Top

Skeletal Radiology

Published in:

01-03-2015 | Scientific Article

Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty

Authors: Sarwar S. Mahmood, Bariq Al-Amiry, Sebastian S. Mukka, Saida Baea, Arkan S. Sayed-Noor

Published in: Skeletal Radiology | Issue 3/2015

Abstract

Background

In total hip arthroplasty (THA), radiographic preoperative planning and postoperative evaluation of acetabular component, femoral offset (FO) and leg length discrepancy (LLD) require good validity, interobserver reliability and intraobserver reproducibility. In this study, we evaluated the validity of the Sundsvall method of FO measurement and the interobserver reliability and intraobserver reproducibility of measurement of FO, LLD, acetabular cup inclination and anteversion.

Material and methods

Ninety patients with primary unilateral osteoarthritis (OA) were included in this prospective study. On postoperative radiographs FO by the Sundsvall method (femoral axis-pelvic midline), FO by a standard method (femoral axis-hip rotational centre-teardrop point), LLD (inter-teardrop line-lesser trochanter), acetabular cup inclination (on AP view the angle between the cup rim and transischial line) and anteversion (on lateral view the angle between the face of acetabulum and a line perpendicular to the horizontal plane) were measured. The interobserver reliability and intraobserver reproducibility were calculated for three independent observers. The concurrent validity and degree of prediction of the Sundsvall method are measured by comparing its results with the standard method.

Results

The interobserver reliability of all measurements was excellent (ICC >0.80), except for LLD, which was substantial (ICC = 0.79). The intraobserver reproducibility of all measurements was excellent (ICC > 0.80). The concurrent validity of the Sundsvall method compared to the standard method was good with a positive correlation.

Conclusion

The Sundsvall method is as reliable as the standard method. The evaluated radiographic measurement methods have the required validity and reliability to be used in clinical practice.

Gililland JM, Anderson LA, Boffeli SL, Pelt CE, Peters CL, Kubiak EN. A fluoroscopic grid in supine total hip arthroplasty: improving cup position, limb length, and hip offset. J Arthroplasty. 2012;27:111–6.PubMedCrossRef

Konyves A, Bannister GC. The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg (Br). 2005;87:155–7.CrossRef

Lecerf G, Fessy MH, Philippot R, Massin P, Giraud F, Flecher X, et al. Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res. 2009;95:210–9.PubMedCrossRef

Tanaka R, Shigematsu M, Motooka T, Mawatari M, Hotokebuchi T. Factors influencing the improvement of gait ability after total hip arthroplasty. J Arthroplasty. 2010;25:982–5.PubMedCrossRef

Pasquier G, Ducharne G, Ali ES, et al. Total hip arthroplasty offset measurement: is C T scan the most accurate option? Orthop Traumatol Surg Res. 2010;96:367–75.PubMedCrossRef

Sabharwal S, Kumar A. Methods for assessing leg length discrepancy. Clin Orthop Relat Res. 2008;466:2910–22.PubMedCentralPubMedCrossRef

Wines AP, McNicol D. Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty. 2006;21:696–701.PubMedCrossRef

Kjellberg M, Englund E, Sayed-Noor AS. A new radiographic method of measuring femoral offset. The Sundsvall method. Hip Int. 2009;19:377–81.PubMed

Bonett DG. Sample size requirements for estimating intraclass correlations with desired precision. Stat Med. 2002;15;21(21):1331–5.CrossRef

10.

Frank ED, Long BW, Smith BJ. Merrill’s atlas of radiographic positioning & procedures. 11th ed. St. Louis: Mosby/Elsevier; 2007.

11.

Woolson ST, Hartford JM, Sawyer A. Results of a method of leg-length equalization for patients undergoing primary total hip replacement. J Arthroplasty. 1999;14:159–64.PubMedCrossRef

12.

Wylde V, Maclean A, Blom AW. Post-operative radiographic factors and patient-reported outcome after total hip replacement. Hip Int. 2012;22:153–9.PubMedCrossRef

13.

Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64-A:1295–306.

14.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRef

15.

Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB. Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res. 2009;467:2895–900.PubMedCentralPubMedCrossRef

16.

Wylde V, Whitehouse SL, Taylor AH, Pattison GT, Bannister GC, Blom AW. Prevalence and functional impact of patient perceived leg length discrepancy after hip replacement. Int Orthop. 2009;33:905–9.PubMedCentralPubMedCrossRef

17.

