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Clinical Orthopaedics and Related Research®

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01-10-2012 | Basic Research

Measuring Acetabular Component Version After THA: CT or Plain Radiograph?

Authors: Benjamin McArthur, MD, Michael Cross, MD, Christina Geatrakas, MD, David Mayman, MD, Bernard Ghelman, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 10/2012

Abstract

Background

Although cross-table lateral radiographs are commonly used to measure acetabular component version after THA, recent studies suggest that CT-based measurement is more accurate. This has been attributed to variations in pelvic tilt, pelvic rotation, and component inclination. Furthermore, it has been suggested, based on limited data, that even with ideal positioning of the cross-table lateral radiograph, CT remains the more accurate modality.

Questions/purposes

We determined whether appropriately positioned cross-table lateral radiographs could provide accurate measurements of acetabular component version, and compared accuracy and reliability of measurements from modified cross-table lateral radiographs with those from standard cross-table lateral radiographs and CT.

Methods

We implanted 27 Sawbones^® pelves with an acetabular cup using computer navigation. CT, an AP view of the pelvis, and cross-table lateral and modified cross-table lateral radiographs were performed for each specimen. For the modified cross-table lateral radiograph, the beam angle varied based on the cup inclination as measured on an AP view of the pelvis. Two independent observers measured acetabular component version and inclination. We calculated intraobserver and interobserver reliabilities for each method and compared these with values obtained from navigation presuming that to be the standard for judging accuracy.

Results

Interobserver and intraobserver reliabilities were greater than 0.95 (95% CI, 0.904–0.999) for all measurements. Correlation with navigated values was 0.96 or greater (95% CI, 0.925–0.998) for all methods. Although CT had the highest correlation with navigated values, the correlations for the modified cross-table lateral and cross-table lateral radiographs were similar.

Conclusion

CT allows for accurate measurement of acetabular component version; however, when properly positioned, cross-table lateral radiograph-derived measurements are similarly accurate.

Clinical Relevance

Our results support the use of plain radiographs to obtain important measurements after THA.

Ackland MK, Bourne WB, Uhthoff HK. Anteversion of the acetabular cup: measurement of angle after total hip replacement. J Bone Joint Surg Br. 1986;68:409–413.PubMed

Blendea S, Troccaz J, Ravey JN, Merloz P. Image-free cup navigation inaccuracy: a two-study approach. Comput Aided Surg. 2007;12:176–180.PubMed

Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, Malchau H. The John Charnley Award: Risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469:319–329.PubMedCrossRef

Calvert GT, Devane PA, Fielden J, Adams K, Horne JG. A double-blind, prospective, randomized controlled trial comparing highly cross-linked and conventional polyethylene in primary total hip arthroplasty. J Arthroplasty. 2009;24:505–510.PubMedCrossRef

Dorr LD, Malik A, Wan Z, Long WT, Harris M. Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin Orthop Relat Res. 2007;465:92–99.PubMed

Ghelman B. Radiographic localization of the acetabular component of a hip prosthesis. Radiology. 1979;130:540–542.PubMed

Ghelman B, Kepler CK, Lyman S, Della Valle AG. CT outperforms radiography for determination of acetabular cup version after THA. Clin Orthop Relat Res. 2009;467:2362–2370.PubMedCrossRef

Hassan DM, Johnston GH, Dust WN, Watson LG, Cassidy D. Radiographic calculation of anteversion in acetabular prostheses. J Arthroplasty. 1995;10:369–372.PubMedCrossRef

Hayakawa K, Minoda Y, Aihara M, Sakawa A, Ohzono K, Tada K. Acetabular component orientation in intra- and postoperative positions in total hip arthroplasty. Arch Orthop Trauma Surg. 2009;129:1151–1156.PubMedCrossRef

10.

Hirakawa K, Mitsugi N, Koshino T, Saito T, Hirasawa Y, Kubo T. Effect of acetabular cup position and orientation in cemented total hip arthroplasty. Clin Orthop Relat Res. 2001;388:135–142.PubMedCrossRef

11.

