Biplanar Low-Dose Radiography is Accurate for Measuring Combined Anteversion after Total Hip Arthroplasty

Esposito, Christina; Miller, Theodore T.; Lipman, Joseph; Carroll, Kaitlin M.; Padgett, Douglas E.; Mayman, David J.; Jerabek, Seth A.

doi:10.1007/s11420-018-09659-7

Cited by 10 publications

(15 citation statements)

References 35 publications

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“…The average absolute differences between EOS and CT measurements were 4 ± 4 for femoral AV. Comparable to the current trial, intraobserver agreement was >0.75, respectively (Cronbach alpha, 0.90) for measurement of femoral AV using EOS imaging [27,29]. Similar observations were made by Tokunaga et al [34].…”

Section: The Present Findingssupporting

confidence: 87%

“…In addition, recent studies demonstrated the potential value of EOS measurement in patients after total hip arthroplasty [4,5,27]. EOS is superior to plain X-rays and standing X-rays in the angle measurement of the acetabular cup and AV of the femoral component even after hip arthroplasty [28,29]. The EOS system, on the other hand, features limitations in patients who are unable to stand or hold the appropriate position for the time of the examination.…”

Section: Technical Aspects Of Eosmentioning

confidence: 99%

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Anteversion Angle Measurement in Suspected Torsional Malalignment of the Femur in 3-Dimensional EOS vs Computed Tomography—A Validation Study

Mayr

Schmidt

Haasters

et al. 2021

The Journal of Arthroplasty

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Background: Computed tomography (CT) scan is the standard for assessment of femoral torsion. This observational study was conducted to evaluate the comparability of the EOS radiation dose scanning system (EOS imaging, Paris, France) and the CT scan in patients with suspected torsional malalignment of the femur. Methods: Patients with suspected torsional malalignment of the femur were included in a study for surgical planning. The primary endpoint was to compare the 3-dimensional radiological (EOS) imaging system with the CT scan to determine femoral anteversion (AV) angle. Three independent raters performed measurements. Comparability of CT scan and EOS values was assessed by Pearson correlation, t test, interobserver reliability, and intraobserver reliability (Cronbach alpha). Results: About 34 femora were examined. Interobserver reliability/intraobserver reliability was 0.911 of 0.955 for EOS and 0.934 of 0.934 for CT scan. EOS system revealed an AV angle of 12.2 ± 10.0 (À15.0 to 32.0 ). CT examinations showed an AV angle of 12.6 ± 9.2 (À3.2 to 35.6 ). About 11 hips featured physiological AV, 14 hips showed decreased AV (<10 ) or retroversion (<0 ), and 9 hips showed increased AV (>20 ). Overall, a strong Pearson correlation of t ¼ 0.855 and a highly significant correlation in the t test for both methods was seen. In patients with decreased AV, retroversion, or increased AV, Pearson correlation only resulted in a moderate/low correlation of t ¼ 0.495 and t ¼ 0.292. The t test showed no significant correlation at malrotation. Conclusion: In torsional malalignment, EOS does not have correlation with CT measurements. In contrast to CT scan, EOS allows femoral torsion measurement independent of legs' positioning.

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Section: The Present Findingssupporting

confidence: 87%

Section: Technical Aspects Of Eosmentioning

confidence: 99%

Anteversion Angle Measurement in Suspected Torsional Malalignment of the Femur in 3-Dimensional EOS vs Computed Tomography—A Validation Study

Mayr

Schmidt

Haasters

et al. 2021

The Journal of Arthroplasty

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“…More investigations about the functional positioning of both components applying three-dimensional (3-D) geometry and comprehensive kinematic analyses confirmed that the interplay between the cup and stem determines the functional prosthetic ROM [ 6 , 26 , 33 , 39 , 88 , 99 ]. Although theoretical, these studies gave prosthesis-based directions on how to functionally position the cup and stem, not only to prevent dislocation or impingement but also to reduce the risk of complications such as wear, squeaking, as well as edge and peak loading [ 4 , 27 , 28 , 52 , 73 , 91 ].…”

