The trochanteric double contour is a valuable landmark for assessing femoral offset underestimation on standard radiographs: a retrospective study

Abstract Background Inaccurate projection on standard pelvic radiographs leads to the underestimation of femoral offset—a critical determinant of postoperative hip function—during total hip arthroplasty (THA) templating. We noted that the posteromedial facet of the greater trochanter and piriformis fossa form a double contour on radiographs, which may be valuable in determining the risk of underestimating femoral offset. We evaluate whether projection errors can be predicted based on the double contour width. Methods Plain anteroposterior (AP) pelvic radiographs and magnetic resonance images (MRIs) of 64 adult hips were evaluated retrospectively. Apparent femoral offset, apparent femoral head diameter and double contour widths were evaluated from the radiographs. X-ray projection errors were estimated by comparison to the true neck length measured on MRIs after calibration to the femoral heads. Multivariate analysis with backward elimination was used to detect associations between the double contour width and radiographic projection errors. Femoral offset underestimation below 10% was considered acceptable for templating. Results The narrowest width of the double line between the femoral neck and piriformis fossa is significantly associated with projection error. When double line widths exceed 5 mm, the risk of projection error greater than 10% is significantly increased compared to narrower double lines, and the acceptability rate for templating drops below 80% (p = 0.02). Conclusion The double contour width is a potential landmark for excluding pelvic AP radiographs unsuitable for THA templating due to inaccurate femoral rotation.

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The Trochanteric Double Contour is a Valuable Landmark for Assessing Femoral Offset Underestimation on Standard Radiographs: A Retrospective Study

10.21203/rs.3.rs-43648/v1 ◽

2020 ◽

Author(s):

Stefan Blümel ◽

Vincent A. Stadelmann ◽

Marco Brioschi ◽

Alexander Küffer ◽

Michael Leunig ◽

...

Keyword(s):

Magnetic Resonance Images ◽

Femoral Offset ◽

Critical Determinant ◽

Double Line ◽

Pelvic Radiographs ◽

Hip Function ◽

Ray Projection ◽

Projection Error ◽

Standard Radiographs ◽

Double Contour

Abstract Background: Inaccurate projection on standard pelvic radiographs leads to the underestimation of femoral offset—a critical determinant of postoperative hip function—during total hip arthroplasty (THA) templating. We noted that the posteromedial facet of the greater trochanter and piriformis fossa form a double contour on radiographs, which may be valuable in determining the risk of underestimating femoral offset. We evaluate whether projection errors can be predicted based on the double contour width.Methods: Plain anteroposterior (AP) pelvic radiographs and magnetic resonance images (MRIs) of 64 adult hips were evaluated retrospectively. Apparent femoral offset, apparent femoral head diameter and double contour widths were evaluated from the radiographs. X-ray projection errors were estimated by comparison to the true neck length measured on MRIs after calibration to the femoral heads. Multivariate analysis with backward elimination was used to detect associations between the double contour width and radiographic projection errors. Femoral offset underestimation below 10% was considered acceptable for templating.Results: The narrowest width of the double line between the femoral neck and piriformis fossa is significantly associated with projection error. When double line widths exceed 5 mm, the risk of projection error greater than 10% is significantly increased compared to narrower double lines, and the acceptability rate for templating drops below 80% (p = 0.02).Conclusion: The double contour width is a potential landmark for excluding pelvic AP radiographs unsuitable for THA templating due to inaccurate femoral rotation.

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Cementoplasty in the Treatment of Avascular Necrosis of the Hip

The Journal of Rheumatology ◽

10.3899/jrheum.080363 ◽

2009 ◽

Vol 36 (2) ◽

pp. 385-389 ◽

Cited By ~ 1

Author(s):

NICOLAS REUTER ◽

ALBAN ROMIER ◽

ZEPHIR HAMBOURG ◽

FRÉDÉRIC PALMIERI ◽

DOMINIQUE FAYET ◽

...

Keyword(s):

Avascular Necrosis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Magnetic Resonance Images ◽

Stage Iii ◽

Joint Effusion ◽

Filler Materials ◽

Double Line ◽

Total Hip ◽

Percutaneous Cementoplasty

Objective.This retrospective study evaluated the role of percutaneous cementoplasty in the treatment of avascular necrosis (AVN) of the hip in order to postpone or avoid total hip replacement.Methods.The study population comprised 40 patients (47 hips) with mean age of 46 ± 4.7 years and mean body mass index of 26.7 ± 4.6 kg/m2. AVN was classified according to the Ficat-Arlet classification as one stage I, 30 stage II, and 16 stage III. The minimum followup was 9 months.Results.It was found that 74.5% of hips were secondarily operated for total hip replacement a mean of 19.9 ± 15 months (median 14 mo) after cementoplasty. As well, 94% of patients with stage 3AVN and 68% with stage 2AVN underwent surgery. Twelve hips were not operated, with a mean followup of 39 ± 19.2 months. Pain decreased by more than 80% after cementoplasty in two-thirds of patients, but the mean pain-free interval was only 8.1 ± 6.6 months (median 5 mo). Nineteen of the 29 working patients were able to transiently return to work. The outcome was more unfavorable with radiological stage III AVN, joint effusion, and/or a double-line sign around the lesions on magnetic resonance images.Conclusion.Despite early relief of pain, the results of the cementoplasty technique were disappointing, with need for arthroplasty surgery in most cases within 2 years. Alternative percutaneous techniques using different filler materials with osteoinductive properties should be evaluated in further studies.

