Archives of Orthopaedic and Trauma Surgery

, Volume 125, Issue 5, pp 291–297

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

  • Rainer Schmidt
  • Rocco Paolo Pitto
  • Alexander Kress
  • Cornelia Ehremann
  • Tobias Eckhard Nowak
  • Udo Reulbach
  • Raimund Forst
  • Lutz Müller
Original Article



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 


  1. 1.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310Google Scholar
  2. 2.
    Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop 257:107–128Google Scholar
  3. 3.
    Engh CA, McGovern TF, Bobyn JD, Harris WH (1992) A quantitative evaluation of periprosthetic bone-remodeling after cementless total hip arthroplasty. J Bone Joint Surg Am 74:1009–1020Google Scholar
  4. 4.
    Engh CA, McGovern TF, Schmidt LM (1993) Roentgenographic densitometry of bone adjacent to a femoral prosthesis. Clin Orthop 292:177–190Google Scholar
  5. 5.
    Gluer CC, Faulkner KG, Estilo MJ, Engelke K, Rosin J, Genant HK (1993) Quality assurance for bone densitometry research studies: concept and impact. Osteoporos Int 3:227–235Google Scholar
  6. 6.
    Gruen TA, McNeice GM, Amstutz HC (1979) ‘Modes of failure’ of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 141:17–27Google Scholar
  7. 7.
    Harris WH (1992) The first 32 years of total hip arthroplasty. One surgeon’s perspective. Clin Orthop 274:6–11Google Scholar
  8. 8.
    Harris WH (1992) Will stress shielding limit the longevity of cemented femoral components of total hip replacement? Clin Orthop 274:120–123Google Scholar
  9. 9.
    Harris WH (1994) Osteolysis and particle disease in hip replacement. A review. Acta Orthop Scand 65:113–123Google Scholar
  10. 10.
    Huiskes R (1987) Finite element analysis of acetabular reconstruction. Noncemented threaded cups. Acta Orthop Scand 58:620–625Google Scholar
  11. 11.
    Huiskes R, Weinans H, Dalstra M (1989) Adaptive bone remodeling and biomechanical design considerations for noncemented total hip arthroplasty. Orthopedics 12:1255–1267Google Scholar
  12. 12.
    Huiskes R, Weinans H, Rietbergen B van (1992) The relationship between stress shielding and bone resorption around total hip stems and the effects of flexible materials. Clin Orthop 274:124–134Google Scholar
  13. 13.
    Jasty M, Bragdon C, Jiranek W, Chandler H, Maloney W, Harris WH (1994) Etiology of osteolysis around porous-coated cementless total hip arthroplasties. Clin Orthop 308:111–126Google Scholar
  14. 14.
    Karrholm J, Herberts P, Hultmark P, Malchau H, Nivbrant B, Thanner J (1997) Radiostereometry of hip prostheses. Review of methodology and clinical results. Clin Orthop 344:94–110Google Scholar
  15. 15.
    Kiratli BJ, Checovich MM, McBeath AA, Wilson MA, Heiner JP (1996) Measurement of bone mineral density by dual-energy x-ray absorptiometry in patients with the Wisconsin hip, an uncemented femoral stem. J Arthroplasty 11:184–193Google Scholar
  16. 16.
    Kroger H, Venesmaa P, Jurvelin J, Miettinen H, Suomalainen O, Alhava E (1998) Bone density at the proximal femur after total hip arthroplasty. Clin Orthop 352:66–74Google Scholar
  17. 17.
    Levenston ME, Beaupre GS, Schurman DJ, Carter DR (1993) Computer simulations of stress-related bone remodeling around noncemented acetabular components. J Arthroplasty 8:595–605Google Scholar
  18. 18.
    Markel MD, Gottsauner-Wolf F, Bogdanske JJ, Wahner HW, Chao EY (1993) Dual energy x-ray absorptiometry of implanted femora after cemented and press-fit total hip arthroplasty in a canine model. J Orthop Res 11:452–456Google Scholar
  19. 19.
    Pellicci PM, Salvati EA, Robinson HJ (1979) Mechanical failures in total hip replacement requiring reoperation. J Bone Joint Surg Am 61:28–36Google Scholar
  20. 20.
    Reiter A, Sabo D, Simank HG, Buchner T, Seidel M, Lukoschek M (1997) Periprosthetic mineral density in cement-free hip replacement arthroplasty (in German). Z Orthop 135:499–504Google Scholar
  21. 21.
    Robertson DD, Magid D, Poss R, Fishman EK, Brooker AF, Sledge CB (1989) Enhanced computed tomographic techniques for the evaluation of total hip arthroplasty. J Arthroplasty 4:271–276Google Scholar
  22. 22.
    Sabo D, Reiter A, Simank HG, Thomsen M, Lukoschek M, Ewerbeck V (1998) Periprosthetic mineralization around cementless total hip endoprosthesis: longitudinal study and cross-sectional study on titanium threaded acetabular cup and cementless Spotorno stem with DEXA. Calcif Tissue Int 62:177–182Google Scholar
  23. 23.
    Santavirta S, Hoikka V, Eskola A, Konttinen YT, Paavilainen T, Tallroth K (1990) Aggressive granulomatous lesions in cementless total hip arthroplasty. J Bone Joint Surg Br 72:980–984Google Scholar
  24. 24.
    Schmidt R, Freund J, Hirschfelder H, Pitto RP (2000) Osteodensitometry in uncemented total hip arthroplasty using computer tomography. Biomed Tech (Berl) 45:70–74Google Scholar
  25. 25.
    Schmidt R, Muller L, Kress A, Hirschfelder H, Aplas A, Pitto RP (2002) A computed tomography assessment of femoral and acetabular bone changes after total hip arthroplasty. Int Orthop 26:299–302Google Scholar
  26. 26.
    Wilkinson JM, Peel NF, Elson RA, Stockley I, Eastell R (2001) Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty. J Bone Joint Surg Br 83:283–288Google Scholar
  27. 27.
    Wright JM, Pellicci PM, Salvati EA, Ghelman B, Roberts MM, Koh JL (2001) Bone density adjacent to press-fit acetabular components. A prospective analysis with quantitative computed tomography. J Bone Joint Surg Am 83:529–536Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Rainer Schmidt
    • 1
  • Rocco Paolo Pitto
    • 2
  • Alexander Kress
    • 1
  • Cornelia Ehremann
    • 1
  • Tobias Eckhard Nowak
    • 1
  • Udo Reulbach
    • 3
  • Raimund Forst
    • 1
  • Lutz Müller
    • 1
  1. 1.Department of OrthopaedicsUniversity of Erlangen-NuernbergErlangenGermany
  2. 2.Department of Orthopaedic SurgeryUniversity of Auckland, Middlemore HospitalNew Zealand
  3. 3.Institut für Medizininformatik, Biometrie und EpidemiologieUniversity of Erlangen-NuernbergErlangenGermany

Personalised recommendations