Digital Radiographic Preoperative Planning and Postoperative Monitoring of Total Hip Replacements. - Techniques, Validation and Implementation -

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1 Digital Radiographic Preoperative Planning and Postoperative Monitoring of Total Hip Replacements - Techniques, Validation and Implementation -

2 The hidden image on the cover: Cover designed by Bertram The The image in the magnifying glass is a stereographic pattern, in which a threedimensional object is hidden. When focusing on the centre of the image and then gradually diverging the eyes (as if watching an object behind the image) a threedimensional display of a pelvis is revealed (see illustration)! It might not be surprising that the idea behind this cover design originates in the parallel idea behind the topics handled in this thesis. Both in preplanning of surgery, as well as postoperative radiographic measurements we use simple two-dimensional images. Yet, the three-dimensional reality behind these two-dimensional materials is to be taken into consideration for maximum yield. Both the problems that accompany this principle as well as the opportunities it creates were scrutinized in this thesis. Or as we say in Dutch: we hebben het onder de loep genomen. The stereogram was build using three-dimensionalmiracle 1.73 (Urry Software Lab and Media Programming Group). The depth mask of the pelvis was rendered with three-dimensional Monster 1.54 (Urry Software Lab and Media Programming Group) using a 3D Studio object based on a CT reconstruction image of a pelvis. Final assembly of the cover image was done using Photoshop 7.0 (Adobe Systems Inc.).

3 RIJKSUNIVERSITEIT GRONINGEN Digital Radiographic Preoperative Planning and Postoperative Monitoring of Total Hip Replacements - Techniques, Validation and Implementation - Proefschrift ter verkrijging van het doctoraat in de Medische Wetenschappen aan de Rijksuniversiteit Groningen op gezag van de Rector Magnificus, dr. F. Zwarts, in het openbaar te verdedigen op woensdag 8 november 2006 om uur door Bertram The geboren op 15 maart 1974 te Maastricht

4 Promotores: Copromotor: Prof. Dr. R.L. Diercks Prof. Dr. J.R. van Horn Dr. Ir. N. Verdonschot Beoordelingscommissie: Prof. Dr. R.G.T. Geesink Prof. Dr. M. Oudkerk Prof. Dr. R.P.H. Veth

5 Paranimfen: Dr. Bas Knobben Ir. Thomas The

6 B. The Digital Radiographic Preoperative Planning and Postoperative Monitoring of Total Hip Replacements - Techniques, Validation and Implementation University Medical Centre Groningen, the Netherlands 2006 ISBN ISBN (electronic) Lay-out Sioe Hoey The-Go No part of this book may be reproduced by any mechanical, photographic or electronic process, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission of the author. All published papers are reprinted with permission and with credit to their resource.

7 Publication of this thesis was financially supported by: Nederlandse Orthopedische Vereniging Oldelft Benelux / Rogan Delft Dutch Arthritis Association Anna-stichting Bauerfeind Benelux Synthes B.V. ConvaTec DePuy

8 Stellingen behorende bij dit proefschrift 1. Het proces dat leidt tot fouten bij wearmetingen door projectieverschillen tussen uitgangs- en follow-up röntgenopname is tot op grote hoogte mathematisch reversibel. (Dit proefschrift) 2. Aannames zijn de achilleshiel van elk model. Virtuele simulaties zijn een krachtig middel om mogelijke consequenties ervan bloot te leggen. (Dit proefschrift) 3. Preoperatieve planningen van totale heuparthroplastieken worden nauwkeuriger door betere correctie van de vergrotingsfactor, neutralisatie van de anteversie van het femur, en gebruik van planbare prothesecomponenten. (Dit proefschrift) 4. Het preplannen van een totale arthroplastiek door iemand anders dan de operateur is bij de heupprothese van weinig waarde, maar levert bij de knieprothese een nauwkeurige voorspelling van de benodigde componentmaten op. (Dit proefschrift) 5. De meetfout van slijtagemetingen aan polyethyleenkommen op individueel niveau is van groter belang dan op groepsniveau, omdat deze niet voorspelbaar is. (Dit proefschrift)

9 6. Met de huidige stand van kennis, is het navigeren bij totale heuparthroplastieken als het navigeren met een kaart in het donker. 7. De keuze tussen impact, fact, or impact factor is niet altijd makkelijk te maken. 8. Power is voor optimisten, p-waarden voor pessimisten, betrouwbaarheidsintervallen voor realisten en promotie-onderzoek voor masochisten. 9. Waarom gaat, zodra de statistiek in beeld komt, niet alleen de data, maar ook het klinische denken in regressie? 10. De meest verwarrende taal is digitaal. 11. Er zou minder tussen bevolkingsgroepen en meer tussen de tanden moeten worden gestookt. 12. Your brain is like your stomach, in the sense that if it s empty, you re willing to put anything in there to fill it up. (S. Adams) 13. Co-auteurschap is het smeergeld van de wetenschap. 14. Het gebrek aan opleidingsstructuur in promotietrajecten is geen promotie voor dergelijke trajecten. 15. Wetenschappers verdienen in Nederland niet wat ze verdienen. 16. No one believes forecasts, but we all want to hear them. (S. Hawking)

10

11 Contents Chapter 1 General introduction Chapter 2 Digital correction of magnification in pelvic x-rays for preoperative planning of hip joint replacement Chapter 3 Comparison of techniques for correction of magnification of pelvic x-rays for hip surgery planning Chapter 4 Comparison of analogue versus digital preoperative planning in total hip and knee arthroplasties Chapter 5 Digital versus analogue preoperative planning of total hip arthroplasties Chapter 6 Correction of error in 2D wear measurements of cemented hip arthroplasties Chapter 7 A new method to make 2D wear measurements less sensitive to projection differences of cemented total hip replacements on AP radiographs Chapter 8 General discussion Chapter 9 Summary 131 Chapter 10 Nederlandse samenvatting Chapter 11 Epiloog, dankwoord, curriculum vitae List of publications

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