Abstract
BACKGROUND:
Although most radiographs used for polyethylene wear measurements have been taken with the patient in the supine position in order to assess penetration by the femoral head into the acetabular polyethylene socket, we have questioned the effect of weight-bearing on the position of the head within the socket. The current study aimed to determine the effect of weight bearing, i.e. standing on the two-dimensional radiographic position of the femoral head within the socket.
PATIENTS AND METHODS:
A total of three hundred and fifty patients (three hundred and eighty three hips) who had had a total hip arthroplasty had digital radiographs made a set of anteroposterior radiographs for each patient: one radiograph was made with the patient supine and one was made with the patient standing in full weight bearing on the replaced hip. The patients were divided into the following two groups: 1) seventy-five patients (eighty-three hips) with conventional polyethylene (CON) (group-1); 2) two hundred and seventy-five patients (three hundred hips) with highly cross-linked polyethylene (XPL) (group-2).
The set of radiograph was taken at three weeks postoperatively and at the time of semiannual follow-up. The average ceramic femoral head penetration was measured with radiographs taken in the standing or supine position at the final follow-up and compared with those of three weeks postoperatively. A single researcher with use of a computerized measurement system performed all measurements on the radiographs of the two-dimensional position of the head. Follow-up period were 13.5 ± 1.0 (range. 11.0–15.5) years in group-1 and 7.6 ± 2.1 (range. 5.0–12.6) years in group-2.
RESULTS:
Linear penetration rates in group-1 were 0.172 ± 0.069 mm/year in supine position and 0.178 ± 0.069 mm/year in standing position (p < 0.05, paired t-test; r2 = 0.88), and the rates in group-2 were 0.029 ± 0.024 mm/year and 0.035 ± 0.027 mm/year respectively (p < 0.0005, paired t-test; r2 = 0.16). The mean ceramic head penetration rate in XPL socket showed 80 to 83% reduction compared with those in CON.
CONCLUSIONS:
We found significant difference between the average total ceramic femoral head penetration between supine and standing radiographs in using both CON and XPL socket. Standing radiographs were useful and recommended for polyethylene socket wear measurements.
Figure legend
Fig. Wear measurement: With use of a computerized measurement system, the thickness of the polyethylene socket (a) was measured along a line connecting the center of the ceramic femoral head to the outer border of the socket at its shortest distance. The wear rate was determined by comparing the thickness in the latest follow up radiograph with the thickness in the initial postoperative radiograph at the same location. Each radiographically measured value was corrected for magnification by a factor derived from comparing the diameter of the ceramic head on the radiograph (b) with its known diameter of 22.225 mm.
