Dual mobility hip arthroplasty wear measurement: Experimental accuracy assessment using radiostereometric analysis (RSA)

SummaryIntroductionThe use of dual mobility cups is an effective method to prevent dislocations. However, the specific design of these implants can raise the suspicion of increased wear and subsequent periprosthetic osteolysis.HypothesisUsing radiostereometric analysis (RSA), migration of the femoral head inside the cup of a dual mobility implant can be defined to apprehend polyethylene wear rate.Study objectivesThe study aimed to establish the precision of RSA measurement of femoral head migration in the cup of a dual mobility implant, and its intra- and interobserver variability.Material and methodsA total hip prosthesis phantom was implanted and placed under weight loading conditions in a simulator. Model-based RSA measurement of implant penetration involved specially machined polyethylene liners with increasing concentric wear (no wear, then 0.25, 0.5 and 0.75mm). Three examiners, blinded to the level of wear, analyzed (10 times) the radiostereometric films of the four liners. There was one experienced, one trained, and one inexperienced examiner. Statistical analysis measured the accuracy, precision, and intra- and interobserver variability by calculating Root Mean Square Error (RMSE), Concordance Correlation Coefficient (CCC), Intra Class correlation Coefficient (ICC), and Bland-Altman plots.ResultsOur protocol, that used a simple geometric model rather than the manufacturer's CAD files, showed precision of 0.072mm and accuracy of 0.034mm, comparable with machining tolerances with low variability. Correlation between wear measurement and true value was excellent with a CCC of 0.9772. Intraobserver reproducibility was very good with an ICC of 0.9856, 0.9883 and 0.9842, respectively for examiners 1, 2 and 3. Interobserver reproducibility was excellent with a CCC of 0.9818 between examiners 2 and 1, and 0.9713 between examiners 3 and 1.DiscussionQuantification of wear is indispensable for the surveillance of dual mobility implants. This in vitro study validates our measurement method. Our results, and comparison with other studies using different measurement technologies (RSA, standard radiographs, Martell method) make model-based RSA the reference method for measuring the wear of total hip prostheses in vivo.Level of evidenceLevel 3. Prospective diagnostic study

To be or not to be an auctioneer: Some thoughts on the legal nature of online eBay auctions and the protection of consumers

This paper discusses the legal classification of online “eBay” auctions. The discussion has key implications on the scope of consumer protection law as sale by auctions are, for example, excluded from the scope of the Consumer Protection (Distance Selling) Regulations 2000. The paper uncovers that online “eBay” auctions cannot always be considered as traditional auctions and that eBay, as an intermediary, is not to be considered as an auctioneer. This creates difficulties associated with a distributive application of consumer protection laws such as the Consumer Protection (Distance Selling) Regulations 2000. Another set of difficulties is associated with a lenient legal regime applicable to the liability of eBay under the Electronic Commerce (EC Directive) Regulations 2002 . The paper concludes that there is an urgent need to clarify the legal classification of online auctions and to rethink the liability of online auction sites to better protect consumers

Validation of the in vivo volumetric wear measurement for total knee prostheses in model-based RSA

Implant failure related to polyethylene wear remains an important issue in total knee arthroplasty. Polyethylene wear is usually assessed in vivo by measuring the remaining insert thickness on X-ray images of the knee. To reflect the amount of wear debris more accurately, a 3-dimensional overlap measurement has been suggested, which is based on implant component models which are matched on calibrated stereo X-ray images using model-based roentgen stereophotogrammatic analysis. The goal of this study was to determine the influence of pose estimation, insert thickness deviation and variation in the femoral-tibial contact location on the accuracy and precision of the measurement using simulations and a phantom experiment. We found that the pose estimation was the largest source of variation. The 95% prediction interval varied between 111 and 283 mm3, which is approximately 100–200% of the detected volumetric wear. Insert thickness variation resulted in prediction intervals of 74–174 mm3. Variation of the femoral-tibial contact location in the phantom experiment gave a prediction interval of 40 mm3. Large differences in the detected wear volume were found for different flexion angles. At most 56% of the true wear volume was detected (129 of 230 mm3, 30° of flexion). In summary, both the accuracy and precision of the volumetric wear measurement were low. The prediction interval of the volumetric wear measurement is at least as large as the measurement outcome itself. This is an important limitation to the applicability of the volumetric wear measurement in clinical practice and further clinical validation is required.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin