Evaluation of the effect of pelvic tilt in the coronal plane on the Norberg angle measured in ventrodorsal radiographic views of a canine hip joint bone model

Influence of Femoral Position and Pelvic Projection on Norberg Angle Measurements

OBJECTIVE

 Canine hip dysplasia is a common orthopaedic disease in dogs. The Norberg angle value is a measure of hip joint laxity. The aim of this study was to quantify the degree of rotation necessary to consider the radiograph as inadequately positioned and to determine the influence of rotation on the Norberg angle.

STUDY DESIGN

 Three sets of radiographs with different positioning and projections were acquired using 10 canine cadavers. Rotation of the pelvis was simulated by rotating the X-ray tube without changing the position of the patient.

RESULTS

 In dorsoventral projections, the Norberg angle value is increased by 3.2 to 5.8%. Due to rotation along the long axis, the Norberg angle increases on one side and decreases on the contralateral side by approximately the same value. Rotation of greater than 2 degrees in a lateral direction is visually perceived by the observer as tilted. Rotation of the projection in the caudoventral to craniodorsal direction causes mild increase of the Norberg angle (≤1%), while rotation of the projection in a cranioventral to caudodorsal direction causes moderate (≤2%) decrease of the Norberg angle. Rotation of less than -10 degrees (caudoventral to craniodorsal) or greater than 10 degrees (cranioventral to caudodorsal) is visually perceived as tilted.

CONCLUSION

 Tilted images that are subjectively perceived evaluable have only little effect on the Norberg angle and are therefore probably acceptable. Dorsoventral projections can be recognized based on the proximal position of the patella and should be excluded from evaluation, as the Norberg angle value can be falsely increased.

Femoral parallelism: evaluation and impact of variation on canine hip dysplasia assessment

Adequate radiographic positioning on the X-ray table is paramount for canine hip dysplasia (HD) screening. The aims of this study were to evaluate femoral parallelism on normal ventrodorsal hip extended (VDHE) view and the effect of femoral angulation (FA) on Norberg Angle (NA) and Hip Congruency Index (HCI). The femoral parallelism was evaluated comparing the alignment of the long femoral axis with the long body axis in normal VDHE views and the effect of FA on NA and HCI on repeated VDHE views with different levels of FA. The femoral long axis in normal VDHE views showed a ranged of FA from -4.85° to 5.85°, mean ± standard deviation (SD) of -0.06 ± 2.41°, 95% CI [-4.88, 4.76°]. In the paired views, the mean ± SD femur adduction of 3.69 ± 1.96° led to a statistically significant decrease NA, and HCI, and femur abduction of 2.89 ± 2.12 led to a statistically significant increase in NA and HCI (p < 0.05). The FA differences were also significantly correlated with both NA differences (r = 0.83) and HCI differences (r = 0.44) (p < 0.001). This work describes a methodology that allows evaluation of femoral parallelism in VDHE views and the results suggest that femur abduction yielded more desirable NA and HCI values and adduction impaired NA and HCI values. The positive linear association of FA with NA and HCI allows the use of regression equations to create corrections, to reduce the influence of poor femoral parallelism in the HD scoring.

Imaging diagnosis of canine hip dysplasia with and without human exposure to ionizing radiation

Hip dysplasia (HD) is one of the most common hereditary orthopaedic diseases in dogs, with serious implications for the quality of life of the affected animals. Radiographic screening is essential for the selection of breeding stock in some at-risk breeds, and radiography is also used in the diagnosis of clinical HD cases. A definitive diagnosis of HD is based on radiographic examination, and the most commonly used view is the ventrodorsal hip extended projection, sometimes in combination with various hip stress-based techniques. Radiographic images require high quality positioning and dogs are usually anesthetized and often manually restrained to facilitate optimal positioning. The 'as low as reasonably achievable' (ALARA) principle used in human radioprotection is not always fulfilled in veterinary practice, except in the UK, where human exposure to ionizing radiation in veterinary medicine is strictly regulated. While each dose of ionizing radiation is small, doses accumulate over a lifetime, which can eventually result in substantial radiation exposure. Therefore, manual restraint should be avoided and mechanical immobilization, sedation or general anaesthesia should be used. This review examines the biological effects of human exposure to ionizing radiation and common sources of veterinary exposure. The diagnostic quality of imaging methods for the diagnosis of canine HD is compared between manually restrained and hands-free dog positioning. Hands-free radiographic techniques are available to assess hip laxity, degenerative joint changes and hip osseous structure while preserving image quality, and can be used to select animals for breeding or for the diagnosis of HD.

