Inducible displacement of cementless total knee arthroplasty components with conventional and weight-bearing CT-based radiostereometric analysis

Aseptic loosening remains one of the top causes of revision surgery of total knee arthroplasty (TKA). Radiostereometric analysis (RSA) is used in research to measure implant migration, however limitations prevent its clinical use. New methods have allowed the same measurements as RSA to be performed with computed tomography (CT) scanners (CT-RSA). The objective of this study is to determine inducible displacement measurements from weight-bearing computed tomography (WBCT) and conventional RSA to assess implant stability. Participants (n = 17) completed RSA exams in the supine and standing position, and WBCT exams in the seated (leg extended) and standing position. Double examinations were performed in the seated (WBCT) or supine (RSA) positions. Inducible displacements were measured with model-based RSA (MBRSA) for RSA exams, and a novel CT-RSA software, V3MA, for WBCT exams. Precision of each technique was calculated between double examinations. Precision data for tibial component total translations and rotations were 0.05 mm and 0.118 degrees, respectively with WBCT-RSA, and were 0.108 mm and 0.269 degrees, respectively with MBRSA. MTPM precision was 0.141 mm with WBCT-RSA and was 0.168 mm with MBRSA. Inducible displacement MTPM of the tibial component was 0.244 +/- 0.220 mm with WBCT-RSA and 0.662 +/- 0.257 mm with MBRSA. Inducible displacement measurements with MBRSA were significantly different from WBCT-RSA for tibial component anterior tilt (p = 0.0002). WBCT-RSA demonstrated comparable precision to MBRSA, and both techniques measured inducible displacements consistent with stable components. Clinical Significance: As the availability of WBCT increases, its use as an alternative to MBRSA is supported to measure the instantaneous fixation of implant components.