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Li X, Qu Y, Wang L, Ai S. The accuracy of cup anteversion measurement on postoperative pelvic radiographs: A comparative retrospective cohort study between DDH and non-DDH patients. Heliyon 2024; 10:e31141. [PMID: 38803989 PMCID: PMC11128930 DOI: 10.1016/j.heliyon.2024.e31141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Rationale and objectives Postoperative pelvic radiographs remain a vital tool for assessing cup orientation after total hip arthroplasty (THA), with the accuracy influenced by various factors. The objective of this study is to investigate the accuracy of cup anteversion measurement in developmental dysplasia of the hip (DDH) patients and others based on postoperative pelvic radiographs conducted under the current heavy workload conditions. Materials and methods Patients who underwent THA at our hospital with both postoperative X-ray and CT images from January 2020 to December 2022 were included in this retrospective cohort study. Virtual X-ray films were generated using digitally reconstructed radiographs (DRR) technology from CT images, with pelvic position perfectly controlled. Radiographic anteversion (RA) was measured on 3D-CT, virtual X-rays, and actual postoperative X-rays, abbreviated as RA_3D, RA_DRR, and RA_Xray, respectively. A repeated-measures analysis of covariance (ANCOVA) was utilized to evaluate the variations in RA within and between different groups across three methods. The Bland-Altman plot analysis showed the variations among methods in DDH and non-DDH patients, setting a clinically acceptable limits of agreement (LOA) at ±5°. Results This study included 154 hip cases, with 63 DDH and 91 other diseases. Repeated-measures ANCOVA revealed a descending trend in RA across three methods, with differences of 2.64° (DDH) vs. 2.74° (others) from 3D to DRR, and 4.89° (DDH) vs. 1.07° (others) from DRR to X-ray. The group by methods interaction effect were significant (p = 0.002). Significant statistical differences in RA_Xray (P = 0.035) were observed between DDH and non-DDH patients, but not in RA_3D and RA_DRR. Bland-Altman plots showed 71.4 % of DDH patients exceeded the clinically acceptable LOA, compared to 36.3 % of other patients. Conclusion Our study indicated that under the current intense workload, the reliability of assessing cup anteversion using postoperative pelvic radiographs is challenged, especially in patients with DDH.
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Affiliation(s)
- Xiaomin Li
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Yang Qu
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Liao Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Songtao Ai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
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Wagler JB, Muir JM, Foley KA, Paprosky WG. Radiographic measurement of leg-length change in the nonoperative leg during total hip arthroplasty: a potential indicator of imaging error? Hip Int 2023; 33:858-863. [PMID: 36642781 DOI: 10.1177/11207000221150783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Anteroposterior (AP) pelvic radiographs are subject to errors that may cause measurement inaccuracy in total hip arthroplasty (THA). Such errors may be detected by measuring pre- to postoperative leg-length changes in the nonoperative leg, which experiences no physical changes during THA. METHODS From AP pelvic radiographs, we measured pre- to postoperative leg-length changes (LLC) in the nonoperative legs of 67 patients who underwent primary THA using the trans-ischial line method. RESULTS An LLC of 0 mm was observed in the nonoperative leg in only 14 cases (21%). A LLC ⩾ 2 mm was observed in 27% (18/67) of cases, including 13% (9/67) with LLC ⩾ 3 mm and 6% (4/67) with LLC ⩾ 4 mm. A post-hoc analysis used a validated method to measure change in pelvic tilt between pre- and postoperative images and found that changes in pelvic tilt ⩾ 4° in the anterior and posterior directions created apparent lengthening (2.0 ± 1.4 mm, p < 0.001 vs. 0-3° of tilt) and shortening (-2.1 ± 1.6 mm, p < 0.001 vs. 0-3° of tilt) of the nonoperative leg, respectively. CONCLUSIONS The current study provides evidence of measurement errors in leg length using AP pelvic radiographs following THA. Changes in pelvic tilt may be in part responsible for these errors, with the direction of change in pelvic tilt influencing the apparent lengthening or shortening of the lower limb. Ultimately, these findings may influence the radiographic measurement and interpretation of leg-length changes following THA.
