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Pettit MH, Kanavathy S, McArthur N, Weiss O, Khanduja V. Measurement Techniques for Leg Length Discrepancy in Total Hip Arthroplasty: A Systematic Review of Reliability and Validity. J Arthroplasty 2022; 37:2507-2516.e11. [PMID: 35605764 DOI: 10.1016/j.arth.2022.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) carries a substantial litigative burden. THA may introduce leg length discrepancy (LLD), necessitating a valid and reliable technique for LLD measurement. This study investigates the reliability and validity of techniques quantitively measuring LLD in both pre- and post-THA. METHODS Embase and MEDLINE databases were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles assessing either the validity or reliability of LLD measurement techniques. Data was pooled using random effects meta-analysis to derive reliability estimates. Study quality was assessed using the Brink and Louw checklist. RESULTS Forty-two articles with 2059 participants were included. Thirty-three investigated reliability and 25 validity. Reliability displayed high heterogeneity. Poor to excellent intra-rater reliability was reported for antero-posterior pelvis radiographs, moderate to excellent for computed tomography scanograms, and good to excellent for clinical methods and teleradiography, and excellent for bi-planar radiography (BPR). Poor to excellent inter-rater reliability was reported for antero-posterior pelvis radiographs and clinical methods, moderate to excellent for teleradiography, good to excellent for computed tomography scanogram and excellent for BPR. The tape measure method is a valid clinical measure of LLD whilst markerless motion analysis and the block method are not. Imaging techniques are appropriately cross-validated with the exception of BPR. CONCLUSION The reported intra- and inter-rater reliability for most measurement techniques vary widely. The tape measure method is a valid clinical measurement of LLD. Imaging techniques have been appropriately cross-validated, with the exception of BPR, although they lack validation against a common reference technique.
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Affiliation(s)
| | | | - Nicholas McArthur
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ori Weiss
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Anderson CG, Brilliant ZR, Jang SJ, Sokrab R, Mayman DJ, Vigdorchik JM, Sculco PK, Jerabek SA. Validating the use of 3D biplanar radiography versus CT when measuring femoral anteversion after total hip arthroplasty : a comparative study. Bone Joint J 2022; 104-B:1196-1201. [PMID: 36317354 DOI: 10.1302/0301-620x.104b11.bjj-2022-0194.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIMS Although CT is considered the benchmark to measure femoral version, 3D biplanar radiography (hipEOS) has recently emerged as a possible alternative with reduced exposure to ionizing radiation and shorter examination time. The aim of our study was to evaluate femoral stem version in postoperative total hip arthroplasty (THA) patients and compare the accuracy of hipEOS to CT. We hypothesize that there will be no significant difference in calculated femoral stem version measurements between the two imaging methods. METHODS In this study, 45 patients who underwent THA between February 2016 and February 2020 and had both a postoperative CT and EOS scan were included for evaluation. A fellowship-trained musculoskeletal radiologist and radiological technician measured femoral version for CT and 3D EOS, respectively. Comparison of values for each imaging modality were assessed for statistical significance. RESULTS Comparison of the mean postoperative femoral stem version measurements between CT and 3D hipEOS showed no significant difference (p = 0.862). In addition, the two version measurements were strongly correlated (r = 0.95; p < 0.001), and the mean paired difference in postoperative femoral version for CT scan and 3D biplanar radiography was -0.09° (95% confidence interval -1.09 to 0.91). Only three stem measurements (6.7%) were considered outliers with a > 5° difference. CONCLUSION Our study supports the use of low-dose biplanar radiography for the postoperative assessment of femoral stem version after THA, demonstrating high correlation with CT. We found no significant difference for postoperative femoral version when comparing CT to 3D EOS. We believe 3D EOS is a reliable option to measure postoperative femoral version given its advantages of lower radiation dosage and shorter examination time.Cite this article: Bone Joint J 2022;104-B(11):1196-1201.
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Affiliation(s)
- Christopher G Anderson
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Zachary R Brilliant
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Seong J Jang
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Ruba Sokrab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Seth A Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, New York, New York, USA
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De Pieri E, Friesenbichler B, List R, Monn S, Casartelli NC, Leunig M, Ferguson SJ. Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults. Front Bioeng Biotechnol 2021; 9:679360. [PMID: 34368092 PMCID: PMC8334869 DOI: 10.3389/fbioe.2021.679360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 01/26/2023] Open
Abstract
Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject’s radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis.
