Skip to main content
SpringerLink
Log in

Intraoperative measurement of cup inclination using fluoroscopy requires a correction factor

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Malpositioning of the cup in total hip arthroplasty (THA) is associated with dislocation, early polyethylene wear, and impingement. The direct anterior approach (DAA) THA allows for intraoperative fluoroscopy imaging (IF). The current study investigates the following research hypotheses: (1) intraoperative measurements of radiographic cup inclination (RI) are reliable and reproducible. (2) A correction factor can compensate for the complex parallax effects when using IF.

Methods

In 2016, 100 consecutive hips underwent primary THA utilizing DAA and IF for cup placement. RI was measured on intraoperative fluoroscopy images and postoperative AP pelvis radiographs.

Results

Determination of RI on IF images is reliable and reproducible (ICC 0.851–0.950). RI measurement on IF images had a good correlation with the corresponding postoperative RI on AP pelvis radiographs (r = 0.538, p < 0.001). However, intraoperative RI measurements are on average 4.9° lower compared to postoperative measurements (SD 2.5°).

Conclusion

Intraoperative fluoroscopy is a reliable tool to measure RI during DAA THA. The surgeon needs to apply a 5°. correction factor to the intraoperative measurements to adjust for parallax.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Boettner F, Zingg M, Emara AK, Waldstein W, Faschingbauer M, Kasparek MF (2016) The accuracy of acetabular component position using a novel method to determine anteversion. J Arthroplast 32(4): 1180–1185

    Article  Google Scholar 

  2. Chan YH (2003) Biostatistics 104: correlational analysis. Singap Med J 44(12):614–619

    CAS  Google Scholar 

  3. Cohen J (1988) Statistical power analysis for the behavioral sciences. L. Erlbaum Associates, Hillsdale

    Google Scholar 

  4. Craiovan B, Weber M, Worlicek M et al (2016) Measuring acetabular cup orientation on Antero-Posterior radiographs of the hip after total hip arthroplasty with a vector arithmetic radiological method. Is it valid and verified for daily clinical practice? Rofo 188(6):574–581

    Article  CAS  Google Scholar 

  5. Derbyshire B (2008) Correction of acetabular cup orientation measurements for X-ray beam offset. Med Eng Phys 30(9):1119–1126

    Article  Google Scholar 

  6. Dora C, Houweling M, Koch P, Sierra RJ (2007) Iliopsoas impingement after total hip replacement: the results of non-operative management, tenotomy or acetabular revision. J Bone Jt Surg Brit Vol 89(8):1031–1035

    Article  CAS  Google Scholar 

  7. Falliner A, Muhle C, Brossmann J (2002) Acetabular inclination and anteversion in infants using 3D MR imaging. Acta Radiologica, 43(2):221–224 (Stockholm, Sweden: 1987)

    Article  CAS  Google Scholar 

  8. Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160

    Article  Google Scholar 

  9. Goergen TG, Resnick D (1975) Evaluation of acetabular anteversion following total hip arthroplasty: necessity of proper centring. Br J Radiol 48(568):259–260

    Article  CAS  Google Scholar 

  10. Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ (1998) Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplast 13(5):530–534

    Article  CAS  Google Scholar 

  11. Lembeck B, Mueller O, Reize P, Wuelker N (2005) Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthopaedica 76(4):517–523

    Article  Google Scholar 

  12. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Jt Surg Am Vol 60(2):217–220

    Article  CAS  Google Scholar 

  13. Lu M, Zhou YX, Du H, Zhang J, Liu J (2013) Reliability and validity of measuring acetabular component orientation by plain anteroposterior radiographs. Clin Orthop Relat Res 471(9):2987–2994

    Article  Google Scholar 

  14. Maratt JD, Esposito CI, McLawhorn AS, Jerabek SA, Padgett DE, Mayman DJ (2015) Pelvic tilt in patients undergoing total hip arthroplasty: when does it matter? J Arthroplast 30(3):387–391

    Article  Google Scholar 

  15. McArthur B, Cross M, Geatrakas C, Mayman D, Ghelman B (2012) Measuring acetabular component version after THA: CT or plain radiograph? Clin Orthop Relat Res 470(10):2810–2818

    Article  Google Scholar 

  16. Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Jt Surg Brit Vol 75(2):228–232

    Article  CAS  Google Scholar 

  17. Ross JR, Tannenbaum EP, Nepple JJ, Kelly BT, Larson CM, Bedi A (2015) Functional acetabular orientation varies between supine and standing radiographs: implications for treatment of femoroacetabular impingement. Clin Orthop Relat Res 473(4):1267–1273

    Article  Google Scholar 

  18. Saxler G, Marx A, Vandevelde D et al (2004) The accuracy of free-hand cup positioning—a CT based measurement of cup placement in 105 total hip arthroplasties. Int Orthop 28(4):198–201

    Article  CAS  Google Scholar 

  19. Schrading S, Schulze A (2016) Preoperative diagnostic imaging and planning. Der Orthopade 45(8):644–652

    Article  CAS  Google Scholar 

  20. Schwarz T, Weber M, Worner M, Renkawitz T, Grifka J, Craiovan B (2017) Central X-ray beam correction of radiographic acetabular cup measurement after THA: an experimental study. Int J Comput Assist Radiol Surg 12(5):829–837

    Article  CAS  Google Scholar 

  21. Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA (2006) Estimation of pelvic tilt on anteroposterior X-rays—a comparison of six parameters. Skeletal Radiol 35(3):149–155

    Article  CAS  Google Scholar 

  22. Thoren B, Sahlstedt B (1990) Influence of pelvic position on radiographic measurements of the prosthetic acetabular component. An experimental study on a pelvic model. Acta Radiol 31(2):133–136 (Stockholm, Sweden: 1987)

    CAS  PubMed  Google Scholar 

  23. Waldstein W, Merle C, Schmidt-Braekling T, Boettner F (2014) Does stem design influence component positioning in total hip arthroplasty using a minimal invasive posterolateral approach? Int Orthop 38(7):1347–1352

    Article  Google Scholar 

  24. Widmer KH (2004) A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplast 19(3):387–390

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Kilian Rueckl, Diego J. Alcaide, Bernhard Springer, Stefan Rueckl & Friedrich Boettner

  2. Department of Orthopaedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Maximilian F. Kasparek

Authors
  1. Kilian Rueckl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diego J. Alcaide
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernhard Springer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Rueckl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maximilian F. Kasparek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Friedrich Boettner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Friedrich Boettner.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rueckl, K., Alcaide, D.J., Springer, B. et al. Intraoperative measurement of cup inclination using fluoroscopy requires a correction factor. Arch Orthop Trauma Surg 139, 1511–1517 (2019). https://doi.org/10.1007/s00402-019-03168-w

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-019-03168-w

Keywords

Search

Navigation