Rofo 2016; 188(06): 574-581
DOI: 10.1055/s-0042-104205
Musculoskeletal System
© Georg Thieme Verlag KG Stuttgart · New York

Measuring Acetabular Cup Orientation on Antero-Posterior Radiographs of the Hip after Total Hip Arthroplasty with a Vector Arithmetic Radiological Method. Is It Valid and Verified for Daily Clinical Practice?

Messung der Hüftpfannenposition auf anteroposterioren Beckenübersichtsaufnahmen nach Implantation einer Hüftendtotalendoprothese mittels vektor-arithmetischer Methode. Wie genau ist dies im klinischen Alltag?
B. Craiovan
1   Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
,
M. Weber
1   Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
,
M. Worlicek
1   Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
,
M. Schneider
1   Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
,
H. R. Springorum
1   Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
,
F. Zeman
2   Center for Clinical Studies, University Medical Center Regensburg, Germany
,
J. Grifka
1   Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
,
T. Renkawitz
1   Orthopedic Surgery, University Medical Center Regensburg, Bad Abbach/Regensburg, Germany
› Author Affiliations
Further Information

Publication History

08 November 2015

14 February 2016

Publication Date:
19 April 2016 (online)

Abstract

Purpose: The aim of this prospective study is to validate a vector arithmetic method for measuring acetabular cup orientation after total hip arthroplasty (THA) and to verify the clinical practice.

Materials and Methods: We measured cup anteversion and inclination of 123 patients after cementless primary THA twice by two examiners on AP pelvic radiographs with a vector arithmetic method and compared with a 3D-CT based reconstruction model within the same radiographic coronal plane.

Results: The mean difference between the radiographic and the 3D-CT measurements was – 1.4° ± 3.9° for inclination and 0.8°± 7.9° for anteversion with excellent correlation for inclination (r = 0.81, p < 0.001) and moderate correlation for anteversion (r = 0.65, p < 0.001). The intraclass correlation coefficient for measurements on radiographs ranged from 0.98 (95 %-CI: 0.98; 0.99) for the first observer to 0.94 (95 %-CI: 0.92; 0.96) for the second observer. The interrater reliability was 0.96 (95 %-CI: 0.93; 0.98) for inclination and 0.93 (95 %-CI: 0.85; 0.96) for anteversion.

Conclusion: The largest errors in measurements were associated with an extraordinary pelvic tilt. In order to get a valuable measurement for measuring cup position after THA on pelvic radiographs by this vector arithmetic method, there is a need for a correct postoperative ap view, with special regards to the pelvic tilt for the future.

Key points:

• Measuring acetabular cup orientation on anteroposterior radiographs of the hip after THA is a helpful procedure in everyday clinical practice as a first-line imaging modality

• CT remains the golden standard to accurately determine acetabular cup position.

• Future measuring on radiographs for cup orientation after THA should account for integration of the pelvic tilt in order to maximize the measurement accuracy.

Citation Format:

• Craiovan B, Weber M, Worlicek M et al. Measuring Acetabular Cup Orientation on Antero-Posterior Radiographs of the Hip after Total Hip Arthroplasty with a Vector Arithmetic Radiological Method. Is It Valid and Verified for Daily Clinical Practice?. Fortschr Röntgenstr 2016; 188: 574 – 581

Zusammenfassung

Ziel: Ziel dieser prospektiven Studie war es eine vektor-arithmetische Methode zur Messung der Hüftpfannenposition nach Implantation einer Hüfttotalendoprothese (Hüft-TEP) zu validieren und deren Genauigkeit für die Anwendung im klinischen Alltag zu überprüfen.

Material und Methoden: Die Pfannenanteversion und -inklination von 123 Patienten nach zementfreier primärer Hüft-TEP wurde zweimal von zwei verblindeten Untersuchern auf einer tiefen Beckenübersichtsaufnahmen im anteroposterioren (ap) Strahlengang mit einer vektor-arithmetischen Methode vermessen und anschließend mit den Werten einer 3D-CT-Referenzmessung durch ein externes Institut unter Berücksichtigung der radiologischen Definition verglichen.

Ergebnisse: Die mittlere Differenz zwischen der radiologischen und der 3D-CT-Messung betrug – 1,4° ± 3,9° für die Inklination und 0,8 ° ± 7,9 ° für die Anteversion. Die Pfanneninklination korrelierte sehr gut (r = 0,81, p < 0,001) und die -anteversion gut (r = 0,65, p < 0,001) mit den 3D-CT Werten. Der Intraclass-Korrelationskoeffizient für die Messung im Röntgen betrug 0.98 (95 %-CI: 0,98; 0,99) für den ersten und 0,94 (95 % -CI: 0,92; 0,96) für den zweiten Untersucher. Die Interrater-Reliabilität betrug 0,96 (95 % -KI: 0,93; 0,98) für die Inklination und 0,93 (95 %-CI: 0,85; 0,96) für die Anteversion.

Schlussfolgerung: Die größten Messfehler traten bei einer außergewöhnlichen Beckenkippung in der Bildebene auf. Um eine verlässliche, dem CT vergleichbare, Bestimmung der Pfannenposition nach Hüft-TEP auf konventionellen Röntgenaufnahmen durch die vektor-arithmetische Methode zu erreichen, ist in Zukunft die Berücksichtigung der Beckenkippung notwendig.

Kernaussagen:

• Messungen der Pfannenposition nach Hüft-TEP auf einer tiefen Beckenübersichtsaufnahmen im ap Röntgen sind im klinischen Alltag als First-Line-Modalität ein hilfreiches Verfahren.

• CT bleibt der Goldstandard, um die Pfannenposition für biomechanische Fragestellungen genau zu bestimmen.

