measure acetabular component anteversion after total hip arthroplasty (THA). CTL measurements may differ by >10 degrees from CT scan measurements, but the reasons for this discrepancy are poorly understood. We compare anteversion measurements made on CTL radiographs and CT scans to identify spinopelvic parameters predictive of inaccuracy. Methods. THA patients (n=47) with preoperative spinopelvic
Over the last few years low dose digital
Evaluation of patient specific spinopelvic mobility requires the detection of bony landmarks in lateral functional radiographs. Current manual landmarking methods are inefficient, and subjective. This study proposes a deep learning model to automate landmark detection and derivation of spinopelvic measurements (SPM). A deep learning model was developed using an international multicenter imaging database of 26,109 landmarked preoperative, and postoperative, lateral functional radiographs (HREC: Bellberry: 2020-08-764-A-2). Three functional positions were analysed: 1) standing, 2) contralateral step-up and 3) flexed seated. Landmarks were manually captured and independently verified by qualified engineers during pre-operative planning with additional assistance of 3D computed tomography derived landmarks. Pelvic tilt (PT), sacral slope (SS), and lumbar lordotic angle (LLA) were derived from the predicted landmark coordinates. Interobserver variability was explored in a pilot study, consisting of 9 qualified engineers, annotating three functional images, while blinded to additional 3D information. The dataset was subdivided into 70:20:10 for training, validation, and testing. The model produced a mean absolute error (MAE), for PT, SS, and LLA of 1.7°±3.1°, 3.4°±3.8°, 4.9°±4.5°, respectively. PT MAE values were dependent on functional position: standing 1.2°±1.3°, step 1.7°±4.0°, and seated 2.4°±3.3°, p< 0.001. The mean model prediction time was 0.7 seconds per image. The interobserver 95% confidence interval (CI) for engineer measured PT, SS and LLA (1.9°, 1.9°, 3.1°, respectively) was comparable to the MAE values generated by the model. The model MAE reported comparable performance to the gold standard when blinded to additional 3D information. LLA prediction produced the lowest SPM accuracy potentially due to error propagation from the SS and L1 landmarks. Reduced PT accuracy in step and seated functional positions may be attributed to an increased occlusion of the pubic-symphysis landmark. Our model shows excellent performance when compared against the current gold standard manual annotation process.
The function of the knee joint is to allow for locomotion and is comprised of various bodily structures including the four major ligaments; medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). The primary function of the ligaments are to provide stability to the joint. The knee is prone to injury as a result of osteoarthritis as well as ligamentous and meniscal lesions. Furthermore, compromised joint integrity due to ligamentous injury may be a result of direct and indirect trauma, illness, occupational hazard as well as lifestyle. A device capable of non-invasively determining the condition of the ligaments in the knee joint would be a useful tool to assist the clinician in making a more informed diagnosis and prognosis of the injury. Furthermore, the device would potentially reduce the probability of a misdiagnosis, timely diagnosis and avoidable surgeries. The existing Laxmeter prototype (UK IPN: GB2520046) is a Stress
When performing scarf osteotomies some surgeons use intraoperative
There are nearly 500,000 people with undiagnosed diabetes mellitus in the UK. The incidental finding vascular calcification on plain radiographs in patients with undiagnosed diabetes has the potential to alter patient management in those presenting with pathology. We hypothesised that the presence of vascular calcification on plain radiographs of the foot may predict the diagnosis of diabetes. The primary aim of this case control study was to determine the positive predictive value of vascular calcification to diagnose diabetes. Secondary aims were to determine the odds of having diabetes dependent on other known risk factors for calcification. A retrospective case control study of 130 diabetic patients were compared to 130 non-diabetic patients that were matched for age and gender. The presence of vascular calcification in anterior, posterior or plantar vessels, and length of calcification were measured on plain radiographs. McNemar's Chi-squared test and positive predictive values were calculated. Conditional logistic regression models were used to estimate the association between calcification and diabetes.Introduction
Methods
