P. Rozing - Academia.edu (original) (raw)

Papers by P. Rozing

Acta Orthopaedica Scandinavica, 1982

Twenty-six knees were scanned after total replacement to evaluate the relationship between bone s... more Twenty-six knees were scanned after total replacement to evaluate the relationship between bone scan, pain, the presence of a radiolucent line at the bone-cement interface and loosening. A radiolucent line was often accompanied by an increased uptake over the affected condyle, but there was no significant relationship with pain or loosening.

We have reviewed 66 consecutiveSouter-Strathclyde arthroplasties of the elbow implanted in 59 pat... more We have reviewed 66 consecutiveSouter-Strathclyde arthroplasties of the elbow implanted in 59 patients between 1982 and 1993. Thirteen patients (15 elbows) (19.6%) died. Sixteen elbows (24.2%) were revised, six for aseptic loosening (9%), four (6%) because of fracture or loosening after a fracture, three (4.5%) for infection and three (4.5%) for dislocation. Four patients refused to attend for review. In 33 elbows with a follow-up of 93 months (60 to 167) complete relief of pain was achieved in 22 (67%) when seen at one year. After ten years or more 36% of the elbows were painfree and 64 % had occasional slight pain especially under loading or stress. The mean gain in the arc of movement was 16°, but a mean flexion contracture of 33 ° remained. The main early complications were intraoperative fractures of the epicondyles (9%), postoperative dislocation (4.5%) and ulnar neuropathy. The incidence of ulnar neuropathy before operation was 19%. After operation 20 patients (33%) had an ul...

Background and purpose: The Souter-Strathclyde total elbow prosthesis is a well-studied replaceme... more Background and purpose: The Souter-Strathclyde total elbow prosthesis is a well-studied replacement therapy for the destructed rheumatoid elbow joint. In the short-term results of a RSA-study we concluded that 8 out of 18 humeral components were at risk for loosening at two years of follow-up. Now we present the long-term results of this study to evaluate these predictions. Patients and Methods: Twenty-one elbows (18 patients) were included in the RSA-study. At risk for loosening was defined as increase of translation of more than 0.4 mm or increase of rotation of more than one degree during the second postoperative year. The average follow-up was 98 months (range: 12–134 months). RSA-measurements were performed post-operatively, at 3 months, 6 months, 12 months and at yearly intervals thereafter. Prosthetic position and radiolucent lines (RLLs) were examined on conventional radiographs. Results: Almost all humeral components, including the ones that were defined to be ‘at risk’ for...

Riassunto La maggior parte delle fratture della diafisi dell’omero puo essere trattata in maniera... more Riassunto La maggior parte delle fratture della diafisi dell’omero puo essere trattata in maniera conservativa. Tuttavia, se c’e la necessita di procedere a riduzione e fissazione, l’osteosintesi con placca e un metodo molto efficace nel trattamento di questo tipo di frattura e della pseudoartrosi. Ciononostante, e una tecnica soggetta a errori tecnici responsabili di una mancata consolidazione o di paralisi del nervo radiale. L’identificazione del nervo radiale, nel corso delle prime fasi della procedure, e l’uso di una placca forata AO da 4.5 mm della lunghezza adatta garantiscono il successo dell’intervento. Per le fratture a livello della parte piu prossimale della diafisi, l’esposizione migliore si ottiene con una via d’accesso anterolaterale, mentre per le fratture a livello del due terzi inferiori della diafisi viene usato un accesso posteriore. Le tecniche di innesto osseo autologo dovrebbero trovare impiego di routine in tutti i casi di mancata consolidazione, anche se teor...

Physical Therapy, 2000

Background and Purpose. The purpose of this case report is to describe the use of end-range mobil... more Background and Purpose. The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. Case Description. Four men and 3 women (mean age=50.2 years, SD=6.0, range=41–65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range= 3–12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. Outcomes. After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=7...

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Nederlands tijdschrift voor geneeskunde, Jan 27, 1980

Journal of Shoulder and Elbow Surgery, 1999

Journal of Orthopaedic Research, 1997

High-tech development within prosthetics for lower limb amputees can benefit from high-tech metho... more High-tech development within prosthetics for lower limb amputees can benefit from high-tech methods to study the socket fit. Roentgen stereophotogrammetry is one such method with high resolution to study stability with point motion and segment motion simultaneously to show how well bonded the socket is to the stump. It has been used to follow results of total joint replacement concerning loosening and wear of components. In this study, one transtibial amputee was examined with tantalum bone markers implanted through skin and also glued into the hard socket. Four different prosthetic suspensions were used, and we simulated four different gait cycle positions and recorded the micromotions between the tibial bone segment and the hard socket three-dimensionally. The vertical motion varied 10 to 30 mm and the AP motion 0 to 15 mm. For the first time, we could measure rotation of the socket on the stump about a vertical axis. The rotation in the transversal plane was 7.5 outward. Airtight sleeve with expulsion valve gave the best stability.