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Affiliation(s)
- Justin B Wagler
- Department of Kinesiology and Health Sciences, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Henckel J, Ramesh A, Hothi H, Richards R, Di Laura A, Hart A. The accuracy and precision of acetabular implant measurements from CT imaging. Front Bioeng Biotechnol 2023; 11:1150061. [PMID: 37187883 PMCID: PMC10175694 DOI: 10.3389/fbioe.2023.1150061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
The placement of acetabular implant components determines the short- and long-term outcomes of total hip replacement (THR) and a number of tools have been developed to assist the surgeon in achieving cup orientation to match the surgical plan. However, the accuracy and precision of 3D-CT for the measurement of acetabular component position and orientation is yet to be established. To investigate this, we compared measurements of cobalt chrome acetabular components implanted into 2 different bony pelvic models between a coordinate measuring Faro arm and 3 different low dose CT images, including 3D-CT, 2D anterior pelvic plane (APP) referenced CT and 2D scanner referenced (SR) CT. Intra-observer differences were assessed using the Intraclass correlation coefficient (ICC). The effect of imaging the pelvis positioned in 3 different orientations within the CT scanner was also assessed. The measured parameters were the angles of inclination and version. 3D-CT measurements were found to closely match the "true values" of the component position measurements, compared with the 2D-CT methods. ICC analysis also showed good agreement between the coordinate measuring arm (CMA) and 3D-CT but poor agreement between the 2D SR method, in the results from two observers. When using the coordinate system of the CT scanner, the measurements consistently produced the greatest error; this method yielded values up to 34° different from the reference digitising arm. However, the difference between the true inclination and version angles and those measured from 3D APP CT was below half a degree in all cases. We concluded that low radiation dose 3D-CT is a validated reference standard for the measurement of acetabular cup orientation.
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Affiliation(s)
- Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Angelika Ramesh
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
- *Correspondence: Angelika Ramesh,
| | - Harry Hothi
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Robin Richards
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, United Kingdom
| | - Anna Di Laura
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, United Kingdom
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Zhang Z, Liu C, Hu F, You Y, Hu W, Zhang X. Are Both Preoperative Full‐Spine 3Dimensional Computed Tomography Scans and X‐Ray Films Necessary for Patients with Ankylosing Spondylitis Kyphosis? Orthop Surg 2022; 14:2618-2624. [PMID: 36102171 PMCID: PMC9531076 DOI: 10.1111/os.13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study is aimed to investigate whether both pre‐operative full‐spine 3Dimensional computed tomography scan (3D CT) and X‐ray film were necessary for patients with severe ankylosing spondylitis (AS) kyphosis deformity. Methods The research objects were selected from the inpatients with AS in our hospital from 2017 to 2019. A total of 42 patients were included in the study. On both the synthesized 2Dimensional (2D) lateral radiograph and X‐ray film, the globe kyphosis (GK), the lumber lordosis (LL), the thoracolumbar kyphosis (TLK) and the thoracic kyphosis (TK) were measured. And the angle seventh thoracic vertebra (T7), the angle twelfth thoracic vertebra (T12) and the angle third lumber vertebra (L3) were also measured. Two researchers with professional medical education were randomly selected to perform the measurement method and record the measurement data. Two researchers independently completed, recorded, and evaluated the accuracy and consistency of the measurement data. This study used intraclass correlation coefficient (ICC) to analyze the synthesized 2D lateral radiograph and general X‐ray film of 42 subjects by two researchers, in order to evaluate the consistency of data measurement results between the examiners. Through the comparison of the above parameters that the GK, LL, TLK, TK, angle T7, angle T12 and angle L3, the evaluation was made both pre‐operative full‐spine 3D CT and X‐ray film were necessary for patients with severe AS kyphosis deformity. Results There was no significant difference between the GK, LL, TLK, TK, angle T7, angle T12, angle L3 on the synthesized 2D lateral radiograph and that on X‐ray film (P = 0.240, 0.324, 0.199, 0.095, 0.421, 0.087, 0.478). Agreement two researchers was excellent with ICC of the GK, LL, TLK, TK, angle T7, angle T12, angle L3 (0.977, 0.969, 0.986, 0.945, 0.947, 0.915, 0.857) on the synthesized 2D lateral radiograph. The Bland–Altman plot results that the measurement results of examiners are reliable and stable. Conclusion By estimating the degree of spinal sagittal imbalance and measuring the Cobb angle, we can see that full‐length spine radiographs of the patients are unnecessary for patients with severe AS kyphosis deformity who will or have undergone preoperative spine 3D CT.
