Assessment of native hip offset on corresponding radiographs and CT: Implications for THA planning

C. Merle, George Grammatopoulos, W. Waldstein, Elise Pegg, M. R. Streit, T. Gotterbarm, David Murray, P. R. Aldinger, H.S. Gill

Research output: Contribution to conferencePaper

Abstract

INTRODUCTION: Restoration of hip offset (HO), which incorporates both acetabular (AO) and femoral offset (FO), determines abductor muscle function and is essential to prevent adverse outcomes such as impingement, dislocation and wear after total hip arthroplasty (THA). Accurate and reliable assessment of femoral and acetabular offset in preoperative planning is crucial as it suggests appropriate design, size and positioning of prosthetic components.
OBJECTIVES: The aim of the present study was to evaluate the accuracy and reliability of native femoral and acetabular offset measurements performed on conventional radiographs with reference to three-dimensional measurements performed on computed tomography (CT) scans in patients with primary end-stage hip osteoarthritis (OA).
METHODS: In a retrospective cohort study, pre-operative anterior-posterior (AP) hip radiographs, AP pelvis radiographs and CT scans of a consecutive series of 131 patients (57 males, 74 females, mean age 60 (range: 42- 79) years, mean body-mass-index (BMI) 27 (range: 19-45) kg/m²) with primary end-stage hip OA were measured. To achieve reproducible radiographic projection, patients were positioned according to a standardized protocol and all images were calibrated. Using validated software programs, FO and AO were measured on corresponding radiographs and on CT scans. Interand intra-observer reliability was evaluated using intra-class correlation coefficients (ICC). Distributions of offset measurements on corresponding images were compared using paired-samples t-tests. Measurement agreement between corresponding radiographic images and CT was assessed using Pearson’s coefficient of correlation (r) and Bland-Altman plots.
RESULTS: ICCs demonstrated a high inter- and intra-observer reliability for all measured parameters (ICC-range: 0.89- 0.99). In the entire cohort, AP pelvis based FO (40.1 mm, 95%CI: 38.9-41.2 mm) was significantly underestimated compared to CT based FO (45.3 mm, 95%CI: 44.3-46.2 mm, p<0.001). There was no difference in mean FO between AP hip radiographs (44.9 mm, 95%CI: 43.8-46.1 mm) and CT scans (p=0.431). No difference in acetabular offset measurements was seen on corresponding AP pelvis radiographs (34.1 mm, 95%CI: 33.0-35.3 mm) and CT scans (33.7 mm, 95%CI: 32.9-34.6 mm, p=0.329). We observed good agreement between FO measurements on AP hip radiographs and CT (r=0.71, p<0.001), and AO measurements on AP pelvis radiographs and CT (r=0.62, p<0.001), respectively.
CONCLUSION: Native hip offset of patients with primary end-stage hip osteoarthritis can be accurately and reliably determined on conventional radiographs when assessing femoral offset on AP hip views and acetabular offset on AP pelvis views, respectively. The present findings support the surgeon in pre-operative templating and may improve individual restoration of hip offset in THA without the routine performance of CT. We recommend to routinely obtain corresponding AP pelvis and AP hip radiographs for pre-operative planning in THA.
Original languageEnglish
Publication statusPublished - 2013
Event14th EFORT Congress 2013 - Istanbul, Turkey
Duration: 5 Jun 20138 Jun 2013

Conference

Conference14th EFORT Congress 2013
CountryTurkey
CityIstanbul
Period5/06/138/06/13

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Arthroplasty
Hip
Thigh
Tomography
Pelvis
Hip Osteoarthritis
Body Mass Index
Cohort Studies
Software
Retrospective Studies
Muscles

Cite this

Merle, C., Grammatopoulos, G., Waldstein, W., Pegg, E., Streit, M. R., Gotterbarm, T., ... Gill, H. S. (2013). Assessment of native hip offset on corresponding radiographs and CT: Implications for THA planning. Paper presented at 14th EFORT Congress 2013, Istanbul, Turkey.

Assessment of native hip offset on corresponding radiographs and CT: Implications for THA planning. / Merle, C.; Grammatopoulos, George; Waldstein, W.; Pegg, Elise; Streit, M. R.; Gotterbarm, T.; Murray, David; Aldinger, P. R.; Gill, H.S.

