Pelvis and total hip arthroplasty acetabular component orientations in sitting and standing positions: measurements reproductibility with EOS imaging system versus conventional radiographies

Abstract

Introduction: The literature has recently underlined the interest of pelvic and acetabular component orientation measurements in the standing and sitting position. Radiographic follow-up of total hip arthroplasty (THA) is based on standard AP and lateral X-rays. The use of EOS™ 2D imaging system reduces patient's radiation exposure compared to conventional X-rays. However, using this system, the validity and reproducibility of angular measurements, have not been studied yet for the measurement of pelvic and acetabular parameters in patients with THA.

Hypothesis: The EOS™ 2D imaging system offers similar advantages to conventional X-rays in the measurement of pelvic and acetabular orientation parameters which are commonly used.

Patients and method: Five angular parameters characterizing pelvic tilt and acetabular cup orientation were determined using the same digital measurement Imagika™ software based on two series of standard X-rays and EOS™ 2D images acquired in both standing and sitting positions. Radiographs from 50 patients with unilateral THA were measured three times by two observers. Intra- and interobserver reproducibility using each method was independently studied then paired comparison was performed.

Results: The ICC and Spearman rank correlation coefficient demonstrated an excellent EOS/conventional X-ray correlation. According to the parameters, the mean difference between these two imaging modalities ranged from 0.30° to 3.43° (P<0.05). The intra- and interobserver variability ranged from ± 2.97° to ± 6.46° using the EOS™ imaging system and from ± 4.26° to ± 10.22° using conventional X-rays (P<0.05).

Discussion: The EOS™ 2D imaging system may replace conventional X-rays in the assessment and monitoring of pelvic and acetabular cup orientation in THA.

Level of evidence: Level III. Prospective diagnostic study.