Analysis of four methods of measuring three-dimensional pelvic tilt in the lateral decubitus position
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ORIGINAL ARTICLE
Analysis of four methods of measuring three-dimensional pelvic tilt in the lateral decubitus position Meredith Stadnyk 1 & Tao Liu 2,3 & Fatemeh Fallahi Arezodar 4 & Lindsey Westover 2 & Jaime A. Carvajal Alba 5 & Edward Masson 6 & Lauren Beaupre 7 & Jacob L. Jaremko 8 & Marwan El-Rich 3 Received: 26 November 2019 / Accepted: 18 July 2020 # International Federation for Medical and Biological Engineering 2020
Abstract Proper alignment of acetabular implantation is necessary for good patient outcomes and preventing complications or additional surgeries in total hip arthroplasty (THA). Rotation of the pelvis in lateral decubitus (LD) is typically not accounted for as surgeons use the surgery table as a reference plane to align implants. This study compared four techniques to measure 3D pelvic rotations in LD position using computer models. CT scans of 19 subjects in LD position were used to create 3D pelvis models. Pelvic rotations were measured by three users using four techniques: landmark (LM), defined plane (DP), anterior pelvic plane (APP), and plane of best symmetry (POBS) methods. Measurements were analysed for intra-user reliability and relationships between methods were assessed using intraclass correlation coefficient, standard error of measurement, and coefficient of determination. The POBS method exhibited the highest inter-observer reliability and is recommended as a new measurement technique to measure pelvic rotations before THA surgery. The LM method exhibited low reliability but may be suitable for expert users familiar with pelvic landmarks. The APP method should only be used when the patients’ APP planes are known in neutral standing and side-lying postures. The DP method is not recommended due to substantial individual variability.
Keywords Total hip arthroplasty . Pelvic rotations . Lateral decubitus . Pelvic angle
Meredith Stadnyk and Tao Liu are co-1st authors * Marwan El-Rich [email protected] 1
Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
2
Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
3
Healthcare Engineering Innovation Center, Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
4
Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Canada
5
Department of Orthopaedics, University of Miami, Miami, USA
6
Department of Surgery, University of Alberta, Edmonton, Canada
7
Department of Physical Therapy, University of Alberta, Edmonton, Canada
8
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
1 Introduction During direct lateral approach total hip arthroplasty (THA) surgery, patients lie in lateral decubitus (LD) position on the operating table to provide the surgeon adequate access and visualisation of the hip joint. Surgeons typically use a similar pelvic tilt angle for all patients, although not all patients’ pelvises are aligned alike, despite patients being positioned similarly [1–5
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