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Affiliation(s)
- Zhen Zhang
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
- Department of Orthopedics, the Fourth Medical Centre Chinese PLA General Hospital Beijing China
| | - Chao Liu
- Department of Orthopedics The Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Fanqi Hu
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
- Department of Orthopedics, the Fourth Medical Centre Chinese PLA General Hospital Beijing China
| | - Yonggang You
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
- Department of Orthopedics, the Fourth Medical Centre Chinese PLA General Hospital Beijing China
| | - Wenhao Hu
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
- Department of Orthopedics, the Fourth Medical Centre Chinese PLA General Hospital Beijing China
| | - Xuesong Zhang
- Medical School of Chinese PLA Chinese PLA General Hospital Beijing China
- Department of Orthopedics, the Fourth Medical Centre Chinese PLA General Hospital Beijing China
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Liu C, Hu F, Li Z, Wang Y, Zhang X. Anterior Pelvic Plane: A Potentially Useful Pelvic Anatomical Reference Plane in Assessing the Patients' Ideal Pelvic Parameters Without the Influence of Spinal Sagittal Deformity. Global Spine J 2022; 12:567-572. [PMID: 32996359 PMCID: PMC9109563 DOI: 10.1177/2192568220958676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Observational study. OBJECTIVE This study was aimed at investigating the reliability of anterior pelvic plane (APP) as an anatomical reference plane for assessing the patients' pelvic incidence in patients with ankylosing spondylitis kyphosis deformity. METHODS The globe kyphosis (GK), lumber lordosis (LL), thoracolumbar kyphosis (TLK), thoracic kyphosis (TK), anatomical cervical 7 sacrum angle (aC7SA), and cervical 7 sacrum angle (C7SA) were measured on full-length spine radiography imagines. The pelvic incidence (PI), anatomical pelvic tilt (aPT), and anatomical sacral slope (aSS) were measured on the pelvic synthesized 2D lateral radiography imagines. Because the angle between APP and vertical line was about 4°, Angle1 and tPT were calculated using the following formulas: Angle1 = aC7SA - 4; PT = aPT + 4. According to the study conducted by Vialle, traditional PT (tPT) was calculated using the following widely accepted formula: tPT = PI * 0.37 - 7. Measured PT (mPT) was also measured on the full-length spine radiography imagines. RESULTS The data analysis showed that PI, mPT, aSS, aPT, and APPA were 50.83 ± 13.44°, 32.52 ± 4.64°, 41.36 ± 9.46°, 8.56 ± 6.80°, and 23.95 ± 5.17°, respectively. There was no significant difference between the PT and tPT (12.56 ± 6.80, 11.49 ± 4.73; P = .152). So, the results demonstrated that the PT could play the equivalent effect as tPT did for making surgical plans in patients with kyphosis deformity. CONCLUSION The pelvic anatomical reference plane had potential to be used in assessing the patients' ideal pelvic incident without the influence of spinal sagittal deformity. The aPT+4 may represent patients' postoperative ideal PT.
