Göran Selvik

Roentgen Stereophotogrammetric Analysis

Soon after Roentgens discovery, the ‘new’ rays were used to produce stereoscopic images or used for spatial reconstruction of positions of foreign bodies. However, no systematic use of roentgen stereo measurements seems to have occurred until the 1970s, although many attempts have been made before. Since 1972, a system for roentgen stereophotogrammetry has been in use at the University Hospital in Lund. The system has been named RSA, roentgen stereophotogrammetric analysis. It is a complete system, including instrumentation for implanting tantalum landmarks, devices for calibration of the stereo roentgen set-up, and comprehensive software. Using different calibration set-ups, any part of the body can be investigated under different conditions using standard roentgen equipment. The computer programs make it possible to calculate spatial landmark coordinates from measured film coordinates, and further to calculate growth, and volume changes or kinematic variables in well-defined and generally used terms. After the basic principles have been established, a survey of applications grouped according to anatomic regions follows. Special emphasis is laid on total hip and knee replacement, which besides complex craniofacial and spinal disorders, are the most rewarding fields of study.

Kinematics of the ankle/foot complex: plantarflexion and dorsiflexion.

In an in vivo investigation of eight healthy volunteers, three dimensional ankle/foot kinematics were analyzed by roentgen stereophotogrammetry in 10° steps of motion from 30° of plantar flexion to 30° of dorsiflexion of the foot. The study included all of the joints between the tibia and the first metatarsal, as well as the talocalcaneal joint, and was performed under full body load. Although the talocrural joint was found to account for most of the rotation around the transverse axis occurring from 30° of plantar flexion to 30° of dorsiflexion, there was a substantial contribution from the joints of the arch. This was seen particularly in the input arc from 30° of plantar flexion to the neutral position, where the dorsiflexion motion of these joints amounted to 10% to 41% of the total transverse axis rotation.

The axis of rotation of the ankle joint

The axis of the talo-crural joint was analysed by roentgen stereophotogrammetry in eight healthy volunteers. Examinations were performed at 10 degrees increments of flexion and pronation/supination of the foot as well as medial and lateral rotation of the leg. Results indicate that the talo-crural joint axis changes continuously throughout the range of movement. In dorsiflexion it tended to be oblique downward and laterally. In rotation of the leg, the axis took varying inclinations between horizontal and vertical. All axes in each subject lay close to the midpoint of a line between the tips of the malleoli. Our study indicates that the talo-crural joint axis may alter considerably during the arc of motion and differ significantly between individuals. This prompts caution in the use of hinge axes in orthoses and prostheses for the ankle.

Kinematics of the Ankle/Foot Complex—Part 2: Pronation and Supination

The influence of pronation and supination of the foot on the joints of the ankle/foot complex was analyzed three dimensionally by roentgen stereophotogrammetry in eight healthy volunteers. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones. The subjects stood on a platform that was tilted in 10°-steps from 20° of pronation to 20° of supination. Pairs of x-ray exposures were made in each position. Calculation of resulting joint deviations from the neutral position showed that the largest amounts of motion occurred in the talonavicular joint followed by the talocalcaneal joint, in the latter case mainly in supination. The joints proximal and distal to the medial cuneiform also participated substantially in the total motion registered. The tibia showed an average of 0.2° of external rotation for each degree of supination of the foot.

Mechanical loosening of total hip prostheses. A radiographic and roentgen stereophotogrammetric study

Twenty patients were examined by standard radiography and roentgen stereophotogrammetric analysis (RSA) during a two-year period after total hip arthroplasty. Eleven of the acetabular components migrated cranially and three femoral components migrated distally. This migration was most rapid during the first four months after operation. Our findings support the possibility that mechanical loosening is initiated by thermal injury during polymerisation of the cement; the less frequent migration of the metallic femoral component compared with the polyethylene acetabular component may be because the metal acts as a heat sink. Standard radiographs were inadequate for assessment of early mechanical loosening, whereas RSA could reveal migration within four months of the arthroplasty.

Active knee motion after cruciate ligament rupture: stereoradiography

In 10 patients with an old injury of the anterior cruciate ligament, the three-dimensional movements of the knee joint were studied when the patients flexed their knees. Tibial motions were recorded using roentgen stereophotogrammetric analysis. Internal rotation and adduction of the tibia were reduced in the injured knees when compared with the intact knees; during flexion of the knee joint, the tibial intercondylar eminence occupied a more lateral and posterior position on the injured side. Our results may indicate that the knee joint is continuously exposed to abnormal stresses when the anterior cruciate ligament is torn.

Kinematics of the Ankle/Foot Complex—Part 3: Influence of Leg Rotation

In an in vivo kinematical investigation, the movements of the ankle/foot complex induced by external rotation of the leg from an internally rotated position were analyzed by roentgen stereophotogrammetry. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones of eight healthy volunteers. Rotations occurring between these bones after 10° increments of leg rotation were calculated in three dimensions. Movement of the leg from an internally rotated position to the neutral was found to induce motion mainly as internal rotation of the talus in relation to the tibia. Further external rotation induced motion mainly in the talonavicular and talocalcaneal joints, whereas a smaller amount of motion was seen in the joint between the navicular and the medial cuneiform.

Analytical stereophotogrammetric determination of three-dimensional knee-joint geometry

An analytical stereophotogrammetric method is introduced to measure the three-dimensional geometry of articular surfaces in vitro. Information of this kind is particularly useful for mathematical joint models and anthropological studies. The method requires no specific equipment, such as a stereocomparator, contrarily to other techniques reported (e.g. Ghosh, 1983) and is relatively simple and inexpensive. The background of the method is outlined in the present paper, and results of accuracy and precision tests are presented. It is shown that an accuracy on the order of 0.2 mm (95% confidence interval) is well feasible in actual knee-joint evaluations, if the measuring procedure is conducted carefully. The method is illustrated by measuring and comparing the articular surface geometries of a bilateral pair of knee joints.

The effect of a stem on the tibial component of knee arthroplasty. A roentgen stereophotogrammetric study of uncemented tibial components in the Freeman-Samuelson knee arthroplasty

We studied the effect of a metal tray with an intramedullary stem on the micromotion of the tibial component in total knee arthroplasty. Of 32 uncemented Freeman-Samuelson knee arthroplasties performed in London and Gothenburg, nine had a metal backing and stem added to the tibial component. Micromotion of the tibial components, expressed as migration and inducible displacement, was analysed using roentgen stereophotogrammetric analysis up to two years follow-up. The addition of a metal back and a 110 mm stem to the standard polyethylene component significantly reduced both migration over two years and inducible displacement.

Instability of total hip prostheses at rotational stress. A roentgen stereophotogrammetric study.

Roentgen stereophotogrammetric analysis (RSA) has been carried out on 24 total hip prostheses (24 patients), which were all painful at weightbearing. The examinations were made with the hip at distraction, compression, external and internal rotation. One acetabular component showed instability only at distraction-compression and one showed instability only at rotation. Four femoral components showed instability at distraction-compression and at rotation, six only at rotation, but none showed instability only at distraction-compression. Thus rotational provocation demonstrated instability in all unstable femoral components; rotational stress must be of importance in mechanical loosening of the femoral component.