The Hip: Preservation, Replacement and Revision

Radiographic Evaluation of the Acetabular Cup

- see postoperative radiographic evaluation of total hip replacement

- Discussion:
    - acetabular component loosening:
    - osteolysis / polyethylene wear

- Component Position: 
    - acetabular component flexion:
          - to measure postoperative cup position, a standing true lateral view of the operated hip allowed direct measurement of cup flexion;
          - cross table lateral:
                 - to measure anteversion, draw a line tangential to the face of the cup and a line drawn perpendicular to the horizontal plane;  
                 - note that supine cross table lateral radiographs may be unreliable for measuring acetabular component anteversion since amount of flexion in the
                        contra-lateral hip will affect the amount of pelvic tilt (and anteversion);
          - Lowenstein lateral radiograph:
                 - provides a lateral view of the acetabular subchondral bone and the cup after implantation
                 - modified Lowenstein lateral radiograph is similar to an oblique radiograph of the pelvis;
                 - patient is turned onto the affected hip at least 45° and as much as necessary to allow the lower limb to be in abduction and external rotation
                        and to be flat on the x-ray table; 

- Assessment of Pelvic Defects: (Classification of Acetabular Defects and Bone Grafting Options)
        - Paprosky classification 
        - assesment of posterior column: (pelvic discontinuity)
        - in cases of acetabular loosening, the integerty of the posterior column may determine whether or not allografting is required



Acetabular revision in total hip replacement with a press-fit cup.

Extra-large press-fit cups without screws for acetabular revision.

A simplified method to determine acetabular cup anteversion from plain radiographs.

Sensitivity and specificity of plain radiographs for detection of medial-wall perforation secondary to osteolysis.

Functional Pelvic Orientation Measured from Lateral Standing and Sitting Radiographs

Reliability and intraoperative validity of preoperative assessment of standardized plain radiographs in predicting bone loss at revision hip surgery.   

The reliability and variation of acetabular component anteversion measurements from cross-table lateral radiographs.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, July 8, 2013 12:23 pm