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Radiological measurements in total hip arthroplasty
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Every year, about 1 million patients worldwide and 20000 patients in Sweden undergo total hip arthroplasty (THA). This type of operation is considered a successful, safe and cost-effective procedure to regain mobility and restore hip joint function in patients suffering from severe hip joint disease or trauma. The main goals of the operation are to relief the pain, improve quality of life (QoL) and to restore the biomechanical forces around the hip with appropriate femoral offset (FO), leg length and proper component position and orientation. The radiographic preoperative planning and postoperative evaluation of these parameters require good validity, interobserver reliability and intraobserver reproducibility. Most patients are satisfied after THA, although this treatment still has its complications. About 10 % of THA patients report persistent pain and suboptimal functional outcome and QoL at long-term follow-up. The absolute number of dissatisfied patients is expected to rise given the increase in the annual number of THA performed. Therefore, every effort should be made to investigate factors that possibly influence THA outcome. The data available about the influence of preoperative radiological severity and symptom duration of OA on the outcome of THA are scarce and contradictory. Further studies even needed to evaluate the effect of obesity on post-operative THA radiological measurements

Abstract [sv]

Varje år opereras ungefär 1 miljon patienter runt om i världen och 20,000 patienter i Sverige med en total höftledsprotes (THA). Höftledsprotesoperation anses vara en av de mest framgångsrika, säkra och kostnadseffektiva kirurgiska åtgärderna med ett syfte att smärtlindra, återställa rörligheten och förbättra livskvaliteten. Höftleden drabbas av artros, åldersrelaterad sjukdom som orsakar destruktion av leden. Vid operation med THA är det viktigt att återställa de biomekaniska krafterna runt höftleden med en adekvat så kallad femoral offset (FO), avståndet mellan höftens rörelsecentrum och mitten av bäckenet, postoperativ benlängdsskillnad (BLS) och ett tillfredsställande komponentläge. Den preoperativa planeringen och den postoperativa röntgenbedömningen av dessa parametrar kräver god tillförlitlighet, det vill säga validitet och reproducerbarhet både mellan olika bedömare och vid upprepade mätningar av samma bedömare. Således är radiologiska mätningar före och efter THA oerhört viktiga för att få bästa resultat efter THA. Det finns inte tillräckligt med information i litteraturen om effekten av den preoperativa radiologiska artrosgraden och symptomduration av artrosen på utfallet av THA. Dessutom behövs ytterligare forskning för att studera effekten av obesitas på de radiologiska mätningarna efter THA.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2018. , p. 69
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1983
Keywords [en]
Total hip arthroplasty, leg length discrepancy, femoral offset, WOMAC, quality of life, radiographicmeasurements, Kellgren-Lawrence, duration, acetabular cup, inclination, anteversion, BMI
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-151862ISBN: 978-91-7601-943-6 (print)OAI: oai:DiVA.org:umu-151862DiVA, id: diva2:1248190
Public defence
2018-10-12, Lionsalen, byggnad 7, målpunkt Y22, 2 tr, Umeå universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-21 Created: 2018-09-14 Last updated: 2018-11-08Bibliographically approved
List of papers
1. Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty
Open this publication in new window or tab >>Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty
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2015 (English)In: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 44, no 3, p. 345-351Article in journal (Refereed) Published
Abstract [en]

