Intraoperative Evaluation of Acetabular Morphology in Hip Arthroscopy Comparing Standard Radiography Versus Fluoroscopy: A Cadaver Study.

Büchler, L; Schwab, Joseph M; Whitlock, Patrick W; Beck, Martin; Tannast, M (2016). Intraoperative Evaluation of Acetabular Morphology in Hip Arthroscopy Comparing Standard Radiography Versus Fluoroscopy: A Cadaver Study. Arthroscopy - the journal of arthroscopic & related surgery, 32(6), pp. 1030-1037. Elsevier 10.1016/j.arthro.2015.12.048

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PURPOSE

To compare quantitative measurements of acetabular morphology obtained using intraoperative fluoroscopy, to standardized anteroposterior (AP) pelvis radiographs.

METHODS

Ten dried human pelvis specimens (20 hips) were imaged using hip-centered fluoroscopy and standardized AP pelvis radiographs. Each hip was evaluated for acetabular version and coverage, including lateral center edge (LCE) angle, acetabular index (AI), total anterior and posterior coverage, and crossover sign.

RESULTS

No statistically significant differences existed between the mean LCE angle (fluoroscopy 36.5° ± 8.3° v plain films 36.1° ± 7.9°, P = .59), acetabular index (0.6° ± 8.6° v 0.2° ± 7.1°, P = .61), ACM angle (44.0° ± 2.6° v 44.1° ± 3.8°, P = .89), Sharp's angle (31.8° ± 5.7° v 32.4° ± 3.9°, P = .44), and the total femoral coverage (80.9% ± 6.4% v 80.7% ± 7.5%, P = .83). Conversely, total anterior coverage (30.7% ± 8.5% v 33.3% ± 8.2%, P < .0001) appeared significantly decreased and the total posterior coverage (54.1% ± 6.9% v 49.1% ± 7.8%, P < .0001) appeared significantly increased in fluoroscopy compared with plain film radiographs. Fluoroscopy also failed to identify the presence of a crossover sign in 30% and underestimated the retroversion index (9% ± 16%, v 13% ± 16%, P = .016).

CONCLUSIONS

The values for the LCE angle and AI determined by hip-centered fluoroscopy did not differ from those obtained by standardized AP plain film radiography. However, fluoroscopy leads to a more anteverted projection of the acetabulum with significantly decreased total anterior coverage, significantly increased total posterior coverage, and underestimated signs of retroversion compared with standardized AP pelvis radiography.

CLINICAL RELEVANCE

This study shows reliable LCE and AI angles but significant differences in the projected anteversion of the acetabulum between standardized AP pelvis radiography and hip-centered fluoroscopy.

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