Improvement in the clinical practicability of roentgen stereophotogrammetric analysis (RSA): Free from the use of the dual X-ray equipment

After total knee replacement, the monitoring of the prosthetic performance is often done by roentgenographic examination. However, the two-dimensional (2D) roentgen images only provide information about the projection onto the anteroposterior (AP) and mediolateral (ML) planes. Historically, the model-based roentgen stereophotogrammetric analysis (RSA) technique has been developed to predict the spatial relationship between prostheses by iteratively comparing the projective data for the prosthetic models and the roentgen images. During examination, the prosthetic poses should be stationary. This should be ensured, either by the use of dual synchronized X-ray equipment or by the use of a specific posture. In practice, these methods are uncommon or technically inconvenient during follow-up examination. This study aims to develop a rotation platform to improve the clinical applicability of the model-based RSA technique. The rotation platform allows the patient to assume a weight-bearing posture, while being steadily rotated so that both AP and ML knee images can be obtained. This study uses X-ray equipment with a single source and flat panel detectors (FPDs). Four tests are conducted to evaluate the quality of the FPD images, steadiness of the rotation platform, and accuracy of the RSA results. The results show that the distortion-induced error of the FPD image is quite minor, and the prosthetic size can be cautiously calibrated by means of the scale ball(s). The rotation platform should be placed closer to the FPD and orthogonal to the projection axis of the X-ray source. Image overlap of the prostheses can be avoided by adjusting both X-ray source and knee posture. The device-induced problems associated with the rotation platform include the steadiness of the platform operation and the balance of the rotated subject. Sawbone tests demonstrate that the outline error, due to the platform, is of the order of the image resolution (= 0.145 mm). In conclusion, the rotation platform with steady rotation, a knee support, and a handle can serve as an alternative method to take prosthetic images, without the loss in accuracy associated with the RSA method.