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Affiliation(s)
- Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | | | - Renate List
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Samara Monn
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zürich, Switzerland
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Jarrett DY, Ecklund K. EOS Imaging of Scoliosis, Leg Length Discrepancy and Alignment. Semin Roentgenol 2021; 56:228-244. [PMID: 34281677 DOI: 10.1053/j.ro.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Delma Y Jarrett
- Assistant Professor of Clinical Radiology, Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY.
| | - Kirsten Ecklund
- Assistant Professor of Radiology, Pediatric Radiology Division Chief, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Cancer and mortality risks of patients with scoliosis from radiation exposure: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3123-3134. [PMID: 32852591 DOI: 10.1007/s00586-020-06573-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/12/2020] [Accepted: 08/16/2020] [Indexed: 01/08/2023]
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Esposito CI, Miller TT, Lipman JD, Carroll KM, Padgett DE, Mayman DJ, Jerabek SA. Biplanar Low-Dose Radiography Is Accurate for Measuring Combined Anteversion After Total Hip Arthroplasty. HSS J 2020; 16:23-29. [PMID: 32015737 PMCID: PMC6974156 DOI: 10.1007/s11420-018-09659-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acetabular component position alone has not been predictive of stability after total hip arthroplasty (THA). Combined anteversion of the acetabulum and femur has the potential of being more predictive of stability. Unfortunately, femoral component position is difficult to measure on plain radiographs. Computed tomography (CT) is the gold standard for measuring implant position post-operatively, but CT exposes patients to a substantial amount of radiation. QUESTIONS/PURPOSES We sought to determine whether biplanar low-dose radiography can be used to accurately measure both acetabular and femoral implant position after THA. METHODS Twenty patients underwent standing low-dose biplanar spine-to-ankle radiographs and supine CT scans 6 weeks after THA. Measurements of acetabular inclination, acetabular anteversion, and femoral anteversion were performed by two blinded observers and compared. RESULTS The average absolute differences between biplanar radiographs and CT scans were 2° ± 2° for acetabular inclination, 3° ± 2° for acetabular anteversion, and 4° ± 4° for femoral anteversion between EOS measurements and CT measurements. Interobserver agreement was good for acetabular inclination, acetabular anteversion, and femoral anteversion (Cronbach's α = 0.90) using biplanar low-dose imaging. CONCLUSION Biplanar radiography is a reliable low-radiation alternative for measuring acetabular inclination, acetabular anteversion, femoral version, and thus combined anteversion compared to CT. Femoral anteversion had the most variability but is still clinically relevant.
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Affiliation(s)
| | - Theodore T. Miller
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Joseph D. Lipman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Kaitlin M. Carroll
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Douglas E. Padgett
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - David J. Mayman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Seth A. Jerabek
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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3D hindfoot alignment measurements based on low-dose biplanar radiographs: a clinical feasibility study. Skeletal Radiol 2019; 48:707-712. [PMID: 30353278 DOI: 10.1007/s00256-018-3089-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test a 3D-hindfoot alignment (HA) measurement technique based on low-dose biplanar radiographs (BPRs) in a clinical setting and compare the results with 2D-HA measurements on long axial view radiographs (LARs). MATERIALS AND METHODS This prospective study was approved by the local institutional review board. HA measurements on 3D-BPR and 2D-LAR of 50 patients (29 female; mean age 47 ± 16.6 years) were compared (positive values = valgus; negative values = varus). Two independent musculoskeletal radiologists (readers 1 and 2) performed 3D-HA measurements on BPR using a custom-made MATLAB code and measured HA on LAR during two separate readout sessions. Descriptive statistics and intraclass correlation coefficients (ICC) were calculated, and Bland-Altman plots were used for intermethod comparison. RESULTS Using BPRs, HA was 0.8° ± 9.°1 (range, -20.2 to 20.0) for reader 1, and 0.7° ± 9.5° (range, -21.2 to 18.3) for reader 2. HA on LARs was -2.0 ° ± 7.0° (range, -27.0° to 11.1°) for reader 1 and - 1.7° ± 7.0° (range, -24.1° to 14.3°) for reader 2. Interreader agreement for measurements was excellent, both for BPRs (ICC = 0.992; 95% CI:0.986-0.995) and LAR measurements (ICC = 0.962; 95% CI:0.932-0.978). Mean difference between the two methods was -2.43° (range, -29.4° to 25.6°) for reader 1 and -2.6° (range,-28.7° to 30.2°) for reader 2. On Bland-Altman plots, three measurements of reader 1 and six measurements of reader 2 were outside of the ±1.96 SD interval. CONCLUSION Hindfoot alignment measurements on 3D-BPR have an excellent interreader agreement in a clinical setting. Large measurement errors can occur in individual patients using 2D-LAR alone. Therefore, we suggest using 3D-BPR measurements in daily routine for the assessment of HA, which are independent of rotational foot malpositioning.