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Affiliation(s)
- Chao Liu
- The First Affiliated Hospital of
Jinan University, Guangzhou, People’s Republic of China
| | - Fanqi Hu
- Chinese People’s Liberation Army
General Hospital (301 Hospital), Beijing, People’s Republic of China,Co-first author
| | - Zhizhong Li
- The First Affiliated Hospital of
Jinan University, Guangzhou, People’s Republic of China,Zhizhong Li, Department of Orthopaedics, The
First Affiliated Hospital of Jinan, University, Huangpu Avenue West Road,
Guangzhou 510632, People’s Republic of China.
| | - Yan Wang
- Chinese People’s Liberation Army
General Hospital (301 Hospital), Beijing, People’s Republic of China
| | - Xuesong Zhang
- Chinese People’s Liberation Army
General Hospital (301 Hospital), Beijing, People’s Republic of China,Xuesong Zhang, Department of Orthopaedics,
Chinese People’s Liberation Army General Hospital (301 Hospital), Fuxing road
28, Beijing 100853, People’s Republic of China.
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Nazaroff J, Mark B, Learned J, Wang D. Measurement of acetabular wall indices: comparison between CT and plain radiography. J Hip Preserv Surg 2021; 8:51-57. [PMID: 34567600 PMCID: PMC8460168 DOI: 10.1093/jhps/hnab008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/12/2020] [Accepted: 01/13/2020] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to compare measurements of anterior wall index (AWI) and posterior wall index (PWI) on computed tomography (CT) to those on radiographs (XR). A consecutive cohort of 33 patients (45 hips total) being evaluated for hip pain with both XR and CT was examined. Preoperative measurements of AWI and PWI were performed utilizing supine anteroposterior pelvic XR and coronal and swiss axial CT scans by two independent raters. Mean differences between XR and CT measurements were compared, and agreement between measurements was assessed using the concordance correlation coefficient (rc) and Bland–Altman analysis. A total of 39 hips in 28 patients were analyzed. The mean patient age was 31.1 ± 9.0 years, and 50% were female. Mean AWI and PWI on XR was 0.50 ± 0.14 and 0.91 ± 0.12, respectively. Measured values of AWI were consistently larger (0.08 ± 0.10, P < 0.01) on XR compared with both coronal and swiss axial CT, with moderate agreement between XR and CT measurements (rc = 0.68–0.70). Measured values of PWI were consistently smaller (0.15 ± 0.12, P < 0.05) on XR compared with both coronal and swiss axial CT, with poor agreement between XR and CT measurements (rc = 0.37–0.45). Measured values of acetabular wall indices on XR were consistently larger for AWI and smaller for PWI relative to CT. Agreement between XR and CT measures of the indices were moderate to poor. This highlights the need for standardization of XR- and CT-based measurements to improve assessment of acetabular coverage and subsequent clinical decision-making.
