CT-Based 3D Reconstruction of Lower Limb Versus X-Ray-Based 3D Reconstruction: A Comparative Analysis and Application for a Safe and Cost-Effective Modality in TKA.

AIM

Patient Specific Instrumentation (PSI) with 3D bone models have been used to improve the outcomes of Total Knee Arthroplasty (TKA). The PSI, however, needs a CT (Computed tomography)/MRI scan to reproduce a bone-based model. However, CT is not a routine imaging method in the TKA and has challenges such as high radiation exposure and increased investigation cost. Any technology or software which could accurately recreate 3D bone models using X-ray would be a cheaper and safer tool. This study is based on one such technology (XrayTo3D) using X-ray to 3D as an alternative to other image-based 3D bone models and PSI available in the market. This study compares the accuracy of XrayTo3D versus a Conventional CT to 3D, in the reconstruction of lower limb bones (femur and tibia).

METHOD

In an analysis of 45 lower limbs, 11 anatomical parameters were measured [Medial Proximal Tibial Angle-MPTA, Tibial(T)-torsion, T-slope, T-length, Mechanical Lateral Distal Femoral Angle (mLDFA), F-version, F-length, Distal femoral Medio lateral width (F-ML), Distal Femoral Antero Posterior (F-AP), Proximal Tibia Antero Posterior (T-AP), Proximal Tibia Medio Lateral (T-ML) based on landmarks selected by three orthopaedic surgeons(numbers of the authors superscript), on two groups of 3D models, one reconstructed using XrayTo3D and the other using CT. Mean and standard-deviation values were measured for all the parameters in both the groups. Statistical association between both the groups was measured by Pearson's correlation coefficient. Two-sided tests of the mean values were calculated to compare the two measurement methods. The interobserver reproducibility within each group was measured by the intraclass correlation coefficient (ICC). Point-to-surface (P2S) error, in the distal femur and proximal tibia regions of the models reconstructed using XrayTo3D, were also measured.

RESULTS

For all the 11 parameters, no statistically significant difference was found between the 2 groups ( > 0.05). Pearson's correlation coefficients for all the parameters were not significant. The interobserver reproducibility was ranging from 0.90 to 1.00 and 0.90 to 1.00 for the XrayTo3D and CT groups, respectively. The mean P2S distance was 1.0 mm in distal femur and 1.1 mm in proximal tibia which was within the acceptable limits.

CONCLUSION

The reconstruction accuracy of the XrayTo3D is an accurate, safe and cost effective as compared to a CT-based method.