Technical Brief

Kinematic Accuracy in Tracking Total Wrist Arthroplasty With Biplane Videoradiography Using a Computed Tomography-Generated Model

[+] Author and Article Information
Bardiya Akhbari

Department of Biomedical Engineering,
Brown University,
Providence, RI 02912
e-mail: bardiya_akhbari@brown.edu

Amy M. Morton

Department of Orthopedics,
Alpert Medical School of Brown University
and Rhode Island Hospital,
Providence, RI 02912
e-mail: amy_morton1@brown.edu

Douglas C. Moore

Department of Orthopedics,
Alpert Medical School of Brown University
and Rhode Island Hospital,
Providence, RI 02912
e-mail: douglas_moore@brown.edu

Arnold-Peter C. Weiss

Department of Orthopedics,
Alpert Medical School of Brown University
and Rhode Island Hospital,
Providence, RI 02912
e-mail: arnold-peter_weiss@brown.edu

Scott W. Wolfe

Hand and Upper Extremity Center,
Hospital for Special Surgery,
New York, NY 10021
e-mail: wolfes@hss.edu

Joseph J. Crisco

Department of Biomedical Engineering,
Brown University,
Providence, RI 02912;
Department of Orthopedics,
Alpert Medical School of Brown University
and Rhode Island Hospital,
Providence, RI 02912
e-mail: joseph_crisco@brown.edu

Manuscript received July 11, 2018; final manuscript received January 27, 2019; published online February 25, 2019. Assoc. Editor: Christian Puttlitz.

J Biomech Eng 141(4), 044503 (Feb 25, 2019) (7 pages) Paper No: BIO-18-1320; doi: 10.1115/1.4042769 History: Received July 11, 2018; Revised January 27, 2019

Total wrist arthroplasty (TWA) for improving the functionality of severe wrist joint pathology has not had the same success, in parameters such as motion restoration and implant survival, as hip, knee, and shoulder arthroplasty. These other arthroplasties have been studied extensively, including the use of biplane videoradiography (BVR) that has allowed investigators to study the in vivo motion of the total joint replacement during dynamic activities. The wrist has not been a previous focus, and utilization of BVR for wrist arthroplasty presents unique challenges due to the design characteristics of TWAs. Accordingly, the aims of this study were (1) to develop a methodology for generating TWA component models for use in BVR and (2) to evaluate the accuracy of model-image registration in a single cadaveric model. A model of the carpal component was constructed from a computed tomography (CT) scan, and a model of the radial component was generated from a surface scanner. BVR was acquired for three anatomical tasks from a cadaver specimen. Optical motion capture (OMC) was used as the gold standard. BVR's bias in flexion/extension, radial/ulnar deviation, and pronosupination was less than 0.3 deg, 0.5 deg, and 0.6 deg. Translation bias was less than 0.2 mm with a standard deviation of less than 0.4 mm. This BVR technique achieved a kinematic accuracy comparable to the previous studies on other total joint replacements. BVR's application to the study of TWA function in patients could advance the understanding of TWA, and thus, the implant's success.

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Grahic Jump Location
Fig. 1

Marker positioning visualized from a rendered CT scan. Five retro-reflective markers were fixed directly to the radius, and five retro-reflective markers were clustered on a thermoplastic plate, rigidly fixed to the third metacarpal via nylon screws.

Grahic Jump Location
Fig. 2

Photo of a Universal2™ carpal component (left), and a 3D digital model generated via thresholding and manual editing of CT images (right)

Grahic Jump Location
Fig. 3

(a) Neutral posture of the components along with their respective coordinate system; red, green, and blue vectors depict the x-axis (pronation/supination), y-axis (flexion/extension), and z-axis (radial/ulnar deviation). (b) and (c) The edges of the carpal and radial components of the implanted Universal2™ TWA super-imposed on the neutral frame radiographs as captured in the BVR cameras. (d) and (e) The silhouettes of the carpal and radial components of the implant on the neutral frame radiographs.

Grahic Jump Location
Fig. 4

Definition of rotation angles and planar ICR for the motion of the carpal components relative to the radial component (this figure depicts only a sagittal plane intersection). In HAM parameters, n is the vector defining the orientation of the screw axis (nx, ny, and nz), and φtot is the rotation about the screw axis. This angle can be decomposed into rotational components (φtot.nx, φtot.ny, and φtot.nz). The screw axis intersects each plane of the radial component coordinate system, providing a plane-specific ICR.

Grahic Jump Location
Fig. 5

Bland-Altman plots of carpal component rotations throughout each task (flexion–extension, RU deviation, and CIRC) calculated from the BVR and OMC data. Columns report the rotation angles in the radial component's coordinate system for each task (Rows). Across all tasks and directions, there was a bias of less than 1 deg, and the limits of agreement were less than 2 deg for all tasks.

Grahic Jump Location
Fig. 6

Bland-Altman analysis of carpal component translations throughout each task (flexion–extension, RU deviation, and CIRC) calculated from the BVR and OMC data. Columns report the translations in the radial component's coordinate system for each task (rows). The Bland–Altman analysis demonstrates a trivial bias of less than 0.2 mm, and the limit of agreement of less than 1 mm for all tasks.



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