Accuracy of plain antero-posterior radiographic-based methods for measurement of acetabular cup version

Alzohiry, Mohammad Ali; Abdelnasser, Mohammad Kamal; Moustafa, Mohamed M. A.; Mahran, Mohamed; Bakr, Hatem; Khalifa, Yaser E.; Abelaal, Ahmed; Atta, Haisam; Said, Galal Z.

doi:10.1007/s00264-018-3984-x

Cited by 15 publications

(15 citation statements)

References 28 publications

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“…For more precise measurements, a computed tomography (CT) can be requested to assess the femoral and acetabular torsion [9]. However, this is not performed routinely and data on the rotational profile of the CT in correlation to plain radiography is lacking in the literature, especially in DDH or borderline hips [10][11][12][13][14]. Some authors have provided a comparison between the lesser trochanter size on plain radiographs to the femoral version on a CT [15], although further description is largely lacking.…”

Section: Introductionmentioning

confidence: 99%

Rotational abnormalities in dysplastic hips and how to predict acetabular torsion

et al. 2022

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Objectives The aim of this study was to investigate the degree to which conventional radiography can represent the acetabular and femoral rotational alignment profile between dysplastic and borderline-dysplastic hips. Methods A retrospective trial was conducted including 56 borderline-dysplastic and dysplastic hips at a mean age of 28.9 years (range from 18 to 46). Inclusion criteria consisted of symptomatic patients with hip dysplasia undergoing 2-dimensional radiography as well as computed tomography. On radiography, the lateral center edge angle, acetabular hip index, hip lateralization index, acetabular index angle, and the Sharp angle were measured, and the presence of a crossover sign was noted. In computed tomography, the full rotational profile of the lower limb was measured. Results Significant correlations were observed in the overall analysis between the anteversion of the acetabulum and the hip lateralization index (mean 0.56, coefficient of regression (CoR) −32.35, p = 0.011) as well as the acetabular index angle with a mean of 11.50 (CoR 0.544, p = 0.018). Similar results were found in the subgroup of dysplastic hips with an acetabular index angle of 13.9 (p = 0.013, CoR 0.74). For the borderline-dysplastic group, no significant correlations between the pelvis radiography and rotational CT were seen. Conclusion Although the femoral and acetabular torsion cannot be predicted from x-rays, the anteversion of the acetabulum correlates with the acetabular index angle, the hip lateralization index, and eventually the beta angle in dysplastic hips. For borderline-dysplastic hips, such results did not show up, which strongly illustrates the need for computed tomography in these cases. Key Points • Much of the current literature focuses on rotational alignment especially with respect to the femur and tibia in healthy patients, although little is known about the acetabular, femoral, and tibial torsion in dysplastic hips. • This is the first study showing significant correlations between the anteversion of the acetabulum and the hip lateralization index as well as the acetabular inclination angle. Also, it is the first study to provide a mechanism for estimation of the torsion of the acetabulum with plain radiography in dysplastic hips. • In borderline-dysplastic hips, no significant correlation was found, which raises the question if a simple x-ray has enough validity to address the acetabular deformity with surgery.

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Section: Introductionmentioning

confidence: 99%

Rotational abnormalities in dysplastic hips and how to predict acetabular torsion

et al. 2022

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“…Thirdly, although the accuracy of OrthoView system measurements has been demonstrated, measurement bias cannot be ignored. X-ray-based postoperative measurements are inferior to computed tomography (CT) and magnetic resonance imaging (MRI); however, studies have confirmed that X-rays have the same accuracy as CT [ 35 – 37 ]. Fourthly, due to the relatively small sample size of our study, and the relatively small number of morbidly obese patients in China, no analysis stratified by BMI was conducted.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted versus manual total hip arthroplasty in obese patients: a retrospective case–control study

