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Reassessment of Computerized Wear Measurement for Total Hip Arthroplasty with Correction for Projectional Image DistortionA Brief Follow-up Report
Matthew J. Kraay, MS, MD1; Rebecca D. Moore, MS2; John M. Martell, MD3; Clare M. Rimnac, PhD2
1 Department of Orthopaedic Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail address: matthew.kraay@uhhospitals.org
2 Departments of Orthopaedics (R.D.M. and C.M.R.) and Mechanical and Aerospace Engineering (C.M.R.), Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106
3 Section of Orthopaedic Surgery and Rehabilitation Medicine, Department of Surgery, The University of Chicago Medical Center, 5841 South Maryland Avenue, MC 3079, Chicago, IL 60637
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Smith and Nephew, Zimmer, Stryker, the Harris Foundation, and UCTech).

Investigation performed at University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio, and The University of Chicago, Chicago, Illinois

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Aug 04;92(9):1858-1867. doi: 10.2106/JBJS.I.00832
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Wear of the ultra-high molecular weight polyethylene articular surface has been recognized as a major factor threatening the long-term success of total hip arthroplasty. Manual techniques that have been used to measure femoral head penetration into the polyethylene have been plagued with poor reproducibility and limited accuracy. Using a previously described phantom model simulating an unworn total hip arthroplasty, we previously demonstrated significant limitations in the accuracy of several widely used computerized wear measurement programs. A major component of these inaccuracies is projectional distortion of the femoral head and acetabular shell on the radiograph. These inaccuracies can be "corrected for" mathematically.


In the present follow-up study, we evaluated a widely used hip wear measurement software program (Hip Analysis Suite version that corrects for these projectional errors with use of our previously described "zero wear" phantom model. A cementless metal-backed acetabular component was evaluated radiographically at three different cephalocaudad locations with respect to a radiopaque centering target. At all three positions, the cup was aligned in three different angles of planar abduction (35°, 45°, 55°) and four angles of planar anteversion (10°, 20°, 30°, 40°). The accuracy and reproducibility of Hip Analysis Suite version were determined and compared with the results obtained with the earlier version, Hip Analysis Suite version 4.0.


Hip Analysis Suite version was significantly more accurate than Hip Analysis Suite version 4.0 for determining linear wear and volumetric wear. Hip Analysis Suite version was significantly more accurate for determining femoral head penetration at the different cephalocaudad acetabular positions and over the range of acetabular component anteversion and abduction angles in comparison with Hip Analysis Suite version 4.0.


With use of the same methodology that was used to evaluate earlier versions of Hip Analysis Suite, the present study showed improvement in the accuracy of wear measurement with Hip Analysis Suite version as compared with Hip Analysis Suite version 4.0.

Clinical Relevance: 

On the basis of the results of the present study, Hip Analysis Suite version appears to fulfill the needs for a user-friendly, efficient, and accurate method of assessment of polyethylene wear following total hip arthroplasty.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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