Van de Vusse Sjors F, De Laat Nienke N, Koster Lennard A, Kaptein Bart L
Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
Acta Orthop. 2025 Mar 31;96:295-303. doi: 10.2340/17453674.2025.43334.
Computed tomography-based radiostereometric analysis (CT-RSA) is an alternative to conventional radiostereometric analysis (RSA) in measuring implant migration, circumventing the need for operative insertion of tantalum markers. The accuracy and precision of different CT-RSA techniques in various joints are still unclear, and the effective radiation dose (ED) of CT-RSA is usually higher than RSA. In this systematic literature review, we aimed to provide an overview of the accuracy, precision, clinical precision, and ED of CT-RSA techniques.
We performed a systematic search in PubMed, Cochrane, and Embase databases. Main search items were "arthroplasty" AND "migration" AND "computed tomography." We included full-text English papers, using CT for migration analysis (CT-RSA) in human, animal, or synthetic models with arthroplasties, reporting accuracy and/or precision. Eligible studies were screened and reviewed by 2 authors independently. Main outcomes were accuracy, precision, and clinical precision of CT-RSA in 6 degrees of freedom. Secondary outcome was the mean ED. A meta-analysis on (clinical) precision of CT-RSA was performed.
23 studies were included involving 163 patients, 20 human cadaveric, 3 porcine cadaveric, and 7 synthetic models. 6 different CT-RSA techniques were used to study 6 different joint components in cervical disc replacement and shoulder, hip, and knee arthroplasty. CT-RSA accuracy ranged between 0.02 and 0.71 mm and 0.03° and 1.00°. CT-RSA precision ranged between 0.00 and 0.47 mm and 0.00° and 1.09°. Mean precision was 0.15 mm (95% confidence interval [CI] 0.05-0.25) in the acetabulum, 0.13 mm (CI 0.00-0.28) and 0.24° (CI 0.00-0.51) in the proximal femur, and 0.04 mm (CI 0.00-0.08) and 0.07° (CI 0.00-0.15) in the proximal tibia. CT-RSA clinical precision ranged between 0.03 and 1.36 mm and 0.06° and 2.25°. Mean clinical precision was 0.13 mm (CI 0.11-0.16) and 0.26° (CI 0.20-0.32) in the acetabulum. The mean ED of CT-RSA ranged between 0.02 and 5.80 mSv.
CT-RSA shows comparable accuracy and precision to standard RSA. CT-RSA seems to be a promising alternative to RSA.
基于计算机断层扫描的放射立体分析（CT-RSA）是测量植入物移位的一种替代传统放射立体分析（RSA）的方法，无需手术插入钽标记物。不同CT-RSA技术在各个关节中的准确性和精确性仍不明确，且CT-RSA的有效辐射剂量通常高于RSA。在这项系统文献综述中，我们旨在概述CT-RSA技术的准确性、精确性、临床精确性和有效辐射剂量。
我们在PubMed、Cochrane和Embase数据库中进行了系统检索。主要检索词为“关节成形术”“移位”和“计算机断层扫描”。我们纳入了全文英文论文，这些论文在人体、动物或带有关节成形术的合成模型中使用CT进行移位分析（CT-RSA），并报告了准确性和/或精确性。符合条件的研究由两名作者独立筛选和评审。主要结局是CT-RSA在6个自由度下的准确性、精确性和临床精确性。次要结局是平均有效辐射剂量。对CT-RSA的（临床）精确性进行了荟萃分析。
纳入了23项研究，涉及163例患者、20个人体尸体、3个猪尸体和7个合成模型。使用6种不同的CT-RSA技术研究了颈椎间盘置换以及肩、髋和膝关节成形术中的6种不同关节组件。CT-RSA的准确性在0.02至0.71毫米和0.03°至1.00°之间。CT-RSA的精确性在0.00至0.47毫米和0.00°至1.09°之间。髋臼的平均精确性为0.15毫米（95%置信区间[CI]0.05 - 0.25），股骨近端为0.13毫米（CI 0.00 - 0.28）和0.24°（CI 0.00 - 0.51），胫骨近端为0.04毫米（CI 0.00 - 0.08）和0.07°（CI 0.00 - 0.15）。CT-RSA的临床精确性在0.03至1.36毫米和0.06°至2.25°之间。髋臼的平均临床精确性为0.13毫米（CI 0.11 - 0.16）和0.26°（CI 0.20 - 0.32）。CT-RSA的平均有效辐射剂量在0.02至5.80毫希沃特之间。
CT-RSA显示出与标准RSA相当的准确性和精确性。CT-RSA似乎是RSA的一种有前景的替代方法。
