Skip to main content
SpringerLink
Log in

Acetabular coverage differs between standing and supine positions: model-based assessment of low-dose biplanar radiographs and comparison with CT

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the feasibility of 2D and 3D acetabular coverage assessments based on low-dose biplanar radiographs (BPR) in comparison with CT, and to demonstrate the influence of weight-bearing position (WBP) on anterior and posterior acetabular coverages.

Methods

Fifty patients (21 females, 29 males) underwent standing BPR and supine CT of the pelvis. Using dedicated software, BPR-based calculations of anterior and posterior 2D coverages and anterior, posterior, and global 3D coverages were performed in standardized anterior pelvic plane (APP) and WBP. CT-based anterior and posterior 2D coverages and global 3D coverage was calculated in APP and compared with BPR-based data. Statistics included intraclass correlation coefficients (ICC) and Bland-Altman plots.

Results

Mean anterior 2D coverage was 21.2% (standard deviation, ± 7.4%) for BPR and 23.8% (± 8.4%) for CT (p = 0.226). Mean posterior 2D coverage was 54.2% (± 9.8%) for BPR and 61.7% (± 9.7%) for CT (p = 0.001). Mean global 3D coverage was 46.5% (± 3.0%) for BPR and 45.6% (± 3.6%) for CT (p = 0.215). The inter-method reliability between CT and BPR and inter-reader reliability for BPR-based measurements were very good for all measurement (all ICC > 0.8). Based on BPR, mean anterior and posterior 3D coverages were 20.5% and 26.0% in WBP and APP, while 25 patients increased anterior and 24 patients increased posterior 3D coverage from APP to WBP with a relative change of coverage of up to 11.9% and 10.0%, respectively.

Conclusions

2D and 3D acetabular coverages can be calculated with very good reliability based on BPR. The impact of standing position on acetabular coverage can be quantified with BPR on an individual basis.

Key Points

• 2D and 3D acetabular coverages can be calculated with very good reliability based on biplanar radiographs in comparison with CT.

• The impact of standing position on anterior and posterior acetabular coverages can be quantified with BPR on an individual basis.

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
Fig. 6

Similar content being viewed by others

Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

APP:

Anterior pelvic plane

BPR:

Biplanar radiographs

CT:

Computer tomography

FAI:

Femoroacetabular impingement

ICC:

Intraclass correlation coefficient

WBP:

Weight-bearing position

References

  1. Klaue K, Wallin A, Ganz R (1988) CT evaluation of coverage and congruency of the hip prior to osteotomy. Clin Orthop Relat Res:15–25

  2. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. https://doi.org/10.1097/01.blo.0000096804.78689.c2:112-120

  3. Larson CM, Moreau-Gaudry A, Kelly BT et al (2015) Are normal hips being labeled as pathologic? A CT-based method for defining normal acetabular coverage. Clin Orthop Relat Res 473:1247–1254

    Article  PubMed  Google Scholar 

  4. Pullen WM, Henebry A, Gaskill T (2014) Variability of acetabular coverage between supine and weightbearing pelvic radiographs. Am J Sports Med 42:2643–2648

    Article  PubMed  Google Scholar 

  5. Mascarenhas VV, Rego P, Dantas P et al (2018) Can we discriminate symptomatic hip patients from asymptomatic volunteers based on anatomic predictors? A 3-dimensional magnetic resonance study on cam, pincer, and spinopelvic parameters. Am J Sports Med 46:3097–3110

    Article  PubMed  Google Scholar 

  6. Ferre R, Gibon E, Hamadouche M, Feydy A, Drape JL (2014) Evaluation of a method for the assessment of anterior acetabular coverage and hip joint space width. Skeletal Radiol 43:599–605

    Article  PubMed  Google Scholar 

  7. Fader RR, Tao MA, Gaudiani MA et al (2018) The role of lumbar lordosis and pelvic sagittal balance in femoroacetabular impingement. Bone Joint J 100-B:1275–1279

    Article  CAS  PubMed  Google Scholar 

  8. Steppacher SD, Lerch TD, Gharanizadeh K et al (2014) Size and shape of the lunate surface in different types of pincer impingement: theoretical implications for surgical therapy. Osteoarthritis Cartilage 22:951–958

    Article  CAS  PubMed  Google Scholar 

  9. Fukushima K, Miyagi M, Inoue G et al (2018) Relationship between spinal sagittal alignment and acetabular coverage: a patient-matched control study. Arch Orthop Trauma Surg 138:1495–1499

    Article  PubMed  Google Scholar 

  10. Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br 81:281–288

    Article  CAS  PubMed  Google Scholar 

  11. Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint with special reference to the complication of osteoarthritis. Acta Chir Scand 83:53–68

    Google Scholar 

  12. Lequesne M (1963) Coxometry. Measurement of the basic angles of the adult radiographic hip by a combined protractor. Rev Rhum Mal Osteoartic 30:479–485

    CAS  PubMed  Google Scholar 

  13. Siebenrock KA, Kistler L, Schwab JM, Buchler L, Tannast M (2012) The acetabular wall index for assessing anteroposterior femoral head coverage in symptomatic patients. Clin Orthop Relat Res 470:3355–3360

