A new approach for assessment of wear in metal-backed acetabular cups using computed tomography: a phantom study with retrievals

Abstract

Background and purpose: Polyethylene wear is an important cause of aseptic loosening in hip arthroplasty. Detection of significant wear usually happens late on, since available diagnostic techniques are either not sensitive enough or too complicated and expensive for routine use. This study evaluates a new approach for measurement of linear wear of metal-backed acetabular cups using CT as the intended clinically feasible method.

Material and methods: 8 retrieved uncemented metal-backed acetabular cups were scanned twice ex vivo using CT. The linear penetration depth of the femoral head into the cup was measured in the CT volumes using dedicated software. Landmark points were placed on the CT images of cup and head, and also on a reference plane in order to calculate the wear vector magnitude and angle to one of the axes. A coordinate-measuring machine was used to test the accuracy of the proposed CT method. For this purpose, the head diameters were also measured by both methods.

Results: Accuracy of the CT method for linear wear measurements was 0.6 mm and wear vector angle was 27 degrees . No systematic difference was found between CT scans.

Interpretation: This study on explanted acetabular cups shows that CT is capable of reliable measurement of linear wear in acetabular cups at a clinically relevant level of accuracy. It was also possible to use the method for assessment of direction of wear.