Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of radiological methods of assessing cup anteversion in total hip replacement

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

Abstract

Study design

Prospective clinical study.

Back ground

In total hip replacement, the placement of the cup is critical as inaccurate placement can cause impingement, accelerated wear and dislocations. The position of the cup is assessed by abduction and anteversion. There are many radiological methods available for this purpose, while the reliability and validity of the methods have not been adequately done. Calculation by CT method is a gold standard. The aim of study was to evaluate the reliability and validity of all the methods.

Methods

In 30 hips of 25 consecutive patients, 13 females and 12 males who underwent primary total hip replacement in our institution, the component version in all the five radiological methods was calculated and compared with CT evaluation of angles. The intra- and interobserver reliabilities were assessed.

Results

Average CT measurement was 23.28 for anteversion. Lewinnek, Liaw, Hassan, Widmer and Ritun methods had average deviation of 4.330, 4.390, 4.880, 6.840 and 6.220, respectively. All the radiographic and CT methods had excellent intra- and interobserver reliabilities (C.I. 0.894–0.960 and 0.861–0.953). All the methods except Widmer had a significant validity against CT.

Conclusion

Plain X-rays (AP) are reliable for measuring cup anteversion. Lewinnek, Liaw, Riten and Hassans methods for calculation of cup anteversion are closer to CT in accuracy (p value >0.05). Widmer method varies significantly (p value <0.05) from CT.

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
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg [Br] 75-B:228–232

    Google Scholar 

  2. Lu M, Zhou YX, Du H, Zhang J, Liu J (2013) Reliability and validity of measuring acetabular component orientation by plain antero–posterior radiographs. Clin Orthop Relat Res 471:2987–2994

    Article  PubMed Central  PubMed  Google Scholar 

  3. Nishino H, Nakamura S, Arai N, Matsushita T (2013) Accuracy and precision of version angle measurements of the acetabular component after total hip arthroplasty. J Arthroplasty 28:1644–1647

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  5. Widmer KH (2004) A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty 19:387–390

    Article  PubMed  Google Scholar 

  6. Hassan DM, Johnston GH, Dust WN, Watson LG, Cassidy D (1995) Radiographic calculation of anteversion in acetabular prostheses. J Arthroplasty 10:369–372

    Article  CAS  PubMed  Google Scholar 

  7. Liaw CK, Hou SM, Yang RS, Wu TY, Fuh CS (2006) A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs. Clin Orthop Relat Res 451:134–139

    Article  PubMed  Google Scholar 

  8. Pradhan R (1999) Planar anteversion of the acetabular cup as determined from plain antero-posterior radiographs. J Bone Joint Surg [Br] 81-B:431–435

    Article  Google Scholar 

  9. Charnley J (1970) Total hip replacement by low friction arthroplasty. Clin Orthop 72:7–21

    CAS  PubMed  Google Scholar 

  10. McArthur B, Cross M, Geatrakas C, Mayman D, Ghelman B (2012) Measuring acetabular component version after THA: CT or plain radiograph? Clin Orthop Relat Res 470:2810–2818

    Article  PubMed Central  PubMed  Google Scholar 

  11. Marx A, von Knoch M, Pförtner J, Wiese M, Saxler G (2006) Misinterpretation of cup anteversion in total hip arthroplasty using planar radiography. Arch Orthop Trauma Surg 126:487–492

    Article  PubMed  Google Scholar 

  12. Visser JD, Konings JG (1981) A new method for measuring angles after total hip arthroplasty. A study of the acetabular cup and femoral component. J Bone Joint Surg [Br] 63-B:556–559

    Google Scholar 

  13. Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg [Am] 64-A:1295–1306

    Google Scholar 

  14. Nho JH, Lee YK, Kim HJ et al (2012) Reliability and validity of measuring version of the acetabular component. J Bone Joint Surg [Br] 94-B:32–36

    Article  Google Scholar 

  15. McKibbin B (1970) Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg [Br] 52-B:148–159

    Google Scholar 

  16. Ackland MK, Bourne WB, Uhthoff HK (1986) Ante-version of the acetabular cup. Measurement of angle after total hip replacement. J Bone Joint Surg [Br] 68-B:409–413

    Google Scholar 

  17. Mian SW, Truchly G, Pflum FA (1992) Computed tomography measurement of acetabular cup anteversion and retroversion in total hip arthroplasty. Clin Orthop Relat Res 276:206–209

    PubMed  Google Scholar 

  18. Babisch JW, Layher F, Amiot LP (2008) The rationale for tilt-adjusted acetabular cup navigation. J Bone Joint Surg [Am] 90:357–365

    Article  Google Scholar 

  19. Widmer KH, Zurfluh B (2004) Compliant positioning of total hip components for optimal range of motion. J Orthop Res 22:815–821

    Article  PubMed  Google Scholar 

  20. Jolles BM, Zangger P, Leyvraz PF (2002) Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty 17:282–288

    Article  CAS  PubMed  Google Scholar 

  21. Olivecrona H, Weidenhielm L, Olivecrona L et al (2004) A new CT method for measuring cup orientation after total hip arthroplasty: a study of 10 patients. Acta Orthop Scand 75:252–260

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bangalore Medical College and Research Institute, Bangalore, India

    K. S. Manjunath

  2. Department of Orthopaedics, Bangalore Medical College and Research Institute, Bangalore, India

    Vijaya Soruban & K. G. Gopalakrishna

Authors
  1. K. S. Manjunath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vijaya Soruban
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. G. Gopalakrishna
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. S. Manjunath.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights and disclosures

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manjunath, K.S., Soruban, V. & Gopalakrishna, K.G. Evaluation of radiological methods of assessing cup anteversion in total hip replacement. Eur J Orthop Surg Traumatol 25, 1285–1292 (2015). https://doi.org/10.1007/s00590-015-1702-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-015-1702-6

Keywords

Search

Navigation