Anteroposterior (AP) radiographs remain the standard of care for pre- and post-operative imaging during total hip arthroplasty (THA), despite known limitation of plain films, including the inability to adequately account for distortion caused by variations in pelvic orientation. Of specific interest to THA surgeons are distortions associated with pelvic tilt, as unaccounted for tilt can significantly alter
The shape of the flexion gap in 20 normal knees was evaluated by axial
Diagnostic interpretation error of paediatric musculoskeletal (MSK) radiographs can lead to late presentation of injuries that subsequently require more invasive surgical interventions with increased risks of morbidity. We aimed to determine the radiograph factors that resulted in diagnostic interpretation challenges for emergency physicians reviewing pediatric MSK radiographs. Emergency physicians provided diagnostic interpretations on 1,850 pediatric MSK radiographs via their participation in a web-based education platform. From this data, we derived interpretation difficulty scores for each radiograph using item response theory. We classified each radiograph by body region, diagnosis (fracture/dislocation absent or present), and, where applicable, the specific fracture location(s) and morphology(ies). We compared the interpretation difficulty scores by diagnosis, fracture location, and morphology. An expert panel reviewed the 65 most commonly misdiagnosed radiographs without a fracture/dislocation to identify normal imaging findings that were commonly mistaken for fractures. We included data from 244 emergency physicians, which resulted in 185,653 unique radiograph interpretations, 42,689 (23.0%) of which were diagnostic errors. For humerus, elbow, forearm, wrist, femur, knee, tibia-fibula radiographs, those without a fracture had higher interpretation difficulty scores relative to those with a fracture; the opposite was true for the hand, pelvis, foot, and ankle radiographs (p < 0 .004 for all comparisons). The descriptive review demonstrated that specific normal anatomy, overlapping bones, and external artefact from muscle or skin folds were often mistaken for fractures. There was a significant difference in difficulty score by anatomic locations of the fracture in the elbow, pelvis, and ankle (p < 0 .004 for all comparisons). Ankle and elbow growth plate, fibular avulsion, and humerus condylar were more difficult to diagnose than other fracture patterns (p < 0 .004 for all comparisons). We identified actionable learning opportunities in paediatric MSK radiograph interpretation for emergency physicians. We will use this information to design targeted education to referring emergency physicians and their trainees with an aim to decrease delayed and missed paediatric MSK injuries.
Diagnostic interpretation error of paediatric musculoskeletal (MSK) radiographs can lead to late presentation of injuries that subsequently require more invasive surgical interventions with increased risks of morbidity. We aimed to determine the radiograph factors that resulted in diagnostic interpretation challenges for emergency physicians reviewing pediatric MSK radiographs. Emergency physicians provided diagnostic interpretations on 1,850 pediatric MSK radiographs via their participation in a web-based education platform. From this data, we derived interpretation difficulty scores for each radiograph using item response theory. We classified each radiograph by body region, diagnosis (fracture/dislocation absent or present), and, where applicable, the specific fracture location(s) and morphology(ies). We compared the interpretation difficulty scores by diagnosis, fracture location, and morphology. An expert panel reviewed the 65 most commonly misdiagnosed radiographs without a fracture/dislocation to identify normal imaging findings that were commonly mistaken for fractures. We included data from 244 emergency physicians, which resulted in 185,653 unique radiograph interpretations, 42,689 (23.0%) of which were diagnostic errors. For humerus, elbow, forearm, wrist, femur, knee, tibia-fibula radiographs, those without a fracture had higher interpretation difficulty scores relative to those with a fracture; the opposite was true for the hand, pelvis, foot, and ankle radiographs (p < 0 .004 for all comparisons). The descriptive review demonstrated that specific normal anatomy, overlapping bones, and external artefact from muscle or skin folds were often mistaken for fractures. There was a significant difference in difficulty score by anatomic locations of the fracture in the elbow, pelvis, and ankle (p < 0 .004 for all comparisons). Ankle and elbow growth plate, fibular avulsion, and humerus condylar were more difficult to diagnose than other fracture patterns (p < 0 .004 for all comparisons). We identified actionable learning opportunities in paediatric MSK radiograph interpretation for emergency physicians. We will use this information to design targeted education to referring emergency physicians and their trainees with an aim to decrease delayed and missed paediatric MSK injuries.