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Accuracy of leg length and femoral offset restoration after total hip arthroplasty with the utilisation of an intraoperative calibration gauge

Hip International ◽

10.1177/1120700019836383 ◽

2019 ◽

Vol 30 (3) ◽

pp. 296-302 ◽

Cited By ~ 1

Author(s):

Oliver Enke ◽

Yadin D Levy ◽

Warwick JM Bruce

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

Leg Length ◽

Femoral Offset ◽

Measuring Device ◽

X Ray ◽

Total Hip ◽

Hip Function ◽

The Mean

Background: Offset and leg length (LL) restoration are critical for the achievement of a stable, well-functioning hip following total hip arthroplasty (THA). Several techniques are described in the literature, including a hip calibration gauge. We question whether meticulous preoperative planning of a specific surgical technique in combination with the utilisation of a calibration gauge can provide an accurate offset and LL restoration. Methods: Retrospective review of 101 unilateral THAs via a posterior approach by a single surgeon. Preoperative radiographic LL and offset were radiographically calculated. Intraoperatively prior to hip dislocation a calibration gauge was used to measure LL and offset with a pin inserted into the iliac crest acting as a static referencing point. All had pelvis x-ray performed 6 weeks postoperatively. A literature review was conducted to establish average postoperative LL/offset values for statistical comparison. Results: The average absolute postoperative leg-length discrepancy (LLD) was 2.51 mm compared to preoperatively 3.54 mm ( p = 0.018). A total of 93.1% and 100% had LLD of ⩽5 mm and ⩽10 mm, respectively. The mean postoperative offset difference was 2.39 mm. The investigated LLD and offset results were comparable with literature data of studies utilising an intraoperative measuring device. LLD was significantly decreased when compared to a free-hand technique (LLD 4.42 mm, p < 0.001). Conclusion: The technique utilising preoperative templating, intraoperative offset verification together with the use of hip calibration gauge yielded accurate LLD and offset restoration as in the literature. Precise offset restoration, which often is a neglected issue, can lead to better abductor vector restoration, hip function and less pain.

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An emerging technology: Nuclear magnetic resonance microscopy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010010706x ◽

1988 ◽

Vol 46 ◽

pp. 1000-1001

Author(s):

M.J. Hennessy ◽

E. Kwok

Keyword(s):

Nuclear Magnetic Resonance ◽

Magnetic Resonance ◽

Relaxation Times ◽

Basic Research ◽

Local Environment ◽

Magnetic Resonance Images ◽

Nmr Microscopy ◽

Mri Scans ◽

Temperature Relaxation ◽

Nuclear Magnetic

Much progress in nuclear magnetic resonance microscope has been made in the last few years as a result of improved instrumentation and techniques being made available through basic research in magnetic resonance imaging (MRI) technologies for medicine. Nuclear magnetic resonance (NMR) was first observed in the hydrogen nucleus in water by Bloch, Purcell and Pound over 40 years ago. Today, in medicine, virtually all commercial MRI scans are made of water bound in tissue. This is also true for NMR microscopy, which has focussed mainly on biological applications. The reason water is the favored molecule for NMR is because water is,the most abundant molecule in biology. It is also the most NMR sensitive having the largest nuclear magnetic moment and having reasonable room temperature relaxation times (from 10 ms to 3 sec). The contrast seen in magnetic resonance images is due mostly to distribution of water relaxation times in sample which are extremely sensitive to the local environment.

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Functional information from magnetic resonance imaging

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100136799 ◽

1995 ◽

Vol 53 ◽

pp. 84-85

Author(s):

Alan P. Koretsky ◽

Afonso Costa e Silva ◽

Yi-Jen Lin

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

High Resolution ◽

Cancer Biology ◽

Imaging Modality ◽

Magnetic Resonance Images ◽

Great Success ◽

Functional Information ◽

Resonance Imaging ◽

High Resolution Mri

Magnetic resonance imaging (MRI) has become established as an important imaging modality for the clinical management of disease. This is primarily due to the great tissue contrast inherent in magnetic resonance images of normal and diseased organs. Due to the wide availability of high field magnets and the ability to generate large and rapidly switched magnetic field gradients there is growing interest in applying high resolution MRI to obtain microscopic information. This symposium on MRI microscopy highlights new developments that are leading to increased resolution. The application of high resolution MRI to significant problems in developmental biology and cancer biology will illustrate the potential of these techniques.In combination with a growing interest in obtaining high resolution MRI there is also a growing interest in obtaining functional information from MRI. The great success of MRI in clinical applications is due to the inherent contrast obtained from different tissues leading to anatomical information.

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