Bone Joint Res 2020;9(7):360–367.

Digitalized analyses of intraoperative acetabular component position using image-matching technique in total hip arthroplasty

Shinya Kawahara, Toshihiko Hara, Taishi Sato, Kazuki Kitade, Takeshi Shimoto, Tetsuro Nakamura, Taro Mawatari, Hidehiko Higaki, Yasuharu Nakashima


Appropriate acetabular component placement has been proposed for prevention of postoperative dislocation in total hip arthroplasty (THA). Manual placements often cause outliers in spite of attempts to insert the component within the intended safe zone; therefore, some surgeons routinely evaluate intraoperative pelvic radiographs to exclude excessive acetabular component malposition. However, their evaluation is often ambiguous in case of the tilted or rotated pelvic position. The purpose of this study was to develop the computational analysis to digitalize the acetabular component orientation regardless of the pelvic tilt or rotation.


Intraoperative pelvic radiographs of 50 patients who underwent THA were collected retrospectively. The 3D pelvic bone model and the acetabular component were image-matched to the intraoperative pelvic radiograph. The radiological anteversion (RA) and radiological inclination (RI) of the acetabular component were calculated and those measurement errors from the postoperative CT data were compared relative to those of the 2D measurements. In addition, the intra- and interobserver differences of the image-matching analysis were evaluated.


Mean measurement errors of the image-matching analyses were significantly small (2.5° (SD 1.4°) and 0.1° (SD 0.9°) in the RA and RI, respectively) relative to those of the 2D measurements. Intra- and interobserver differences were similarly small from the clinical perspective.


We have developed a computational analysis of acetabular component orientation using an image-matching technique with small measurement errors compared to visual evaluations regardless of the pelvic tilt or rotation.

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