INTRODUCTION. Despite our best efforts, orthopaedic surgeons do not always achieve desired results in acetabular cup positioning in total hip arthroplasty. New advancements in digital
Background. Dislocation is a common complication following total hip arthroplasty (THA), and accounts for a high percentage of subsequent revisions. The purpose of this study was to develop a convolutional neural network (CNN) model to identify patients at high risk for dislocation based on postoperative anteroposterior (AP) pelvis radiographs. Methods. We retrospectively evaluated radiographs for a cohort of 13,970 primary THAs with 374 dislocations over 5 years of follow-up. Overall, 1,490 radiographs from dislocated and 91,094 from non-dislocated THAs were included in the analysis. A CNN object detection model (YOLO-V3) was trained to crop the images by centering on the femoral head. A ResNet18 classifier was trained to predict subsequent hip dislocation from the cropped imaging. The ResNet18 classifier was initialized with ImageNet weights and trained using FastAI (V1.0) running on PyTorch. The training was run for 15 epochs using ten-fold cross validation, data oversampling and augmentation. Results. The hip dislocation prediction classifier achieved the following mean performance: accuracy= 49.5(±4.1)%, sensitivity= 89.0(±2.2)%, specificity= 48.8(±4.2)%, positive predictive value= 3.3(±0.3)%, negative predictive value= 99.5(±0.1)%, and area under the receiver operating characteristic curve= 76.7(±3.6)%. Saliency maps demonstrated that the model placed the greatest emphasis on the femoral head and acetabular component. Conclusions. Existing prediction methods fail to identify patients at high risk of dislocation following THA. Our prediction model has high sensitivity and negative predictive value. Therefore, it can be helpful in rapid assessment of risk for dislocation following THA. The model further suggests
Pelvic x-ray is a routine part of the primary survey of Advanced Trauma Life Support (ATLS) guidelines. However, pelvic CT is the gold standard in the diagnosis of pelvic fractures. This study aims to confirm the safety of a modified ATLS algorithm omitting pelvic x-ray in hemodynamically stable polytraumatized patients with clinically stable pelvis, in favour of later pelvic CT scan. A retrospective analysis of polytraumatized patients in our emergency room was conducted between 2005 and 2006. Inclusion criteria were blunt abdominal trauma, initial hemodynamic stability and clinically stable pelvis. We excluded patients requiring immediate intervention. We reviewed the records of 452 patients. 91 fulfilled inclusion criteria (56% male, mean age 45 years). 43% were road traffic accidents and 47% falls. In 68/91 (75%) patients, both pelvic x-ray and CT examination were performed; the remainder had only pelvic CT. In 6/68 (9%) patients, pelvic fracture was diagnosed by pelvic x-ray. None false positive pelvic x-ray was detected. In 3/68 (4%) cases a fracture was missed in the pelvic x-ray, but confirmed on CT. 5 (56%) were classified type A fractures, and another 4 (44%) B 2.1 in computed tomography (AO classification). One A 2.1 fracture was found in a clinically stable patient who only received CT scan (1/23). In hemodynamically stable patients with clinically stable pelvis, x-ray sensitivity is only 67% and it may safely be omitted in favor of a pelvic CT examination. The results support the safety and utility of our modified ATLS algorithm
Fluoroscopic C-arms are operated by medical
Accurate measurement of pelvic tilt (PT) is critical in diagnosing hip and spine pathologies. Yet a sagittal pelvic radiograph with good quality is not always available. Studies explored the correlation between PT and sacro-femoral-pubic (SFP) angle from anteroposterior (AP) radiographs yet demonstrated conflicting conclusions about its feasibilities. This study aims to perform a cohort-controlled meta-analysis to examine the correlation between the SFP angle and PT and proposes an application range of the method. This study searched PubMed, Embase, Cochrane, and Web of Science databases for studies that evaluated the correlation between SFP angle and PT. The Pearson's correlation coefficient r from studies were tabulated and compared. Pooled r for overall and gender/age (teenage or adult) controlled subgroup were reported using Fisher's Z transformation. Heterogeneity and publication bias were evaluated using Egger's regression test for the funnel plot asymmetry. Eleven studies were recruited, with nine reported r (totalling 1,247 patients). The overall pooled r was 0.61 with high inter-study heterogeneity (I2 = 75.95%). Subgroup analysis showed that the adult group had a higher r than the teenage group (0.70 versus 0.56, p < 0.001). Although statistically insignificant (p = 0.062), the female group showed a higher r than the male group (0.72 versus 0.65). The SFP method must be used with caution and should not be used in the male teenage group. The current studies did not demonstrate that the SFP method was superior to other AP landmarks correlating to PT. Identical heterogeneity was observed among studies, indicating that more ethnicity-segregated and gender-specific subgroup studies might be necessary. More data input analysing the errors will be useful.
