Comparison of two different Radiostereometric analysis (RSA) systems with markerless elementary geometrical shape modeling for the measurement of stem migration.

Abstract

Radiostereometric analysis (RSA) is the gold standard of measurement for in vivo 3D implants migration. The aim of this study was to evaluate the in vivo precision of 2 RSA marker-based systems compared with that of marker-free, elementary geometrical shape modeling RSA. Stem migration was measured in 50 patients recruited from an on-going Randomized Controlled Trial. We performed marker-based analysis with the Um RSA and RSAcore systems and compared these results with those of the elementary geometrical shape RSA. The precision for subsidence was 0.118 mm for Um RSA, 0.141 mm for RSAcore, and 0.136 mm for elementary geometrical shape RSA. The precision for retroversion was 1.3° for elementary geometrical shape RSA, approximately 2-fold greater than that for the other methods. The intraclass correlation coefficient between the marker-based systems and elementary geometrical shape RSA was approximately 0.5 for retroversion. All 3 methods yielded ICCs for subsidence and varus-valgus rotation above 0.9. We found an excellent correlation between marker-based RSA and elementary geometrical shape RSA for subsidence and varus-valgus rotation, independent of the system used. The precisions for out-of-plane migration were inferior for elementary geometrical shape RSA. Therefore, as a mechanism of failure, retroversion may be more difficult to detect early. This is to our knowledge the first study to compare different RSA systems with or without markers on the implant. Marker-based RSA has high precision in all planes, independent of the system used. Elementary geometrical shape RSA is inferior in out-of-plane migration.