CT protocols for lower limb arthroplasty: the Stanmore hip and knee protocols

Area of Science:

• Orthopaedic surgery
• Medical imaging
• Radiology

Background:

• Computed tomography (CT) is vital for 3D surgical planning in lower limb joint replacements, including implant positioning and robotic assistance.
• Current CT imaging guidelines vary significantly between orthopaedic companies, leading to inconsistencies in image quality and radiation exposure.
• This variability can result in scan rejections and repeat imaging, impacting clinical workflow and patient safety.

Purpose of the Study:

• To consolidate and harmonize existing CT imaging protocols for lower limb arthroplasty.
• To minimize ambiguity and enhance clarity, clinical practice, and patient safety through standardized imaging workflows.
• To develop user-friendly protocols that capture essential anatomical details for surgical planning and monitoring.

Main Methods:

• A multidisciplinary team critically reviewed 17 hip and 12 knee CT protocols from orthopaedic companies.
• Imaging elements, including scan volume and technical parameters, were assessed for deficiencies and inconsistencies.
• Five harmonized CT protocols were recommended through informal consensus: primary hip, revision hip, primary knee, revision knee, and total femoral replacement.

Main Results:

• Significant variability was identified in scan parameters and imaging guidelines across existing company protocols.
• The harmonized protocols prioritize high-resolution imaging with optimal parameters, reduced scan volume, and minimized metal artifacts.
• The developed protocols are clear, concise, consistent, comprehensive, and flexible for various implant planning needs.

Conclusions:

• Harmonized CT protocols streamline the imaging process for lower limb arthroplasty, reducing duplication and inconsistencies.
• These standardized protocols enhance alignment across companies and improve the reliability of 3D surgical planning.
• The user-friendly protocols facilitate accurate planning and monitoring, ultimately improving patient care and safety.