Comparison of two and three-dimensional computerized polyethylene wear analysis after total hip arthroplasty
Comparison of two and three-dimensional computerized polyethylene wear analysis after total hip arthroplasty
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DOI：
10.2106/00004623-200306000-00020
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发表时间：
2003-06-01
影响因子：
5.3
通讯作者：
Jacobs, J
中科院分区：
文献类型：
--
作者：
Martell, JM;Berkson, E;Jacobs, J
背景资料：准确测定体内髋臼聚乙烯磨损对于评估全髋关节置换关节面的临床性能是必要的。在这项研究中，我们的目的是确定两个和三维计算机磨损分析的临床表现，并评估这种性能的影响，对患者的研究，旨在检测磨损的全髋关节prosthes.Methods：两个和三维数字计算机分析髋臼聚乙烯磨损进行了153髋关节140例。髋臼部件由钛髋臼杯中的聚乙烯衬垫组成，与28 mm钴铬合金股骨部件形成关节。影像学随访的平均持续时间为8.4年。计算二维与三维分析的相关系数，以及两种技术检测到的磨损之间的差异。同一观察者对每个图像进行两次分析，以评估二维和三维分析的可重复性。每种技术的临床性能对前瞻性研究中足够功效所需样本量的影响进行了评估。结果：二维和三维磨损分析之间存在高度相关性（r（2）= 0.933）。在595次观察中，有31次（5.2%）使用二维和三维技术得出的磨损值不一致。Logistic回归分析表明髋臼前倾对这种不一致发生的可能性有显著影响。二维技术检测到90.1%的总线性磨损，随后通过三维分析检测。通过二维分析检测到的平均磨损值为1.09 mm，通过三维分析检测到的平均磨损值为1.21 mm。二维技术的可重复性是三维技术的四倍。功率分析表明，高达1.4倍以上的患者需要被招募，如果三维技术被用于磨损analysis.Conclusions：虽然三维分析检测到10%以上的磨损，其可重复性是四倍，比二维技术差，因此，患者招募要求磨损检测更高。侧位X线片质量差导致三维分析的可重复性降低。三维分析可能对高度前倾的髋臼杯有用，但该技术在磨损检测方面的改善有限，再加上其较差的可重复性，限制了其临床价值。证据等级：诊断研究，IV-2级（较差的参考标准）。证据等级的完整描述见作者说明。
Background: The accurate determination of acetabular polyethylene wear in vivo is necessary to assess the clinical performance of the bearing surfaces of total hip replacements. Our objective in this study was to determine the clinical performance of two and three-dimensional computerized wear analysis and to assess the implications of this performance on requirements for patient enrollment in studies designed to detect wear of total hip prostheses.Methods: Two and three-dimensional digital computerized analyses of acetabular polyethylene wear were performed on 153 hips in 140 patients. The acetabular components consisted of a polyethylene insert in a titanium shell, articulating with a 28-mm cobalt-chromium femoral component. The average duration of radiographic follow-up was 8.4 years. The correlation coefficient for two-dimensional versus three-dimensional analysis was calculated, as was the difference between the wear detected by the two techniques. The same observer analyzed each image twice, allowing an assessment of the repeatability of the two-dimensional and three-dimensional analyses. The impact of the clinical performance of each technique on the sample size needed for adequate power in prospective studies was evaluated.Results: There was a high correlation between two-dimensional and three-dimensional wear analysis (r(2) = 0.933). In thirty-one (5.2%) of 595 observations, the wear values derived with the two-dimensional and three-dimensional techniques were not consistent. Logistic regression demonstrated that acetabular anteversion had a significant effect on the likelihood of such inconsistency occurring. The two-dimensional technique detected 90.1% of the total linear wear subsequently detected by the three-dimensional analysis. The average wear value was 1.09 mm as detected by two-dimensional analysis and 1.21 mm as detected by three-dimensional analysis. The two-dimensional technique was four times more repeatable than the three-dimensional technique. Power analysis indicated that up to 1.4 times more patients need to be enrolled if the three-dimensional technique is used for wear analysis.Conclusions: While three-dimensional analysis detected 10% more wear, its repeatability was four times worse than that of the two-dimensional technique and, as a consequence, patient enrollment requirements for wear detection were higher. The poor quality of the lateral radiographs contributed to the decrease in the repeatability of the three-dimensional analysis. Three-dimensional analysis may be useful for highly anteverted cups, but the limited improvement in wear detection achieved with that technique, coupled with its inferior repeatability, limits its clinical value.Level of Evidence: Diagnostic study, Level IV-2 (poor reference standard). See Instructions to Authors for a complete description of levels of evidence.