Skip to main content
Log in

Validation of a statistical shape model-based 2D/3D reconstruction method for determination of cup orientation after THA

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to validate the accuracy and reproducibility of a statistical shape model-based 2D/3D reconstruction method for determining cup orientation after total hip arthroplasty. With a statistical shape model, this method allows reconstructing a patient-specific 3D-model of the pelvis from a standard AP X-ray radiograph. Cup orientation (inclination and anteversion) is then calculated with respect to the anterior pelvic plane that is derived from the reconstructed model.

Materials and methods

The validation study was conducted retrospectively on datasets of 29 patients (31 hips). Among them, there were 15 men (15 hips) and 14 women (16 hips). The average age of the patients was 69.4±8.5 (49−82) years. Each dataset has one postoperative X-ray radiograph and one postoperative CT scan. The postoperative CT scan for each patient was used to establish the ground truth for the cup orientation. The cup anteversion and inclination that were calculated from the 2D/3D reconstruction method were compared to the associated ground truth. To validate reproducibility and reliability, two observers performed measurements for each dataset twice in order to measure the reproducibility and the reliability of the 2D/3D reconstruction method.

Results

Our validation study demonstrated a mean accuracy of 0.4 ± 1.8° (−2.6° to 3.3°) for inclination and a mean accuracy of 0.6±1.5° (−2.0° to 3.9°) for anteversion. Through the Bland-Altman analysis, no systematic errors in accuracy were detected. The method showed very good consistency for both parameters.

Conclusions

Our validation results demonstrate that the statistical shape model-based 2D/3D reconstruction-based method is an accurate, consistent, and reproducible technique to measure cup orientation from postoperative X-ray radiographs. The best results were achieved with radiographs including the bilateral anterior superior iliac spines and the cranial part of non-fractured pelvises.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ali Kahn MA, Brakenbury PH, Reynolds IS (1981) Dislocation following total hip replacement. J Bone Joint Surg Br 63(B): 214–218

    Google Scholar 

  2. McCollum DE, Gray WJG (1990) Dislocation after total hip arthroplasty. Causes and prevention. Clin Orthop 261: 159–170

    PubMed  Google Scholar 

  3. Sarmiento A, Ebramzadeh E, Gogan WJ, McKellop HA (1990) Cup containment and orientation in cemented total hip arthroplasties. J Bone Joint Surg Br 72: 996–1002

    PubMed  CAS  Google Scholar 

  4. Bader RJ, Steinhauser E, Willmann G, Gradinger R (2001) The effects of implant position, design and wear on the range of motion after total hip arthroplasty. Hip Int 11: 80–90

    Google Scholar 

  5. 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

    PubMed  CAS  Google Scholar 

  6. Patil S, Bergula A, Chen PC, Colwell CW Jr, D’Lima DD (2003) Polyethylene wear and acetabular component orientation. J Bone Joint Surg Am 85: 56–63

    PubMed  Google Scholar 

  7. Widmer KH (2007) Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty. Int Orthop 31(suppl 1): S29–S33

    Article  PubMed  Google Scholar 

  8. Kalteis T, Handel M, Herold T, Perlick L, Paetzel C, Grifka J (2006) Position of the acetabular cup-accuracy of radiographic calculation compared to CT-based measurement. Eur J Radiol 58: 294–300

    Article  PubMed  Google Scholar 

  9. Marx A, 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 

  10. Tannast M, Zheng G, Anderegg C et al (2005) Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop 438: 182–190

    PubMed  CAS  Google Scholar 

  11. Pradhan R (1999) Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg Br 81(B): 431–435

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Della Valle CJ, Kaplan K, Jazrawi A, Ahmed S, Jaffe WL (2004) Primary total hip arthroplasty with a flanged, cemented all-polyethylene acetabular component: evaluation at a minimum of 20 years. J Arthroplasty 19: 23–26

    Article  PubMed  Google Scholar 

  14. Arai N, Nakamura S, Matsushita T, Suzuki S (2010) Minimal radiation dose computed tomography for measurement of cup orientation in total hip arthroplasty. J Arthroplasty 25: 263–267

    Article  PubMed  Google Scholar 

  15. LaRose D, Cassenti L, Jaramaz B, Moody JE, Kanade T, DiGioia AM (2000) Post-operative measurement of acetabular cup position using X-ray/CT registration. In: Proceedings of the 3rd international conference on medical image computing and computer-assisted intervention (MICCAI), LNCS 1935, 1104–1113