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Lerisson H, Amzallag-Bellenger É, Cebulski-Delebarre A, Nectoux E, Desmulliez G, Duhamel A, Drumez E, Herbaux B, Boutry N. Assessment of micro-dose biplanar radiography in lower limb measurements in children. Eur Radiol 2017; 28:1778-1787. [PMID: 29164381 DOI: 10.1007/s00330-017-5144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 10/03/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate in children microdose protocol compared with low dose for lower limb alignment (LLA) measurements on biplanar radiography. METHODS Children 6 years or older were included. Height, weight and hip width were measured prior to imaging. Hip width allowed classifying children into morphotype M1 (width <25 cm), M2 (25-35 cm) or M3 (>35 cm) corresponding to predefined acquisition parameters (kV, mA, tube speed). Micro- and low-dose protocols were used alternately, with simultaneous acquisition of frontal and lateral radiographs. LLA measurements were performed by two independent observers (n = 526). In 15 children per morphotype, a third observer performed measurements twice (n = 180). Intraclass correlation coefficients and the dose (delivered, absorbed) were calculated. RESULTS 100 girls and 160 boys (mean age = 11.7 years) were investigated: 74 M1 (mean BMI, 15.7kg/m2), 149 M2 (19.8 kg/m2) and 40 M3 (30.2 kg/m2). With microdose, inter- and intra-observer agreement was >0.90 for lengths whatever the morphotype, 0.75-0.90 (M1) and >0.90 (M2, M3) for valgus/varus and flexion/hyperextension deviations. Dose reduction reached a factor of 8.5 and 5.4 for the delivered and absorbed dose respectively. CONCLUSIONS Microdose could be used for LLA measurements in children and permits a significant dose reduction. KEY POINTS • Lower limb lengths of children can be evaluated with microdose biplanar radiography. • Valgus/varus deviations also can be evaluated with microdose biplanar radiography. • Microdose biplanar radiography significantly reduces delivered and absorbed dose in children.
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Affiliation(s)
- Héloïse Lerisson
- Department of Pediatric Imaging, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, F-59000, Lille, France.
| | - Élisa Amzallag-Bellenger
- Department of Pediatric Imaging, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, F-59000, Lille, France
| | - Aurélie Cebulski-Delebarre
- Department of Pediatric Imaging, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, F-59000, Lille, France
| | - Eric Nectoux
- Department of Pediatric Surgery, Hôpital Jeanne de Flandre, CHU Lille, F-59000, Lille, France
| | - Geoffrey Desmulliez
- Department of Radioprotection, Délégation Qualité, Risques, Vigilances, CHU Lille, F-59000, Lille, France
| | - Alain Duhamel
- Department of Biostatistics, Univ. Lille, CHU Lille; EA 2694 - Santé Publique : épidémiologie et qualité des soins, F-59000, Lille, France
| | - Elodie Drumez
- Department of Biostatistics, Univ. Lille, CHU Lille; EA 2694 - Santé Publique : épidémiologie et qualité des soins, F-59000, Lille, France
| | - Bernard Herbaux
- Department of Pediatric Surgery, Hôpital Jeanne de Flandre, CHU Lille, F-59000, Lille, France
| | - Nathalie Boutry
- Department of Pediatric Imaging, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, F-59000, Lille, France
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Ghostine B, Sauret C, Assi A, Bakouny Z, Khalil N, Skalli W, Ghanem I. Influence of patient axial malpositioning on the trueness and precision of pelvic parameters obtained from 3D reconstructions based on biplanar radiographs. Eur Radiol 2016; 27:1295-1302. [DOI: 10.1007/s00330-016-4452-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
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