{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:00:15Z","timestamp":1790182815915,"version":"4.1.0"},"reference-count":38,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Radiostereometric analysis (RSA) is the gold standard for assessing implant migration, with 1-year migration thresholds predicting later revision. While inducible displacement under immediate load may enable single-session functional stability assessment, no established threshold exists. We systematically reviewed RSA-measured inducible displacement after primary knee arthroplasty to determine whether a threshold identifying at-risk implants can be derived from the existing literature, and to characterize responses to loading, differences between fixation methods, temporal patterns, and the relationship to migration.Methods:\u00a0We searched PubMed, Web of Science, Scopus, and Embase (April 2025) for studies reporting in vivo RSA-measured inducible displacement after primary knee arthroplasty, requiring quantitative data with specified reference and load conditions. Studies were evaluated for links between inducible displacement and supine, non-weightbearing migration. We assessed bias risk using RoB 2 and ROBINS-E. Due to high heterogeneity, a descriptive synthesis was performed; meta-analysis and regression were not feasible (PROSPERO CRD420251043748).Results:\u00a023 studies were included. The most common outcome was maximum total point motion (MTPM) during supine-to-single-leg weightbearing (SLWB). Cemented tibial components tended to show greater displacement than cementless designs. Rotatory stress tests produced the largest absolute displacements; differences within the same study from SLWB were minimal. Predictive evidence remained limited.Conclusion:\u00a0Inducible displacement may indicate functional stability. The existing literature provides no threshold to identify at-risk implants and reporting was too heterogeneous to support a cut-off value. SLWB was the most common protocol. Prospective studies with standardized protocols and clinical endpoints are necessary.<\/jats:p>","DOI":"10.2340\/17453674.2026.46318","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:03:17Z","timestamp":1790179397000},"source":"Crossref","is-referenced-by-count":0,"title":["Inducible displacement measured with radiostereometric analysis in primary knee arthroplasty: a systematic review of clinical studies"],"prefix":"10.2340","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3329-096X","authenticated-orcid":false,"given":"Jonathan Hugo","family":"J\u00fcrgens-Lahnstein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanne Frost","family":"Teilmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil Toft","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren","family":"Rytter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4530-2075","authenticated-orcid":false,"given":"Maiken","family":"Stilling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9889-7570","authenticated-orcid":false,"given":"Elise","family":"Laende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"169251","doi-asserted-by":"crossref","unstructured":"Selvik G. 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Marker-based versus model-based radiostereometric analysis of total knee arthroplasty migration: a reanalysis with comparable mean outcomes despite distinct types of measurement error. Acta Ortho 2019; 90(4): 366-72. doi: 10.1080\/17453674.2019.1605692.","DOI":"10.1080\/17453674.2019.1605692"},{"key":"169255","doi-asserted-by":"crossref","unstructured":"Ryd L, Lindstrand A, Rosenquist R, Selvik G. Tibial component fixation in knee arthroplasty. Clin Orthop Relat Res 1986; (213): 141-9. PMID: 3780083","DOI":"10.1097\/00003086-198612000-00017"},{"key":"169256","doi-asserted-by":"crossref","unstructured":"K\u00e4rrholm J. Radiostereometric analysis of early implant migration: a valuable tool to ensure proper introduction of new implants. Acta Orthop 2012; 83(6): 551-2. doi: 10.3109\/17453674.2012.745352.","DOI":"10.3109\/17453674.2012.745352"},{"key":"169257","doi-asserted-by":"crossref","unstructured":"Hasan S, Marang-van de Mheen P J, Kaptein B L, Nelissen R G H H, Pijls B G. RSA-tested tka implants on average have lower mean 10-year revision rates than non-RSA-tested designs. Clin Orthop Relat Res 2020; 478(6): 1232-41. doi: 10.1097\/CORR.0000000000001209.","DOI":"10.1097\/CORR.0000000000001209"},{"key":"169258","doi-asserted-by":"crossref","unstructured":"Nelissen R G HH , Pijls B G, K\u00e4rrholm J, Malchau H, Nieuwenhuijse M J, Valstar E R. RSA and registries: the quest for phased introduction of new implants. J Bone