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tannast M, Fritsch S, Zheng G, Siebenrock KA, Steppacher SD (2015) Which radiographic hip parameters do not have to be corrected for pelvic rotation and tilt? Clin Orthop Relat Res 473:1255–1266

    Article  PubMed  Google Scholar 

  15. Henebry A, Gaskill T (2013) The effect of pelvic tilt on radiographic markers of acetabular coverage. Am J Sports Med 41:2599–2603

    Article  PubMed  Google Scholar 

  16. Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J (2008) Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg Br 90:1428–1434

    Article  CAS  PubMed  Google Scholar 

  17. Miyasaka D, Ito T, Imai N et al (2014) Three-dimensional assessment of femoral head coverage in normal and dysplastic hips: a novel method. Acta Med Okayama 68:277–284

    PubMed  Google Scholar 

  18. Chaibi Y, Cresson T, Aubert B et al (2012) Fast 3D reconstruction of the lower limb using a parametric model and statistical inferences and clinical measurements calculation from biplanar X-rays. Comput Methods Biomech Biomed Engin 15:457–466

    Article  CAS  PubMed  Google Scholar 

  19. Chiron P, Demoulin L, Wytrykowski K, Cavaignac E, Reina N, Murgier J (2017) Radiation dose and magnification in pelvic X-ray: EOS imaging system versus plain radiographs. Orthop Traumatol Surg Res 103:1155–1159

    Article  CAS  PubMed  Google Scholar 

  20. Dietrich TJ, Pfirrmann CW, Schwab A, Pankalla K, Buck FM (2013) Comparison of radiation dose, workflow, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose X-ray system for upright full-length lower limb and whole spine radiography. Skeletal Radiol 42:959–967

    Article  PubMed  Google Scholar 

  21. Buck FM, Guggenberger R, Koch PP, Pfirrmann CW (2012) Femoral and tibial torsion measurements with 3D models based on low-dose biplanar radiographs in comparison with standard CT measurements. AJR Am J Roentgenol 199:W607–W612

    Article  PubMed  Google Scholar 

  22. Agten CA, Jonczy M, Ullrich O, Pfirrmann CWA, Sutter R, Buck FM (2017) Measurement of acetabular version based on biplanar radiographs with 3D reconstructions in comparison to CT as reference standard in cadavers. Clin Anat 30:591–598

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  24. Schindelin J, Arganda-Carreras I, Frise E et al (2012) Fiji: an open-source platform for biological-image analysis. Nat Methods 9:676–682

    Article  CAS  PubMed  Google Scholar 

  25. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  CAS  PubMed  Google Scholar 

  26. Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284–290

    Article  Google Scholar 

  27. Siebenrock KA, Scholl E, Lottenbach M, Ganz R (1999) Bernese periacetabular osteotomy. Clin Orthop Relat Res:9–20

  28. Steppacher SD, Tannast M, Ganz R, Siebenrock KA (2008) Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 466:1633–1644

    Article  PubMed  PubMed Central  Google Scholar 

  29. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res:67–73

  30. Peters CL, Erickson JA (2006) Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am 88:1735–1741

    Article  PubMed  Google Scholar 

  31. Hansen BJ, Harris MD, Anderson LA, Peters CL, Weiss JA, Anderson AE (2012) Correlation between radiographic measures of acetabular morphology with 3D femoral head coverage in patients with acetabular retroversion. Acta Orthop 83:233–239

    Article  PubMed  PubMed Central  Google Scholar 

  32. Riviere C, Hardijzer A, Lazennec JY, Beaule P, Muirhead-Allwood S, Cobb J (2017) Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: a systematic review. Orthop Traumatol Surg Res 103:549–557

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Nasr Makni and Omar Gachouch for their work on the custom-made software packages. This project has been performed in cooperation with EOS imaging Inc., which provided the prototype software evaluated in this study. The authors had full control over the data at any point in time and guarantee the accuracy of the presented data and integrity of the study.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, University Hospital Balgrist, Forchstrasse 340, CH-8008, Zurich, Switzerland

    Benjamin Fritz, Christoph A. Agten, Franca K. Boldt, Christian W. A. Pfirrmann & Reto Sutter

  2. Faculty of Medicine, University of Zurich, Zurich, Switzerland

    Benjamin Fritz, Christoph A. Agten, Franca K. Boldt, Patrick O. Zingg, Christian W. A. Pfirrmann & Reto Sutter

  3. Department of Orthopedics, University Hospital Balgrist, Forchstrasse 340, Zurich, Switzerland

    Patrick O. Zingg

Authors
  1. Benjamin Fritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph A. Agten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Franca K. Boldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick O. Zingg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian W. A. Pfirrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reto Sutter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Fritz.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Reto Sutter.

Conflict of interest

The authors of this manuscript declare relationships with the following company: EOS imaging Inc.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the  local ethics committee.

Ethical approval

Local ethics committee approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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

Fritz, B., Agten, C.A., Boldt, F.K. et al. Acetabular coverage differs between standing and supine positions: model-based assessment of low-dose biplanar radiographs and comparison with CT. Eur Radiol 29, 5691–5699 (2019). https://doi.org/10.1007/s00330-019-06136-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-019-06136-5

Keywords

Search

Navigation