GeoGebra: A reliable and free software for measuring acetabular cup anteversion on digitalized plain radiographs.
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ABSTRACT: Objective
Although accurate measurement of cup anteversion in hip replacement requires CT scans, however, its routine application, especially during follow-up, remains economically and ethically unreasonable. Thus, several methods have been devised for making this measurement on plain radiographs. In recent years, several ways have been adopted using software on digital radiographs. We present one such method which uses open access mathematical software GeoGebra.Methods
Anteversion was measured on 72 radiographs (36 cemented; 36 uncemented) by three different observers using this software. One observer repeated measurements at three weeks interval.Results
The intraclass correlation coefficient for interobserver variability and intraobserver variability was 0.982 (0.973-0.989) and 0.986 (0.978-0.991) respectively. There was a significant difference in the reliability of the method for cemented and uncemented cups with higher reliability for cemented cups (p < 0.001).Conclusion
GeoGebra software can be used as a reliable alternative for measuring acetabular cup anteversion on good quality well centred digital radiographs of the pelvis.
SUBMITTER: Bachhal V
PROVIDER: S-EPMC7068040 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundTo create a safe zone, an understanding of the combined femoral and acetabular mating during hip motion is required. We investigated the position of the femoral head inside the acetabular liner during simulated hip motion. We hypothesized that cup and stem anteversions do not equally affect hip motion and combined hip anteversion.MethodsHip implant motion was simulated in standing, sitting, sit-to-stand, bending forward, squatting, and pivoting positions using the MATLAB software. A line passing through the center of the stem neck and the center of the prosthetic head exits at the polar axis (PA) of the prosthetic head. When the prosthetic head and liner are parallel, the PA faces the center of the liner (PA position = 0, 0). By simulating hip motion in 1-degree increments, the maximum distance of the PA from the liner center and the direction of its movement were measured (polar coordination system).ResultsThe effect of modifying cup and stem anteversion on the direction and distance of the PA's change inside the acetabular liner was different. Stem anteversion influenced the PA position inside the liner more than cup anteversion during sitting, sit-to-stand, squatting, and bending forward (P = .0001). This effect was evident even when comparing stems with different neck angles (P = .0001).ConclusionCup anteversion, stem anteversion, and stem neck-shaft angle affected the PA position inside the liner and combined anteversion in different ways. Thus, focusing on cup orientation alone when assessing hip motion during different daily activities is inadequate.
| S-EPMC8197737 | biostudies-literature
Project description:Measuring acetabular anteversion is relevant to routine follow-up of total hip arthroplasties (THAs) and for malfunctioning THAs. Imageless navigation facilitates acetabular component orientation relative to the anterior pelvic plane (APP) or to the APP adjusted for sagittal pelvic tilt (PT). The optimal plain radiographic method for the postoperative assessment of anteversion is not agreed upon.(1) Do anteversion measurements on plain radiographs correlate more with APP anteversion or PT-adjusted anteversion? (2) Do measurements of anteversion performed on supine anteroposterior (AP) radiographs more accurately reflect intraoperative anteversion values for navigated THA compared to anteversion measured on cross-table lateral (CL) radiographs?Seventy patients receiving primary navigated THA were included. APP and PT-adjusted anteversion were recorded; the latter defined the intraoperative target for anteversion. Postoperative anteversion was measured on supine AP pelvis radiographs with computer software and CL radiographs with conventional methods. Intraoperative measurements were used as the reference standards for comparisons.Mean intraoperative APP anteversion was 20.6°?±?5.6°. Mean intraoperative PT-adjusted anteversion was 22.9°?±?4.5°. Mean anteversion was 22.7°?±?4.7° on AP radiographs and 27.2°?±?4.2° on CL radiographs (p?<?0.001). Only correlations between PT-adjusted anteversion and radiographic assessments of anteversion were significant. The mean difference between PT-adjusted anteversion and anteversion on AP radiographs was -0.2°?±?4.3°, while the mean difference between the PT-adjusted anteversion and anteversion measured on CL radiographs was 4.3?±?5.1° (p?<?0.001).Plain film assessment of anteversion was more accurate on supine AP radiographs than on CL radiographs, which overestimated acetabular anteversion.
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Project description:BackgroundOur aim was to determine the reliability of plain abdominal radiographs for the evaluation of abdominal gas content in patients with functional digestive symptoms.MethodsAbdominal CT scan scout views, mimicking a conventional plain abdominal radiograph, were obtained from 30 patients both during episodes of abdominal distension and basal conditions. Physicians (n = 50) were instructed to rate the estimated volume of gas in the 60 images presented in random sequence using a scale graded from 0 to ≥600 ml.Key resultsThe gas volumes estimated in the scout views differed from those measured by CT by a median of 90 (95% CI 70-102) ml, and the misestimation was not related to the absolute volume in the image. The accuracy of the observers, measured by their mean misestimation, was not related to their specialty or the training status (misestimation by 96 (95% CI 85-104) ml in staff vs 78 (70-106) ml in residents; p = 0.297). The accuracy was independent of the order of presentation of the images. Gas volume measured by CT in the images obtained during episodes of abdominal distension differed by a median of 39 (95% CI 29-66) ml from those during basal conditions, and this difference was misestimated by a median of 107 (95% CI 94-119) ml. The accuracy of these estimations was not related to the absolute gas volumes (R = -0.352; p < 0.001) or the magnitude of the differences.Conclusions & inferencesPlain abdominal radiographs have limited value for the evaluation of abdominal gas volume in patients with functional gut disorders.
