Purpose: Total knee arthroplasty (TKA) 3D kinematic analysis requires 2D/3D image registration of X-ray fluoroscopic images and a computer-aided design (CAD) model of the knee implant. However, these techniques cannot provide information on the radiolucent polyethylene insert, since the insert silhouette does not appear clearly in X-ray images. Therefore, it is difficult to obtain the 3D kinematics of the polyethylene insert, particularly the mobile-bearing insert. A technique for 3D kinematic analysis of a mobile-bearing insert used in TKA was developed using X-ray fluoroscopy. The method was tested and a clinical application was evaluated.
Methods: Tantalum beads and a CAD model of the mobile-bearing TKA insert are used for 3D pose estimation of the mobile-bearing insert used in TKA using X-ray fluoroscopy. The insert model was created using four identical tantalum beads precisely located at known positions in a polyethylene insert using a specially designed insertion device. Finally, the 3D pose of the insert model was estimated using a feature-based 2D/3D registration technique, using the silhouette of beads in fluoroscopic images and the corresponding CAD insert model. In vitro testing for the repeatability of the positioning of the tantalum beads and computer simulations for 3D pose estimation of the mobile-bearing insert were performed.
Experimental results: The pose estimation accuracy achieved was sufficient for analyzing mobile-bearing TKA kinematics (RMS error: within 1.0 mm and 1.0°, except for medial-lateral translation). In a clinical application, nine patients with mobile-bearing TKA were investigated and analyzed with respect to a deep knee bending motion.
Conclusions: A 3D kinematic analysis technique was developed that enables accurate quantitative evaluation of mobile-bearing TKA kinematics. This method may be useful for improving implant design and optimizing TKA surgical techniques.