The validity of a novel radiological method for measuring femoral stem version on anteroposterior radiographs of the hip after total hip arthroplasty

Weber, Markus; Lechler, Philipp; Kunow, Frederik von; Völlner, Florian; Keshmiri, Armin; Hapfelmeier, Alexander; Grifka, Joachim; Renkawitz, Tobias

doi:10.1302/0301-620x.97b3.34618

Cited by 50 publications

(27 citation statements)

References 25 publications

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“…Sendtner et al found a range from -19°retroversion to 33°anteversion in cementless THA, which is in accordance with the results of Wines et al, who showed a range from -15°-52° [11,12]. Weber et al developed a new mathematical formula for measuring stem version using the projected prosthetic neck-shaft angle (NSA) on AP radiographs and compared the results with three-dimensional CT scans (3D-CT) [13]. The authors found a high reliability and validity in the evaluation of the stem version in cementless THA, considering the limitation that this method cannot differentiate between anteversion and retroversion.…”

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confidence: 60%

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Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty

Worlicek

Weber

Zeman

et al. 2016

Fortschr Röntgenstr

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Purpose: The purpose of this study was to evaluate the validity of commercially available planning software on plain radiographs after THA compared to CT scans as the gold standard. Patients and Methods: In a prospective clinical study, anteroposterior (AP) radiographs and three-dimensional CT scans (3D-CT) were obtained for 121 patients, who underwent minimally invasive, cementless THA with a straight tapered stem, in a lateral decubitus position. For measuring SV, we used digital planning software (TraumaCad 2.0, BrainLAB Feldkirchen, Germany). Two independent raters repeated the analysis after a six-week interval. Radiological measurements were compared with 3D-CT measurements by an independent, blinded external institute. This investigation was approved by the local ethics commission (no.?10?-121-?0263) and is a secondary analysis of a larger project (DRKS00?000?739, German Clinical Trials Register May-02???2011). Results: The radiograph measurements showed very high intra- and interrater agreement. The intra-class correlation (ICC) of the intrarater agreement was 0.97 for rater 1 and 0.98 for rater 2. The intrarater reliability was 0.99 using the mean values of both rater measurements. The mean difference between the average radiograph measurement and the 3D-CT-based measurement was 0.41? (SD 11.24?) (range: ?33.85??22.50?; 95?% limits of agreement: ?21.63???22.45), but there was no correlation found between both methods. Conclusion: Measuring stem version with the help of commercially available digital planning software on plain radiographs after THA has high intra- and interrater reliability but clinically inacceptable validity and reliability when compared to 3D-CT scans. Key Points: ??Measuring stem torsion after THA on plain radiographs with digital planning software is not valid. Citation Format: ??Worlicek M, Weber M, Zeman F et?al. Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty. Fortschr R?ntgenstr 2016; 188: 763???767

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confidence: 60%

“…Another accurate method for the assessment of SV is to use a mathematical formula, which puts the projected NSA of the stem on plain AP radiographs in relation to the true NSA of the implant. This method was described by Weber et al and was valid compared to 3D-CT (r = 0.88, p < 0.001) [13].…”

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confidence: 91%

Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty

Worlicek

Weber

Zeman

et al. 2016

Fortschr Röntgenstr

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“…[4,6,7] According to Lechler using standard femoral components, the effect of hip rotation on the projected femoral offset and rotation-corrected femoral offset has not been studied following ssTHA. [8,9] Due to the particular design of ssTHA, the long axis of the stem does not necessarily follow the long axis of the femoral shaft resulting in a wide range of acceptable varus or valgus positions. Therefore, contrasting standard THA, the postoperative FO of the prosthesis may vary significantly from the FO of the native femur.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…The necessity to identify hip rotation and correct the FO has been shown in previous publications. [6,8] However, this method has not been applied to ssTHA before. For the correct interpretation of FO in postoperative radiographs, it is necessary to address the effect of hip rotation.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The Influence of Hip Rotation on Femoral Offset Following Short Stem Total Hip Arthroplasty

