Reproducibility of radiographic hip measurements in adults
ABSTRACT INTRODUCTION: Hip dysplasia may cause pain and premature hip osteoarthritis. Here, our objective was to assess the inter- and intraobserver reproducibility of radiographic hip parameter measurement in adults. METHODS: We used anteroposterior pelvic radiographs and false-profile lateral hip radiographs from 30 individuals (60 hips) enrolled in a prevalence study of hip osteoarthritis. For each hip, two independent observers recorded five parameters twice, at an interval of 1month. The five parameters were the vertical-center-edge angle (VCE), the anterior center-edge angle (vertical-center-anterior angle, VCA), the acetabular roof angle (HTE), the neck-shaft angle (CC'D), and acetabulum depth (AD). Reproducibility was assessed using Bland-Altman plots, intraclass correlation coefficients (ICCs), and kappa coefficients for the radiographic diagnosis of hip dysplasia using widely accepted cutoffs. RESULTS: Of the 60 hips, 51 were assessable. Intraobserver ICC values ranged from 0.72 to 0.94 and interobserver ICC values from 0.68 to 0.84. Kappa coefficients were between 0.60 and 1.00, except for the VCA angle (κ=0.41). CONCLUSION: In this study, reproducibility of the main radiographic hip parameters was good according to all evaluation methods used. However, CC'D and, to an even greater extent, the VCA angle seemed challenging to measure.
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ABSTRACT: The aim of this study was to evaluate the limitations of the Tönnis angle as one of the most commonly used parameters in the diagnosis of acetabular dysplasia, and to explore the feasibility of the modified Tönnis angle in the diagnosis of acetabular dysplasia. A total of 224 patients (120 females and 104 males) with 448 hips, aged between 15 and 83 years (median, 45.0 years), were selected for the measurement of the center-edge (CE) and Tönnis angles. To evaluate the relative position of the medial edge of the acetabular sourcil, a new parameter, known as the center-medial-edge (CME) angle, was designed. As an improvement of the Tönnis angle, a new angle preliminarily termed the modified Tönnis angle was created. In addition, the degree of clarity of the medial edge of the acetabular sourcil on radiograph was evaluated, and the hips were divided into the clear-edge and blurred-edge groups. The hips belonging to the blurred-edge group could not be used for Tönnis angle measurements. All measurements were performed digitally using the tool of the picture-archiving communication system. Among the 448 acetabular sourcils, 142 had a blurred medial edge (31.7%). The mean value of the CME angle was 37.94°, with a range of 21.76-63.99°. The 95% prediction interval of the modified Tönnis angle was estimated to be -6.39 to 11.73°. The correlation coefficients were -0.838 between the CE and Tönnis angles, 0.889 between the Tönnis and modified Tönnis angles and -0.905 between the CE and modified Tönnis angles. In conclusion, the modified Tönnis angle can substitute for the Tönnis angle without joint space narrowing and subluxation of the hip, particularly when the Tönnis angle cannot be measured due to a blurred medial edge of the acetabular sourcil on pelvic radiograph.Experimental and therapeutic medicine 12/2014; 8(6):1934-1938. DOI:10.3892/etm.2014.2009 · 0.94 Impact Factor
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ABSTRACT: To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs. Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115A degrees through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs. The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible. The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography.Skeletal Radiology 07/2014; 43(11). DOI:10.1007/s00256-014-1949-8 · 1.74 Impact Factor
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ABSTRACT: The early recovery period after periacetabular osteotomy (PAO) can be limited by pain and activity restrictions. Modifications of the Bernese PAO, including sparing the rectus tendon and discontinuing routine arthrotomy, may accelerate early postoperative recovery compared with the standard approach.Clinical Orthopaedics and Related Research 08/2014; 473(2). DOI:10.1007/s11999-014-3837-x · 2.88 Impact Factor