Journal of Biomechanics, 1999

In this paper the applicability in terms of measurement accuracy of the &&Flock of Birds'' six D.... more In this paper the applicability in terms of measurement accuracy of the &&Flock of Birds'' six D.O.F. electromagnetic tracking device in shoulder research is investigated. Position measurements in a workspace of approximately 1 m were performed using a stylus. The andom error at the stylustip appeared to be 1.86, 1.98 and 2.54 mm for x-, y-and z-coordinate, respectively. The error caused by distortion of the magnetic "eld by metal in the concrete of especially the #oor was 20.8, 22.2 and 20.4 mm for the x-, y-and zcoordinate, respectively. Calibration and leaving out the measurements closests to the #oor lowered this error to 2.07, 2.38 and 2.35 mm. Orientation errors of the shoulder bones evolving from the measurement inaccuracy were estimated from repeated measurements of shoulder bony landmarks of ten subjects by means of the stylus. These errors were generally below 23. This is lower than found for the same measurements using a spatial linkage digitizer. It is concluded that the &&Flock of Birds'' is a useful tool for shoulder kinematic studies.

Journal of Biomechanics, 1998

Until recently, Roentgen Stereophotogrammetric Analysis (RSA) required the manual definition of a... more Until recently, Roentgen Stereophotogrammetric Analysis (RSA) required the manual definition of all markers using a high-resolution measurement table. To automate this tedious and time-consuming process and to eliminate observer variabilities, an analytical software package has been developed and validated for the detection, identification, and matching of markers in RSA radiographs. The digital analysis procedure consisted of the following steps: (1) the detection of markers using a variant of the Hough circle-finder technique; (2) the identification and labeling of the detected markers; (3) the reconstruction of the three-dimensional position of the bone markers and the prosthetic markers; and (4) the computation of micromotion. To assess the influence of film digitization, the measurements obtained from nine phantom radiographs using two different film scanners were compared with the results obtained by manual processing. All markers in the phantom radiographs were automatically detected and correctly labeled. The best results were obtained with a Vidar VXR-12 CCD scanner, for which the measurement errors were comparable to the errors associated with the manual approach. To assess the in vivo reproducibility, 30 patient radiographs were analyzed twice with the manual as well as with the automated procedure. Approximately, 85% of all calibration markers and bone markers were automatically detected and correctly matched. The calibration errors and the rigid-body errors show that the accuracy of the automated procedure is comparable to the accuracy of the manual procedure. The rigid-body errors had comparable mean values for both techniques: 0.05 mm for the tibia and 0.06 mm for the prosthesis. The reproducibility of the automated procedure showed to be slightly better than that of the manual procedure. The maximum errors in the computed translation and rotation of the tibial component were 0.11 mm and 0.24, compared to 0.13 mm and 0.27 for the manual RSA procedure. The total processing time is less than 10 min per radiograph, including interactive corrections, compared to approximately 1 h for the manual approach. In conclusion, a new and widely applicable, computer-assisted technique has become available to detect, identify, and match markers in RSA radiographs and to assess the micromotion of endoprostheses. This new technique will be used in our clinic for our hip, knee, and elbow studies.

Journal of Biomechanics, 2008

Image-based Roentgen stereophotogrammetric analysis (IBRSA) integrates 2D-3D image registration a... more Image-based Roentgen stereophotogrammetric analysis (IBRSA) integrates 2D-3D image registration and conventional RSA. Instead of radiopaque RSA bone markers, IBRSA uses 3D CT data, from which digitally reconstructed radiographs (DRRs) are generated. Using 2D-3D image registration, the 3D pose of the CT is iteratively adjusted such that the generated DRRs resemble the 2D RSA images as closely as possible, according to an image matching metric. Effectively, by registering all 2D follow-up moments to the same 3D CT, the CT volume functions as common ground. In two experiments, using RSA and using a micromanipulator as gold standard, IBRSA has been validated on cadaveric and sawbone scapula radiographs, and good matching results have been achieved. The accuracy was: |m|o0.083 mm for translations and |m|o0.0231 for rotations. The precision s in x-, y-, and z-direction was 0.090, 0.077, and 0.220 mm for translations and 0.1551, 0.2431, and 0.0741 for rotations. Our results show that the accuracy and precision of in vitro IBRSA, performed under ideal laboratory conditions, are lower than in vitro standard RSA but higher than in vivo standard RSA. Because IBRSA does not require radiopaque markers, it adds functionality to the RSA method by opening new directions and possibilities for research, such as dynamic analyses using fluoroscopy on subjects without markers and computer navigation applications.

