Three-dimensional acetabular orientation measurement in a reliable coordinate system among one hundred Chinese

Determining three-dimensional (3D) acetabular orientation is important for several orthopaedic scenarios, but the complex geometries of both pelvis and acetabulum make measurements of orientation unreliable. Acetabular orientation may also differ between the sexes or racial groups. We aimed to (1) establish and evaluate a novel method for measuring 3D acetabular orientation, (2) apply this new method to a large population of Chinese subjects, and (3) report relevant characteristics of native acetabular orientation in this population. We obtained computed tomography scans taken for non-orthopaedic indications in 100 Chinese subjects (50 male, 50 female). A novel algorithm tailored to segmentation of the hip joint was used to construct 3D pelvic models from these scans. We developed a surface-based method to establish a reliable 3D pelvic coordinate system and software to semi-automatically measure 3D acetabular orientation. Differences in various acetabular orientations were compared within and between subjects, between male and female subjects, and between our subjects and subjects previously reported by another group. The reported method was reliable (intraclass correlation coefficient >0.999). Acetabular orientations were symmetrical within subjects, but ranged widely between subjects. The sexes differed significantly in acetabular anteversion (average difference, 3.0°; p < 0.001) and inclination (1.5°; p < 0.03). Acetabular anteversion and inclination were substantially smaller among our Chinese subjects than previously reported for American subjects. Thus, our method was reliable and sensitive, and we detected sex differences in 3D acetabular orientation. Awareness of differences between the sexes and races is the first step towards better reconstruction of the hip joint for all individuals and could also be applied to other orthopaedic scenarios.

[1]  J. Lewis,et al.  Dislocations after total hip-replacement arthroplasties. , 1978, The Journal of bone and joint surgery. American volume.

[2]  Leo Joskowicz,et al.  Acetabular orientation variability and symmetry based on CT scans of adults , 2010, International Journal of Computer Assisted Radiology and Surgery.

[3]  B Jaramaz,et al.  Variations in acetabular anatomy with reference to total hip replacement. , 2008, The Journal of bone and joint surgery. British volume.

[4]  D. Bonett Sample size requirements for estimating intraclass correlations with desired precision , 2002, Statistics in medicine.

[5]  J. Spadaro,et al.  The Journal of Bone and Joint Surgery American Volume , 2006 .

[6]  Shoji Ishii,et al.  Radiographic method to measure the inclination angle of the acetabulum , 2008, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[7]  Guoyan Zheng,et al.  Evaluation of Constant Thickness Cartilage Models vs. Patient Specific Cartilage Models for an Optimized Computer-Assisted Planning of Periacetabular Osteotomy , 2016, PloS one.

[8]  W. Jian,et al.  The Geometry of the Bone Structure Associated with Total Hip Arthroplasty , 2014, PloS one.

[9]  P Benum,et al.  Pelvic Inclination and Spatial Orientation of the Acetabulum , 1990, Acta radiologica.

[10]  Jennifer S Wayne,et al.  A novel approach for determining three-dimensional acetabular orientation: results from two hundred subjects. , 2014, The Journal of bone and joint surgery. American volume.

[11]  F. Layher,et al.  The rationale for tilt-adjusted acetabular cup navigation. , 2008, The Journal of bone and joint surgery. American volume.

[12]  Eric Vandenbussche,et al.  The Asymmetric Profile of the Acetabulum , 2008, Clinical orthopaedics and related research.

[13]  R. Ganz,et al.  CT evaluation of coverage and congruency of the hip prior to osteotomy. , 1988, Clinical orthopaedics and related research.

[14]  Leslie G. Portney Dpt PhD Fapta,et al.  Foundations of Clinical Research: Applications to Practice , 2015 .

[15]  William H. Harris,et al.  SYMPOSIUM: PAPERS PRESENTED AT THE ANNUAL CLOSED MEETING OF THE INTERNATIONAL HIP SOCIETY The Etiology of Osteoarthritis of the Hip An Integrated Mechanical Concept , 2007 .

[16]  Frank Langlotz,et al.  Radiographic analysis of femoroacetabular impingement with Hip2norm—reliable and validated , 2008, Journal of Orthopaedic Research.

[17]  Burkhard Lembeck,et al.  Pelvic tilt makes acetabular cup navigation inaccurate , 2005, Acta orthopaedica.

[18]  W. Capello,et al.  Morphologic Features of the Acetabulum and Femur: Anteversion Angle and Implant Positioning , 2001, Clinical orthopaedics and related research.

[19]  Ronald M. Summers,et al.  Acetabular rim and surface segmentation for hip surgery planning and dysplasia evaluation , 2008, SPIE Medical Imaging.

[20]  Frank Langlotz,et al.  Anatomic Referencing of Cup Orientation in Total Hip Arthroplasty , 2005, Clinical orthopaedics and related research.

[21]  Rupesh Tarwala,et al.  Robotic assisted total hip arthroplasty using the MAKO platform , 2011, Current reviews in musculoskeletal medicine.

[22]  D. Murray The definition and measurement of acetabular orientation. , 1993, The Journal of bone and joint surgery. British volume.

[23]  D. Tönnis Normal values of the hip joint for the evaluation of X-rays in children and adults. , 1976, Clinical orthopaedics and related research.

[24]  S B Murphy,et al.  Acetabular dysplasia in the adolescent and young adult. , 1990, Clinical orthopaedics and related research.

[25]  Marc Puls,et al.  Automated detection of the osseous acetabular rim using three-dimensional models of the pelvis , 2011, Comput. Biol. Medicine.

[26]  Michael Nogler,et al.  Hemispheric cups do not reproduce acetabular rim morphology , 2007, Acta orthopaedica.