Computed Tomography Measurement of Acetabular Cup Anteversion and Retroversion in Total Hip Arthroplasty

Mian, Shahid W.; Truchly, George; Pflum, Francis A.

doi:10.1097/00003086-199203000-00027

Cited by 61 publications

(35 citation statements)

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“…Although there is no gold standard to validate either measurement method, the discrepancy between CT and cross-table lateral films casts doubt on the radiographic measurements, given the low ICC for serial plain film measurements discussed above and correction of pelvic tilt and rotation using reformatted CT. Mian et al [22] provided an early description of using CT after THA to measure acetabular component anteversion. Although describing their method of anteversion calculation using CT as ''highly accurate'' based on an in vitro model, they provided no data to support this claim.…”

Section: Discussionmentioning

confidence: 99%

“…1). Prior studies have confirmed CT as an accurate method to determine anteversion of acetabular cups after THA [22,27]. In addition, the CT scan provided measurement of femoral stem version that was not used for this study.…”

Section: Methodsmentioning

confidence: 99%

“…Despite these potential sources for inaccuracy, cross-table lateral radiographs are widely used for evaluation of version and continue to be used as sole measures of anteversion [5,25,29]. The previously mentioned sources of inaccuracy are mitigated when version is calculated using CT scans, specifically those related to patient positioning and centering of the beam [22]. Instead of requiring an individualized optimal beam orientation to best evaluate the position of the cup, evaluation of version with CT scans requires reformatting to provide views of the acetabular cup in the appropriate planes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

CT Outperforms Radiography for Determination of Acetabular Cup Version after THA

Ghelman

Kepler

Lyman

et al. 2009

Clinical Orthopaedics &Amp; Related Research

103

102

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Precise evaluation of acetabular cup version is necessary for patients with recurrent hip dislocation after THA. We retrospectively studied 42 patients, who underwent THAs, with multiple cross-table lateral radiographs and CT scans to determine whether radiographic or CT measurement of acetabular component version is more accurate. One observer measured cup version on all radiographs. CT scans were interpreted by one observer. Twenty radiographs were measured twice each by two observers to determine intraobserver and interobserver reliability. We implanted cups in four model pelvises using navigation and compared measurements of anteversion made with radiographs and CT scans. Intraclass correlation coefficients (ICC) for anteversion measurements of two observers were 0.9990 and 0.9998, respectively, when comparing measurements of identical radiographs (intraobserver). Paired values for two observers measuring the same radiograph had an ICC of 0.9686 (interobserver) compared with 0.7412 for measurements from serial radiographs of the same component. The ICC comparing radiographic versus CT-based measurements was 0.6981. CT measurements had stronger correlations with navigated values than radiographic measurements. Accuracy of anteversion measurements on crosstable radiographs depends on radiographic technique and patient positioning whereas properly performed CT measurements are independent of patient position.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

CT Outperforms Radiography for Determination of Acetabular Cup Version after THA

Ghelman

Kepler

Lyman

et al. 2009

Clinical Orthopaedics &Amp; Related Research

103

102

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“…Using CT-based calculation, an exact reference plane can be defined. Such reference provides highly accurate information of the three-dimensional cup position [15,19,20]. In the current study, orientation of the acetabular components was determined using a CT scan of the pelvis.…”

Section: Introductionmentioning

confidence: 99%

The accuracy of free-hand cup positioning - a CT based measurement of cup placement in 105 total hip arthroplasties

Saxler

Marx

Vandevelde³

et al. 2004

International Orthopaedics (SICOT)

180

101

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We studied 105 patients who received a total hip arthroplasty between June 1985 and August 2001 using freehand positioning of the acetabular cup. Using pelvic CT scan and the hip-plan module of SurgiGATESystem (Medivision, Oberdorf, Switzerland), we measured the angles of inclination and anteversion of the cup. Mean inclination angle was 45.8°±10.1°(range: 23.0-71.5°) and mean anteversion angle was 27.3°±15.0°(range: −23.5°to 59.0°). We compared the results to the "safe" position as defined by Lewinnek et al. and found that only 27/105 cups were implanted within the limits of the safe position.We conclude that a safe position as defined by Lewinnek et al. [13] was only achieved in a minority of the cups that were implanted freehand.

