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Biplanar Low-Dose Radiography Is Accurate for Measuring Combined Anteversion After Total Hip Arthroplasty

  • Original Article
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HSS Journal ®

Abstract

Background

Acetabular component position alone has not been predictive of stability after total hip arthroplasty (THA). Combined anteversion of the acetabulum and femur has the potential of being more predictive of stability. Unfortunately, femoral component position is difficult to measure on plain radiographs. Computed tomography (CT) is the gold standard for measuring implant position post-operatively, but CT exposes patients to a substantial amount of radiation.

Questions/Purposes

We sought to determine whether biplanar low-dose radiography can be used to accurately measure both acetabular and femoral implant position after THA.

Methods

Twenty patients underwent standing low-dose biplanar spine-to-ankle radiographs and supine CT scans 6 weeks after THA. Measurements of acetabular inclination, acetabular anteversion, and femoral anteversion were performed by two blinded observers and compared.

Results

The average absolute differences between biplanar radiographs and CT scans were 2° ± 2° for acetabular inclination, 3° ± 2° for acetabular anteversion, and 4° ± 4° for femoral anteversion between EOS measurements and CT measurements. Interobserver agreement was good for acetabular inclination, acetabular anteversion, and femoral anteversion (Cronbach’s α = 0.90) using biplanar low-dose imaging.

Conclusion

Biplanar radiography is a reliable low-radiation alternative for measuring acetabular inclination, acetabular anteversion, femoral version, and thus combined anteversion compared to CT. Femoral anteversion had the most variability but is still clinically relevant.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Christina I. Esposito PhD, Theodore T. Miller MD, Joseph D. Lipman MS, Kaitlin M. Carroll BS, Douglas E. Padgett MD, David J. Mayman MD & Seth A. Jerabek MD

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  1. Christina I. Esposito PhD
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  2. Theodore T. Miller MD
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Correspondence to Christina I. Esposito PhD.

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Conflict of Interest

Christina I. Esposito, PhD, and Kaitlin M. Carroll, BS, declare that they have no conflicts of interest. David J. Mayman, MD, reports stock or stock options from Imagen Technologies and OrthAlign; personal fees for consultancy, lectures, and grants from Smith & Nephew; and board membership with the Knee Society. Douglas E. Padgett, MD, reports board membership with American Joint Replacement Registry, Journal of Arthroplasty, and Hip Society; personal fees and royalties from DJ Orthopaedics and PixarBio; and stock or stock options from PixarBio. Joseph D. Lipman, MS, reports royalties from Exactech, Inc., LimaCorporate, Mathys Ltd., and Ortho Development Corporation. Seth A. Jerabek, MD, reports personal fees, speakers’ fees, royalties, and grants from Stryker and stock and stock options from Imagen Technologies. Theodore T. Miller, MD, reports educational fees from Amirsys Publishing Co.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

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Level of Evidence: Level II: Diagnostic Study.

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Esposito, C.I., Miller, T.T., Lipman, J.D. et al. Biplanar Low-Dose Radiography Is Accurate for Measuring Combined Anteversion After Total Hip Arthroplasty. HSS Jrnl 16, 23–29 (2020). https://doi.org/10.1007/s11420-018-09659-7

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