In total hip arthroplasty (THA), radiographic preoperative planning and postoperative evaluation of acetabular component, femoral offset (FO) and leg length discrepancy (LLD) require good validity, interobserver reliability and intraobserver reproducibility. In this study, we evaluated the validity of the Sundsvall method of FO measurement and the interobserver reliability and intraobserver reproducibility of measurement of FO, LLD, acetabular cup inclination and anteversion. Ninety patients with primary unilateral osteoarthritis (OA) were included in this prospective study. On postoperative radiographs FO by the Sundsvall method (femoral axis-pelvic midline), FO by a standard method (femoral axis-hip rotational centre-teardrop point), LLD (inter-teardrop line-lesser trochanter), acetabular cup inclination (on AP view the angle between the cup rim and transischial line) and anteversion (on lateral view the angle between the face of acetabulum and a line perpendicular to the horizontal plane) were measured. The interobserver reliability and intraobserver reproducibility were calculated for three independent observers. The concurrent validity and degree of prediction of the Sundsvall method are measured by comparing its results with the standard method. The interobserver reliability of all measurements was excellent (ICC > 0.80), except for LLD, which was substantial (ICC = 0.79). The intraobserver reproducibility of all measurements was excellent (ICC > 0.80). The concurrent validity of the Sundsvall method compared to the standard method was good with a positive correlation. The Sundsvall method is as reliable as the standard method. The evaluated radiographic measurement methods have the required validity and reliability to be used in clinical practice.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Radiographic measurements, Total hip arthroplasty, Leg length discrepancy, Femoral offset, etabular cup, Inclination, Anteversion
National Category
Surgery Orthopaedics Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-100945 (URN)10.1007/s00256-014-2055-7 (DOI)000348925400005 ()25403426 (PubMedID)
Available from: 2015-03-20 Created: 2015-03-16 Last updated: 2018-11-08Bibliographically approved
2. Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?
Open this publication in new window or tab >>Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?
2017 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 9, p. 1125-1131, article id UNSP 0284185116684676Article in journal (Refereed) Published
Abstract [en]

Background: Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose: To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods: Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening >= 10mm (n = 41) or with reduced global FO >5mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results: Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC >= 0.69). Conclusion: Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2017
Keywords
Hip arthroplasty, leg length discrepancy, femoral offset, plain radiographs, reliability
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-138202 (URN)10.1177/0284185116684676 (DOI)000405779200013 ()
Note

Originally included in thesis in manuscript form with title Leg lengthening and femoral offset reduction after total hip arthroplasty: where is the problem located – stem or cup?

Available from: 2017-08-21 Created: 2017-08-21 Last updated: 2018-11-08Bibliographically approved
3. The Influence of Radiological Severity and Symptom Duration of Osteoarthritis on Postoperative Outcome After Total Hip Arthroplasty: A Prospective Cohort Study
Open this publication in new window or tab >>The Influence of Radiological Severity and Symptom Duration of Osteoarthritis on Postoperative Outcome After Total Hip Arthroplasty: A Prospective Cohort Study
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2018 (English)In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 33, no 2, p. 436-440Article in journal (Refereed) Published
Abstract [en]

Background: We aimed to investigate the influence of preoperative radiological severity and symptom duration of hip osteoarthritis (OA) on the postoperative functional outcome, quality of life, as well as abductor muscle strength after total hip arthroplasty (THA). Methods: In this prospective cohort study, we studied 250 patients. Preoperatively, we evaluated the function with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life with euroqol-5D (EQ-5D). At 1 year after THA, the same scores and also hip abductor muscle strength were measured in 222 patients. We divided the cohort twice, first according to the radiological OA severity [Kellgren-Lawrence classification (KL)] and then according to the OA symptom duration. We investigated whether the preoperative KL class and symptom duration influenced the 1-year WOMAC (primary outcome measure) or EQ-5D and abductor muscle strength (secondary outcome measures). Results: The crude results showed that KL class and symptom duration had no influence (P = .90 and P = .20, respectively) on the 1-yearWOMAC. Younger age, male gender, and lower body mass index were associated with a better function. Regarding 1-year EQ-5D, the crude results showed that body mass index and KL class had no influence (P = .83 and P = .39, respectively). The adjusted results showed that only age and gender influenced the postoperative EQ-5D. No influence of the tested factors was found on the 1-year abductor muscle strength. Conclusion: Preoperative radiological OA severity and symptom duration had no influence on the outcome of THA and should probably not affect the decision about timing the operative intervention. 

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2018
Keywords
radiological severity, symptom duration, hip osteoarthritis, postoperative outcome, total hip throplasty
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-145155 (URN)10.1016/j.arth.2017.09.051 (DOI)000424145000022 ()29066249 (PubMedID)
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2018-11-08Bibliographically approved
4. Does body mass index affect restoration of femoral offset and leg length and cup positioning after total hip arthroplasty?: A prospective radiological cohort study
Open this publication in new window or tab >>Does body mass index affect restoration of femoral offset and leg length and cup positioning after total hip arthroplasty?: A prospective radiological cohort study
(English)In: Article in journal, Meeting abstract (Other academic) Submitted
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-151712 (URN)
Available from: 2018-09-10 Created: 2018-09-10 Last updated: 2018-11-08

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Al-Amiry, Bariq

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