title: Precision of radiostereometric analysis (RSA) of acetabular cup stability and polyethylene wear improved by adding tantalum beads to the liner.
abstract: OBJECTIVE
  In traditional radiostereometric analysis (RSA), 1 segment defines both the acetabular shell and the polyethylene liner. However, inserting beads into the polyethylene liner permits employment of the shell and liner as 2 separate segments, enabling distinct analysis of the precision of 3 measurement methods in determining femoral head penetration and shell migration.
  
  
  METHODS
  The UmRSA program was used to analyze the double examinations of 51 hips to determine if there was a difference in using the shell-only segment, the liner-only segment, or the shell + liner segment to measure wear and acetabular cup stability. The standard deviation multiplied by the critical value (from a t distribution) established the precision of each method.
  
  
  RESULTS
  Due to the imprecision of the automated edge detection, the shell-only method was least desirable. The shell + liner and liner-only methods had a precision of 0.115 mm and 0.086 mm, respectively, when measuring head penetration. For shell migration, the shell + liner had a precision of 0.108 mm, which was better than the precision of the shell-only method. In both the penetration and migration analyses, the shell + liner condition number was statistically significantly lower and the bead count was significantly higher than for the other methods.
  
  
  CONCLUSIONS
  Insertion of beads in the polyethylene improves the precision of femoral head penetration and shell migration measurements. A greater dispersion and number of beads when combining the liner with the shell generated more reliable results in both analyses, by engaging a larger portion of the radiograph.
authors.affiliation: a 1 Harris Orthopaedic Laboratory , Massachusetts General Hospital, Boston, MA.
authors.forename: Audrey K
authors.initials: AK
authors.lastname: Nebergall
authors.affiliation: b 2 Biostatistics Department , Harvard University, Cambridge, MA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Rader
authors.affiliation: c 3 Department of Orthopedics , Hvidovre University Hospital, Copenhagen, Denmark .
authors.forename: Henrik
authors.initials: H
authors.lastname: Palm
authors.affiliation: a 1 Harris Orthopaedic Laboratory , Massachusetts General Hospital, Boston, MA.
authors.forename: Henrik
authors.initials: H
authors.lastname: Malchau
authors.affiliation: a 1 Harris Orthopaedic Laboratory , Massachusetts General Hospital, Boston, MA.
authors.forename: Meridith E
authors.initials: ME
authors.lastname: Greene
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020959:Polyethylene / Q000627:therapeutic use; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D059869:Radiostereometric Analysis; D013635:Tantalum / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013635:Tantalum; D020959:Polyethylene