Model-Based Roentgen Stereophotogrammetric Analysis Using Elementary Geometrical Shape Models: Reliability of Migration Measurements for an Anatomically Shaped Femoral Stem Component

Elementary Geometrical Shape (EGS) models present an alternative approach to detect in vivo migration of total hip arthroplasty using model-based Roentgen Stereophotogrammetric Analysis (mbRSA). However, its applicability for an irregular-shaped femoral stem and the reliability of this mbRSA approach has not been proven so far. The aim of this study is to assess the effect of multi-rater and an anatomically shaped femoral stem design onto resulting implant to bone migration results. The retrospective analysis included 18 clinical cases of anatomically shaped stem with 10-year RSA follow-ups. Three raters repeatedly measured all RSA follow-ups for evaluating the rater equivalence and intra-rater reliability. The results proved the equivalence between different raters for mbRSA using EGS models (mbRSA-EGS), hence it simplified the investigation of rater reliability to intra-rater reliability. In all in-plane migration measurements, mbRSA-EGS shows good intra-rater reliability and small intra-rater variability (translation: <0.15 mm; rotation: <0.18 deg). However, the reliability is worse in the out-of-plane measurements, especially the cranial-caudal rotation (intra-rater variability: 0.99–1.81 deg). Overall, mbRSA-EGS can be an alternative approach next to surface models while the in-plane migration of femoral stem (e.g., the implant subsidence for loosening prediction) have more research interested than other directions.