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Reliability and Validity of Measuring Acetabular Component Orientation by Plain Anteroposterior Radiographs

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

Abstract

Background

Inaccurate placement of an acetabular cup can cause impingement, dislocation, and accelerated wear. However, there is no universally agreed-on approach to measuring cup position using plain radiographs.

Objectives/purposes

Our goal was to evaluate the reliability and validity of measuring the orientation of acetabular components on plain anteroposterior (AP) radiographs.

Methods

We obtained plain AP radiographs and CT scans for 60 patients who underwent 60 primary total hip arthroplasties (THAs). The method devised by Lewinnek et al. was used to measure the orientation of acetabular components on plain AP radiographs, and three-dimensional (3-D) CT scans were used to measure both the radiographic anteversion angle and the inclination angle. Reliability was evaluated by analysis of the agreement between inter- and intraobserver measurements using plain AP radiographs. Measurements on 3-D CT scans were regarded as the reference standard; validity was assessed by comparing radiographic measurements with the CT scans.

Results

Inter- and intraobserver reliability for measuring component orientation on plain AP radiographs was nearly perfect with intraclass correlation coefficients of 0.896 and 0.969 for anteversion and 0.984 and 0.993 for inclination. Measurement of cup inclination angles differed between plain radiographs and CT scans, but the difference was small, and the difference, although statistically significant, probably was not clinically important (2.3° ± 1.8°, p < 0.001). There was no significant difference between the anteversion as measured on CT scan versus that measured on plain radiographs (p = 0.19).

Conclusions

Measurement of the orientation of acetabular components on plain AP radiographs is reliable and accurate compared with measurement on CT.

Level of Evidence

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

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Acknowledgments

Medical editor, Katharine O’Moore-Klopf ELS (East Setauket, NY, USA), provided professional English-language editing of this article.

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Authors and Affiliations

  1. Department of Adult Reconstructive Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China

    Ming Lu MD, Yi-Xin Zhou MD, PhD, Hui Du MD, Ji Zhang MD & Jian Liu MD

Authors
  1. Ming Lu MD
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  2. Yi-Xin Zhou MD, PhD
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  3. Hui Du MD
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  4. Ji Zhang MD
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  5. Jian Liu MD
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Corresponding author

Correspondence to Yi-Xin Zhou MD, PhD.

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Lu, M., Zhou, YX., Du, H. et al. Reliability and Validity of Measuring Acetabular Component Orientation by Plain Anteroposterior Radiographs. Clin Orthop Relat Res 471, 2987–2994 (2013). https://doi.org/10.1007/s11999-013-3021-8

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  • DOI: https://doi.org/10.1007/s11999-013-3021-8

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