Assessment of implant position after total knee arthroplasty by dual-energy computed tomography

Correct alignment of prosthetic components is the most important factor for the success of total knee arthroplasty (TKA). Dual-energy computed tomography (DECT) may be a reliable method in determining implant position after TKA.

To evaluate the accuracy and reproducibility of DECT in determining implant position after TKA.

Institutional review board approval was obtained. Forty-five patients (age 75.2 ± 6.4 years) prospectively underwent TKA at our institution between May and December 2012. DECT was performed 1 year after surgery, using an alignment similar to a standing position and generating images at an extrapolated energy of 120 kVp, in order to reduce metal artifacts. Implant position was evaluated by two independent readers. Intra- and inter-observer agreements were calculated. DECT measurements on implant position were compared with the preoperative planning based on radiographs. Additional clinical and DECT findings were taken into account.

Metal artifact reduction was judged satisfactory in all cases. Regarding implant position assessed with DECT, good to excellent intra-observer (k: 0.74-0.87 and k: 0.75-0.88, respectively), and inter-observer agreement (k: 0.72-0.82) were found. In the comparison with preoperative planning, the widest limits of agreement were within 3.9° for the sagittal orientation of tibial component. A single patient with postoperative knee pain and stiffness had periprosthetic osteopenia, quadriceps femoris tendon calcifications, articular effusion, and excessive intrarotation of the femoral component.

DECT is an accurate and reproducible tool for determining implant position after TKA.