Elbow kinematics : studies of the elbow joint under normal conditions and after joint replacement
Author: Ericson, Anne
Date: 2010-06-18
Location: Rolf Lufts Auditorium
Time: 09.00
Department: Institutionen för molekylär medicin och kirurgi / Department of Molecular Medicine and Surgery
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Abstract
Background: Total elbow arthroplasty (TEA) is used for treatment of
patients with severe pain and disability due to reumatoid arthritis. Long
term results are not as good as for hip and knee replacements. Further
development of the implant designs and surgical technique based on proper
knowledge of the in vivo biomechanical joint properties are required to
improve results.
Aim: To analyse the variation and the position of the instantaneous flexion axes in vivo in the normal elbow joint and after TEA.
Patients and Methods: Radiostereometric analysis (RSA) was used to determine the inclinations of the instantaneous elbow flexion axes in six healthy volunteers (study I) and in 13 patients with TEA (study III). Two of the implants were of a linked type (GSB III) and 11 were unlinked (five Capitellocondylar and six Kudo). Tantalum markers were implanted in the humerus and the ulna, defining two rigid bodies. Simultaneous radiographs were taken in maximum extension, 30, 60, 90, 120 and 150 degrees of flexion. The kinematic analysis defined the instantaneous flexion axes for each flexion increment and these were illustrated in standard drawings.
Computed tomography (CT) was used in study II and IV to determine and visualise the position of the flexion axes relative to the individual joint in 3D. A spiral CT scan of the elbow was performed on the same subjects as in study I and on six of the patients that participated in study III (three Capitellocondylar and three Kudo prostheses). A linear algebraic solution was developed for a conform transformation between the RSA and CT data. Stability parameters were generated during the transformation. The calculated coordinates for the intersect points of the axes lateral and medial to the joint could be imported from RSA and designated in the 3D volume. The positions of the flexion axes could be visualised individually for each subject and patient by connecting the intersect points.
Results: Study I. The range of the axis inclinations varied between subjects from 2.2º to 14.3º in the frontal and 1.6º to 9.8º in the horizontal planes. Mean axis inclination varied from 6,5º valgus to 6,2º varus, and from 2,4º internal to 2,2º external rotation. Study II. The median error between the transformed RSA coordinates and the CT coordinates was 0.22 mm, the rotation error 0.001º-0.006 ºand the scaling factor 0.985-1.035. The kinematic data for the instantaneous flexion axes were successfully transformed to the CT volume and axis position could be visualised in the 3D volume. Study III. The dispersion of axes varied for the unlinked prostheses from 4.1º to 84.3º (Kudo) and from 0.8º to 19.7º (Capitellocondylar) in the frontal plane. In the horizontal plane the dispersions varied from 3,3º to 45,0º and from 2,3º to 20,9º respectively. The two linked prosthesis (GSB) had axis dispersions of 13.0º and 15.4º in the frontal and 1,9º and 4,6º in the horizontal planes. Study IV. The prosthesis could be visualised in the CT volume with few or minor artefacts. All markers could be indentified and localised in the CT coordinate system. The RSA data could be fused with the CT data and the flexion axes visualised for the individual prosthesis.
Conclusions: The use of RSA permitted determination of the inclination of the instantaneous elbow flexion axes in vivo in healthy volunteers and in patients after TEA. The proposed algorithm for fusion of RSA and CT data made it possible to also determine and visualise the 3D positions of the axes in the individual joint. As our proposed method for fusing RSA and CT data can be used in vivo in small series without further invasive technique, it can be of value for early in vivo assessment of new implants.
Aim: To analyse the variation and the position of the instantaneous flexion axes in vivo in the normal elbow joint and after TEA.
Patients and Methods: Radiostereometric analysis (RSA) was used to determine the inclinations of the instantaneous elbow flexion axes in six healthy volunteers (study I) and in 13 patients with TEA (study III). Two of the implants were of a linked type (GSB III) and 11 were unlinked (five Capitellocondylar and six Kudo). Tantalum markers were implanted in the humerus and the ulna, defining two rigid bodies. Simultaneous radiographs were taken in maximum extension, 30, 60, 90, 120 and 150 degrees of flexion. The kinematic analysis defined the instantaneous flexion axes for each flexion increment and these were illustrated in standard drawings.
