Validity and Reliability of Intraoperative Radiographs to Assess Leg Length During Total Hip Arthroplasty: Correlation and Reproducibility of Anatomic Distances

Herisson, Olivier; Felden, A.; Hamadouche, Moussa; Anract, Philippe; Biau, David

doi:10.1016/j.arth.2016.05.004

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…As a consequence, we used the distance from the lesser trochanter to the trans-ischial line on the 4-week followup radiograph as a proxy for leg length. Although not a true leg length, this measurement is commonly employed in the joint replacement community 16 17 18 19 20 21 22 23 24 25 26 27 32) . The data used for this study also represent the experience of a single surgeon who has performed more than 4,000 hip replacements over almost three decades and may not be generalizable to what could be expected for other surgeons, particularly those with less experience.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Intraoperative Radiographs on Component Position and Leg Length during Routine Posterior Approach Total Hip Arthroplasty

et al. 2021

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Purpose Accurate component placement and restoration of patient anatomy are critical in total hip arthroplasty (THA) surgery. Although intraoperative radiographs are sometimes utilized, it is unclear whether this practice can improve accuracy. Materials and Methods This study evaluated acetabular cup abduction, anteversion, leg length, and offset among 100 posterior approach THAs performed without imaging (No X-ray group) and compared them to a subsequent series of 100 THAs where an intraoperative radiograph was taken with the trial components in place (X-ray group). THAs were performed using a posterior approach by a single, experienced surgeon whose goal was to place the cup at 45° of abduction and 30° of anteversion. Supine anteroposterior pelvic digital radiographs taken at the first (nominal 4-week) postoperative visit were used for measurements. Results Slight differences in cup abduction (47°±6° vs 44°±6°, respectively, P =0.003) and anteversion angle (35°±6° vs 31°±6°, respectively, P <0.001) were observed between the X-ray and No X-ray groups; however, a similar proportion of cups within 10° of the target angles was observed (76% vs 83%, respectively, P =0.22). No difference in offset measurements (1.1±6.6 mm vs 0.3±6.9 mm, respectively, P =0.42) or leg lengths (0.3±3.8 mm vs 0.3±4.8 mm, respectively, P =0.94) was observed between the X-ray and No X-ray groups; however, the X-ray group showed less leg length variation ( P =0.05). Conclusion In this study, the routine use of intraoperative radiographs was not associated with improved implant positioning for uncomplicated primary THA.

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Section: Discussionmentioning

confidence: 99%

The Effect of Intraoperative Radiographs on Component Position and Leg Length during Routine Posterior Approach Total Hip Arthroplasty

et al. 2021

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“…For comparison, this simple technique appears more accurate than intra-operative x-ray assessment of LLD with patients in a lateral position. One study found that taking an x-ray with a patient in a lateral position resulted in 20% of cases displaying an intra-operative LLD measurement more than 5 mm different from that measured on a post-operative supine AP pelvis x-ray[ 12 ]. It also remains unclear as to the amount of post-operative LLD that can be tolerated without impacting patient function or satisfaction post-operatively[ 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Reliability of a simple fluoroscopic image to assess leg length discrepancy during direct anterior approach total hip arthroplasty

Caus¹,

Reist²,

Bernard³

et al. 2021

WJO

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BACKGROUND Direct anterior approach (DAA) total hip arthroplasty (THA) in a supine position provides a unique opportunity to assess leg length discrepancy (LLD) intra-operatively with fluoroscopy. Reported fluoroscopic techniques are useful but are generally complicated or costly. Despite the use of multiple techniques for leg length assessment, LLD continues to be a major post-operative source of patient dissatisfaction further emphasizing the importance of near-anatomic restoration. The utility of an alternative direct measurement of LLD on an intra-operative fluoroscopic pelvic image during DAA THA has not been reported. AIM To determine the reliability of a novel simple intra-operative measurement of LLD using a parallel line technique on a single fluoroscopic digital image of the pelvis. METHODS One hundred and seventy-one patients who underwent DAA THA were included for analysis. Intra-operative fluoroscopic and post-operative anterior-posterior radiographs were imported to TraumaCad and calibrated for LLD measurement. LLD was measured on each image using the right-left hip differences in lesser trochanter to pelvic reference line distances. Pelvic reference points included the teardrops and ischia. Fluoroscopic LLD was compared to the gold-standard measurement of LLD measured on a post-operative radiograph. RESULTS Mean absolute difference in teardrop referenced LLD between fluoroscopic and post-operative radiographs was 2.17 mm and based on the ischia mean absolute difference was 2.63 mm. Linear regression of fluoroscopic and post-operative radiograph LLD based on teardrop and ischia LLD found r 2 values of 0.57 and 0.84, respectively. Mean absolute difference between fluoroscopic and post-operative x-ray LLD was within 5 mm in 95% of cases regardless of pelvic reference. CONCLUSION This study demonstrates that a single fluoroscopic view obtained during DAA THA for leg length assessment is clinically useful.

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“…Femoral stem size and position relative to the greater and lesser trochanters further dictates the level of the intended proximal femoral neck osteotomy to achieve desired lengthening. The final template provides an approximate value for planned limb lengthening, which is then carried out and can be confirmed intraoperatively with various techniques [ 4 , [12] , [13] , [14] ].…”

Section: Introductionmentioning

confidence: 99%

“…Pelvic rotation, femoral abduction, and other positional changes are factors that influence the outcomes of this method. Enabling technologies have been developed to enhance the accuracy of fluoroscopy when evaluating changes in leg length and offset [ 13 ] ( Fig. 4 ) and can also produce rapid overlay comparisons intraoperatively and correct for differences in femur abduction and adduction ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Digital Fluoroscopic Navigation for Limb Length Restoration During Anterior Total Hip Arthroplasty

O’Leary¹,

Saxena²,

Argüelles³

et al. 2022

Arthroplasty Today

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Validity and Reliability of Intraoperative Radiographs to Assess Leg Length During Total Hip Arthroplasty: Correlation and Reproducibility of Anatomic Distances

Cited by 12 publications

References 30 publications

The Effect of Intraoperative Radiographs on Component Position and Leg Length during Routine Posterior Approach Total Hip Arthroplasty

The Effect of Intraoperative Radiographs on Component Position and Leg Length during Routine Posterior Approach Total Hip Arthroplasty

Reliability of a simple fluoroscopic image to assess leg length discrepancy during direct anterior approach total hip arthroplasty

Digital Fluoroscopic Navigation for Limb Length Restoration During Anterior Total Hip Arthroplasty

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