Section: Introductionmentioning

confidence: 99%

The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components

Widmer

2020

Clin Orthop Relat Res

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Background Lewinnek’s recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. Questions/purposes (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. Methods A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation referencing to body planes was used: cups were abducted from 20° to 70°, and anteverted from -10° to 40°. Stems were rotated from -10° to 40° anteversion, neck-shaft angles varied from 115° to 143°, and head sizes varied from 28 to 40 mm. Hip movements up to the point of prosthetic impingement were tested, including simple flexion/extension, internal/external rotation, ab/adduction, combinations of these, and activities of daily living that were known to trigger dislocation. For each combination of parameters, the impingement-free combined target zone was determined. Maximizing the size of the combined target zone was the optimization criterion. Results The combined target zones for impingement-free cup orientation had polygonal boundaries. Their size and position in the diagram changed with stem anteversion, neck-shaft angle, head size, and target ROM. The largest target zones were at neck-shaft angles from 125° to 127°, at stem anteversions from 10° to 20°, and at radiographic cup anteversions between 17° and 25°. Cup anteversion and stem anteversion were inverse-linearly correlated supporting the combined-anteversion concept. The range of impingement-free cup inclinations depended on head size, stem anteversion, and neck-shaft angle. For a 127°-neck-shaft angle, the lowest cup inclinations that fell within the target zone were 42° for the 28-mm and 35° for the 40-mm head. Cup anteversion and combined version depended on neck-shaft angle. For head size 32-mm cup, anteversion was 6° for a 115° neck-shaft angle and 25° for a 135°-neck-shaft angle, and combined version was 15° and 34° respectively. Conclusions The shape, size, and location of the combined target zones were dependent on design and implantation parameters of both components. Changing the prosthesis design or changing implantation parameters also changed the combined target zone. A maximized combi...

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“…A low-dose digital stereoradiography, EOS (EOS Imaging, Paris, France) system, was compared with CT scan for FSV evaluation in two studies. 4,5 This system produces a full length, weight bearing images using minimal radiation. It is composed of orthogonally placed two image acquisition systems each containing an x-ray tube and a linear detector in a C-shaped vertically travelling arm.…”

Section: Resultsmentioning

confidence: 99%

A review of plain radiographic methods for measuring femoral version after total hip arthroplasty and validation of modified Budin’s method in Indian population

Mittal

Kumar

Nandimandalam

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Multiple plain radiographic methods; cross table radiographic method, modified Budin method, projected neck-shaft angle method, and trans lateral decubitus view method using Ogata-Goldsand formula, have been described in literature for measurement of femoral stem version (FSV) after total hip arthroplasty (THA). Purpose: To review these multiple radiographic methods and also determine validity and accuracy of modified Budin method in Indian population. Patients and methods: A literature search for different methods described for FSV measurement was performed and these methods were reviewed. In addition, for validation of modified Budin method in Indian population, data was collected for 36 THAs prospectively. A posteroanterior radiograph with patient sitting in 90 hip flexion and 30 abduction was taken 3 weeks and 6 weeks after surgery for calculating the FSV using modified Budin method. At 3 weeks, a CT scan was also done for version measurement. Intra and interobserver reliability, and reproducibility of radiographic FSV measurement, and the correlation between CT scan and radiographic FSV measurement were statistically calculated. Results: All the reviewed studies demonstrated that their method is comparable to CT method for FSV measurement, except FSV measured on cross table radiographic view. However, there were only one or at most two studies of every method described except for modified Budin technique. The mean FSV in our prospective case series using 'modified Budin' method was 11.6 which was comparable to the mean of CT scan version measurement (12.3 ). The mean difference was 0.7 which was not statistically significant (p value > 0.05). In addition, there was high intra-class correlation coefficient in radiographic FSV for both intra-and inter-observer reliability. Conclusion: Multiple methods have been described and validated in literature, however, the 'modified Budin' view have proved multiple times to have excellent reliability and validity for easy measurement of FSV.

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Biplanar Low-Dose Radiography is Accurate for Measuring Combined Anteversion after Total Hip Arthroplasty

Cited by 10 publications

References 35 publications

Anteversion Angle Measurement in Suspected Torsional Malalignment of the Femur in 3-Dimensional EOS vs Computed Tomography—A Validation Study

Anteversion Angle Measurement in Suspected Torsional Malalignment of the Femur in 3-Dimensional EOS vs Computed Tomography—A Validation Study

The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components

A review of plain radiographic methods for measuring femoral version after total hip arthroplasty and validation of modified Budin’s method in Indian population

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