Computed tomography (CT) was used in study II and IV to determine and visualise the position of the flexion axes relative to the individual joint in 3D. A spiral CT scan of the elbow was performed on the same subjects as in study I and on six of the patients that participated in study III (three Capitellocondylar and three Kudo prostheses). A linear algebraic solution was developed for a conform transformation between the RSA and CT data. Stability parameters were generated during the transformation. The calculated coordinates for the intersect points of the axes lateral and medial to the joint could be imported from RSA and designated in the 3D volume. The positions of the flexion axes could be visualised individually for each subject and patient by connecting the intersect points.
Results: Study I. The range of the axis inclinations varied between subjects from 2.2º to 14.3º in the frontal and 1.6º to 9.8º in the horizontal planes. Mean axis inclination varied from 6,5º valgus to 6,2º varus, and from 2,4º internal to 2,2º external rotation. Study II. The median error between the transformed RSA coordinates and the CT coordinates was 0.22 mm, the rotation error 0.001º-0.006 ºand the scaling factor 0.985-1.035. The kinematic data for the instantaneous flexion axes were successfully transformed to the CT volume and axis position could be visualised in the 3D volume. Study III. The dispersion of axes varied for the unlinked prostheses from 4.1º to 84.3º (Kudo) and from 0.8º to 19.7º (Capitellocondylar) in the frontal plane. In the horizontal plane the dispersions varied from 3,3º to 45,0º and from 2,3º to 20,9º respectively. The two linked prosthesis (GSB) had axis dispersions of 13.0º and 15.4º in the frontal and 1,9º and 4,6º in the horizontal planes. Study IV. The prosthesis could be visualised in the CT volume with few or minor artefacts. All markers could be indentified and localised in the CT coordinate system. The RSA data could be fused with the CT data and the flexion axes visualised for the individual prosthesis.
Conclusions: The use of RSA permitted determination of the inclination of the instantaneous elbow flexion axes in vivo in healthy volunteers and in patients after TEA. The proposed algorithm for fusion of RSA and CT data made it possible to also determine and visualise the 3D positions of the axes in the individual joint. As our proposed method for fusing RSA and CT data can be used in vivo in small series without further invasive technique, it can be of value for early in vivo assessment of new implants.
List of papers:
I. Ericson A, Arndt A, Stark A, Wretenberg P, Lundberg A (2003). "Variation in the position and orientation of the elbow flexion axis." J Bone Joint Surg Br 85(4): 538-44
Pubmed
II. Ericson A, Arndt A, Stark A, Noz ME, Maguire GQ Jr, Zeleznik MP, Olivecrona H (2007). "Fusion of radiostereometric analysis data into computed tomography space: application to the elbow joint." J Biomech 40(2): 296-304. Epub 2006 Mar 13
Pubmed
III. Ericson A, Stark A, Arndt A (2008). "Variation in the position of the elbow flexion axis after total joint replacement with three different prostheses." J Shoulder Elbow Surg 17(5): 760-7. Epub 2008 Jul 10
Pubmed
IV. Ericson A, Olivecrona H, Stark A, Noz ME, Maguire GQ, Zeleznik MP, Arndt A (2010). "Computed tomography analysis of radiostereometric data to determine flexion axes after total joint replacement: Application to the elbow joint." J Biomech Apr 13: Epub ahead of print
Pubmed
I. Ericson A, Arndt A, Stark A, Wretenberg P, Lundberg A (2003). "Variation in the position and orientation of the elbow flexion axis." J Bone Joint Surg Br 85(4): 538-44
Pubmed
II. Ericson A, Arndt A, Stark A, Noz ME, Maguire GQ Jr, Zeleznik MP, Olivecrona H (2007). "Fusion of radiostereometric analysis data into computed tomography space: application to the elbow joint." J Biomech 40(2): 296-304. Epub 2006 Mar 13
Pubmed
III. Ericson A, Stark A, Arndt A (2008). "Variation in the position of the elbow flexion axis after total joint replacement with three different prostheses." J Shoulder Elbow Surg 17(5): 760-7. Epub 2008 Jul 10
Pubmed
IV. Ericson A, Olivecrona H, Stark A, Noz ME, Maguire GQ, Zeleznik MP, Arndt A (2010). "Computed tomography analysis of radiostereometric data to determine flexion axes after total joint replacement: Application to the elbow joint." J Biomech Apr 13: Epub ahead of print
Pubmed
Issue date: 2010-05-28
Rights:
Publication year: 2010
ISBN: 978-91-7409-975-1
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