Assessment of Acetabular Component Anteversion after Total Hip Arthroplasty: Comparison of Anteroposterior and Cross-Table Lateral Radiographs with Computed Tomography Scans

Background: Several methods of measurement of anteversion of acetabular components after total hip arthroplasty (THA) have been described in the literature using plain radiographs or computed tomography (CT) scans. None of these have proved to be the gold standard. We aimed to study the correlation between the CT and radiographic methods of calculation of acetabulum anteversion. Methods: CT scans of the pelvis, anteroposterior (AP) and cross-table lateral (CL) radiographs were obtained in 60 patients who underwent THA two weeks after surgery. Anteversion was measured using Widmer method and Liaw method on AP radiographs, and the ischiolateral method on CL radiographs. Anteversion measured on the CT scan was taken as the reference anteversion and the above measurements were analysed for correlation with the measurements on CT scan. Intraclass correlation coefficients (ICCs) were calculated for both intra- and interobserver reliability. Results: Mean acetabular version on CL radiographs was 53.1 +/- 10.7. Mean version on AP radiographs by Widmer method was 21.4 +/- 3.6 and by Liaw method was 20.3 +/- 4.8. Mean version on CT scans was 26.02 +/- 6.8. There was a good correlation between the acetabular version on CT scans with the version on AP radiographs by Widmer method (r = 0.78, p < 0.001) and Liaw method (r = 0.87, p < 0.001). Good correlation was seen between the acetabular version on CL radiographs and CT scans (r = 0.91, p < 0.001). Also, a good correlation was observed between the acetabular version measurements on CL radiographs and AP radiographs by Widmer method (r = 0.81, p < 0.001) or Liaw method (r = 0.70, p < 0.001). Excellent inter- and intraobserver reliability were seen for all the measurements. Conclusions: Calculation of acetabular component version on AP views as well as CL views of plain radiographs showed a strong correlation with the version measurements on CT scans. Good correlations were observed between different techniques of measurement on radiographs. Therefore, all these measurements can be valid methods for assessment of anteversion.