The best method for evaluating anteversion of the acetabular component after total hip arthroplasty on plain radiographs

Yang Soo Park, Won Chul Shin, Sang Min Lee, Sang Ho Kwak, Jung Yun Bae, Kuen Tak Suh, Yang Soo Park, Won Chul Shin, Sang Min Lee, Sang Ho Kwak, Jung Yun Bae, Kuen Tak Suh

Abstract

Background: Several radiological methods for measuring the anteversion of the acetabular component after total hip arthroplasty (THA) exist, and no single standardized method has been established. We evaluated the reliability and accuracy of six widely utilized methods (Liaw et al., Lewinnek et al., Widmer, Hassan et al., Ackland et al., and Woo and Morrey) for measuring anteversion on plain radiographs, using a reference standard in the same definition obtained from the PolyWare programme.

Methods: We reviewed 71 patients who underwent primary unilateral THA. The anteversion of the acetabular component was measured on pelvis AP radiographs using five different methods (Liaw et al., Lewinnek et al., Widmer, Hassan et al., and Ackland et al.) and on cross-table lateral radiographs using the method of Woo and Morrey. The values obtained using the PolyWare programme, which determines the anteversion of the acetabular component by edge detection, were regarded as the reference standard.

Results: Intra- and inter-observer reliabilities were excellent for all methods using plain radiographs, including the PolyWare programme. The method of Liaw et al. obtained values similar to those obtained using the PolyWare programme and was thus considered accurate (P = 0.447). However, values obtained using the other five methods significantly differed from those obtained using the PolyWare programme and were thus considered less accurate (P < 0.001, P < 0.001, P < 0.001, P = 0.007, and P < 0.001, respectively).

Conclusion: The method of Liaw et al. is more accurate than other methods using plain radiographs for the measurement of the anteversion of the acetabular component after THA, with reference to the anteversion obtained from the PolyWare programme.

Keywords: Acetabular component; Anteversion; Plain radiograph; Total hip arthroplasty.

Conflict of interest statement

Ethics approval and consent to participate

The research protocol was approved by Institutional Review Board approval (decision number, 05-2015-040).

Written informed consent was obtained from all patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Depiction of the method of Liaw et al. The β angle is used to calculate the anteversion. b Depiction of the method of Lewinnek et al. The long and short axes of the ellipse are used to calculate the anteversion. c Depiction of Widmer’s method. The short axis of the ellipse and total length of the acetabular component are used to calculate the anteversion. d Depiction of the method of Hassan et al. The long axis of ellipse and the head edge are used to calculate anteversion. e Depiction of the method of Ackland et al. Each perpendicular distance from the end of the ellipse to the cross section between the tangent and the diametrical line is used to calculate the anteversion. f Depiction of the method of Woo and Morrey. The cross-table lateral radiograph is used to calculated the anteversion
Fig. 2
Fig. 2
Depiction of the measurement of the anteversion using the PolyWare programme

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