Original Article

Archives of Orthopaedic and Trauma Surgery

, Volume 125, Issue 5, pp 291-297

First online:

Inter- and intraobserver assessment of periacetabular osteodensitometry after cemented and uncemented total hip arthroplasty using computed tomography

  • Rainer SchmidtAffiliated withDepartment of Orthopaedics, University of Erlangen-Nuernberg Email author 
  • , Rocco Paolo PittoAffiliated withDepartment of Orthopaedic Surgery, University of Auckland, Middlemore Hospital
  • , Alexander KressAffiliated withDepartment of Orthopaedics, University of Erlangen-Nuernberg
  • , Cornelia EhremannAffiliated withDepartment of Orthopaedics, University of Erlangen-Nuernberg
  • , Tobias Eckhard NowakAffiliated withDepartment of Orthopaedics, University of Erlangen-Nuernberg
  • , Udo ReulbachAffiliated withInstitut für Medizininformatik, Biometrie und Epidemiologie, University of Erlangen-Nuernberg
  • , Raimund ForstAffiliated withDepartment of Orthopaedics, University of Erlangen-Nuernberg
  • , Lutz MüllerAffiliated withDepartment of Orthopaedics, University of Erlangen-Nuernberg

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access



This study was initiated to evaluate the reproducibility of a novel method for measuring the periacetabular bone density after insertion of cemented and uncemented acetabular cups using CT in vivo.

Materials and methods

CT scans were obtained from 20 patients after cemented polyethylene cup implantation (ZCA, Zimmer, USA) and 20 patients after uncemented titanium alloy cup fixation (Cerafit, Ceraver, France). A manual segmentation of cancellous and cortical pelvic bone ventral, dorsal and cranial to the cup was undertaken. Values are given in Hounsfield units. Inter- and intraobserver studies were conducted using a special analysis software tool. To define the reproducibility of the method, all measurements were evaluated according to Bland and Altman.


For both cemented and uncemented acetabular cups, reproducibility of bone density measurement for cortical and cancellous bone cranial, ventral and dorsal to the cup was high. There was no significant difference between the intraobsever study (two repeated measurements) and the interobserver study (two investigators), indicating the reproducibility of the method independent of the investigator.


In conclusion, the periacetabular bone density measurement as conducted in this CT study is a new reproducible method for in vivo evaluation of cortical and cancellous pelvic bone after cemented and uncemented acetabular cup implantation. In vivo CT measurements will allow a thorough assessment of periacetabular stress-shielding phenomena.


Reproducibility Osteodensitometry Bone density Total hip arthroplasty Computed tomography