Misinterpretation of cup anteversion in total hip arthroplasty using planar radiography

Marx, A.; Knoch, Marius von; Pförtner, J.; Wiese, M.; Saxler, Guido

doi:10.1007/s00402-006-0163-0

Cited by 65 publications

(91 citation statements)

References 24 publications

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“…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. In an experiment similar to ours, Marx et al [20] evaluated anteversion values measured from AP radiographs using several techniques in comparison to CT-based values and reported considerable difference between CT-based and radiograph-based values, with the radiographs tending to underestimate the anteversion by between 6°and 14°. Like the current study, that study had no gold standard and thus was able to comment only on differences between measurement methods, not on improved accuracy of one method over another because of this limitation.…”

Section: Discussionmentioning

confidence: 53%

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: 53%

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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show abstract

“…First is the use of a computer software program to obtain inclination and version angles without accounting for pelvic tilt, which could influence the calculated angles. Recent studies show CT scans measure acetabular version more accurately than radiographs [15] and the combination of CT scans and radiographic information is the most effective tool to accurately measure cup position [31,43,51,57]. Second, we did not measure the rotational position of the femoral stem in the femoral canal.…”

Section: Discussionmentioning

confidence: 97%

The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

Callanan

Jarrett

Bragdon

et al. 2011

Clinical Orthopaedics &Amp; Related Research

487

406

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Background Few studies have examined factors that affect acetabular cup positioning. Since cup positioning has been linked to dislocation and increased bearing surface wear, these factors affecting cup position are important considerations. Question/purposes We determined the percent of optimally positioned acetabular cups and whether patient and surgical factors affected acetabular component position. Methods We obtained postoperative AP pelvis and crosstable lateral radiographs on 2061 consecutive patients who received a THA or hip resurfacing from 2004 to 2008. One thousand nine hundred and fifty-two hips had AP pelvic radiographs with correct position of the hip center, and 1823 had both version and abduction angles measured. The AP radiograph was measured using Hip Analysis Suite TM to calculate the cup inclination and version angles, using the lateral film to determine version direction. Acceptable ranges were defined for abduction (30°-45°) and version (5°-25°).Results From the 1823 hips, 1144 (63%) acetabular cups were within the abduction range, 1441 (79%) were within the version range, and 917 (50%) were within the range for both. Surgical approach, surgeon volume, and obesity (body mass index [ 30) independently predicted malpositioned cups.

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“…Different techniques for measurement of cup anteversion from plain AP views have been described, but with different conclusions concerning validity (9). There are various reasons for this.…”

Section: Discussionmentioning

confidence: 99%

“…We therefore assume that the use of a single reviewer should not adversely affect our observations. While plain AP pelvic radiographs easily can be obtained, their accurate interpretation is subject to error (9,17,18). Both the direction of the central beam and tilt of the pelvis could influence the calculation of anteversion and cause significant errors (10).…”

Section: Discussionmentioning

confidence: 99%

Cross table lateral radiography for measurement of acetabular cup version

Reikerås

Gunderson

2016

Ann. Transl. Med.

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Background: Appropriate orientation of the acetabular cup is an important factor for long-term results of total hip arthroplasty. For measurement of cup version cross-table lateral radiography is frequently used, but the reliability has been questioned. We compared cross table lateral radiography with computed tomography in patients that had undergone primary total hip arthroplasty. Methods:The study was prospectively done in 117 patients (117 hips). At 3 months after total hip replacement the acetabular version was measured by cross table lateral radiography and compared to measurements by computed tomography.Results: By cross table lateral radiography acetabular anteversion was on mean 13.9° with a standard deviation of 10.1° as compared to 17.8°±12.6° by computed tomography. Mean difference was −3.8 with a distribution of measurements of ±13 degrees for 95% of the cases.Conclusions: Our study shows that cross table radiography provides acceptable information for clinical use, but has limited use for precise analysis of acetabular cup version.

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Misinterpretation of cup anteversion in total hip arthroplasty using planar radiography

Abstract: Planar radiographs are too imprecise for exact evaluation of the correct cup AV after THA. CT-based analysis may be necessary if exact values are required.

Cited by 65 publications

References 24 publications

CT Outperforms Radiography for Determination of Acetabular Cup Version after THA

CT Outperforms Radiography for Determination of Acetabular Cup Version after THA

The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

Cross table lateral radiography for measurement of acetabular cup version

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