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Reliability of Overcoverage Parameters With Varying Morphologic Pincer Features: Comparison of EOS® and Radiography

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

Abstract

Background

Multiple radiographic parameters used for diagnosis and quantification of morphologic pincer features have emerged, but the degree to which pelvic tilt or rotation affects conventional radiography and EOS® is unknown.

Question/purposes

We asked: (1) What is the reliability of EOS® and conventional radiography at increasing sizes of morphologic pincer features with varying degrees of tilt and rotation? (2) What is the effect of tilt and rotation on acetabular overcoverage measurements?

Methods

Using a dry cadaveric pelvis, AP conventional radiographs and EOS® images were taken at intervals of increasing modeled pincer size with 0° to 15° varying tilt and rotation. Lateral center-edge angle, Sharp angle, Tönnis angle, crossover sign, and retroversion index were measured on all images. Statistical analysis was conducted.

Results

The intermodality intraclass correlation coefficients for conventional radiography and EOS® radiography across all pincer sizes, rotations, and tilts were excellent (0.93–0.98). Crossover sign was in perfect agreement in conventional radiography and EOS®. Rotation of the hip away from the beam source and/or increased anterior tilt falsely increased all overcoverage parameters except for Tönnis angle. Rotation away from the beam of 10°or greater or anterior tilt of 5° or greater produced a false-positive crossover sign.

Conclusions

EOS® radiography maintained excellent reliability in comparison to conventional radiography but both were equally vulnerable to the effects of tilt and rotation for quantification of hip parameters used in acetabular overcoverage assessment. A standardized pelvic radiograph ensuring that the pelvis is not excessively tilted or rotated should be used for assessing acetabular overcoverage parameters.

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Acknowledgments

We thank Natalie McNeil RT, for assistance with conventional radiography acquisition and Dave R. Andrews RT, for assistance with EOS® acquisition.

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Authors and Affiliations

  1. Center for Hip Preservation and Children’s Orthopaedics, 5471 Kearny Villa Road, Suite 200, San Diego, CA, 92123, USA

    Shafagh Monazzam MD & Harish S. Hosalkar MD

  2. Dr Agashe Hospital, Mumbai, India

    Mandar Agashe MD

Authors
  1. Shafagh Monazzam MD
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  2. Mandar Agashe MD
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  3. Harish S. Hosalkar MD
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Corresponding author

Correspondence to Harish S. Hosalkar MD.

Additional information

The institution of the authors has received, during the study period, funding from EOS Imaging Inc (Cambridge, MA, USA).

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.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

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

This study was performed at Rady Children’s Hospital, San Diego, CA, USA.

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Monazzam, S., Agashe, M. & Hosalkar, H.S. Reliability of Overcoverage Parameters With Varying Morphologic Pincer Features: Comparison of EOS® and Radiography. Clin Orthop Relat Res 471, 2578–2585 (2013). https://doi.org/10.1007/s11999-013-3001-z

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  • DOI: https://doi.org/10.1007/s11999-013-3001-z

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