Detecting femur-insert collisions to improve precision of fluoroscopic knee arthroplasty analysis

Fluoroscopic analysis is an important tool for assessing in vivo kinematics of knee prostheses. Most commonly, a single-plane fluoroscopic setup is used to capture the motion of prostheses during a particular task. Unfortunately, single-plane fluoroscopic analysis is imprecise in the out-of-plane direction. This can result in reconstructing physically impossible poses, in which--for example--the femoral component intersects with the insert, as the normal pose estimation process does not take into account the relation between the components. In the proposed method, the poses of both components are estimated simultaneously, while preventing femur-insert collisions. In a phantom study, the accuracy and precision of the new method in estimating the relative pose of the femoral component were compared to those of the original method. With reverse engineered models, the errors in estimating the out-of-plane position decreased from 2.0+/-0.7 to 0.1+/-0.1 mm, without effects on the errors in rotations and the in-plane positions. With CAD models, the errors in estimating the out-of-plane position decreased from 5.3+/-0.7 mm (mean+/-SD) to 0.0+/-0.4 mm, at the expense of a decreased precision for the other position or orientation parameters. In conclusion, collision detection can prevent reconstructing impossible poses and it improves the position and motion estimation in the out-of-plane direction.