2013. Paper presented at 14th EFORT Congress 2013, Istanbul, Turkey.

Research output: Contribution to conferencePaper

Merle, C, Grammatopoulos, G, Waldstein, W, Pegg, E, Streit, MR, Gotterbarm, T, Murray, D, Aldinger, PR & Gill, HS 2013, 'Assessment of native hip offset on corresponding radiographs and CT: Implications for THA planning' Paper presented at 14th EFORT Congress 2013, Istanbul, Turkey, 5/06/13 - 8/06/13, .
Merle C, Grammatopoulos G, Waldstein W, Pegg E, Streit MR, Gotterbarm T et al. Assessment of native hip offset on corresponding radiographs and CT: Implications for THA planning. 2013. Paper presented at 14th EFORT Congress 2013, Istanbul, Turkey.
Merle, C. ; Grammatopoulos, George ; Waldstein, W. ; Pegg, Elise ; Streit, M. R. ; Gotterbarm, T. ; Murray, David ; Aldinger, P. R. ; Gill, H.S. / Assessment of native hip offset on corresponding radiographs and CT: Implications for THA planning. Paper presented at 14th EFORT Congress 2013, Istanbul, Turkey.
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title = "Assessment of native hip offset on corresponding radiographs and CT: Implications for THA planning",
abstract = "INTRODUCTION: Restoration of hip offset (HO), which incorporates both acetabular (AO) and femoral offset (FO), determines abductor muscle function and is essential to prevent adverse outcomes such as impingement, dislocation and wear after total hip arthroplasty (THA). Accurate and reliable assessment of femoral and acetabular offset in preoperative planning is crucial as it suggests appropriate design, size and positioning of prosthetic components. OBJECTIVES: The aim of the present study was to evaluate the accuracy and reliability of native femoral and acetabular offset measurements performed on conventional radiographs with reference to three-dimensional measurements performed on computed tomography (CT) scans in patients with primary end-stage hip osteoarthritis (OA). METHODS: In a retrospective cohort study, pre-operative anterior-posterior (AP) hip radiographs, AP pelvis radiographs and CT scans of a consecutive series of 131 patients (57 males, 74 females, mean age 60 (range: 42- 79) years, mean body-mass-index (BMI) 27 (range: 19-45) kg/m²) with primary end-stage hip OA were measured. To achieve reproducible radiographic projection, patients were positioned according to a standardized protocol and all images were calibrated. Using validated software programs, FO and AO were measured on corresponding radiographs and on CT scans. Interand intra-observer reliability was evaluated using intra-class correlation coefficients (ICC). Distributions of offset measurements on corresponding images were compared using paired-samples t-tests. Measurement agreement between corresponding radiographic images and CT was assessed using Pearson’s coefficient of correlation (r) and Bland-Altman plots. RESULTS: ICCs demonstrated a high inter- and intra-observer reliability for all measured parameters (ICC-range: 0.89- 0.99). In the entire cohort, AP pelvis based FO (40.1 mm, 95{\%}CI: 38.9-41.2 mm) was significantly underestimated compared to CT based FO (45.3 mm, 95{\%}CI: 44.3-46.2 mm, p<0.001). There was no difference in mean FO between AP hip radiographs (44.9 mm, 95{\%}CI: 43.8-46.1 mm) and CT scans (p=0.431). No difference in acetabular offset measurements was seen on corresponding AP pelvis radiographs (34.1 mm, 95{\%}CI: 33.0-35.3 mm) and CT scans (33.7 mm, 95{\%}CI: 32.9-34.6 mm, p=0.329). We observed good agreement between FO measurements on AP hip radiographs and CT (r=0.71, p<0.001), and AO measurements on AP pelvis radiographs and CT (r=0.62, p<0.001), respectively. CONCLUSION: Native hip offset of patients with primary end-stage hip osteoarthritis can be accurately and reliably determined on conventional radiographs when assessing femoral offset on AP hip views and acetabular offset on AP pelvis views, respectively. The present findings support the surgeon in pre-operative templating and may improve individual restoration of hip offset in THA without the routine performance of CT. We recommend to routinely obtain corresponding AP pelvis and AP hip radiographs for pre-operative planning in THA.",
author = "C. Merle and George Grammatopoulos and W. Waldstein and Elise Pegg and Streit, {M. R.} and T. Gotterbarm and David Murray and Aldinger, {P. R.} and H.S. Gill",
year = "2013",
language = "English",
note = "14th EFORT Congress 2013 ; Conference date: 05-06-2013 Through 08-06-2013",

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TY - CONF

T1 - Assessment of native hip offset on corresponding radiographs and CT: Implications for THA planning

AU - Merle, C.

AU - Grammatopoulos, George

AU - Waldstein, W.

AU - Pegg, Elise

AU - Streit, M. R.

AU - Gotterbarm, T.

AU - Murray, David

AU - Aldinger, P. R.

AU - Gill, H.S.

