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Rofo 2016; 188(08): 763-767
DOI: 10.1055/s-0042-106975
Musculoskeletal System
© Georg Thieme Verlag KG Stuttgart · New York

Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty

Digitale Planungssoftware ist nicht geeignet die Torsion des Implantatschaftes nach endoprothetischem Hüftersatz zu bestimmen
M. Worlicek
1   Departement of Orthopedic Surgery, University of Regensburg, Bad Abbach, Germany
,
M. Weber
1   Departement of Orthopedic Surgery, University of Regensburg, Bad Abbach, Germany
,
F. Zeman
2   Center of Clinical Studies, University of Regensburg, Regensburg, Germany
,
M. Wörner
1   Departement of Orthopedic Surgery, University of Regensburg, Bad Abbach, Germany
,
M. Schneider
1   Departement of Orthopedic Surgery, University of Regensburg, Bad Abbach, Germany
,
J. Grifka
1   Departement of Orthopedic Surgery, University of Regensburg, Bad Abbach, Germany
,
T. Renkawitz
1   Departement of Orthopedic Surgery, University of Regensburg, Bad Abbach, Germany
,
B. Craiovan
1   Departement of Orthopedic Surgery, University of Regensburg, Bad Abbach, Germany
› Author Affiliations
Further Information

Publication History

20 February 2016

13 April 2016

Publication Date:
29 June 2016 (online)

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Abstract

Purpose: The purpose of this study was to evaluate the validity of commercially available planning software on plain radiographs after THA compared to CT scans as the gold standard.

Patients and Methods: In a prospective clinical study, anteroposterior (AP) radiographs and three-dimensional CT scans (3D-CT) were obtained for 121 patients, who underwent minimally invasive, cementless THA with a straight tapered stem, in a lateral decubitus position. For measuring SV, we used digital planning software (TraumaCad 2.0, BrainLAB Feldkirchen, Germany). Two independent raters repeated the analysis after a six-week interval. Radiological measurements were compared with 3D-CT measurements by an independent, blinded external institute. This investigation was approved by the local ethics commission (no. 10 -121- 0263) and is a secondary analysis of a larger project (DRKS00 000 739, German Clinical Trials Register May-02 – 2011).

Results: The radiograph measurements showed very high intra- and interrater agreement. The intra-class correlation (ICC) of the intrarater agreement was 0.97 for rater 1 and 0.98 for rater 2. The intrarater reliability was 0.99 using the mean values of both rater measurements. The mean difference between the average radiograph measurement and the 3D-CT-based measurement was 0.41° (SD 11.24°) (range: –33.85°–22.50°; 95 % limits of agreement: –21.63 – 22.45), but there was no correlation found between both methods.

Conclusion: Measuring stem version with the help of commercially available digital planning software on plain radiographs after THA has high intra- and interrater reliability but clinically inacceptable validity and reliability when compared to 3D-CT scans.

Key Points:

• Measuring stem torsion after THA on plain radiographs with digital planning software is not valid.

Citation Format:

• Worlicek M, Weber M, Zeman F et al. Digital Planning Software Fails to Reflect Stem Torsion on Plain Radiographs after Total Hip Arthroplasty. Fortschr Röntgenstr 2016; 188: 763 – 767

Zusammenfassung

Zielsetzung: Ziel dieser Studie war es die Validität einer kommerziell verfügbaren Planungssoftware zur Vermessung von zweidimensionalen Röntgenbildern, im Vergleich zu CT-Aufnahmen zu bestimmen.

Patienten und Methoden: In einer sekundären Analyse einer großen prospektiven, kontrollierten Studie (DRKS00 000 739, Deutsches Register klinischer Studien 02.05.2011), wurden anteriorposteriore Hüftübersichtsaufnahmen und 3D-CT-Aufnahmen einer Untergruppe von 121 Patienten, die einen endoprothetischen Hüftersatz erhielten, untersucht. Der Eingriff wurde über einen minimalinvasiven Zugang, in Seitenlage, unter Verwendung eines nichtzementierten, kegelförmigen Geradschaftes durchgeführt. Zur Messung der Schafttorsion verwendeten wir eine digitale Planungssoftware (TraumaCad 2.0, BrainLAB Feldkirchen, Deutschland). Die Messungen wurden von zwei unabhängigen Untersuchern durchgeführt und nach sechs Wochen wiederholt. Die Ergebnisse wurden mit 3D-CT-Messungen eines unabhängigen, verblindeten, externen Instituts verglichen. Die Untersuchung wurde durch die ansässige Ethikkommission (Nr. 10 -121- 0263) genehmigt.

Ergebinsse: Die Messungen der Röntgenbilder zeigten eine sehr hohe Übereinstimmung, sowohl zwischen den Untersuchern, als auch zwischen den Erst- und Zweitmessungen der einzelnen Untersucher. Die Intra-Klassen-Korrelation der Erst- und Zweitmessungen lag bei 0,97 für Untersucher 1 und bei 0,98 für Untersucher 2. Die Zuverlässigkeit der Messungen zwischen beiden Untersuchern lag bei 0,99 bzgl. der Durchschnittswerte beider Messungen. Die mittlere Abweichung zwischen den Durchschnittswerten der Messungen auf den Röntgenbildern und den 3D-CT Messungen lag bei 0,41° (SA 11,24°) (Messbereich –33,85°–22,50°; 95 % limits of agreement –21,63 – 22,45), allerdings konnte keine Korrelation zwischen beiden Methoden nachgewiesen werden.

Schlussfolgerung: Die Vermessung der Schafttorsion mit einer kommerziell verfügbaren, digitalen Planungssoftware auf zweidimensionalen Röntgenbildern, nach endoprothetischem Hüftersatz, zeigt trotz guter Reproduzierbarkeit, eine klinisch inakzeptable Ungenauigkeit verglichen mit 3D-CT-Aufnahmen.

Kernaussagen:

• Die Vermessung der Schafttorsion auf zweidimensionalen Röntgenbildern mit digitaler Planungssoftware ist nicht valide.

Key words

hip arthroplasty - stem version - anterior posterior radiographs - planning software - CT
 

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