Acetabular component orientation can directly influence dislocation rates, polyethylene wear, and revision rates. Precise placement has been found to occur in only 38–47% after total hip arthroplasty (THA). The recent introduction of digital
The modified Radiological Union Scale for Tibia (mRUST) fractures score was developed in order to assess progress to union and define a numerical assessment of fracture healing of metadiaphyseal fractures. This score has been shown to be valuable in predicting radiological union; however, there is no information on the sensitivity, specificity, and accuracy of this index for various cut-off scores. The aim of this study is to evaluate sensitivity, specificity, accuracy, and cut-off points of the mRUST score for the diagnosis of metadiaphyseal fractures healing. A cohort of 146 distal femur fractures were retrospectively identified at our institution. After excluding AO/OTA type B fractures, nonunions, follow-up less than 12 weeks, and patients aged less than 16 years, 104 sets of radiographs were included for analysis. Anteroposterior and lateral femur radiographs at six weeks, 12 weeks, 24 weeks, and final follow-up were separately scored by three surgeons using the mRUST score. The sensitivity and specificity of mean mRUST score were calculated using clinical and further radiological findings as a gold standard for ultimate fracture healing. A receiver operating characteristic curve was also performed to determine the cut-off points at each time point.Aims
Methods
A
Identifying and restoring alignment is a primary aim of total knee arthroplasty (TKA). In the coronal plane, the pre-pathological hip knee angle can be predicted using an arithmetic method (aHKA) by measuring the medial proximal tibial angle (MPTA) and lateral distal femoral angle (aHKA=MPTA - LDFA). The aHKA is shown to be predictive of coronal alignment prior to the onset of osteoarthritis; a useful guide when considering a non-mechanically aligned TKA. The aim of this study is to investigate the intra- and inter-observer accuracy of aHKA measurements on long leg standing radiographs (LLR) and preoperative Mako CT planning scans (CTs). Sixty-eight patients who underwent TKA from 2020–2021 with pre-operative LLR and CTs were included. Three observers (Surgeon, Fellow, Registrar) measured the LDFA and MPTA on LLR and CT independently on three separate occasions, to determine aHKA. Statistical analysis was undertaken with Bland-Altman test and coefficient of repeatability. An average intra-observer measurement error of 3.5° on LLR and 1.73° on CTs for MPTA was detected. Inter-observer errors were 2.74° on LLR and 1.28° on CTs. For LDFA, average intra-observer measurement error was 2.93° on LLR and 2.3° on CTs, with inter-observer errors of 2.31° on LLR and 1.92° on CTs. Average aHKA intra-observer error was 4.8° on LLR and 2.82° on CTs. Inter-observer error of 3.56° for LLR and 2.0° on CTs was measured. The aHKA is reproducible on both LLR and CT. CT measurements are more reproducible both between and within observers. The difference between measurements using LLR and CT is small and hence these two can be considered interchangeable. CT may obviate the need for LLRs and may overcome difficulties associated with positioning, rotation, body habitus and flexion contractures when assessing coronal alignment.
Low dose technology of an EOS scanner allows mechanical axis radiographs to be produced using a continuously moving x-ray emitting a thin beam to form a single image which includes all three joints, without the need for stitching. The aim of this study was to identify necessary improvements to enable effective interpretation of the radiographs, and to assess whether the quality of the radiographs varied by production method compared to a previous audit of CR and DR radiographs. 8 domains were identified based on a previous audit using the acronym MECHANIC each defining the qualities required for a radiograph to meet the criteria. 100 mechanical axis radiographs produced using conventional and digital methods were analysed in the original study to assess how many radiographs met the described criteria. The same criteria were amended and used to assess 123 different mechanical axis radiographs in the follow up study following the introduction of the EOS scanner, in which 77 were produced using EOS and 46 were produced using conventional and digital methods.Introduction
Materials and Methods
Despite our best efforts, orthopaedic surgeons do not always achieve desired results in acetabular cup positioning in total hip arthroplasty (THA). Although ideal abduction and anteversion angles vary depending on surgeon preference, patient factors and anatomy, studies have shown that improperly positioned cups lead to increased failure rates in THA. While there have been many technological advancements in THA, including using CT-guided and fluoroscopic techniques, the cost for the hospital and time required to use this technology sometimes force hospitals not to use them. New advancements in digital
Knee alignment affects both the development and surgical treatment of knee osteoarthritis. Automating femorotibial angle (FTA) and hip-knee-ankle angle (HKA) measurement from radiographs could improve reliability and save time. Further, if the gold-standard HKA from full-limb radiographs could be accurately predicted from knee-only radiographs then the need for more expensive equipment and radiation exposure could be reduced. The aim of this research is to assess if deep learning methods can predict FTA and HKA angle from posteroanterior (PA) knee radiographs. Convolutional neural networks with densely connected final layers were trained to analyse PA knee radiographs from the Osteoarthritis Initiative (OAI) database with corresponding angle measurements. The FTA dataset with 6149 radiographs and HKA dataset with 2351 radiographs were split into training, validation and test datasets in a 70:15:15 ratio. Separate models were learnt for the prediction of FTA and HKA, which were trained using mean squared error as a loss function. Heat maps were used to identify the anatomical features within each image that most contributed to the predicted angles.Abstract