Hands-Free Conventional Radiographic Ventrodorsal Hip Extended View

Hip dysplasia (HD) is an important hereditary orthopedic disease in the dog associated with osteoarthritis and inadequate welfare for affected animals. The radiographic ventrodorsal hip extended (VDHE) view is used worldwide to select the better animals for breeding. This view normally is performed with manual restraining of the dog to obtain radiographs with acceptable technical quality. The veterinarian exposition to ionizing radiation is inevitable. In this study, the technical quality of VDHE radiographs and hip measurements was compared in 65 dogs radiographed twice, one with the common veterinarian manual restraining and the other obtained using a hind limb holder device, without the veterinarian within the X-ray room. The variables studied were pelvic tilting, patella displacement index, Norberg angle (NA), and subluxation hip category. The results showed a random distribution of right and left pelvic tilting, patella lateral or medial displacement, and hip subluxation categories in both samples (P > 0.05). The holder device positioning showed a better pelvic symmetry (P < 0.05) and a similar patellar displacement (P > 0.05). The mean ± standard deviation of NA was 101.1° ± 6.2° and 100.9° ± 6.1° in the manual and holder device hind limb restraining, respectively (P > 0.05), and the lower limit of 95% confidence interval of intraclass correlation coefficient was >0.75. These results showed statistical reproducibility of NA measurements by the hind limb holder device, and the examiner was protected from exposure to ionizing radiation within the X-ray room.

Comparison of Reliability of Norberg Angle and Distraction Index as Measurements for Hip Laxity in Dogs

OBJECTIVE

 The main purpose of the study was to compare reliability of measurements for the evaluation of hip joint laxity in 59 dogs.

MATERIALS AND METHODS

 Measurement of the distraction index (DI) of the PennHIP method and the Norberg angle (NA) of the Fédération Cynologique Internationale (FCI) scoring scheme as well as scoring according to the FCI scheme and the Swiss scoring scheme were performed by three observers at different level of experience. For each dog, two radiographs were acquired with each method by the same operator to evaluate intraoperator-reliability.

RESULTS

 Intraoperator-reliability was slightly better for the NA compared with the DI with an intraclass correlation coefficient (ICC) of 0.962 and 0.892 respectively. The ICC showed excellent results in intraobserver-reliability and interobserver-reliability for both the NA (ICC 0.975; 0.969) and the DI (ICC 0.986; 0.972). Thus, the NA as well as the DI can be considered as reliable measurements. The FCI scheme and the Swiss scoring scheme provide similar reliability. While the FCI scheme seems to be slightly more reliable in experienced observers (Kappa FCI 0.687; Kappa Swiss 0.681), the Swiss scoring scheme had a noticeable better reliability for the unexperienced observer (Kappa FCI 0.465; Kappa Swiss 0.514).

CLINICAL SIGNIFICANCE

 The Swiss scoring scheme provides a structured guideline for the interpretation of hip radiographs and can thus be recommended to unexperienced observers.

Analysis of pelvic rotation on the standard hip ventrodorsal extended radiographic view

OBJECTIVES

To study the symmetry of the iliac horizontal diameter (IHD) maximum obturator foramen width (OFW), ischiatic femoral overlap (IFO), pelvic horizontal radius (PHR), femoral head diameter (FHD), and obturator foramen area (OFA) parameters in the normal hip extended radiographic view and to evaluate the correlation of pelvic rotation with the magnitude of asymmetry of these parameters.

METHODS

Nine canine cadavers from adult, large and giant breeds were radiographed in standard hip extended views and with 2°, 4° and 6° degrees of rotation. The variables IHD, OFW, IFO, PHR, FHD, and OFA were analysed in radiographs.

