Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA.
Bone Joint J. 2019 Sep;101-B(9):1042-1049. doi: 10.1302/0301-620X.101B9.BJJ-2019-0085.R1.
Several radiological methods of measuring anteversion of the acetabular component after total hip arthroplasty (THA) have been described. These are limited by low reproducibility, are less accurate than CT 3D reconstruction, and are cumbersome to use. These methods also partly rely on the identification of obscured radiological borders of the component. We propose two novel methods, the Area and Orthogonal methods, which have been designed to maximize use of readily identifiable points while maintaining the same trigonometric principles.
A retrospective study of plain radiographs was conducted on 160 hips of 141 patients who had undergone primary THA. We compared the reliability and accuracy of the Area and Orthogonal methods with two of the current leading methods: those of Widmer and Lewinnek, respectively.
The 160 anteroposterior pelvis films revealed that the proposed Area method was statistically different from those described by Widmer and Lewinnek (p < 0.001 and p = 0.004, respectively). They gave the highest inter- and intraobserver reliability (0.992 and 0.998, respectively), and took less time (27.50 seconds (sd 3.19); p < 0.001) to complete. In addition, 21 available CT 3D reconstructions revealed the Area method achieved the highest Pearson's correlation coefficient (r = 0.956; p < 0.001) and least statistical difference (p = 0.704) from CT with a mean within 1° of CT-3D reconstruction between ranges of 1° to 30° of measured radiological anteversion.
Our results support the proposed Area method to be the most reliable, accurate, and speedy. They did not support any statistical superiority of the proposed Orthogonal method to that of the Widmer or Lewinnek method. Cite this article: 2019;101-B:1042-1049.
已经描述了几种测量全髋关节置换术后髋臼组件前倾角的放射学方法。这些方法的重复性低，不如 CT 三维重建准确，使用起来繁琐。这些方法还部分依赖于对组件遮挡放射学边界的识别。我们提出了两种新方法，即面积法和正交法，它们旨在最大限度地利用易于识别的点，同时保持相同的三角原理。
对 141 名患者的 160 髋进行了回顾性平片研究，这些患者均接受了初次全髋关节置换术。我们比较了面积法和正交法与 Widmer 和 Lewinnek 两种当前主要方法的可靠性和准确性。
160 张前后骨盆片显示，所提出的面积法与 Widmer 和 Lewinnek 描述的方法在统计学上存在显著差异（p < 0.001 和 p = 0.004）。它们具有最高的观察者内和观察者间可靠性（分别为 0.992 和 0.998），并且完成时间更短（27.50 秒（sd 3.19）；p < 0.001）。此外，21 个可用的 CT 三维重建显示面积法与 CT 相关性最高（r = 0.956；p < 0.001），与 CT 的统计差异最小（p = 0.704），在测量的放射学前倾角为 1°至 30°的范围内，其与 CT-3D 重建的差异在 1°以内。
我们的结果支持所提出的面积法是最可靠、最准确和最快的方法。它们不支持所提出的正交法相对于 Widmer 或 Lewinnek 法有任何统计学上的优势。
引用：2019;101-B:1042-1049.