Boese

Bredow

Ettinger

et al. 2016

The Journal of Arthroplasty

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“…Inaccurate placement of femoral and acetabular components is associated with dislocation [1], a decreased range of motion [2,3], periprosthetic impingement [2], and component wear [4]. For orientation of the femoral component, stem torsion can be assessed by means of the neck-shaft angle (NSA) [5]. The orientation of the acetabular cup is described by the angle of inclination and anteversion [6].…”

Section: Introductionmentioning

confidence: 99%

Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA – An Experimental Study

Schwarz¹,

Weber²,

Dornia

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNGZiel Nach Hüft-TEP-Versorgungen ist die korrekte Vermessung der Pfannenstellung in postoperativen Röntgenaufnah-men wichtig für die Qualitätskontrolle. In dieser Studie stellen wir eine neue Methode vor, mit der wir Messungenauigkeiten, die sich durch die Beckenverkippung und -verdrehung ergeben, korrigieren können.Methode In einem experimentellen Ansatz implantierten wir eine Prothesenpfanne in ein Kunststoffbecken und bestimmten die tatsächliche Pfannenstellung in einer CT. Um die Auswirkung der Beckenverkippung und -verdrehung auf die Pfannenstellung in AP Röntgenbildern darzustellen, wurde das Becken auf einer Halterung fixiert, mit der eine graduelle Vor-und Rückwärts-Kippung (± 15°) sowie eine Beckenverdrehung (0°bis 20°zur Gegenseite) umgesetzt werden konnte. Zur Korrektur von Messfehlern, die sich aus der Beckenverkippung und -rotation ergeben, entwickelten wir gemäß der Definitionen der Anteversion und Inklination nach Murray ein neues Korrekturverfahren, mit dem die Pfannenstellung in einem Becken bezogenen Koordinatensystem (Anterior Pelvic Plane) vermessen werden kann. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. ABSTR AC TPurpose Accurate assessment of cup orientation on postoperative pelvic radiographs is essential for evaluating outcome after THA. Here, we present a novel method for correcting measurement inaccuracies due to pelvic tilt and rotation.Method In an experimental setting, a cup was implanted into a dummy pelvis, and its final position was verified via CT. To show the effect of pelvic tilt and rotation on cup position, the dummy was fixed to a rack to achieve a tilt between + 15°a nterior and -15°posterior and 0°to 20°rotation to the contralateral side. According to Murray's definitions of anteversion and inclination, we created a novel corrective procedure to measure cup position in the pelvic reference frame (anterior pelvic plane) to compensate measurement errors due to pelvic tilt and rotation.Results The cup anteversion measured on CT was 23.3°; on AP pelvic radiographs, however, variations in pelvic tilt (± 15°) resulted in anteversion angles between 11.0°and 36.2°(mean error 8.3°± 3.9°). The cup inclination was 34.1°o n CT and ranged between 31.0°and 38.7°(m. e. 2.3°± 1.5°) on radiographs. Pelvic rotation between 0°and 20°showed high variation in radiographic anteversion (21.2°-31.2°, m. e. 6.0°± 3.1°) and inclination (34.1°-27.2°, m. e. 3.4°± 2.5°). Our novel correction algorithm for pelvic tilt reduced the mean error in anteversion measurements to 0.6°± 0.2°and in inclination measurements to 0.7°(SD± 0.2). Similarly, the mean error due to pelvic rotation was reduced to 0.4°± 0.4°for anteversion and to 1.3°± 0.8 for inclination.

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The validity of a novel radiological method for measuring femoral stem version on anteroposterior radiographs of the hip after total hip arthroplasty

Cited by 50 publications

References 25 publications

Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty

Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty

The Influence of Hip Rotation on Femoral Offset Following Short Stem Total Hip Arthroplasty

Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA – An Experimental Study

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