et al. 2022

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Aims The objective of this study was to evaluate the accuracy of acetabular cup positioning in the obese patients when using robotic-assisted technology during total hip arthroplasty (THA). Methods Data were retrospectively collected from patients who underwent primary (THA) with a body mass index (BMI) ≥ 28 kg/m2 and ≥ 1 year of follow-up between January 2018 and December 2019. Their demographics, diagnosis, acetabular cup positioning, American Society of Anesthesiologists (ASA) score, Harris Hip Score (HHS), and Forgotten Joint Score (FJS) at the final follow-up were recorded for analysis. Results There were no statistically significant differences between the two groups in height, weight, BMI, ASA score, or preoperative Harris Hip Score (HHS). Also, there was no difference in inclination angle between the two groups (R-THA: 41.29° ± 3.04°; manual THA (M-THA): 40.47° ± 5.46°; P = 0.312). However, the mean anteversion angle was greater in the R-THA group (20.71° ± 1.98° vs. 19.08° ± 4.04°; P < 0.001). Compared to M-THA, R-THA more frequently achieved an acetabular cup angle within 5° of the target (anteversion, 98.1% vs. 78.1% P = 0.001; inclination, 88.5% vs. 53.1%, P < 0.001). The R-THA group was more advantageous in restoring the hip center of rotation (COR) and leg length difference (LLD). There was no statistical difference in postoperative HHS (P = 0.404) or FJS (P = 0.497) between the two groups. Conclusions Compared to manual technique, robotic-assisted technique provided more precise acetabular cup positioning and better leg length restoration for obese patients. The robotic-assisted technique was more advantageous in recovering the center of rotation position and achieved a higher proportion of the acetabular cup placed in the target safety zone. Further studies are needed to confirm the clinical outcomes of surgeries in obese patients using robotic-assisted technology.

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“…12 Alzohiry et al recommend the Lewinnek et al and Liaw methods for determining the anteversion angle on anteroposterior pelvis or anteroposterior hip radiographs. 13 Figure 3 is an X-ray of a patient that sustained a right neck of femur fracture. In the Liaw method, a line is drawn across the maximal diameter of the ellipse (AB) on the anteroposterior radiograph, and another point (C) midway on the ellipse, which is the intersection of the ellipse, and a line perpendicular to and going through the midpoint of AB is determined.…”

Section: Discussionmentioning

confidence: 99%

An audit on the accuracy of freehand acetabular cup positioning in total hip arthroplasty with the direct lateral approach at a tertiary institution over seven years

et al. 2022

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BACKGROUND: The direct lateral approach for total hip replacement has been traditionally reserved and described for neck of femur fractures. Advantages of this approach include technically easy access to the acetabulum and femur and low incidence of hip dislocation. Imperfect positioning of the acetabular component leads to increased risk for dislocations, accelerated wear, reduced range of motion and increased revision rate. Freehand technique has been the gold standard for many decades, but newer technologies like computer navigation and robotic-assisted surgery have shown to improve the accuracy of cup placement. This study reports on the accuracy of freehand cup positioning via the direct lateral approach with mention of the dislocation rate METHODS: We retrospectively reviewed 253 patients who had total hip replacements done via the direct lateral approach. The patients' files were evaluated for patient parameters, demographic details, aetiology of hip pathology, confirmation of approach used, comorbidities and history of previous relevant surgery. The postoperative radiographs were analysed for acetabular component position inclination and anteversion. Dislocation rates were calculated as a secondary objective RESULTS: The radiographic analysis was performed using the Liaw method based on trigonometry of the eclipse generated. This showed a mean cup inclination of 42.3° (95% CI: 41.3-43.3°) and anteversion of 12.7° (95% CI: 12.0-13.7°). A total of 57% of the acetabular cups were within the safe zones described by Lewinnek. Of them, 78% were in the 30-50° range for inclination and 73% in the 5-25° range for anteversion. There were ten dislocations within one year from the index procedure: a dislocation rate of 4.0% (95% CI: 2.8-8.5% CONCLUSION: The freehand technique using the direct lateral approach for acetabular cup placement produces a poor overall accuracy of only 57%. Although our study only commented on ten dislocations, the rate (4%) is significantly worse compared to the 0.43% reported in literature for the direct lateral approach. The radiographic results for inclination and anteversion are comparable to other freehand techniques, regardless of the approach used, but significantly worse than results achieved with navigation and robotics Level of evidence: Level 4

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Accuracy of plain antero-posterior radiographic-based methods for measurement of acetabular cup version

Abstract: For measurement of acetabular cup version angle, we recommend the use of Lewinnek and Liaw et al. methods both in AP-P and in AP-H, while Hassan et al.'s method is recommended in AP-P only, and Widmer and Ackland et al.'s methods in AP-H only.

Cited by 15 publications

References 28 publications

Rotational abnormalities in dysplastic hips and how to predict acetabular torsion

Rotational abnormalities in dysplastic hips and how to predict acetabular torsion

Robotic-assisted versus manual total hip arthroplasty in obese patients: a retrospective case–control study

An audit on the accuracy of freehand acetabular cup positioning in total hip arthroplasty with the direct lateral approach at a tertiary institution over seven years

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