Archives of Orthopaedic and Trauma Surgery

, Volume 126, Issue 7, pp 487–492 | Cite as

Misinterpretation of cup anteversion in total hip arthroplasty using planar radiography

  • Axel Marx
  • Marius von Knoch
  • Jörg Pförtner
  • Matthias Wiese
  • Guido Saxler
Orthopaedic Surgery



Anteroposterior pelvic radiographs are routinely used to monitor cup orientation in total hip arthroplasty (THA). Analysis of planar radiographs leads to a certain degree of measurement error for the cup anteversion (AV). With the current study, we wanted to clarify whether planar radiography can be used for accurate evaluation of the THA position.

Materials and methods

The postoperative orientation of pelvic implants in 42 patients was analyzed according to five documented mathematical algorithms using planar radiographs. Postoperative computed tomography (CT) pelvis scans were available for all patients. A CT-based navigation system was used to determine AV.


The comparison showed that all five formulas presented substantial variations for the AV angle. Of these, Widmer’s algorithm presented the smallest difference compared to the CT. Misinterpretation of postoperative planar radiographs is a common problem in THA.


Planar radiographs are too imprecise for exact evaluation of the correct cup AV after THA. CT-based analysis may be necessary if exact values are required.


Hip arthroplasty Anteversion Planar radiography CT-based navigation system 


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Axel Marx
    • 1
  • Marius von Knoch
    • 1
  • Jörg Pförtner
    • 1
  • Matthias Wiese
    • 2
  • Guido Saxler
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Duisburg-EssenEssenGermany
  2. 2.Department of Orthopaedic SurgeryUniversity of BochumBochumGermany

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