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Accuracy of measuring acetabular cup position after total hip arthroplasty: comparison between a radiographic planning software and three-dimensional computed tomography

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Abstract

Purpose

Various methods are available for measuring acetabular cup position after total hip arthroplasty (THA) on standard anterior-posterior (AP) radiographs. We compared the accuracy of a commercial radiographic planning software program with that of three-dimensional computed tomography (3D-CT) scans.

Methods

We obtained plain AP radiographs and 3D-CTs from 65 patients after THA. In addition to calculating cup anteversion and inclination with 3D-CT, we determined the cup position using the radiographic planning software program mediCAD® 2.5 (Hectec, Niederviehbach, Germany). Furthermore, we compared the measurements using the inter-teardrop and bi-ischial lines as pelvic landmarks.

Results

The mean difference in anteversion between 3D-CT and mediCAD® software was 0.1° using the inter-teardrop line (standard deviation [SD], 8.8°; range, −21° to 23°; p = 0.97) and 0.4° using the bi-ischial line (SD, 8.8°; range, −23° to 21°; p = 0.72). Inclination showed a mean difference of 0.6° using the inter-teardrop line (SD, 4.4°; range, −9° to 21°; p = 0.24) and 0.5° using bi-ischial line (SD, 4.6°; range, −9° to 22°; p = 0.35). The means for absolute differences were 7.2° for anteversion and 3.1° for inclination. With regard to using the bi-ischial or inter-teardrop line, no significant difference was found between the two pelvic landmarks. The intra-class correlation coefficient (ICC) was analysed for anteversion and inclination using either the inter-teardrop line or the bi-ischial line as radiographic baseline.

Conclusions

A radiographic planning software program (mediCAD®) is a helpful tool for measuring cup inclination on AP radiographs. With respect to anteversion, measurements are rather susceptible to mistakes with mean inaccuracies of over 7°. Thus, 3D-CT remains the “gold standard” if a lower tolerance limit (±3°) is required for more complex biomechanical evaluations. As a pelvic landmark, the interteardrop line is preferential to the bi-ischial line because of its lower impact on the position of the pelvis.

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Correspondence to Michael Woerner.

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Conflict of interest

No author’s financial or any other conflicts of interest are related directly or indirectly to the subject of this article, particularly not with Hectec GmbH, Niederviehbach, Germany. Funding for this clinical trial was provided by the German Federal Ministry of Education and Research (BMBF; grant number 01EZ0915). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval and informed consent

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Bayraktar, V., Weber, M., von Kunow, F. et al. Accuracy of measuring acetabular cup position after total hip arthroplasty: comparison between a radiographic planning software and three-dimensional computed tomography. International Orthopaedics (SICOT) 41, 731–738 (2017). https://doi.org/10.1007/s00264-016-3240-1

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  • DOI: https://doi.org/10.1007/s00264-016-3240-1

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