• Zukünftige Messungen der Pfannenposition nach Hüft-TEP auf tiefen Beckenübersichtsaufnahmen im ap Röntgen sollten die Beckenkippung in der frontalen Bildebene berücksichtigen, um die Messgenauigkeit zu erhöhen.

 
  • References

  • 1 Leichtle U, Gosselke N, Wirth C et al. Radiologische Evaluation der Variationsbreite der Pfannenpositionierung bei konventioneller Hüftendoprothesenversorgung. RöFo – Fortschritte Auf Dem Geb Röntgenstrahlen Bildgeb Verfahr 2007; 179: 46-52
  • 2 Renkawitz T, Haimerl M, Dohmen L et al. Minimally invasive computer-navigated total hip arthroplasty, following the concept of femur first and combined anteversion: design of a blinded randomized controlled trial. BMC Musculoskelet Disord 2011; 12: 192
  • 3 Eckardt A, Karbowski A, Schwitalle M et al. Messung der Pfannenwanderung bei zementfreien Hüftimplantaten. RöFo – Fortschritte Auf Dem Geb Röntgenstrahlen Bildgeb Verfahr 1998; 169: 146-151
  • 4 Lewinnek GE, Lewis JL, Tarr R et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60: 217-220
  • 5 Hube R, Dienst M, von Roth P. Complications after minimally invasive total hip arthroplasty. Orthop 2014; 43: 47-53
  • 6 Kalteis T, Handel M, Herold T et al. Position of the acetabular cup – accuracy of radiographic calculation compared to CT-based measurement. Eur J Radiol 2006; 58: 294-300
  • 7 Marx A, von Knoch M, Pförtner J et al. Misinterpretation of cup anteversion in total hip arthroplasty using planar radiography. Arch Orthop Trauma Surg 2006; 126: 487-492
  • 8 Tannast M, Zheng G, Anderegg C et al. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop 2005; 438: 182-190
  • 9 Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg Br 1999; 81: 431-435
  • 10 Widmer KH. A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty 2004; 19: 387-390
  • 11 Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br 1993; 75: 228-232
  • 12 DiGioia AM, Hafez MA, Jaramaz B et al. Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop 2006; 453: 272-276
  • 13 Kalteis T, Handel M, Bäthis H et al. Imageless navigation for insertion of the acetabular component in total hip arthroplasty: is it as accurate as CT-based navigation?. J Bone Joint Surg Br 2006; 88: 163-167
  • 14 Babisch JW, Layher F, Amiot LP. The rationale for tilt-adjusted acetabular cup navigation. J Bone Joint Surg Am 2008; 90: 357-365
  • 15 Renkawitz T, Weber M, Springorum HR et al. Impingement-free range of movement, acetabular component cover and early clinical results comparing ‘femur-first’ navigation and ‘conventional’ minimally invasive total hip arthroplasty. Bone Jt J 2015; in press. 97
  • 16 Harrison CL, Thomson AI, Cutts S et al. Research synthesis of recommended acetabular cup orientations for total hip arthroplasty. J Arthroplasty 2014; 29: 377-382
  • 17 Wan Z, Malik A, Jaramaz B et al. Imaging and Navigation Measurement of Acetabular Component Position in THA. Clin Orthop 2008; 467: 32-42
  • 18 Nho JH, Lee YK, Kim HJ et al. Reliability and validity of measuring version of the acetabular component. J Bone Joint Surg Br 2012; 94-B: 32-36
  • 19 Bland JM, Altman DG. Measurement error and correlation coefficients. BMJ 1996; 313: 41-42
  • 20 Ottersbach A, Haaker R. Optimization of cup positioning in THA--comparison between conventional mechanical instrumentation and computer-assisted implanted cups by using the orthopilot navigation system. Z Für Orthop Ihre Grenzgeb 2005; 143: 611-615
  • 21 Eilander W, Harris SJ, Henkus HE et al. Functional acetabular component position with supine total hip replacement. Bone Jt J 2013; 95-B: 1326-1331
  • 22 Kanawade V, Dorr LD, Wan Z. Predictability of Acetabular Component Angular Change with Postural Shift from Standing to Sitting Position. J Bone Jt Surg 2014; 96: 978-986
  • 23 Ross JR, Nepple JJ, Philippon MJ et al. Effect of changes in pelvic tilt on range of motion to impingement and radiographic parameters of acetabular morphologic characteristics. Am J Sports Med 2014; 42: 2402-2409
  • 24 Zheng G, Zhang X. Computer assisted determination of acetabular cup orientation using 2D-3D image registration. Int J Comput Assist Radiol Surg 2010; 5: 437-447
  • 25 Steppacher SD, Tannast M, Zheng G et al. Validation of a new method for determination of cup orientation in THA. J Orthop Res Off Publ Orthop Res Soc 2009; 27: 1583-1588
  • 26 Lu M, Zhou YX, Du H et al. Reliability and validity of measuring acetabular component orientation by plain anteroposterior radiographs. Clin Orthop 2013; 471: 2987-2994
  • 27 Craiovan B, Renkawitz T, Weber M et al. Is the acetabular cup orientation after total hip arthroplasty on a two dimension or three dimension model accurate?. Int Orthop 2014; 38: 2009-2015
  • 28 Anda S, Svenningsen S, Grontvedt T et al. Pelvic inclination and spatial orientation of the acetabulum. A radiographic, computed tomographic and clinical investigation. Acta Radiol Stockh Swed 1987 1990; 31: 389-394
  • 29 Lembeck B, Mueller O, Reize P et al. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop 2005; 76: 517-523
  • 30 Nishihara S, Sugano N, Nishii T et al. Measurements of pelvic flexion angle using three-dimensional computed tomography. Clin Orthop 2003; 140-151