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Affiliation(s)
- Jaron Nazaroff
- University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA
| | - Bryan Mark
- University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA.,Department of Orthopaedic Surgery, University of California Irvine Health, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA
| | - James Learned
- University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA.,Department of Orthopaedic Surgery, University of California Irvine Health, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA
| | - Dean Wang
- University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA.,Department of Orthopaedic Surgery, University of California Irvine Health, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA
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7
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Xu J, Su B, Zhang W, Sun H, Li D, Cai Z, Chen M, Qiu M, Ma R. 3D simulation of radiographic projections to test and reduce the effect of pelvic tilt on the accuracy of cross-table lateral radiography. BMC Musculoskelet Disord 2020; 21:843. [PMID: 33317489 PMCID: PMC7737258 DOI: 10.1186/s12891-020-03858-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cross-table lateral (CL) radiography is a convenient and feasible method to assess cup version angle (VA) after total hip arthroplasty; However, pelvic tilt (PT) may contribute to its measurement inaccuracy. How PT affects CL radiographic measurements have not been well studied. We sought (1) to determine the effect of the PT on cup version measurement on CL radiography and (2) to develop a method for reducing measurement errors caused by the PT. Methods We used 3D technique to construct standard model and capture CL radiography simulation. A linear regression model was created to analyze the relationship between PT and VA. CL radiography and computed tomography (CT) were performed for the enrolled patients after surgery. The consistency between CL and CT measurements were verified by intra-class correlation coefficient (ICC). Results There was a high correlation between the VA and PT. For each 1-degree increased in the PT, the VA decreased by 0.76° (R2 = 0.995, p < 0.001). Based on the data, we created a corrective formula to convert the radiographic measurements into values approximating the actual VA under a natural pelvic position. The VA measurements corrected by our equation was in high agreement with the CT-measured values with reference to the corresponding PT (ICC = 0.988, p < 0.001), which was in sharp contrast to that without PT control (ICC = 0.454, p = 0.203). Conclusions The PT may contribute to cup version measurement inaccuracies on CL radiography. Our mathematical algorithm can serve as a reliable method to improve the accuracy of CL radiography.
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Affiliation(s)
- Jie Xu
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baohua Su
- Department of Orthopedic Surgery, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhui Zhang
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Sun
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deng Li
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqing Cai
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiyi Chen
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiling Qiu
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruofan Ma
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Larsen BM, Borgwardt A, Ribel-Madsen S, Zerahn B. False profile view is independently associated with serum metal levels in patients with metal-on-metal hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:1029-1036. [PMID: 33244659 DOI: 10.1007/s00590-020-02839-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Elevated levels of serum metal ions can be found in some patients with metal-on-metal (MoM) hip replacements. This study seeks to identify whether there is a significant association between the contact patch to rim distance (CPRD) and the anterior center edge angle (ACEA), respectively, and serum cobalt (Co) and chromium (Cr) levels in patients treated with unilateral MoM hip replacements by using standing anteroposterior and false profile view radiographs. METHODS This is a retrospective analysis on 53 patients with either unilateral ReCap or M2a-Magnum MoM hip replacements operated in 2006 or 2007. Univariate linear regression and multivariable linear regression (MLR) analyses were performed using the CPRD and ACEA along with risk factors for elevated serum levels of Co and Cr previously suggested in the literature as explanatory variables. Serum Co and Cr were measured using inductively coupled plasma mass spectrometry. RESULTS The MLR model showed that the same three variables (gender, CPRD and ACEA) were significantly associated with serum levels of both Co and Cr explaining approximately half of the variation. A univariate analysis showed a polynomial association between both anteversion angle and the ACEA with serum levels of Co and Cr. The vertex of the polynomial function was located at approximately 20° and 40°, respectively. CONCLUSION Gender, CPRD and ACEA are independently associated with serum levels of Co and Cr. Both ACEA and anteversion angles have optimae associated with low serum metal levels which may be useful for post-surgery evaluation of cup positioning.
