A Clinically Practical Method of Manually Assessing Polyethylene Liner Thickness

Background: Most orthopaedists do not have access to contemporary computer-assisted radiographic techniques and therefore must use manual radiographic methods to assess polyethylene wear. The accuracy of most manual methods, however, has not been verified on clinical radiographs. In this study, we used manufacturer-developed wear templates to measure polyethylene wear and compared that technique with two other commonly used manual radiographic methods. Our purpose was to compare the accuracy of these techniques and thus determine their usefulness in assessing polyethylene wear in individual patients. Methods: We analyzed seventeen polyethylene liners that were retrieved during revision operations after a mean of 12.0 years in situ. With use of digital calipers, we directly measured the true minimum polyethylene thickness of the explanted liner. We then measured the polyethylene thickness on anteroposterior pelvic radiographs that had been made before the revision. Three different manual techniques were used to evaluate the radiographs: the Dorr method, the Livermore method, and the newly described wear-template method. The minimum polyethylene thickness that was calculated with use of each of these methods was compared with the thickness as determined by direct measurement of the explanted liner. Results: The mean error for the Dorr method (1.54 ± 1.21 mm) was significantly greater than that for both the Livermore method (0.07 ± 0.62 mm) and the wear-template method (-0.04 ± 0.28 mm) (p < 0.01). The mean error for the Dorr method was significantly greater than zero (p < 0.01), indicating that this method consistently overestimated the true measurement. In contrast, the mean errors for the Livermore and wear-template methods were not significantly different from zero (p = 0.64 and 0.58, respectively), indicating that these methods did not consistently underestimate or overestimate the true measurement. However, the large standard deviations for all three methods suggest that the ranges in error are wide. The limits of agreement for the Livermore technique ranged from a 1.17-mm underestimation to a 1.31-mm overestimation of the true thickness of the polyethylene; those of the wear-template technique were smaller, ranging from a 0.60-mm underestimation to a 0.52-mm overestimation. Conclusion: The practicing orthopaedist needs an accurate and efficient method for determining the polyethylene thickness of modular acetabular components. We found that the template method best met this requirement because it involved a simple procedure: placing the template over the radiograph and measuring the distance between the femoral head and the inner surface of the metal shell. The other methods were less accurate, required additional information from the manufacturer, were more time-consuming, and were not as easy to demonstrate to the patient.