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“…In Abhängigkeit von Einstellung des Zentralstrahles, Lagerung des Patienten, Beckenkippung und Implantatposition ergeben sich Fehlerbreiten von mehr als 10° [15,16,17]. Die Genauigkeitsanalyse eines Navigationssystemes für die Hüftendoprothetik durch die Positionsbestimmung der real implantierten Pfanne in den postoperativen Becken-Computertomographien mit Hilfe der CT-basierten Planungssoftware ist daher gegenwärtig als Kontrollverfahren der Wahl anzusehen [1,7].…”

Section: Diskussionunclassified

Genauigkeit eines bildfreien Navigationssystemes für die Hüftpfannenimplantation – eine anatomische Studie / Accuracy of an Image-free Cup Navigation System – an Anatomical Study

Kalteis¹,

Beckmann²,

Herold³

et al. 2004

Biomedizinische Technik/Biomedical Engineering

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EinleitungLewinnek hat in klinischen und anatomischen Studien die Komplikationsraten der Hüftgelenkendoprothetik mit der Pfannenausrichtung korreliert und die sogenannte "safe zone" der Pfannenimplantation mit einer Inklinationsstellung von 45 ± 10°und einer Anteversion von 15 ± 10°definiert [13]. Eine ungenaue Pfannenimplantation außerhalb dieser "safe zone" schränkt den möglichen Bewegungsumfang (range of motion) des künstlichen Hüft-gelenkes ein, kann durch unphysiologische Belastungen zu einem erhöhten Abrieb der Gleitflächen und zu einer vorzeitigen aseptischen Prothesenlockerung führen sowie eine erhöhte Luxationsgefahr bedingen [2,11,18].Diese "safe zone" der Pfannenposition wird jedoch bei der konventionellen Operationstechnik auch von erfahrenen Operateuren in bis zu 78% der Hüftendoprothe-senimplantationen nicht erreicht [1,5,8] Die Pfannenposition ist entscheidend für die Funktion einer Hüftge-lenktotalendoprothese. Allerdings kann bei konventionellen Operationsverfahren eine korrekte Pfannenposition aufgrund der fehlenden Information über die Beckenstellung häufig nicht erreicht werden. Für CT-basierte und Fluoroskopie-gestützte Navigationsverfahren konnte eine signifikante Verbesserung der Implantationsgenauigkeit nachgewiesen werden. Die Akzeptanz dieser Systeme ist jedoch aufgrund der zusätzlichen Strahlenbelastung, der hohen Kosten sowie des vermehrten Zeitaufwandes gering. In der vorliegenden anatomischen Studie wurde ein alternatives Navigationsverfahren, die bildfreie Navigation, hinsichtlich ihrer Genauigkeit untersucht. Das bildfreie Navigationssystem ist mit wenigen zusätzlichen Arbeitsschritten verbunden, führt zu keiner wesentlichen Verzögerung der Operation und benötigt keine zusätzliche Bildgebung. An 10 Hüften humaner Leichen wurden Press-fit-Pfannen bildfrei navigiert implantiert und die Pfannenposition intraoperativ mit einem CTbasierten Navigationssystem sowie postoperativ im Becken-CT kontrolliert. Mit einer durchschnittlichen Inklination von 44°(Spanne 40-48°, SABW 2,7°) und einer Anteversion von 18°(Spanne 12-24°, SABW 4,1°) lagen alle Pfannen im Bereich der angestrebten safe zone. Die Genauigkeitsanalyse der bildfreien Navigationssoftware ergab im Vergleich zum CT-basierten Navigationssystem sowie zur postoperativen Becken-CT eine nur geringe, für den klinischen Einsatz tolerable Abweichung für die Pfanneninklination und -anteversion. Das getestete bildfreie Navigationssystem erscheint als eine in der klinischen Routine praktikable und zuverlässige Alternative für die computerunterstützte Implantation von Hüftgelenkspfannen.Key words: Computer-assisted surgery -Image-free navigation -Hip arthroplasty -Hip endoprosthesisThe position of the acetabular cup is of decisive importance for the function of a total hip replacement (THR). Using the conventional surgical technique, correct placement of the cup often fails due to a lack of information about pelvic tilt. With CT-based and fluoroscopicallyassisted navigation procedures the accuracy of implantation has been significantly impro...

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Computed Tomography Measurement of Acetabular Cup Anteversion and Retroversion in Total Hip Arthroplasty

Cited by 61 publications

References 0 publications

CT Outperforms Radiography for Determination of Acetabular Cup Version after THA

CT Outperforms Radiography for Determination of Acetabular Cup Version after THA

The accuracy of free-hand cup positioning - a CT based measurement of cup placement in 105 total hip arthroplasties

Genauigkeit eines bildfreien Navigationssystemes für die Hüftpfannenimplantation – eine anatomische Studie / Accuracy of an Image-free Cup Navigation System – an Anatomical Study

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