RESULTS

The IHD measurements exhibited repeatability, bilateral symmetry and 95% of confidence interval of asymmetry in different pelvic rotations without superposition (p <0.05); OFW and IFO exhibited repeatability, bilateral symmetry and a small superposition in 95% of confidence interval of asymmetry according different pelvic rotations; PHR, FHD and OFA exhibited repeatability, bilateral symmetry and unacceptable superposition in 95% of confidence interval of asymmetry depending on pelvic rotation.

CLINICAL SIGNIFICANCE

The IHD is the recommended variable and OFW is an acceptable variable in order to evaluate slight pelvic rotation. The data may be used in qualitative analyses of hip extended radiographic views. In the future, complementary studies should be performed to evaluate the impact of degree of pelvic rotation on the hip dysplasia score.

Associations between early radiographic and computed tomographic measures and canine hip joint osteoarthritis at maturity

OBJECTIVE

To evaluate associations of measures assessed by radiography, 2-D CT, and 3-D CT of the hip joints of immature dogs with osteoarthritis in the same joints at maturity.

ANIMALS

46 hound-type dogs from a colony predisposed to osteoarthritis.

PROCEDURES

Images of hip joints (1/dog) were obtained at 16, 32, and 104 weeks of age. Radiographic measures included Norberg angle, distraction index, and osteoarthritis score. Two-dimensional CT measures included acetabular index, percentage of femoral head coverage, and center edge, horizontal toit externe, acetabular anteversion, and ventral, dorsal, and horizontal acetabular sector angles. Three-dimensional CT measures were femoral head and neck volume, femoral neck angle, and femoral head and neck radius. Differences among measures at 16 and 32 weeks in dogs with different osteoarthritis scores at later time points, relationships among variables at each time point, and relationships of single and combined measures with the presence of osteoarthritis at 104 weeks were evaluated.

RESULTS

The 16- and 32-week distraction index, center edge angle, dorsal acetabular sector angle, horizontal acetabular sector angle, percentage of femoral head coverage, acetabular index, and Norberg angle and the 32-week femoral neck angle varied significantly with osteoarthritis severity at 104 weeks. Presence of osteoarthritis in mature dogs was most strongly associated with 16-week combined measures of distraction index and center edge angle and 32-week combined measures of dorsal acetabular sector angle and Norberg angle.

CONCLUSIONS AND CLINICAL RELEVANCE

Changes in hip joint morphology associated with radiographic signs of osteoarthritis were detectable as early as 16 weeks of age and varied with osteoarthritis severity in adult dogs. The use of combined hip joint measures may improve early identification of dogs predisposed to hip joint osteoarthritis.

EFFECTS OF PELVIC AND FEMORAL POSITIONING ON CANINE NORBERG ANGLE MEASUREMENTS AND TEST–RETEST RELIABILITY: A COMPUTED TOMOGRAPHY-BASED SIMULATION STUDY

Canine hip dysplasia is a common disease in dogs, often diagnosed by using the Norberg angle (NA), an index for the laxity of the hip joint. Measurement of the NA can be affected by the pelvic and femoral positioning during imaging, the effects and test–retest reliability of which have not been documented. To bridge the gap in knowledge, computed tomography data from 11 Labrador Retriever dogs were obtained and used to generate synthetic ventrodorsal radiographs of the hip for NA measurements via a perspective projection model. Twenty-five synthetic radiographs of the hips were generated at positions defined by combinations of five pelvic tilt angles (-20° to 20° at 10° intervals) and five femoral elevation angles (from full extension to 40° at 10° intervals). For each radiograph, the NA was measured three times by each of the two experienced veterinarian examiners. It was found that both the increase in caudal pelvic tilt and femoral elevation increased the measured NA, although the intra- and inter-examiner reliability was very good for a given hip position. The current results suggest that careful positioning of the pelvis and femur during radiographic imaging is critical for accurately measuring the NA, and thus the laxity of the hip, for the clinical diagnosis of hip dysplasia.