A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs

Orientation of the hip cup is important in total hip arthroplasties. Orientation includes abduction (inclination) and anteversion. Anteversion can be considered as true (anatomic) and planar (radiographic) anteversion. Some measurement methods either are too complicated or are less precise. We developed a new protractor to measure cup orientation using postoperative anteroposterior radiographs centered at the hip. The new protractor measures true and planar anteversion and abduction easily and precisely. We verified its accuracy using a software simulator and simulated 45 radiographs of total hip arthroplasties with 15 different anteversions ranging from 15 degrees-29 degrees and 45 actual radiographs of total hip arthroplasties. We then measured the planar anteversion with our method and the method of Lewinnek et al. Maximal errors were 3 degrees and 2.61 degrees, respectively, and mean errors were 0.96 degrees and 1.2 degrees, respectively. The standard deviations were 0.74 degrees with our method and 0.57 degrees with the method of Lewinnek et al. For the real radiographs, the mean of absolute difference between the two methods was 1.34 degrees, and the standard deviation was 1.13 degrees. We found no difference between the two methods and no difference in our findings compared with those of Pradhan.