Clinical Rehabilitation, 2004

Subjects: A 20-year-old woman, known to have cerebral palsy and a spastic hemiparesis, suffered f... more Subjects: A 20-year-old woman, known to have cerebral palsy and a spastic hemiparesis, suffered from frequent (up to 20 times a day) and painful posterior dislocation of the affected shoulder. Interventions: For the last two years we have treated her with injections with botulinum toxin A (100 U Botox®) in the M. subscapularis. Results: Pain and dislocation rate have improved substantially.

Clinical Neurology and Neurosurgery, 1993

Clinical Biomechanics, 2004

To investigate the effect of glenoid component inclination angle on the fixation of cemented glen... more To investigate the effect of glenoid component inclination angle on the fixation of cemented glenoid-bone structures and humeral head subluxation. Results of shoulder replacements, in terms of glenoid component fixation and joint functionality, are bad and must be improved. Repeated glenoid component tilting, a result of eccentric contact forces harms glenoid component fixation. However, the effect of glenoid component inclination is unknown. Keeled glenoid components are cemented into bone substitutes and positioned under inclination angles varying between -4.5 degrees and +4.5 degrees . For each inclination angle 5 glenoid specimens are loaded by a horizontal, constant joint compression force (725 (SD 10) N) and a vertical, superior directed subluxation force (shear force), cyclically varying between 0 and 350 (SD 1) N. After 200,000 load cycles, the upper and lower glenoid component rim-displacements are measured during 1500 additional load cycles by custom made displacement sensors. The maximal superior rim-displacement significantly increased and the minimal inferior rim-displacement dramatically decreased for increasing glenoid component inclination angles up to +4.5 degrees . Maximal ratio of subluxation force over compression force significantly decreased for increasing glenoid component inclination. According to this study, decreasing glenoid component inclination angle decreases glenoid component tilting and humeral head subluxation and the results can be used to improve total shoulder replacements. Better understanding of the effect of glenoid component inclination on glenoid component tilting and humeral head subluxation may be useful information for the surgeon to improve results of the total shoulder arthroplasty, when replacing the glenoid surface.

Archives of Orthopaedic and Trauma Surgery, 1992

The incidence of loosening of a cemented glenoid component in total shoulder arthroplasty, detect... more The incidence of loosening of a cemented glenoid component in total shoulder arthroplasty, detected by means of radiolucent lines or positional shift of the component on true antero-posterior radiographs, has been reported to be between 0% to 44%. These numbers depend on the criteria used for loosening and on the length of follow-up. Radiolucent lines are however difficult to detect and to interpret, because of the mobility of the shoulder girdle and the obliquity of the glenoid, which hinder standardisation of radiographs. After review of radiolucencies around cemented glenoid components with a mean follow-up of 5. 3 years in 48 patients we found progressive changes to be present predominantly at the inferior pole of the component. This may hold a clue for the mechanism behind loosening of this implant. Since loosening is generally defined as a complete radiolucent line around the glenoid component and is difficult to assess as a result of the oblique orientation of the glenoid, an underestimation of the loosening rate using radiological data was suspected. Therefore a pilot study using Roentgen Stereophotogrammatric Analysis (RSA) was performed. In five patients an additional analysis of glenoid component loosening using digital Roentgen Stereophotogrammetric Analysis (RSA) was performed. The relative motion of the glenoid component with respect to the scapula was assessed and the length of this translation vector was used to represent migration. Loosening was defined as a migration of the component, exceeding the pessimistic estimate of the accuracy of RSA 0. 3 mm for this study. After three years of follow-up, three out of five glenoid components had loosened (1. 2 – 5. 5 mm migration). In only one patient with a gross loosened glenoid, the radiological signs were consistent with the RSA findings. It was concluded that when traditional radiographs are used for assessment of early loosening, the loosening rate is underestimated. We recommend that RSA be used for this.