  16. Blendea S, Eckman K, Jaramaz B, Levison TJ, DiGioia AM (2005) Measurements of acetabular cup position and pelvic spatial orientation after total hip arthroplasty using computed tomography/radiography matching. Comput Aided Surg 10: 37–43

    PubMed  Google Scholar 

  17. Jaramaz B, Eckman K (2006) 2D/3D registration for measurement of implant alignment after total hip replacement. In: Proceedings of the 9th international conference on medical image computing and computer-assisted intervention (MICCAI), LNCS 4191, 653–661

  18. Penney GP, Edwards PJ, Hipwell JH, Slomczykowski M, Revie I, Hawkes DJ (2007) Postoperative calculation of acetabular cup position using 2D-3D registration. IEEE Trans Biomed Eng 54: 1342–1348

    Article  PubMed  Google Scholar 

  19. Zheng G, Steppacher S, Zhang X, Tannast M (2007) Precise estimation of postoperative cup alignment from single standard X-ray radiograph with gonadal shielding. In: Proceedings of 2007 international conference on medical image computing and computer assisted intervention (MICCAI), LNCS 4792, 951–959

  20. Zheng G, Zhang X (2010) Computer assisted determination of acetabular cup orientation using 2D-3D image registration. Int J CARS 5: 437–447

    Article  Google Scholar 

  21. Steppacher SD, Tannast M, Zheng G et al (2009) Validation of a new method for determination of cup orientation in THA. J Orthop Res 27: 1583–1588

    Article  PubMed  Google Scholar 

  22. Jaramaz B, DiGioia AM, Blackwell M, Nikou C (1998) Computer assisted measurement of cup placement in total hip replacement. Clin Orthop 354: 70–81

    Article  PubMed  Google Scholar 

  23. Tannast M, Langlotz U, Siebenrock KA, Wiese M, Bernsmann K, Langlotz F (2005) Anatomical referencing of cup orientation in total hip arthroplasty. Clin Orthop 436: 144–150

    PubMed  Google Scholar 

  24. Langlotz U, Grützner PA, Bernsmann K et al (2007) Accuracy considerations in navigated cup placement for THR. Proc Inst Mech Eng [H] 221: 739–753

    CAS  Google Scholar 

  25. Zheng G (2009) Statistically deformable 2D/3D registration for accurate determination of post-operative cup orientation from single standard X-ray radiograph. In: Proceedings of the 12th international conference on medical image computing and computer-assisted intervention (MICCAI), LNCS 5761, 820–827

  26. Zheng G (2010) Statistically deformable 2D/3D registration for estimating post-operative cup orientation from a single standard AP X-ray radiograph. Ann Biomed Eng 38(9): 2910–2927

    Article  PubMed  Google Scholar 

  27. Seradge H, Nagle KR, Miller RJ (1982) Analysis of version in the acetabular cup. Clin Orthop 166: 152–157

    PubMed  Google Scholar 

  28. Bland JM, Altman DG (1996) Measurement error and correlation coefficients. BMJ 313(7048): 41–42

    Article  PubMed  CAS  Google Scholar 

  29. http://faculty.vassar.edu/lowry/webtext.html

  30. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476): 307–310

    Article  PubMed  CAS  Google Scholar 

  31. Tannast M, Mistry S, Steppacher SD et al (2008) Radiographic analysis of femoroacetabular impingement with Hip2Norm—reliable and validated. J Orthop Res 26: 1199–1205

    Article  PubMed  Google Scholar 

  32. Lin F, Lim D, Wixson RL, Milos S, Hendrix RW, Makhsous M (2008) Validation of a computer navigation system and a CT method for determination of the orientation of implanted acetabular cup in total hip arthroplasty: a cadaver study. Clin Biomech 23: 1004–1011

    Article  Google Scholar 

  33. Beckmann J, Lüring C, Tingart M, Anders S, Grifka J, Köck FX (2009) Cup positioning in THA: current status and pitfalls. A systematic evaluation of the literature. Arch Othop Trauma Surg 129: 863–872

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G. Zheng.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zheng, G., von Recum, J., Nolte, LP. et al. Validation of a statistical shape model-based 2D/3D reconstruction method for determination of cup orientation after THA. Int J CARS 7, 225–231 (2012). https://doi.org/10.1007/s11548-011-0644-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11548-011-0644-7

Keywords

Navigation