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

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.

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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

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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.

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Correspondence to Benjamin Fritz.

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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.

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Written informed consent was waived by the  local ethics committee.

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Local ethics committee approval was obtained.

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• retrospective

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• performed at one institution

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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

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

Keywords

  • Acetabulum
  • Hip joint
  • Radiography
  • Weight-bearing
  • Reproducibility of results