Objectives
Methods
Objectives. The purpose of this study was to compare the joint space width between one-leg and both-legs standing radiographs in order to diagnose a primary osteoarthritis of the knee. Methods. Digital radiographs of 100 medial osteoarthritic knees in 50 patients were performed. The patients had undergone one-leg standing anteroposterior (AP) views by standing on the affected leg while a both-legs standing AP view was undertaken while standing on both legs. The severity of the osteoarthritis was evaluated using the joint space width and Kellgren-Lawrence (KL)
Bone ingrowth fixation of large diameter, beaded cobalt chromium cups is generally considered to be reliable but this is typically judged radiographically. To date, implant retrieval data of attached bone has been limited. This study evaluated correlations between the pre-revision
We have previously developed a
Introduction. In prosthetic knee surgery, the axis of the lower limb is often determined only by static
The accurate assessment of compartmental involvement in degenerative arthritis of the knee is important when planning operative treatment. Standard
Introduction: It could be shown that an ample number of classical hip parameters for
Axial radiographs were obtained under valgus and external rotation stress at 45° of knee flexion with and without contraction of the quadriceps muscle in order to assess the dynamics of patellar subluxation or dislocation. The
An uncomplicated, quantitative method of determining density from X-rays would be of extreme value to clinicians. In this study we perform a thorough assessment of applying a step wedge to grey level calibration method to X-rays obtained using Computed
Two critical steps in achieving optimal results and minimizing complications (dislocation, lengthening, and intra-operative fracture) are careful pre-operative planning and more recently, the option of intra-operative imaging in order to optimise accurate and reproducible total hip replacement. The important issues to ascertain are relative limb length, offset and center of rotation. It is important to start the case knowing the patient's perception of their limb length. Patient perception is equally important, if not more important, than the
Radiological examination is a useful tool in assessing osteoarthritis (OA) in the knee. We have compared the extent of osteoarthritis in the knee graded on radiographs and by intraoperative observation to determine if there is significant difference with relevance to preop-erative planning.
Radiological measurements are an essential component of the assessment of outcome following knee arthroplasty. However, plain
The recent introduction of digital
The primary aim of this study was to report the radiological outcomes of patients with a dorsally displaced distal radius fracture who were randomized to a moulded cast or surgical fixation with wires following manipulation and closed reduction of their fracture. The secondary aim was to correlate radiological outcomes with patient-reported outcome measures (PROMs) in the year following injury. Participants were recruited as part of DRAFFT2, a UK multicentre clinical trial. Participants were aged 16 years or over with a dorsally displaced distal radius fracture, and were eligible for the trial if they needed a manipulation of their fracture, as recommended by their treating surgeon. Participants were randomly allocated on a 1:1 ratio to moulded cast or Kirschner wires after manipulation of the fracture in the operating theatre. Standard posteroanterior and lateral radiographs were performed in the radiology department of participating centres at the time of the patient’s initial assessment in the emergency department and six weeks postoperatively. Intraoperative fluoroscopic images taken at the time of fracture reduction were also assessed.Aims
Methods
Purpose: To determine the need for routine serial radiographs in the management of forearm fractures in children. Material and Methods: A binational study was conducted in 202 consecutive children with closed forearm fractures. In the 91 patients with stable fractures that did not require reduction, clinical and
Iterative finite element (FE) models are used to simulate bone remodelling that takes place due to the surgical insertion of an implant or to simulate fracture healing. In such simulations element material properties are calculated after each iteration of solving the model. New material properties are calculated based on the results derived by the model during the last iteration. Once the FE model has gone through a number of such iterations it is often necessary to assess the remodelling that has taken place. The method widely used to do this is to analyse element Young's modulus plots taken at particular sections through the model. Although this method gives relevant information which is often helpful when comparing different implants, the information is rather abstract and is difficult to compare with patient data which is commonly in the form of radiographs. The authors suggest a simple technique that can be used to generate synthetic radiograph images from FE models. These images allow relatively easy comparisons of FE derived information with patient radiographs. Another clear advantage of this technique is that clinicians (who are familiar with reading radiographs) are able to understand and interpret them readily. To demonstrate the technique a three dimensional (3D) model of the proximal tibia implanted with an Oxford Unicompartmental Knee replacement was created based on CT data obtained from a cadaveric tibia. The model's initial element material properties were calculated from the same CT data set using a relationship between