The application value of DR metal artifact reduction technology in total knee arthroplasty

Abstract Objective To evaluate the effect of the Digital Radiography (DR) metal artifact reduction (MAR) technology (Enhanced Visualization Processing Plus, EVP Plus) in improving image quality in total knee arthroplasty (TKA) patients and its clinical value. Methods This exploratory prospective paired study included 96 patients who underwent routine postoperative DR follow-up after total knee arthroplasty at Lanzhou University Second Hospital between October 2024 and June 2025. DR images were collected, and the DR metal artifact reduction technology (EVP Plus) was applied for image reconstruction. Subjective and objective image quality analyses were performed. Results Objective image quality analysis revealed that, compared with the original images, the processed images demonstrated a reduction in noise values in the region of interest (ROI), an increase in signal-to-noise ratio (SNR), and a decrease in contrast-to-noise ratio (CNR) between the ROI and adjacent bone and soft tissues (P < 0.001). Clinical lesion detectability evaluation showed a significant increase in lesion detection rate (P < 0.05). Conclusion DR metal artifact reduction demonstrates significant clinical value after total knee arthroplasty through effective artifact suppression, improved image quality, and enhanced peri-implant lesion detection.