Anteroposterior Radiographs Are More Accurate than Cross-Table Lateral Radiographs for Acetabular Anteversion Assessment: a Retrospective Cohort Study

Abstract

Background

Measuring acetabular anteversion is relevant to routine follow-up of total hip arthroplasties (THAs) and for malfunctioning THAs. Imageless navigation facilitates acetabular component orientation relative to the anterior pelvic plane (APP) or to the APP adjusted for sagittal pelvic tilt (PT). The optimal plain radiographic method for the postoperative assessment of anteversion is not agreed upon.

Questions/Purposes

(1) Do anteversion measurements on plain radiographs correlate more with APP anteversion or PT-adjusted anteversion? (2) Do measurements of anteversion performed on supine anteroposterior (AP) radiographs more accurately reflect intraoperative anteversion values for navigated THA compared to anteversion measured on cross-table lateral (CL) radiographs?

Methods

Seventy patients receiving primary navigated THA were included. APP and PT-adjusted anteversion were recorded; the latter defined the intraoperative target for anteversion. Postoperative anteversion was measured on supine AP pelvis radiographs with computer software and CL radiographs with conventional methods. Intraoperative measurements were used as the reference standards for comparisons.

Results

Mean intraoperative APP anteversion was 20.6° ± 5.6°. Mean intraoperative PT-adjusted anteversion was 22.9° ± 4.5°. Mean anteversion was 22.7° ± 4.7° on AP radiographs and 27.2° ± 4.2° on CL radiographs (p < 0.001). Only correlations between PT-adjusted anteversion and radiographic assessments of anteversion were significant. The mean difference between PT-adjusted anteversion and anteversion on AP radiographs was −0.2° ± 4.3°, while the mean difference between the PT-adjusted anteversion and anteversion measured on CL radiographs was 4.3 ± 5.1° (p < 0.001).

Conclusion

Plain film assessment of anteversion was more accurate on supine AP radiographs than on CL radiographs, which overestimated acetabular anteversion.

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Disclosures

Conflict of Interest

Peter K. Sculco, MD, Alexander S. McLawhorn, MD, MBA, Kaitlin Carroll, BA, and Benjamin A. McArthur, MD, have declared that they have no conflict of interest. David J. Mayman, MD, reports other from OrthoAlign and personal fees from Smith & Nephew and Stryker, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was waived from all patients for being included in the study.

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Correspondence to Peter K. Sculco MD.

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Level of Evidence: Level III, Diagnostic Study

Work performed at the Hospital for Special Surgery, New York, NY.

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Sculco, P.K., McLawhorn, A.S., Carroll, K. et al. Anteroposterior Radiographs Are More Accurate than Cross-Table Lateral Radiographs for Acetabular Anteversion Assessment: a Retrospective Cohort Study. HSS Jrnl 12, 32–38 (2016). https://doi.org/10.1007/s11420-015-9472-6

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Keywords

  • total hip replacement
  • computer-assisted surgery
  • radiographic film
  • anteversion
  • diagnostic imaging