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Affiliation(s)
- Bo Madvig Larsen
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Arne Borgwardt
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Søren Ribel-Madsen
- Department of Orthopaedic Surgery, Bispebjerg and Frederiksberg University Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Radiographic assessment of the cup orientation after total hip arthroplasty: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:130. [PMID: 32175423 DOI: 10.21037/atm.2019.12.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimal acetabular cup orientation is of substantial importance to good long-term function and low complication rates after total hip arthroplasty (THA). The radiographic anteversion (RA) and inclination (RI) angles of the cup are typically studied due to the practicability, simplicity, and ease of interpretation of their measurements. A great number of methods have been developed to date, most of which have been performed on pelvic or hip anteroposterior radiographs. However, there are primarily two influencing factors for these methods: X-ray offset and pelvic rotation. In addition, there are three types of pelvic rotations about the transverse, longitudinal, and anteroposterior axes of the body. Their effects on the RA and RI angles of the cup are interactively correlated with the position and true orientation of the cup. To date, various fitted or analytical models have been established to disclose the correlations between the X-ray offset and pelvic rotation and the RA and RI angles of the cup. Most of these models do not incorporate all the potential influencing parameters. Advanced methods for performing X-ray offset and pelvic rotation corrections are mainly performed on a single pelvic AP radiograph, two synchronized radiographs, or a two-dimensional/three-dimensional (2D-3D) registration system. Some measurement systems, originally developed for evaluating implant migration or wear, could also be used for correcting the X-ray offset and pelvic rotation simultaneously, but some drawbacks still exist with these systems. Above all, the 2D-3D registration technique might be an alternative and powerful tool for accurately measuring cup orientation. In addition to the current methods used for postoperative assessment, navigation systems and augmented reality are also used for the preoperative planning and intraoperative guidance of cup placement. With the continuing development of artificial intelligence and machine learning, these techniques could be incorporated into robot-assisted orthopaedic surgery in the future.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pei-Fu Tang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
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Dunlap AE, Mathews KG, Walters BL, Bruner KA, Ru H, Marcellin-Little DJ. Three-dimensional assessment of the influence of juvenile pubic symphysiodesis on the pelvic geometry of dogs. Am J Vet Res 2018; 79:1217-1225. [PMID: 30372155 DOI: 10.2460/ajvr.79.11.1217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the 3-D geometry of canine pelves and to characterize the long-term effects of juvenile pubic symphysiodesis (JPS) on pelvic geometry by comparing the pelvic configuration between littermates that did and did not undergo the procedure. ANIMALS 24 Labrador Retriever, Golden Retriever, or Labrador Retriever-Golden Retriever crossbred service dogs from 13 litters. PROCEDURES At 16 weeks old, puppies with a hip joint distraction index ≥ 0.5 were randomly assigned to undergo thermal JPS (n = 9), mechanical JPS (7), or a sham (control) surgical procedure (8). Ten years later, each dog underwent a CT scan of the pelvic region. Modeling software was used to create 3-D reconstructions from the CT scans, and various pelvic measurements were made and compared among the 3 treatments. RESULTS Compared with the control treatment, thermal and mechanical JPS increased the hemipelvis acetabular angle by 4°, the acetabular angle of lateral opening by 5°, and the orientation of the medial acetabular wall in a transverse plane by 6°, which indicated that JPS increased dorsal femoral head coverage by the acetabulum. Both JPS procedures decreased the pelvic canal area by approximately 20% and acetabular inclination by 6° but did not alter acetabular retroversion. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that thermal and mechanical JPS were equally effective in altering the 3-D pelvic geometry of dogs. These findings may help guide future studies of alternatives for optimizing canine pelvic anatomy to minimize the risk of hip dysplasia and associated osteoarthritis.
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11
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New cross-table lateral radiography method for measuring acetabular component anteversion in total hip arthroplasty: a prospective study of 93 primary THA. Hip Int 2017; 27:293-298. [PMID: 28165589 DOI: 10.5301/hipint.5000456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Various methods have been described for measuring acetabular component anteversion. However, accurate measurement of anteversion is difficult. We herein propose a new method using cross-table lateral (CL) radiography performed with the contralateral hip flexed to 45° (45° flexed CL radiography). The main purpose of this study was to evaluate the reliability and validity of this new method. METHODS The study group included 93 patients who underwent total hip arthroplasty (THA). All hips were evaluated with computed tomography (CT) and both standard and 45° flexed CL radiographs to measure acetabular component anteversion the week after THA. The intraobserver and interobserver reliability of each measurement was assessed. Plain radiography measurements were compared with reference CT measurements to evaluate their validity. RESULTS All measurements had excellent intraobserver and interobserver reliability, and plain radiography measurements correlated well with CT measurements. The mean measurements were 21.9° (3°-39°) with CT, 24.9° (7°-47°; p<0.001) with standard CL radiographs, and 22.5° (7°-43°; p = 0.112) with 45° flexed CL radiographs. DISCUSSION The anteversion values measured with our new method were closer to the CT values used as a reference standard than those with standard CL radiographs. Our new method appears to be reliable and valid for measuring acetabular component anteversion.
