Li Xiaomin, Qu Yang, Wang Liao, Ai Songtao
Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China.
Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China.
Heliyon. 2024 May 16;10(10):e31141. doi: 10.1016/j.heliyon.2024.e31141. eCollection 2024 May 30.
Postoperative pelvic radiographs remain a vital tool for assessing cup orientation after total hip arthroplasty (THA), with the accuracy influenced by various factors. The objective of this study is to investigate the accuracy of cup anteversion measurement in developmental dysplasia of the hip (DDH) patients and others based on postoperative pelvic radiographs conducted under the current heavy workload conditions.
Patients who underwent THA at our hospital with both postoperative X-ray and CT images from January 2020 to December 2022 were included in this retrospective cohort study. Virtual X-ray films were generated using digitally reconstructed radiographs (DRR) technology from CT images, with pelvic position perfectly controlled. Radiographic anteversion (RA) was measured on 3D-CT, virtual X-rays, and actual postoperative X-rays, abbreviated as RA_3D, RA_DRR, and RA_Xray, respectively. A repeated-measures analysis of covariance (ANCOVA) was utilized to evaluate the variations in RA within and between different groups across three methods. The Bland-Altman plot analysis showed the variations among methods in DDH and non-DDH patients, setting a clinically acceptable limits of agreement (LOA) at ±5°.
This study included 154 hip cases, with 63 DDH and 91 other diseases. Repeated-measures ANCOVA revealed a descending trend in RA across three methods, with differences of 2.64° (DDH) vs. 2.74° (others) from 3D to DRR, and 4.89° (DDH) vs. 1.07° (others) from DRR to X-ray. The group by methods interaction effect were significant (p = 0.002). Significant statistical differences in RA_Xray (P = 0.035) were observed between DDH and non-DDH patients, but not in RA_3D and RA_DRR. Bland-Altman plots showed 71.4 % of DDH patients exceeded the clinically acceptable LOA, compared to 36.3 % of other patients.
Our study indicated that under the current intense workload, the reliability of assessing cup anteversion using postoperative pelvic radiographs is challenged, especially in patients with DDH.
术后骨盆X线片仍然是评估全髋关节置换术（THA）后髋臼方向的重要工具，其准确性受多种因素影响。本研究的目的是基于当前繁重工作量条件下进行的术后骨盆X线片，调查发育性髋关节发育不良（DDH）患者及其他患者髋臼前倾角测量的准确性。
本回顾性队列研究纳入了2020年1月至2022年12月在我院接受THA且有术后X线和CT图像的患者。使用数字重建X线片（DRR）技术从CT图像生成虚拟X线片，骨盆位置得到完美控制。在三维CT、虚拟X线片和实际术后X线片上测量影像学前倾角（RA），分别简称为RA_3D、RA_DRR和RA_Xray。采用重复测量协方差分析（ANCOVA）评估三种方法在不同组内和组间RA的差异。Bland-Altman图分析显示了DDH和非DDH患者不同方法之间的差异，将临床可接受的一致性界限（LOA）设定为±5°。
本研究纳入154例髋关节病例，其中63例为DDH，91例为其他疾病。重复测量ANCOVA显示三种方法的RA呈下降趋势，从3D到DRR，DDH组差异为2.64°，其他组为2.74°；从DRR到X线，DDH组差异为4.89°，其他组为1.07°。方法与分组的交互效应显著（p = 0.002）。DDH和非DDH患者在RA_Xray上存在显著统计学差异（P = 0.035），但在RA_3D和RA_DRR上无差异。Bland-Altman图显示，71.4%的DDH患者超出了临床可接受的LOA，而其他患者为36.3%。
我们的研究表明，在当前高强度工作量下，使用术后骨盆X线片评估髋臼前倾角的可靠性受到挑战，尤其是在DDH患者中。
