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Pelvic Flexion Measurement From Lateral Projection Radiographs is Clinically Reliable

  • Basic Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Pelvic flexion affects orientation of the acetabular cup; however, pelvic position is not static in daily activities. During THA it is difficult to know the degree of pelvic flexion with the patient in the lateral position and that position is static. However, surgeons need to appropriately determine pelvic tilt to properly insert the acetabular component.

Questions/purposes

We investigated the reliability of pelvic flexion angle that was measured by manually identifying the location of the pubic symphysis and bilateral anterior superior iliac spines using synthesized lateral radiographs.

Methods

We synthesized 49 lateral radiographs based on CT data. Each of the 49 radiographs had a unique position: 7° of varying lateral tilt and rotation in each of seven selected pelvic flexion angles. The pelvic flexion angle was measured three times by three independent observers in each position and determined the accuracy (based on the true value from the reconstructions) and reliability of the measures.

Results

The measurement error was 0.1° (range, −4.8° to 4.0°). There was a tendency for errors when the pelvic flexion angle was 0° or ± 5°; the errors were less when the pelvic flexion angle was ± 10° or ± 20°. Lateral tilt was associated with greater error than rotation. The intraclass correlation coefficient (ICC) of the average value was 0.967. For one observer, more than two measurements are necessary for the ICC to be greater than 0.8, and only one measurement was needed for two of the three observers.

Conclusions

Our data suggest measurement of pelvic flexion angle using lateral radiographs is reliable. We recommend the measurement be performed once by two observers for better reliability.

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Acknowledgments

We thank Hayato Suzuki MD, Ryota Takubo MD, and Yoji Horigome MD, for their useful input in this study.

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Authors and Affiliations

  1. Department of Orthopaedics Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachidori, Niigata, Japan

    Norio Imai MD, Tomoyuki Ito PhD, Ken Suda MD, Dai Miyasaka PhD & Naoto Endo PhD

Authors
  1. Norio Imai MD
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  2. Tomoyuki Ito PhD
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  3. Ken Suda MD
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  4. Dai Miyasaka PhD
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  5. Naoto Endo PhD
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Corresponding author

Correspondence to Norio Imai MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Imai, N., Ito, T., Suda, K. et al. Pelvic Flexion Measurement From Lateral Projection Radiographs is Clinically Reliable. Clin Orthop Relat Res 471, 1271–1276 (2013). https://doi.org/10.1007/s11999-012-2700-1

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  • DOI: https://doi.org/10.1007/s11999-012-2700-1

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