The Journal of Bone and Joint Surgery (American) 85:505-511 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
Validation of Two and Three-Dimensional Radiographic Techniques for Measuring Polyethylene Wear After Total Hip Arthroplasty
Andrew J. Hui, MESc,
Richard W. McCalden, MD,
John M. Martell, MD,
Steven J. MacDonald, MD,
Robert B. Bourne, MD and
Cecil H. Rorabeck, MD
Investigation performed at the Division of Orthopaedic Surgery, London Health Sciences Centre—University Campus, London, Ontario, Canada
Andrew J. Hui, MESc
Richard W. McCalden, MD
Steven J. MacDonald, MD
Robert B. Bourne, MD
Cecil H. Rorabeck, MD
Orthopaedic Research Laboratory (A.J.H.) and Division of Orthopaedic Surgery (R.W.McC., S.J.MacD., R.B.B., and C.H.R.), London Health Sciences Centre—University Campus, London, ON N6A 5A5, Canada. E-mail address for A.J. Hui: ahui{at}uwo.ca E-mail address for R.W. McCalden: richard.mccalden@lhsc.on.ca. E-mail address for S.J. MacDonald: steven.macdonald@lhsc.on.ca. E-mail address for R.B. Bourne: robert.bourne@lhsc.on.ca. E-mail address for C.H. Rorabeck: cecil.rorabeck@lhsc.on.ca
John M. Martell, MD
Section of Orthopaedic Surgery and Rehabilitative Medicine, University of Chicago, 5841 South Maryland Avenue, MC 3079, Chicago, IL 60637. E-mail address: jmartell@surgery.bsd.uchicago.edu
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from The Arthritis Society. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: Three-dimensional radiographic techniques have been developed to estimate in vivo polyethylene wear of total hip replacements. We are not aware of any published study examining the accuracy of these in vivo methods. Our objective was to validate two radiographic techniques by comparing their results with those obtained directly from retrieved specimens.
Methods: A coordinate measuring machine was used to probe the interior bearing surface of seventeen acetabular liners that had been retrieved at revision surgery. Solid models were created to determine volumetric polyethylene loss and linear depth and direction of wear. Two in vivo radiographic techniques (PolyWare and the Martell Hip Analysis Suite) were used to calculate two-dimensional linear, three-dimensional linear, and volumetric wear. The radiographic analysis was done independently, and the results were compared with the known values of polyethylene wear derived with use of the coordinate measuring machine.
Results: Correlation coefficients comparing the values for two-dimensional and three-dimensional linear wear and volumetric wear derived with the PolyWare radiographic technique with the values derived with the coordinate measuring machine were r
2 = 0.78, r
2 = 0.75, and r
2 = 0.91, respectively (all p < 0.001), and the correlation coefficients comparing the values derived with the Martell Hip Analysis Suite radiographic technique with those derived with the coordinate measuring machine were r
2 = 0.80, r
2 = 0.84, and r
2 = 0.91, respectively (p < 0.001). The average absolute difference between the radiographic estimates and the results derived with the coordinate measuring machine was approximately 19% (range, 13% to 24%).
Conclusions: There was good agreement between the wear estimates made with both in vivo techniques and the measurements of the retrieved polyethylene liners made with the coordinate measuring machine. Two-dimensional wear analysis (based on anteroposterior radiographs) accounted for most of the polyethylene wear, while one technique of three-dimensional wear analysis (PolyWare) demonstrated some additional wear in the lateral plane.
Clinical Relevance: The use of two-dimensional measurements, based solely on an anteroposterior radiograph, may suffice in the clinical setting. In this series, these techniques detected relatively large changes in femoral head penetration.
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