PY - 2013

Y1 - 2013

N2 - INTRODUCTION: Restoration of hip offset (HO), which incorporates both acetabular (AO) and femoral offset (FO), determines abductor muscle function and is essential to prevent adverse outcomes such as impingement, dislocation and wear after total hip arthroplasty (THA). Accurate and reliable assessment of femoral and acetabular offset in preoperative planning is crucial as it suggests appropriate design, size and positioning of prosthetic components. OBJECTIVES: The aim of the present study was to evaluate the accuracy and reliability of native femoral and acetabular offset measurements performed on conventional radiographs with reference to three-dimensional measurements performed on computed tomography (CT) scans in patients with primary end-stage hip osteoarthritis (OA). METHODS: In a retrospective cohort study, pre-operative anterior-posterior (AP) hip radiographs, AP pelvis radiographs and CT scans of a consecutive series of 131 patients (57 males, 74 females, mean age 60 (range: 42- 79) years, mean body-mass-index (BMI) 27 (range: 19-45) kg/m²) with primary end-stage hip OA were measured. To achieve reproducible radiographic projection, patients were positioned according to a standardized protocol and all images were calibrated. Using validated software programs, FO and AO were measured on corresponding radiographs and on CT scans. Interand intra-observer reliability was evaluated using intra-class correlation coefficients (ICC). Distributions of offset measurements on corresponding images were compared using paired-samples t-tests. Measurement agreement between corresponding radiographic images and CT was assessed using Pearson’s coefficient of correlation (r) and Bland-Altman plots. RESULTS: ICCs demonstrated a high inter- and intra-observer reliability for all measured parameters (ICC-range: 0.89- 0.99). In the entire cohort, AP pelvis based FO (40.1 mm, 95%CI: 38.9-41.2 mm) was significantly underestimated compared to CT based FO (45.3 mm, 95%CI: 44.3-46.2 mm, p<0.001). There was no difference in mean FO between AP hip radiographs (44.9 mm, 95%CI: 43.8-46.1 mm) and CT scans (p=0.431). No difference in acetabular offset measurements was seen on corresponding AP pelvis radiographs (34.1 mm, 95%CI: 33.0-35.3 mm) and CT scans (33.7 mm, 95%CI: 32.9-34.6 mm, p=0.329). We observed good agreement between FO measurements on AP hip radiographs and CT (r=0.71, p<0.001), and AO measurements on AP pelvis radiographs and CT (r=0.62, p<0.001), respectively. CONCLUSION: Native hip offset of patients with primary end-stage hip osteoarthritis can be accurately and reliably determined on conventional radiographs when assessing femoral offset on AP hip views and acetabular offset on AP pelvis views, respectively. The present findings support the surgeon in pre-operative templating and may improve individual restoration of hip offset in THA without the routine performance of CT. We recommend to routinely obtain corresponding AP pelvis and AP hip radiographs for pre-operative planning in THA.

AB - INTRODUCTION: Restoration of hip offset (HO), which incorporates both acetabular (AO) and femoral offset (FO), determines abductor muscle function and is essential to prevent adverse outcomes such as impingement, dislocation and wear after total hip arthroplasty (THA). Accurate and reliable assessment of femoral and acetabular offset in preoperative planning is crucial as it suggests appropriate design, size and positioning of prosthetic components. OBJECTIVES: The aim of the present study was to evaluate the accuracy and reliability of native femoral and acetabular offset measurements performed on conventional radiographs with reference to three-dimensional measurements performed on computed tomography (CT) scans in patients with primary end-stage hip osteoarthritis (OA). METHODS: In a retrospective cohort study, pre-operative anterior-posterior (AP) hip radiographs, AP pelvis radiographs and CT scans of a consecutive series of 131 patients (57 males, 74 females, mean age 60 (range: 42- 79) years, mean body-mass-index (BMI) 27 (range: 19-45) kg/m²) with primary end-stage hip OA were measured. To achieve reproducible radiographic projection, patients were positioned according to a standardized protocol and all images were calibrated. Using validated software programs, FO and AO were measured on corresponding radiographs and on CT scans. Interand intra-observer reliability was evaluated using intra-class correlation coefficients (ICC). Distributions of offset measurements on corresponding images were compared using paired-samples t-tests. Measurement agreement between corresponding radiographic images and CT was assessed using Pearson’s coefficient of correlation (r) and Bland-Altman plots. RESULTS: ICCs demonstrated a high inter- and intra-observer reliability for all measured parameters (ICC-range: 0.89- 0.99). In the entire cohort, AP pelvis based FO (40.1 mm, 95%CI: 38.9-41.2 mm) was significantly underestimated compared to CT based FO (45.3 mm, 95%CI: 44.3-46.2 mm, p<0.001). There was no difference in mean FO between AP hip radiographs (44.9 mm, 95%CI: 43.8-46.1 mm) and CT scans (p=0.431). No difference in acetabular offset measurements was seen on corresponding AP pelvis radiographs (34.1 mm, 95%CI: 33.0-35.3 mm) and CT scans (33.7 mm, 95%CI: 32.9-34.6 mm, p=0.329). We observed good agreement between FO measurements on AP hip radiographs and CT (r=0.71, p<0.001), and AO measurements on AP pelvis radiographs and CT (r=0.62, p<0.001), respectively. CONCLUSION: Native hip offset of patients with primary end-stage hip osteoarthritis can be accurately and reliably determined on conventional radiographs when assessing femoral offset on AP hip views and acetabular offset on AP pelvis views, respectively. The present findings support the surgeon in pre-operative templating and may improve individual restoration of hip offset in THA without the routine performance of CT. We recommend to routinely obtain corresponding AP pelvis and AP hip radiographs for pre-operative planning in THA.

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