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Project description:BackgroundA number of radiographic signs have been previously demonstrated to be associated with degenerative rotator cuff tears. An ability to predict the presence of a tear by radiography would permit the early commencement of appropriate treatment and the avoidance of unnecessary invasive investigations. The aim of the present study was to determine the accuracy of using radiographic signs to predict the presence of a cuff tear on arthroscopy.MethodsFifty consecutive patients who had undergone shoulder arthroscopy and had pre-operative plain radiographs were included. Pre-operative radiographs were reviewed by a consultant shoulder surgeon, a consultant radiologist and a senior clinical fellow for the following signs: acromial spur; subjective reduction of subacromial space; sourcil sign; acromial acetabularization; os acromiale; greater tuberosity cortical irregularity; greater tuberosity sclerosis; humeral head rounding; cyst; and reduction in acromiohumeral head distance.ResultsThe presence of tuberosity sclerosis (p < 0.0001), tuberosity irregularities (p < 0.0001), tuberosity cyst (p = 0.004) and sourcil sign (p = 0.019) was associated with the presence of a rotator cuff tear. The combined sensitivity of prediction of tear by the observers following radiographic review was 91.7%, with a combined negative predictive value of 80%.ConclusionsThe assessment of radiographs by senior clinicians is a useful tool for confirming the absence of a rotator cuff tear.
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Project description:BackgroundFused hips with spine stiffness in ankylosing spondylitis (AS) reduce spinopelvic mobility. We aimed to assess spinopelvic mobility pattern and acetabular anteversion in AS after total hip arthroplasty (THA).Material and methodsNinety-four stiff hips in 58 AS individuals (mean age: 37.05) who underwent THA between 2012 and 2018 with a modified lateral approach were included. Twenty-three hips were fused, and 71 hips had mean flexion of 37.67°. Pelvic tilt, pelvic inclination, sacral slope (SS), and lumbar lordosis were correlated with THA, and functional outcomes were assessed at 34.6-month mean follow-up.ResultsThirty-seven had a stuck sitting pattern with stuck standing seen in 4 individuals. SS standing before and after THA were 25.08° and 27.30°. SS sitting was 8.99° compared to 16.80°. SS from sitting to standing was reduced (17.7°) in 17 individuals. Spine stiffness in extension was seen in 4 out of 37. Mean acetabular inclination after THA was 42.67°, and acetabular anteversion was 17.48°. Flexion after THA improved to mean 98.47°. Changes in SS from sitting to standing were correlated with THA (r-value: 0.93, P-value: .0001). The Harris Hip Score improved from 25.31 to 82.39 (P-value <.05), and the mean 12-item Short Form Survey at review was 52.18 and 59.55 (physical and mental components). The mean Western Ontario and Mc Master Universities Arthritis Index score was 17.56.ConclusionsSpinopelvic mobility change was <10° after THA in AS, stuck sitting was seen in 37 of 58 (63.8%), and stuck standing was seen in 4 of 58 (6.9%), including spine stiffness in flexion or extension. Acetabular anteversion assessed was 17.48° (standard deviation: 4.41), with significant functional improvement.Level of evidenceLevel 4.
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Project description:Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods - A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered. Results - 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced postoperative dislocation whereas others did not. The majority of articles could not identify a statistically significant difference between dislocating and non-dislocating THA with regard to mean angles of cup anteversion and inclination. Most of the articles that assessed cup placement within the Lewinnek safe zone did not show a statistically significant reduction in dislocation rate. Alternative target ranges have been proposed by several authors. Interpretation - The Lewinnek safe zone could not be justified. It is difficult to draw broad conclusions regarding a definitive target zone for cup positioning in THA, due to variability between studies and the likely multifactorial nature of THA dislocation. Future studies comparing cup positioning and dislocation rate should investigate surgical approach separately. Standardized tools for measurement of cup positioning should be implemented to allow comparison between studies.
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Project description:Background Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon’s ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images. Methods We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey results. Interrater reliability was determined through interclass correlation coefficients. Results A majority of surgeons preferred the direct anterior approach (83.3%) and utilized IF during surgery (70%). Surgeons surveyed were on average 5.9° away from the true value of inclination (standard deviation = 4.7) and 8.8° away from the true value of anteversion (standard deviation = 6.0). Respondents were within 5° of both inclination and anteversion in 19.7% of cases, and within 10° in 57.3% of cases. All surgeons were determined to have poor reliability in estimating anteversion (interclass correlation coefficient < 0.5). Only 2 surgeons were determined to have moderate reliability when estimating inclination. Conclusions Surgeons, when solely relying on IF for the estimation of anteversion and inclination, are unreliable. Utilization of other techniques in conjunction with IF would improve observer reliability.
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