Ng VY, Kean JR, Glassman AH. Current concepts review: limb-length discrepancy after hip arthroplasty. J Bone Joint Surg Am. 2013;95:1426–36.PubMedCrossRef

18.

Cassidy KA, Noticewala MS, Macaulay W, Lee JH, Geller JA. Effect of femoral offset on pain and function after total hip arthroplasty. J Arthroplasty. 2012;27(10):1863–9.PubMedCrossRef

19.

Kjellberg M, Al-Amiry B, Englund E, Sjödén GO, Sayed-Noor AS. Measurement of leg length discrepancy after total hip arthroplasty. The reliability of a plain radiographic method compared to CT-scanogram. Skelet Radiol. 2012;41:187–91.CrossRef

20.

McWilliams AB, Grainger AJ, O’Connor PJ, Redmond AC, Stewart TD, Stone MH. Assessing reproducibility for radiographic measurement of leg length inequality after total hip replacement. Hip Int. 2012;22:539–44.PubMedCrossRef

21.

Patel SR, Toms AP, Rehman JM, Wimhurst J. A reliability study of measurement tools available on standard picture archiving and communication system workstations for the evaluation of hip radiographs following arthroplasty. J Bone Joint Surg Am. 2011;93:1712–9.PubMed

22.

Meermans G, Malik A, Witt J, Haddad F. Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty. Clin Orthop Relat Res. 2011;469(6):1677–82.PubMedCentralPubMedCrossRef

23.

Steinberg B, Harris WH. The offset problem in total hip arthroplasty. Contemp Orthop. 1992;24:555–62.

24.

Loughead JM, Chesney D, Holland JP, McCaskie AW. Comparison of offset in Birmingham hip resurfacing and hybrid total hip arthroplasty. J Bone Joint Surg (Br). 2005;87:163–6.CrossRef

25.

Moskal JT, Capps SG. Acetabular component positioning in total hip arthroplasty: an evidence-based analysis. J Arthroplasty. 2011;26:1432.PubMedCrossRef

26.

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

27.

Lu M, Zhou YX, Du H, Zhang J, Liu J. Reliability and validity of measuring acetabular component orientation by plain anteroposterior radiographs. Clin Orthop Relat Res. 2013;471:2987–94.PubMedCentralPubMedCrossRef

28.

Park SW, Park JH, Han SB, Choi GW, Song DI, An ES. Are portable imaging intraoperative radiographs helpful for assessing adequate acetabular cup positioning in total hip arthroplasty? J Korean Med Sci. 2009;24:315–9.PubMedCentralPubMedCrossRef

29.

Clohisy JC, Carlisle JC, Trousdale R, Kim YJ, Beaule PE, Morgan P, et al. Radiographic evaluation of the hip has limited reliability. Clin Orthop Relat Res. 2009;467:666–75.PubMedCentralPubMedCrossRef

30.

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;26:84–7.PubMedCrossRef

31.

Nho JH, Lee YK, Kim HJ, Ha YC, Suh YS, Koo KH. Reliability and validity of measuring version of the acetabular component. J Bone Joint Surg (Br). 2012;94:32–6.CrossRef

32.

McArthur B, Cross M, Geatrakas C, Mayman D, Ghelman B. Measuring acetabular component version after THA: CT or plain radiograph? Clin Orthop Relat Res. 2012;470:2810–8.PubMedCentralPubMedCrossRef

33.

Rubin PJ, Leyvraz PF, Aubaniac JM, et al. The morphology of the proximal femur. A three dimensional radiographic analysis. J Bone Joint Surg (Br). 1992;74:28.

34.

Varghese B, Muthukumar N, Balasubramaniam M, et al. Reliability of measurements with digital radiographs—a myth. Acta Orthop Belg. 2011;5:622.

Title: Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty
Authors: Sarwar S. Mahmood
Bariq Al-Amiry
Sebastian S. Mukka
Saida Baea
Arkan S. Sayed-Noor
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Skeletal Radiology / Issue 3/2015
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-014-2055-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty

Abstract

Background

Material and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Material and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2015

Trunnionosis: the latest culprit in adverse reactions to metal debris following hip arthroplasty

Cysts of the anterior horn lateral meniscus and the ACL: is there a relationship?

FGFR3-related condition: a skeletal dysplasia with similarities to thanatophoric dysplasia and SADDAN due to Lys650Met

Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma

Quality-controlled dose reduction of full-leg radiography in patients with knee malalignment

Use of MR arthrography in detecting tears of the ligamentum teres with arthroscopic correlation