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Do Changes in Pelvic Rotation and Tilt Affect Measurement of the Anterior Center Edge Angle on False Profile Radiographs? A Cadaveric Study

Putnam, Sara M., MD; Clohisy, John C., MD; Nepple, Jeffrey J., MD

Clinical Orthopaedics and Related Research®: May 2019 - Volume 477 - Issue 5 - p 1066–1072
doi: 10.1097/CORR.0000000000000636
2018 BERNESE HIP SYMPOSIUM
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Background The false profile radiograph assesses acetabular coverage in prearthritic hip conditions. Precise rotation of this radiograph is difficult to obtain, so the clinician must interpret radiographs with nonstandard pelvic rotation or tilt, despite limited evidence of how this may affect the anterior center edge angle measurement.

Questions/purposes (1) Does pelvic rotation alter the measurement of the anterior center edge angle on false profile views? (2) Does pelvic tilt alter the measurement of the anterior center edge angle on false profile views? (3) Is there an objective way to assess appropriate pelvic rotation for the false profile view?

Methods Eight cadaver hips (four female, four male; one hip randomly selected per pelvis) were included in the study. Hips with degenerative changes, evidence of previous fracture or trauma, or previous surgical intervention were excluded. Specimens were between 68 to 92 years of age (median, 76 years). The specimens were fixed to a custom jig, and radiographs were taken at 5° intervals of rotation (45–85°) and 5° intervals of pelvic tilt (+10° to -10°). The primary outcome variable, anterior center edge angle, was measured for each rotation and tilt.

Results Every degree increase in pelvic rotation toward a true lateral resulted in 0.18° increase in the anterior center edge angle (95% confidence interval [CI], 0.07–0.29; p = 0.002). For every degree increase in pelvic tilt, the anterior center edge angle increased 0.65° (95% CI, 0.5–0.8; p < 0.001). We verified that standard pelvic rotation of 65° for a false profile radiograph was present when the space between the femoral heads is 66% to 100% of the diameter of the femoral head being imaged.

Conclusions This study shows that the anterior center edge angle increases as pelvic tilt increases, with a 6° increase in anterior center edge angle for each 10° increase in pelvic tilt. Since the false profile radiograph is obtained standing, the patient should be counseled to avoid adopting a forced posture, ensuring the radiograph remains an accurate functional representation of the patient’s anatomy. In contrast, pelvic rotation did not influence the anterior center edge angle by an important margin, and while we recommend that radiographs continue to be obtained with standardized pelvic rotation, aberrant pelvic rotation will likely not result in a clinically meaningful difference in anterior center edge angle measurements. In the future, studies to identify the specific regions of acetabular anatomy that constitute the radiographic measurement of the anterior center edge angle would enhance current understanding of the associated radiographic anatomy, and consequently improve the ability of the surgeon to treat the specific area of pathology.

Clinical Relevance In practice, the clinician should pay close attention to pelvic tilt, as a 10° change in tilt may cause 6° of change in the anterior center edge angle. However, false profile radiographs obtained within ± 20° of the targeted 65° of rotation will result in less than 4° change in the anterior center edge angle.

S. M. Putnam, J. C. Clohisy, J. J. Nepple, Washington University Department of Orthopedic Surgery, St. Louis, MO, USA

S. M. Putnam, Department of Orthopedic Surgery, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68132, USA, Email: sara.putnam@unmc.edu

This research was funded by a Resident Research Grant (SMP) through the Orthopaedic Research and Education Foundation.

One of the authors certifies that he (JCC) has received grants in the amount of USD 100,001 to USD 1,000,000, and personal fees outside the submitted work in an amount less than USD 10,000, during the study period from Zimmer Biomet (Warsaw, IN, USA); personal fees outside the submitted work, during the study period, in an amount of USD 10,000 to USD 100,000 from Microport Orthopedics Inc (Arlington, TN, USA); grants outside the submitted work, during the study period, in an amount of less than USD 10,000 from Smith & Nephew; personal fees outside the submitted work, during the study period, in an amount of less than USD 10,000 from Wolters Kluwer Health (Philadelphia, PA, USA).

One of the authors certifies that he (JJN) has received personal fees, outside the submitted work, in an amount of less than USD 10,000 and grants in an amount of less than USD 10,000 from Smith & Nephew (Andover, MA, USA); grants in an amount of USD 100,001 to USD 1,000,000 from Zimmer (Warsaw, IN, USA); personal fees in an amount of less than USD 10,000 from Ceterix (Fremont, CA, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Received June 21, 2018

Accepted December 17, 2018

© 2019 Lippincott Williams & Wilkins LWW
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