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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 10-08-2023 | Bone Defect | KNEE

Tibial bone defect prediction based on preoperative artefact-reduced CT imaging is superior to standard radiograph assessment

Authors: Marco Brenneis, Dimitrios A. Flevas, Troy D. Bornes, Sebastian Braun, Andrea Meurer, Peter K. Sculco, Fernando J. Quevedo-González, Friedrich Boettner

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2023

Abstract

Purpose

The purpose of this study was to evaluate the accuracy of preoperative CT-based Anderson Orthopaedic Research Institute (AORI)-grading and to correlate Computed tomography (CT)-based volumetric defect measurements with intraoperative AORI findings.

Methods

99 patients undergoing revision total knee arthroplasty (rTKA) with preoperative CT-images were identified in an institutional revision registry. CT-image segmentation with 3D-Slicer Software was used to create 3D tibial bone defects which were then graded according to the AORI-classification. The AORI classification categorizes tibial defects into three types: Type I has healthy cortical and cancellous bone near the joint line, Type II involves metaphyseal bone loss affecting one or both condyles, and Type III indicates deficient metaphyseal bone with distal defects and potential damage to the patellar tendon and collateral ligament attachments. These 3D-CT gradings were compared to preoperative X-ray and intraoperative AORI grading. The Friedman test was used to investigate differences between AORI values of each measurement method. Volumetric 3D-bone defect measurements were used to investigate the relationship between AORI classification and volumetric defect size in the three anatomic zones of the tibia.

Results

Substantial agreements between preoperative 3D-CT AORI and intraoperative AORI (kappa = 0.663; P < 0.01) and fair agreements between preoperative X-ray AORI and intraoperative AORI grading (kappa = 0.304; P < 0.01) were found. Moderate correlations between volume of remaining bone and intraoperative AORI grading were found in epiphysis (r_S = – 0.529; P < 0.001), metaphysis (r_S = – 0.557; P < 0.001) and diaphysis (r_S = – 0.421; P < 0.001). Small volumetric differences between AORI I vs. AORI II defects and relatively large differences between AORI II and AORI III defects in each zone were detected.

Conclusion

Tibial bone defect prediction based on preoperative 3D-CT segmentation showed a substantial agreement with intraoperative findings and is superior to standard radiograph assessment. The relatively small difference in defect volume between AORI I, IIa and IIb suggests that updated CT-based classifications might hold benefits for the planning of rTKA.

Level of evidence

Retrospective Cohort Study; III

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Title: Tibial bone defect prediction based on preoperative artefact-reduced CT imaging is superior to standard radiograph assessment
Authors: Marco Brenneis
Dimitrios A. Flevas
Troy D. Bornes
Sebastian Braun
Andrea Meurer
Peter K. Sculco
Fernando J. Quevedo-González
Friedrich Boettner
Publication date: 10-08-2023
Publisher: Springer Berlin Heidelberg
Keywords: Bone Defect
Computed Tomography
Computed Tomography
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07527-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Tibial bone defect prediction based on preoperative artefact-reduced CT imaging is superior to standard radiograph assessment

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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