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A new radiographic acetabular cup anteversion measurement method in total hip arthroplasty: a clinical study

  • Original Article • HIP - ARTRHOPLASTY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

The acetabular cup positioning is one of the most crucial steps affecting stability and wear rates in total hip arthroplasty. Different methods have been described for determining the anteversion of the acetabular cup in the literature. But there is still not a widely accepted method to assess the acetabular anteversion radiography. The aim of this study is to measure the acetabular anteversion angle on a single pelvis AP radiography with our method which was proven with an experimental study before.

Materials and methods

A total of 15 patients (8 males, 7 females) who underwent total hip arthroplasty and have had a pelvis computed tomography scans in our outpatient clinic were evaluated retrospectively. The anteversion angle was calculated in all of pelvis CT scans. For radiological measurement, the formula defined by the authors in an experimental model previously was used.

Results

Statistically significant difference was not determined between radiographic and CT-based measurements (p = 0.207; p > 0.05). A statistically significant agreement was observed at a level of 98.8% between radiographic and CT-based measurements (ICC = 0.988; 95% CI 0.966–0.996; p < 0.01).

Conclusion

Assessment of the acetabular cup anteversion is very important to predict the possible complications after total hip arthroplasty. Although many methods have been defined for this purpose, each of these has advantages and disadvantages. In particular, with computed tomography method, the patient is exposed to excessive radiation, whereas we think that our method is a preferred method due to features not requiring additional equipment, low radiation exposure, being simple, cost-effectiveness, easily applicable and almost 100% accurate.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Hisar İntercontinental Hospital, Istanbul, Turkey

    G. Saka

  2. Department of Orthopedics and Traumatology, Ümraniye Research and Education Hospital, Istanbul, Turkey

    G. Altun

  3. Department of Orthopedics and Traumatology, Beykent University Faculty of Medicine, Istanbul, Turkey

    H. Burc

  4. Department of Orthopedics and Traumatology, Bosphorus Spine Center, Istanbul, Turkey

    M. Aydogan

Authors
  1. G. Saka
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  2. G. Altun
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  3. H. Burc
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  4. M. Aydogan
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Corresponding author

Correspondence to G. Altun.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Appendix: The mathematical explanation of the formula

Appendix: The mathematical explanation of the formula

OA = OB = OE = r


OP1 = OP2 = r


When the AP1B circle turns around AB as much as AP2B, the turning angle will be P1OP2 = α.


While the view of AP1B circle is AB line, the view (projection) of AP2BP3 circle is ACBD ellipse.


OP1P2E ┴ AB = OP1 ┴ AB, OP2 ┴ AB, OP1 ┴ OE


OP1//P2C and CP2O angle is equal α angle.


P2C ┴ OE (projection) OC = b OP2 = r


OP2C right triangle, sin α = OC/OP2 = b/r


AB: distance between two tips of ellipse


AK: distance between P point and projection of P point on AB line.


P point: the optimum point which was not superimposed by the head and neck of the femoral component on the ellipse.


K point: projection of P point on AB line


Ellipse equation x2/a2 + y2/b2 = 1 here; OA = a = r, OC = b


PK and KA are measurable lengths, PK = y, OK = x = OA–AK = r − l


x2/a2 + y2/b2 = 1 · (a2b2)


b2x2 + a2y2 = a2b2 ± b2x2 ± a2b2 = ± a2y2 · (− 1)


b2 (a2 − × 2) = a2y2


b2 = a2y2/a2–x2 b = ay/√a2 − x2a = r,


x = (r − l) to find b.


x2 = r2 − 2rl + l2


sin α = b/a = y/√r2 − r2 + 2rl − l2 = y/√2rl − l2


=PK/√2r · AK − AK2 = PK/√AK(2r − AK)


2r − AK = BK Sin α = PK/√AK · BK


α  = arc sin PK/√AK · BK

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Saka, G., Altun, G., Burc, H. et al. A new radiographic acetabular cup anteversion measurement method in total hip arthroplasty: a clinical study. Eur J Orthop Surg Traumatol 29, 813–818 (2019). https://doi.org/10.1007/s00590-019-02384-9

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