Kalteis T, Handel M, Herold T, Perlick L, Paetzel C, Grifka J. Position of the acetabular cup: accuracy of radiographic calculation compared to CT-based measurement. Eur J Radiol. 2006;58:294–300.PubMedCrossRef

12.

Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty. 1998;13:530–534.PubMedCrossRef

13.

Langton DJ, Sprowson AP, Mahadeva D, Bhatnagar S, Holland JP, Nargol AVF. Cup anteversion in hip resurfacing: validation of EBRA and the presentation of a simple clinical grading system. J Arthroplasty. 2010;25:607–613.PubMedCrossRef

14.

Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop. 2005;76:517–523.PubMedCrossRef

15.

Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–220.PubMed

16.

Liaw CK, Hou SM, Yang RS, Wu TY, Fuh CS. A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs. Clin Orthop Relat Res. 2006;451:134–139.PubMedCrossRef

17.

Liaw CK, Yang RS, Hou SM, Wu TY, Fuh CS. Measurement of the acetabular cup anteversion on simulated radiographs. J Arthroplasty. 2009;24:468–474.PubMedCrossRef

18.

Malik A, Wan Z, Jaramaz B, Bowman G, Dorr LD. A validation model for measurement of acetabular component position. J Arthroplasty. 2010;25:812–819.PubMedCrossRef

19.

Markel DC, Andary JL, Pagano P, Nasser S. Assessment of acetabular version by plain radiograph. Am J Orthop (Belle Mead NJ). 2007;36:39–41.

20.

McCollum DE, Gray WJ. Dislocation after total hip arthroplasty: causes and prevention. Clin Orthop Relat Res. 1990;261:159–170.PubMed

21.

Mian SW, Truchly G, Pflum FA. Computed tomography measurement of acetabular cup anteversion and retroversion in total hip arthroplasty. Clin Orthop Relat Res. 1992;276:206–209.PubMed

22.

Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.PubMed

23.

Najarian BC, Kilgore JE, Markel DC. Evaluation of component positioning in primary total hip arthroplasty using an imageless navigation device compared with traditional methods. J Arthroplasty. 2009;24:15–21.PubMedCrossRef

24.

Nunley RM, Keeney JA, Zhu J, Clohisy JC, Barrack RL. The reliability and variation of acetabular component anteversion measurements from cross-table lateral radiographs. J Arthroplasty. 2011;26:84–87.PubMedCrossRef

25.

Padgett DE, Hendrix SL, Mologne TS, Peterson DA, Holley KA. Effectiveness of an acetabular positioning device in primary total hip arthroplasty. HSS J. 2005;1:64–67.PubMedCrossRef

26.

Ritter MA. Dislocation and subluxation of the total hip replacement. Clin Orthop Relat Res. 1976;121:92–94.PubMed

27.

Sah AP, Estok DM 2nd. Dislocation rate after conversion from hip hemiarthroplasty to total hip arthroplasty. J Bone Joint Surg Am. 2008;90:506–516.PubMedCrossRef

28.

Schmalzried TP, Guttmann D, Grecula M, Amstutz HC. The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg Am. 1994;76:677–688.PubMed

29.

Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–428.PubMedCrossRef

30.

Spencer JM, Day RE, Sloan KE, Beaver RJ. Computer navigation of the acetabular component: a cadaver reliability study. J Bone Joint Surg Br. 2006;88:972–975.PubMedCrossRef

31.

Wan Z, Boutary M, Dorr LD. The influence of acetabular component position on wear in total hip arthroplasty. J Arthroplasty. 2008;23:51–56.PubMedCrossRef

32.

Yao L, Yao J, Gold RH. Measurement of acetabular version on the axiolateral radiograph. Clin Orthop Relat Res. 1995;316:106–111.PubMed

Title: Measuring Acetabular Component Version After THA: CT or Plain Radiograph?
Authors: Benjamin McArthur, MD
Michael Cross, MD
Christina Geatrakas, MD
David Mayman, MD
Bernard Ghelman, MD
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 10/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2292-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Measuring Acetabular Component Version After THA: CT or Plain Radiograph?

Abstract

Background

Questions/purposes

Methods

Results

Conclusion

Clinical Relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusion

Clinical Relevance

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