Joint Surg Am 2011; 93(Suppl 3): 62-5. doi: 10.2106\/JBJS.K.00907.","DOI":"10.2106\/JBJS.K.00907"},{"key":"169259","doi-asserted-by":"crossref","unstructured":"Pijls B G, Valstar E R, Nouta K-A, Plevier J WM, Fiocco M, Middeldorp S, et al. Early migration of tibial components is associated with late revision: a systematic review and meta-analysis of 21,000 knee arthroplasties. Acta Orthop 2012; 83(6): 614-24. doi: 10.3109\/17453674.2012.747052.","DOI":"10.3109\/17453674.2012.747052"},{"key":"169260","doi-asserted-by":"crossref","unstructured":"Wee MA ter, Dobbe J G G, Kievit A J, Schafroth M U, Maas M, Blankevoort L, et al. Inducible displacement CT for implant loosening detection: a scoping review on methods, validation, and challenges. Acta Orthop 2026; 97: 136-47. doi: 10.2340\/17453674.2026.45512.","DOI":"10.2340\/17453674.2026.45512"},{"key":"169261","doi-asserted-by":"crossref","unstructured":"Kaptein B L, Pijls B, Koster L, K\u00e4rrholm J, Hull M, Niesen A, et al. The International Radiostereometry Society. Guideline for RSA and CT-RSA implant migration measurements: an update of standardizations and recommendations. Acta Orthop 2024; 95: 256-67. doi: 10.2340\/17453674.2024.40709.","DOI":"10.2340\/17453674.2024.40709"},{"key":"169262","doi-asserted-by":"crossref","unstructured":"Sterne J A C, Savovi\u0107 J, Page M J, Elbers R G, Blencowe N S, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898. doi: 10.1136\/bmj.l4898.","DOI":"10.1136\/bmj.l4898"},{"key":"169263","doi-asserted-by":"crossref","unstructured":"Higgins J P T, Morgan R L, Rooney A A, Taylor K W, Thayer K A, Silva R A, et al. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). Environ Int 2024; 186: 108602. doi: 10.1016\/j.envint.2024.108602.","DOI":"10.1016\/j.envint.2024.108602"},{"key":"169264","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2025. 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Inducible displacement of a trabecular metal tibial monoblock component. J Arthroplasty 2010; 25(6): 893-900. doi: 10.1016\/j.arth.2009.06.015.","DOI":"10.1016\/j.arth.2009.06.015"},{"key":"169271","doi-asserted-by":"crossref","unstructured":"Hansson U, Toksvig-Larsen S, Jorn L P, Ryd L. Mobile vs. fixed meniscal bearing in total knee replacement: a randomised radiostereometric study. Knee 2005; 12(6): 414-18. doi: 10.1016\/j.knee.2004.12.002.","DOI":"10.1016\/j.knee.2004.12.002"},{"key":"169272","doi-asserted-by":"crossref","unstructured":"Bragonzoni L, Russo A, Loreti I, Montagna L, Visani A, Marcacci M. The stress-inducible displacement detected through RSA in non-migrating UKR. Knee 2005; 12(4): 301-6. doi: 10.1016\/j.knee.2004.09.006.","DOI":"10.1016\/j.knee.2004.09.006"},{"key":"169273","doi-asserted-by":"crossref","unstructured":"Regn\u00e9r L, Carlsson L, K\u00e4rrholm J, Herberts P. Tibial component fixation in porous- and hydroxyapatite-coated total knee arthroplasty: a radiostereometric evaluation of migration and inducible displacement after 5 years. J Arthroplasty 2000; 15(6): 681-9. doi: 10.1054\/arth.2000.8103.","DOI":"10.1054\/arth.2000.8103"},{"key":"169274","doi-asserted-by":"crossref","unstructured":"Puijk R, Koster L A, Pijls B G C W, Singh J, Schager M, Kaptein B L, et al. 5-year migration and inducible displacement of the uncemented LCS and ATTUNE rotating platform knee systems: a secondary report of a randomized controlled RSA trial. Acta Orthop 2025; 96: 59-65. doi: 10.2340\/17453674.2024.42744.","DOI":"10.2340\/17453674.2024.42744"},{"key":"169275","doi-asserted-by":"crossref","unstructured":"Hext R A, Kaptein B L, Howard J L, Lanting B A, Teeter M G. Inducible displacement of cementless total knee arthroplasty components with conventional and weight-bearing CT-based radiostereometric analysis. 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Axial and sagittal rotation of cementless tibial baseplates occurs in bone under joint loading. J Arthroplasty 2023; 38(6): 1166-71. doi: 10.1016\/j.arth.2023.03.002.","DOI":"10.1016\/j.arth.2023.03.002"},{"key":"169279","doi-asserted-by":"crossref","unstructured":"Petersen M M, Nielsen P T, Lebech A, Toksvig-Larsen S, Lund B. Preoperative bone mineral density of the proximal tibia and migration of the tibial component after uncemented total knee arthroplasty. J Arthroplasty 1999; 14(1): 77-81. doi: 10.1016\/s0883-5403(99)90206-1.","DOI":"10.1016\/S0883-5403(99)90206-1"},{"key":"169280","doi-asserted-by":"crossref","unstructured":"Hilding M B, Yuan X, Ryd L. The stability of three different cementless tibial components: a randomized radiostereometric study in 45 knee arthroplasty patients. 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