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CT Outperforms Radiography for Determination of Acetabular Cup Version after THA

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Clinical Orthopaedics and Related Research®

Abstract

Precise evaluation of acetabular cup version is necessary for patients with recurrent hip dislocation after THA. We retrospectively studied 42 patients, who underwent THAs, with multiple cross-table lateral radiographs and CT scans to determine whether radiographic or CT measurement of acetabular component version is more accurate. One observer measured cup version on all radiographs. CT scans were interpreted by one observer. Twenty radiographs were measured twice each by two observers to determine intraobserver and interobserver reliability. We implanted cups in four model pelvises using navigation and compared measurements of anteversion made with radiographs and CT scans. Intraclass correlation coefficients (ICC) for anteversion measurements of two observers were 0.9990 and 0.9998, respectively, when comparing measurements of identical radiographs (intraobserver). Paired values for two observers measuring the same radiograph had an ICC of 0.9686 (interobserver) compared with 0.7412 for measurements from serial radiographs of the same component. The ICC comparing radiographic versus CT-based measurements was 0.6981. CT measurements had stronger correlations with navigated values than radiographic measurements. Accuracy of anteversion measurements on cross-table radiographs depends on radiographic technique and patient positioning whereas properly performed CT measurements are independent of patient position.

Level of Evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Dr. Thomas P. Sculco for allowing use of his patients in this study, Clara Hilario for assistance in the computer navigation laboratory, and Gregory Schack of Smith and Nephew for donating the computer navigation system and acetabular components used in the study.

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Authors and Affiliations

  1. Department of Radiology, Hospital for Special Surgery, New York, NY, USA

    Bernard Ghelman MD

  2. The Hip and Knee Service—Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Christopher K. Kepler MD, MBA & Alejandro González Della Valle MD

  3. Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA

    Stephen Lyman PhD

Authors
  1. Bernard Ghelman MD
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  2. Christopher K. Kepler MD, MBA
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  3. Stephen Lyman PhD
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  4. Alejandro González Della Valle MD
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Corresponding author

Correspondence to Christopher K. Kepler MD, MBA.

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Each author certifies that he or she has no 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.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Ghelman, B., Kepler, C.K., Lyman, S. et al. CT Outperforms Radiography for Determination of Acetabular Cup Version after THA. Clin Orthop Relat Res 467, 2362–2370 (2009). https://doi.org/10.1007/s11999-009-0774-1

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  • DOI: https://doi.org/10.1007/s11999-009-0774-1

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