Acta Orthopaedica, 2002

21 elbows in 18 patients with rheumatoid arthritis were treated with a Souter-Strathclyde total e... more 21 elbows in 18 patients with rheumatoid arthritis were treated with a Souter-Strathclyde total elbow prosthesis. 18 elbows were included in a radiostereometry (RSA) study. The aim of this clinical RSA study was to assess the three-dimensional micromotion pattern of the Souter-Strathclyde prosthesis, and thereby gain insight in the aseptic loosening process of this prosthesis. Implants were defined as at risk of aseptic loosening when the translation rate during the second postoperative year was more than 0.4 mm along one or more coordinate axes and/or the rate of rotation was more than 1 degrees about one or more coordinate axes. Clinical examination revealed an increase in the range of motion and a marked reduction in pain. The RSA showed that 8 of 18 humeral components were at risk of aseptic loosening, although no signs of such loosening-defined as a complete radiolucent line of 2 mm or more-were found on the plain radiographs. In 7 humeral components, an anterior tilt about the transverse axis was seen that resulted in an anterior translation of the proximal tip and a posterior translation of the component&amp;amp;amp;amp;amp;amp;amp;#39;s trochlea. Long-term studies of the Souter-Strathclyde prosthesis, have shown that this rotation is a specific pattern of failure in some implants. None of the ulnar components was at risk for aseptic loosening. Improvements in fixation of the Souter-Strathclyde total elbow arthroplasty should focus on the humeral component. At present, the lateral flange of the implant is enlarged to improve rotational stability about the transverse and longitudinal axes. The effect of this change in design on micromotion of the Souter-Strathclyde total elbow prosthesis will be studied in a randomized RSA study comparing the new design to the existing one.

Acta Orthopaedica Scandinavica, 2000

Journal of Materials Science: Materials in Medicine, 1994

Fluorapatite-coated implants have been studied for the first time under non-optimal tissue condit... more Fluorapatite-coated implants have been studied for the first time under non-optimal tissue conditions and have shown promising results. The influence of arthritis on the tissue response to implants coated with fluorapatite (FA) was studied in an arthritis model. Immune complexinduced arthritis was elicited in the right knee-joint of eight rabbits while the contralateral joint served as control. Ti-6AI 4V cylinders, plasma-spray coated with FA were implanted in the patellar groove (PG) and medial femoral condyle (MC) in each knee for 6 weeks. Histology showed a close bone-to-implant contact at the lateral surface of the implants without any intervening soft tissue or inflammatory cells. Histomorphometry revealed no differences in bone apposition between control and arthritic joints, but the MC-implants showed more bone apposition than the PG-implants. Parts of the implant surface were not covered by bone, but were in contact with bone marrow. The FA coating on the implant sides did not show signs of resorption in the control and arthritic joints, but the coating on the upper surface of the implants was partially resorbed in both the control and arthritic joints. The arrangement and composition of the regenerating tissue in this location was profoundly influenced by the inflammatory process in the arthritic joints. In a previous study, using the same arthritis model, an impaired bone formation was found around commercially pure titanium implants in arthritic joints. In the present study, the unimpaired bone formation around FA-implants in the arthritic joints indicates that an FA coating adds advantageous properties to metal implants used in tissues influenced by an ongoing inflammation.

Journal of Biomechanics, 2000

In the current study the interobserver and intraobserver reliability of a recently developed meth... more In the current study the interobserver and intraobserver reliability of a recently developed method to obtain the position and orientation vectors of the flexion-extension axis of the elbow in vivo is determined. The method uses the Flock of Birds six degrees-of-freedom electromagnetic tracking device. Ten subjects performed three trials comprising five flexion and extension cycles. The movements of the forearm with respect to the upper arm were recorded. Observer A measured two trials and observer B measured one trial. Optimal instantaneous helical axes were calculated in a humeral coordinate system for each trial. Intraclass correlation coefficients and 99% confidence intervals were computed to compare the three measurements. Zero was in the range of all the narrow confidence intervals, which is strong indication for resemblance. Interobserver intraclass correlation coefficients values for orientation vectors were good to excellent and intraobserver values were fair to good. The intraclass correlation coefficients values for position vectors were lower, probably due to the lack of variance between subjects. It is concluded that the method is reliable and can be used in certain clinical settings.