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Noback PC, Danoff JR, Herschmiller T, Bobman JT, Shah RP, Geller JA, Macaulay W. Plain Radiographs are a Useful Substitute for Computed Tomography in Evaluating Acetabular Cup Version. J Arthroplasty 2016; 31:2320-4. [PMID: 27181489 DOI: 10.1016/j.arth.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/22/2016] [Accepted: 03/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to compare acetabular component version measurements from cross-table lateral (XTL) radiographs, anteroposterior pelvis (AP-P) and anteroposterior hip (AP-H) radiographs, and axial pelvic computed tomography (CT) scans. METHODS One hundred fifty hips met our inclusion criteria of having a CT, XTL, and AP-P done postoperatively. Version was measured by 2 authors. Pearson regression analysis assessed correlation between versions of the modalities. Analysis of variance testing compared the averages of the values as a whole and based on demographics. When available, comparisons were also done with AP-H radiographs. RESULTS Mean version for XTL and CT scan was 21.7° and 23.8°, respectively, whereas that from AP-P and AP-H radiographs was 12.5° and 17.2°, respectively. XTL and AP-H version measures were closely correlated with CT (P = .81), whereas AP-P measurements were only moderately correlated with CT (P = .75). AP-P and AP-H were significantly (P < .05) different from CT, whereas XTL was not (P = .36). CONCLUSION The XTL radiograph remains a useful, cheaper, and safer substitute for CT scan when assessing supine version in the postoperative setting.
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Affiliation(s)
- Peter C Noback
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Jonathan R Danoff
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Thomas Herschmiller
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Jacob T Bobman
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Roshan P Shah
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Jeffrey A Geller
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - William Macaulay
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
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Reikeras O, Gunderson RB. Cross table lateral radiography for measurement of acetabular cup version. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:169. [PMID: 27275482 DOI: 10.21037/atm.2016.05.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Appropriate orientation of the acetabular cup is an important factor for long-term results of total hip arthroplasty. For measurement of cup version cross-table lateral radiography is frequently used, but the reliability has been questioned. We compared cross table lateral radiography with computed tomography in patients that had undergone primary total hip arthroplasty. METHODS The study was prospectively done in 117 patients (117 hips). At 3 months after total hip replacement the acetabular version was measured by cross table lateral radiography and compared to measurements by computed tomography. RESULTS By cross table lateral radiography acetabular anteversion was on mean 13.9° with a standard deviation of 10.1° as compared to 17.8°±12.6° by computed tomography. Mean difference was -3.8 with a distribution of measurements of ±13 degrees for 95% of the cases. CONCLUSIONS Our study shows that cross table radiography provides acceptable information for clinical use, but has limited use for precise analysis of acetabular cup version.
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Affiliation(s)
- Olav Reikeras
- 1 Department of Orthopedics, 2 Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ragnhild Beate Gunderson
- 1 Department of Orthopedics, 2 Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Sculco PK, McLawhorn AS, Carroll KM, McArthur BA, Mayman DJ. Anteroposterior Radiographs Are More Accurate than Cross-Table Lateral Radiographs for Acetabular Anteversion Assessment: a Retrospective Cohort Study. HSS J 2016; 12:32-8. [PMID: 26855625 PMCID: PMC4733699 DOI: 10.1007/s11420-015-9472-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Measuring acetabular anteversion is relevant to routine follow-up of total hip arthroplasties (THAs) and for malfunctioning THAs. Imageless navigation facilitates acetabular component orientation relative to the anterior pelvic plane (APP) or to the APP adjusted for sagittal pelvic tilt (PT). The optimal plain radiographic method for the postoperative assessment of anteversion is not agreed upon. QUESTIONS/PURPOSES (1) Do anteversion measurements on plain radiographs correlate more with APP anteversion or PT-adjusted anteversion? (2) Do measurements of anteversion performed on supine anteroposterior (AP) radiographs more accurately reflect intraoperative anteversion values for navigated THA compared to anteversion measured on cross-table lateral (CL) radiographs? METHODS Seventy patients receiving primary navigated THA were included. APP and PT-adjusted anteversion were recorded; the latter defined the intraoperative target for anteversion. Postoperative anteversion was measured on supine AP pelvis radiographs with computer software and CL radiographs with conventional methods. Intraoperative measurements were used as the reference standards for comparisons. RESULTS Mean intraoperative APP anteversion was 20.6° ± 5.6°. Mean intraoperative PT-adjusted anteversion was 22.9° ± 4.5°. Mean anteversion was 22.7° ± 4.7° on AP radiographs and 27.2° ± 4.2° on CL radiographs (p < 0.001). Only correlations between PT-adjusted anteversion and radiographic assessments of anteversion were significant. The mean difference between PT-adjusted anteversion and anteversion on AP radiographs was -0.2° ± 4.3°, while the mean difference between the PT-adjusted anteversion and anteversion measured on CL radiographs was 4.3 ± 5.1° (p < 0.001). CONCLUSION Plain film assessment of anteversion was more accurate on supine AP radiographs than on CL radiographs, which overestimated acetabular anteversion.
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Affiliation(s)
- Peter K. Sculco
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Alexander S. McLawhorn
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Kaitlin M. Carroll
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Benjamin A. McArthur
- />Washington Orthopedics and Sports Medicine, 5215 Loughboro Road NW, Suite 200, Washington, DC 20016 USA
| | - David J. Mayman
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Evaluation of radiological methods of assessing cup anteversion in total hip replacement. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1285-92. [DOI: 10.1007/s00590-015-1702-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/04/2015] [Indexed: 11/26/2022]
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Nomura T, Naito M, Nakamura Y, Ida T, Kuroda D, Kobayashi T, Sakamoto T, Seo H. An analysis of the best method for evaluating anteversion of the acetabular component after total hip replacement on plain radiographs. Bone Joint J 2014; 96-B:597-603. [DOI: 10.1302/0301-620x.96b.33013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several radiological methods of measuring anteversion of the acetabular component after total hip replacement (THR) have been described. These studies used different definitions and reference planes to compare methods, allowing for misinterpretation of the results. We compared the reliability and accuracy of five current methods using plain radiographs (those of Lewinnek, Widmer, Liaw, Pradhan, and Woo and Morrey) with CT measurements, using the same definition and reference plane. We retrospectively studied the plain radiographs and CT scans in 84 hips of 84 patients who underwent primary THR. Intra- and inter-observer reliability were high for the measurement of inclination and anteversion with all methods on plain radiographs and CT scans. The measurements of inclination on plain radiographs were similar to the measurements using CT (p = 0.043). The mean difference between CT measurements was 0.6° (-5.9° to 6.8°). Measurements using Widmer’s method were the most similar to those using CT (p = 0.088), with a mean difference between CT measurements of -0.9° (-10.4° to 9.1°), whereas the other four methods differed significantly from those using CT (p < 0.001). This study has shown that Widmer’s method is the best for evaluating the anteversion of the acetabular component on plain radiographs. Cite this article: Bone Joint J 2014; 96-B:597–603.
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Affiliation(s)
- T. Nomura
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - M. Naito
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Y. Nakamura
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - T. Ida
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - D. Kuroda
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - T. Kobayashi
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - T. Sakamoto
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - H. Seo
- Department of Orthopaedic Surgery, Faculty
of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
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